MAINTENANCE OF ETHICAL STANDARD

Ethical standard is maintained by overseeing professional conduct of registered medical practitioner by the council critically. His name can be suspended or removed altogether if the disciplinary committee of the council finds him guilty of professional misconduct.

DEVELOPMENT OF MEDICAL PRACTITIONER

Human Being

Medical Practitioner

• MP (Medical practitioner) is given extensive instructions / training to equip him with knowledge and skills peculiar to practice of medicine

• Before granting registration (legal practitioner) he has to sit for qualifying examination

• Once registered, he is like any other practitioner, free to practice the art of healing

• MP must understand his duty (sphere of professional activity) in pursuit of his noble profession

State/Employer

Doctor

Teacher/Colleague

Family/Himself Patient

A careful analysis of the work of MP will indicate that he owe a duty towards his patients, teachers, state, himself and family (ethical and legal)

• To perform these duties, he must have a peculiar skill and Knowledge

(commensurating with his claim) backed by authority i.e. Registration

• The granted authority will not allow him to become careless or his attitude become

unkind towards his patients

Ethics

The word “Ethics” is noun and according to Oxford dictionary, it has been equated with the word moral or relating to morals i.e. moral duty, moral principles, moral problems, treating moral questions and moral judgment; evolving the meaning of morality:

What is right?What is wrong?What is virtuous?What is evil?

In Human Conduct

Definition

Ethics is the study of the general nature of morals and specific moral choices to be made by an individual in his relationship with others

In other words it implies the principles or the standards governing the conduct of the members of society

Medical ethics

Medical ethics, may be defined as a code of behavior (moral) voluntarily accepted with in the medical profession as opposed to statutes and regulations imposed by official legislation

Position of medical practitioner / patient in society

Medical practitioner enjoys privileged position in society as he has both skill and authority.

The patient is at his mercy, helpless, dependent and vulnerable, is in a state of complete surrender.

Medical practitioner’s work analysis

Medical practitioner, throughout his life, come across situations, where he has to face ethical issues and these issues become more important because of the special relationship between him and his patient.

Besides, there are some aspects of medical practice where he has to choose between two alternatives

• The patient is insisting on abortion, but the medical practitioner thinks that it is

medically unjustified

• The medical practitioner prescribes morphine in case of severe angina, but the patient objects to it that use of narcotic is

prohibited in religion

• In case of an insurance compensation, the sufferer demands damages that medical practitioner considers unjust

These are the few examples of numerous situations, where the interest of one party comes into conflict with the scruples of the other.

Resolving such dilemma involves ethical consideration

Ethical behavior

Civilized behavior and Good manners.

Taking the example of medical profession, important issues are history taking and physical examination of the patient’s body, as these are pre-requisite to prescription of appropriate treatment

History taking means, on many occasions, taking the secrets of the patient, even the most guarded ones

Physical examination of the body means manipulation of any part of the body and / or introduction of finger / instrument in any opening (even private) of the body

Prescription of appropriate treatment includes administration of drugs (even poisons, drugs of addictions etc.) and administration of treatment such as laprotomy, D&C, IUD or ligation

Those aspects of medical practitioner’s behavior which fall out side formal legislation or cannot be brought under legislation are left largely to the conscience of the individual medical practitioner but the limits are set by the profession

In case of violation, the wrongdoer may be declared unfit for the profession being guilty of infamous / professional misconduct.

Professional misconduct or Infamous conduct

“ If a medical man, during the pursuit of his profession, has done something, which is regarded disgraceful or dishonorable by his professional brethren of good repute and competency, than it is open to the Medical Council, to say that he is guilty of professional misconduct or infamous conduct”

Medical practitioner must avoid being involved or to fall prey to professional misconduct which are remembered as 5As

5As

1.Abuse of privilege:• Issuing false medical certificate• Prescription of dangerous drugs for abuse• Disclosure of patient’s secrets

2.Abuse of professional knowledge:• Criminal abortion

3.Abuse of doctor patient relationship:• Indecent assault and adultery with patient

• Association with unqualified person in running business

5.Advertising / convincing with a view to have unreasonable gains

Disciplinary Proceedings Against Medical Practitioner

Patient ComplaintCourt Conviction Hospital Administration

President PMDCComplaint Rejected

being frivolous

Asked Doctor to Explain

Disciplinary Committee

Registration Canceled

Complaint Dismissed

Complaint Dismissed

Warning Issued

Registration Suspend

Ethics in relation to colleagues

Much of the ethics of medical practice represents purely intra professional code of conduct

•Criticism•Unfair competition•Privileges of colleagues and their families

Ethics in relation to patients

Ethics in relation to patients has a special significance having primary consideration not to take advantage of his privilege in view of his special training or position as a professional man i.e. law relating to medical practice

•Consent•Negligence•Infamous conduct

Ethics in relation to employer Medical ethics is also necessary to express the independence of individual practitioner to offer his service as he sees fit in accordance with the ethical standards, even in defiance of the request or demands of the patient or even employer i.e.

• Attend the court and give guidance• Inform police about unexplained suspected death• Inform public health authorities of any

notify able disease or food poisoning

Scope of medical ethicsNot fixed in to rigid boundaries because it continues to widen with modern developments and new inventions, examples being practice of organ transplantation, artificial insemination and cloning

Each invention creates new problems requiring laying of ethical principles suited to the new situation

It would be useful to keep the following golden troika in mind

1. Adherence to scientific basis2. Impartial presentation of scientific findings3. Dedication to serving justice

Code of medical ethicsThe oldest known to the medical profession is the one that used to be sworn by Greek physicians, the Hippocratic Oath.

Formerly, this Oath used to be pledged by fresh entrants to the medical profession at their graduation ceremonies.

Unfortunately, the practice of taking such ethical Oath has been discontinued, resulting in gross transgression of ethical behavior of medical practitioner and has given disrepute to the medical profession

The World Medical Association, after the Second World War, took cognizance of the deteriorating ethical standards in Geneva and restated the Hippocratic Oath in simple language and modern style known as Declaration of Geneva, upon which the International Code of medical Ethics is based.

The P M D C with slight modifications has adopted this Oath as Code of Medical Ethics in Pakistan for administration to medical graduates at the time of their graduation:

Code of medical ethics in Pakistan

“In the name of Allah, Most Gracious and Merciful.• I solemnly pledge that I shall abide by the principles

laid down in the Code of Medical Ethics of PM&DC. • I further make solemn declaration that:• I consecrate my life to the service of humanity• I will give my teachers the respect and gratitude which is their due• I will practice my profession with conscience dignity

and fear of God• The health of my patient will be my first consideration

• I will respect the secretes, which are confided in me• I will maintain by all the means in my power, the honor

and the noble traditions of the medical profession• My colleagues will be my brothers and sisters• I will not permit consideration of religion, nationality, race, party politics, social standings to intervene between my duty and my patient• I will maintain the utmost respect, for human life, from the time of conception; even under threat, and will not use my medical knowledge contrary to the laws of humanity• I make these promises solemnly, free and upon my honor.”

Emerge as a friend

Doctor vs community

Conscience and ethics

Morality Professionalism

Fear of God