Ethical considerations in podiatric care of the older patient

Ethical issues are constantly changing. Today, there is a greater consideration of the social issues as they relate to medical care. The questions of comfort are of greater concern for as we deal with increasing numbers of aging patients and chronic disease, cure may not always be possible; thus, patient management is a key issue. There are greater concerns for the rights of patients, their privacy, and the relationships that need to be maintained between doctors and their patients. There is a greater focus on the quality of life and not just saving a life. There are new questions posed in relation to the termination of treatment, particularly in relation to aging and at what point is there harm and not good from treatment. There is also the issue of public rights and whether the system should be permitted to develop without a freedom of choice or restrictions on podiatric care that are not imposed on any other professional service. Ethics and bioethics in itself is more than a statutory issue, it is more than policy. It also must be an educational issue that considers societal issues in the changing delivery of health care. It must now deal with professional liability and cost containment because now there are mechanisms for the rationing of care based on costs alone. Ethics must be based on respect, obligation, professional responsibility, as well as care issues. It must be an issue of moral relevance. Ethics must continue to deal with conduct, professional relationships, and human dignity. It must deal with improved knowledge and skills. It must consider and maintain the highest possible level of professional judgement. Ethics must also consider professional responsibility and obligation beyond what might be required to meet the legal basis of practice. Simply being "this side of legal" is not adequate in both an ethical and moral sense. If we recognize that it is the public that ultimately will determine our future health care system, partly on a preconceived need, partly on cost, partly on opinion, and partly on political impression, then we in podiatric medicine must assume a greater responsibility in protecting and promoting quality care, ethical conduct, and serving as a moving force in the changes that will take place in our health care delivery system in the future. Foot care is both basic and needed. Our state practice acts and laws and regulations have established this fact and demonstrated a public need for podiatry. Our obligation is to protect that need with integrity.