Medical Ethics

The beginning & the end

Hornet’s nest

Definition Medical Ethics is primarily a field of

applied ethics, the study of moral values and judgements as they apply to medicine

Ethics provide a useful framework to understand and resolve conflicts

Values Autonomy Beneficence Non-maleficence

Justice Dignity Truthfulness and honesty

Autonomy Recognizes the right of individual to self

determination, to make informed decisions

Basis of informed consent and advanced directives

Beneficence Do good

Means taking actions that serve the best interests of patients

Both medical and financial

Non-maleficence First, do no harm (primum non nocere)

Balanced against the principle of beneficence i.e. the likely benefits should outweigh the likely risks

Defined by its cultural context

Conflicts Autonomy vs. Beneficence- Euthanasia

Autonomy vs. Non-malaficence- Hypochondriac patient

Individual vs. Family/Society/Religion

Choosing treatment Effective

Beneficial

Burden- physical, financial, emotional

Informed Consent- Elements Patient to have decision making

capacity Autonomous authorization Disclose all relevant information i.e.

potential benefits, risks, cost and alternatives

Comprehension

Euthanasia A deliberate intervention undertaken

with the express intention of ending a life, to relieve intractable suffering

Voluntary (with consent) or Involuntary

Active or Passive (withholding of treatment necessary for continuation of life)

End-of-life care Refers to medical care of patients with

an advanced, progressive and incurable illness

Refer to advanced directives, if any left by the patient

Advanced Directives or Living Will Specific instructions given by individuals

regarding treatment, in case of incapacity or inability to make decisions

Why? Frequently death in healthcare facilities is

unnecessarily prolonged, painful, expensive and emotionally burdensome

Problem- Hypothetical

Healthcare Proxy Allowing an individual to appoint

someone to make healthcare decisions on his/her behalf, if one should ever be rendered incapable of making his/her wishes known

The appointed representative can make real-time decisions

End of life interventions Cardio-Pulmonary Resuscitation (CPR) Mechanical Ventilation Vasopressors Hospitalization and/or ICU care Nutrition Hydration

Palliative care Pain- Opioids Agitation- Benzodiazepines Nausea/Vomiting- Antiemetics Constipation- Laxatives/Enema Dyspnoea- Morphine/Oxygen Depression- Antidepressants

No proven drug for loss of appetite or wish to eat (man nahin karta)

MCI Code of Ethics- Summary A physician shall uphold the dignity of

his profession

Prime objective of the medical profession is to render service

Personal financial interests of physician should not conflict with the medical interests of the patient

MCI code- contd. A physician is free to choose whom he

will serve

Consultations should be justifiable and in patient’s interest only

Consultation request should be in writing and specific

Hippocratic Oath

A rite of passage for practitioners of Medicine

Hippocratic Oath- salient points

Share knowledge Avoid overtreatment & therapeutic

nihilism Don’t be ashamed to say- I know not Don’t play God Respect privacy of patient Treat the patient, and not fever or

cancer

Charak samhita on ethics A physician should work to help others

get rid of their ills, and not to earn money or fulfill own aspirations

One who practices medicine to help others is successful and happy

A physician should treat patient like his/her son and continuously strive to rid them of their suffering

Conclusion

Do no harm, personal or financial

Treat others as you would treat yourself