Nicholas Burney

Biomedical Ethics

Reflective Essay

            In this essay, I will explicate a moral framework that I will use to guide my practice in my first several years as a Physician Assistant, based on the reasons I chose to become a medical practitioner and the different facets of practice that I value the most. I have chosen to become a PA for several reasons, including the upholding of several ethical principles, the ability to hone and develop my physical skills, and for the ability to contribute positively to the people in my community that are experiencing a deadly crisis of drug abuse. I believe that a PA is the ideal role for me, as they are typically on the front lines in the delivery of medical care. From this position, they are able to perform many bedside and advanced procedures, including surgical interventions, and they are able to spend a great deal more time with a patient than a physician. I also strongly believe that being a PA will allow me to influence my community of New Yorkers and Staten Islanders that have been struggling with opioid and alcohol addiction.

            There are many different aspects of the clinical practice that I would like to explore, based on my previous training. I was trained as a lab manager in a neuroscience laboratory, where I performed stereotaxic surgeries on mice, involving and a long series and many hours of delicate movements and procedures in order to ensure mouse survived and the experiment went correctly. Being able to work with my hands gives me a great deal of personal satisfaction, and I’d like to use those skills I developed and transfer them to being able to aid human patients. I also think that my position as lab manager, and being the person to turn to whenever there was an emergency, has given me some perspective on the high-stress environment of medicine as described by Dr. Orfi in What Doctors Feel¹ (It also helped that our research focused on the amygdala). I’m also very fond of the idea of getting a medical-model based education that would supplement and enhance the things I had learned in the lab and would grant me a deeper understanding of the pathologies and etiologies of many physical and neurological disorders. As previously stated, I’m also interested in helping those that are grappling with their addictions, as many people on Staten Island have experienced mortalities associated with opioid drugs like oxycodone². I’m also a very strong advocate for patient choice, and for patients being able to choose their method and delivery of care, and I absolutely do not believe in coercion or use of force to thrust interventions on those that don’t wish to receive them.

            There are several ethical principles that were covered over the course of this semester that will help provide a framework of support and justification for these clinical practices. The first one is beneficence, or the belief that healthcare professionals have a duty to promote the welfare and contribute to the good of their patients³. Beneficence dictates that we provide care that benefits the patient mentally and physically, and that we do not cause them harm. Nonmaleficence is closely linked to beneficence, and is the belief that clinicians do not cause, and seek to minimize harm to the patient³. Nonmaleficence means that we must be mindful about making errors, and to try and reduce performing interventions that can have some negative consequences to the patient if at all possible. Lastly, supporting patient autonomy (as free action and effective deliberation) means promoting the patient’s ability to consider all of the choices available to them, and helping them to choose the things that they feel most closely aligns with their own morals.

            The ethical principles of beneficence, nonmaleficence, and patient autonomy can all be used to support my interests in clinical practice. Being able to bring my previously acquired knowledge and skills, and performing surgical procedures like suturing and bone drilling will be able to benefit my patients and prevent more harm from occurring than is strictly necessary. As I continue to practice and become more adept at wielding the tools, the more likely I will be to perform the procedures correctly, leave the patient with less scarring and less chances of adverse complications developing. Likewise, as I gain more clinical experience and I become more accustomed to people depending on me for treatment, I will be able to provide both patients and other clinicians with a sense of reliability and ability to handle stressful situations. This can be of great benefit to an emergency department or cardiac unit, where high-mortality emergencies can happen very rapidly. In clinicals, I will also have more exposure to various diseases and gain a deeper understanding of the pathologies involved. This will allow me to formulate better treatments and create better outcomes for the patient. More knowledge will also allow me to provide more choices and better explanations while helping patients choose the course of action that they feel is most right for their wellbeing. In a similar vein, I will also use the principle of nonmaleficence to try and combat opioid over-prescription by trying to find alternatives and by educating patients on the risks of forming a dependency. I believe this can help prevent further harm to an already devastated community.

            With these principles in mind as a guide, I aim to become the most competent, steadfast Physician Assistant I can be, for the sake of my patients and my own personal moral satisfaction.

1. Orfi D. (2015). Scared witless . In D Orfi, What doctors feel, (pp. 64-94). Boston, MA: Beacon Press.
2. Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns

Danovich, Dimitry et al.

Journal of Emergency Medicine, Volume 57, Issue 2, 156 – 161

• Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.
• Yeo, M et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.