REGULATIONS OF PHYSICIAN AND REGULATONS OF MEDICAL PROCEDURES.ppt

8/14/2019 REGULATIONS OF PHYSICIAN AND REGULATONS OF MEDICAL PROCEDURES.ppt

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REGULATIONS OFPHYSICIAN

CONDUCT


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VALUES, COMPETENCE,

AND RESPONSIBILITYThe physician-patient is based on brotherhood.

The physician must maintain the higheststandards of justice. He should also follow thefollowing guidelines : good intentions,

avoiding doubtful things, leaving alonematters that do not concern him, loving forothers, causing no harm, giving sincereadvice, avoiding the prohibited, doing the

enjoined acts, renouncing greed, avoidingsterile arguments, respect for life, basingdecisions and actions on evidence, followingthe dictates of conscience, righteous acts,


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quality work, guarding the tongue, avoidinganger and rage, humane limits, consciousnessof God in all circumstances, performing goodacts to wipe out bad ones, treating people

with the best of manners, restraint andmodesty, maintaining objectivity, seekinghelp from God, and avoiding oppression ortransgression against others. The physician

should be professionally competent , balanced, have responsibility and accountability .

He must work for the benefit of the patients andthe community.


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MEDICAL DECISIONSNo medical procedures can be carried out

without informed consent of the patientexcept in cases of legal incompetence. Thepatient has the purest intentions in decisionsin the best interests of his or her life. Others

may have bias their decision-making. Thepatient must be free and capable of givinginformed consent. Informed consent requiresdisclosure by the physician, understanding by

the patient, voluntariness of the decision,legal competence of the patient,recommendation of the physician on the bestcourse of action, decision by the patient, andauthorization by the patient to carry out theprocedures.


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The patient is free to male decisions

regarding choice of physicians and

choice of treatments. Consent can be by

proxy in the form of the patientdelegating decision making or by means

of a living will.


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Valid consent must be voluntary, informed, andby a person with capacity to consent. Itinvolves explaining the procedurecontemplated, making sure the patient

understands, and offering the patient achoice.

Consent is limited to what was explained to thepatient except in an emergency. Refusal to

consent must be an informed refusal (patientunderstands what he is doing). Refusal toconsent by a competent adult even ifirrational is conclusive and treatment can

only be given by permission of the court.


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Doubts about consent are resolved in favor ofpreserving life. Spouses and family membersdo not have an automatic right to consent. Aspouse cannot overrule the patients choice.

Advance directives, proxy informed consentby the family are made for the unconsciousterminal patient on withholding orwithdrawal of treatment.

Physician assisted suicide, active euthanasia,and voluntary euthanasia are illegal. A do notresuscitate order (DNR) by a physician couldcreate legal complications.


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The living will has the following advantages:(a) reassuring the patient that terminal care

will be carried out as he or she desires

(b) providing guidance and legal protection and

thus relieving the physicians of the burdenof decision making and legal liabilities

(c) relieving the family of the mental stressinvolved in making decisions about terminal

care. The disadvantage of a living will is thatit may not anticipate all developments of thefuture thus limiting the options available tothe physicians and the family.


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The device of the power of attorney can be usedinstead of the living will or advance directive.Decision by a proxy can work in two ways:

(a) decide what the patient would have decided

if able(b) decide in the best interests of the patient.

Informed consent is still required forphysicians in special practices such as a shipsdoctor, prison doctor, doctors in armedforces. Police surgeons may have to carry outexaminations on suspects without informedconsent.


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CONSENT OF THE INCOMPETENT

Competent children can consent to treatmentbut cannot refuse treatment. The consent ofone parent is sufficient if the 2 disagree.Parental choice takes precedence over the

childs choice. Courts can overrule parents.Life-saving treatment of minors is given evenif parents refuse. Parental choice is final intherapeutic or non-therapeutic research on

children. Mental patients cannot consent totreatment, research, or sterilization becauseof their intellectual incompetence.


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They are admitted, detained, and treatedvoluntarily or involuntarily for their ownbenefit, in emergencies, for purposes ofassessment, if they are a danger to

themselves, or on a court order. Suicidalpatients tend to refuse treatment becausethey want to die. Nutrition, hydration, andtreatment can be withdrawn in a persistent

vegetative state since the chance of recoveryis low. There is no moral difference betweenwithholding and withdrawing futiletreatment.


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Labor and delivery are emergencies that

require immediate decisions but the

woman may not be competent and

proxies are used. Forced medicalintervention and cesarean section may

be ordered in the fetal interest. Birth

plans can be treated as an advancedirective.


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DISCLOSURE AND TRUTHFULNESS

As part of the professional contract between thephysician and the patient, the physician musttell the whole truth. Patients have the right toknow the risks and benefits of medicalprocedure in order for them to make anautonomous informed consent. Deceptionviolates fidelity. If disclosure will cause harmit is not obligatory. Partial disclosure andwhite or technical lies are permissible under

necessity. Disclosure to the family and otherprofessionals is allowed if it is necessary fortreatment purposes. Physicians must usetheir judgment in disclosure of bad news to

the patient.


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PRIVACY AND CONFIDENTIALITY

Privacy and confidentiality are often confused.Privacy is the right to make decisions aboutpersonal or private matters and blockingaccess to private information. The patient

voluntarily allows the physician access toprivate information in the trust that it willnot be disclosed to others. This confidentialitymust be maintained within the confines of the

Law even after death of the patient. Inroutine hospital practice many persons haveaccess to confidential information but all areenjoined to keep such information

confidential.


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Confidentiality includes medical records of anyform. The patient should not makeunnecessary revelation of negative thingsabout himself or herself. The physician can

not disclose confidential information to athird party without the consent of the patient.Information can be released without theconsent of the patient for purposes of medical

care, for criminal investigations, and in thepublic interest. Release is not justifiedwithout patient consent for the followingpurposes: education, research, medical audit,

employment or insurance.


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FIDELITY

The principle of fidelity requires thatphysicians be faithful to their patients. Itincludes: acting in faith, fulfillingagreements, maintaining relations, and

fiduciary responsibilities (trust andconfidence). It is not based on a writtencontract. Abandoning the patient at any stageof treatment without alternative

arrangements is a violation of fidelity. Thefidelity obligation may conflict with theobligation to protect third parties bydisclosing contagious disease or dangerous

behavior of the patient.


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The physician may find himself in a

situation of divided loyalty between the

interests of the patient and the interests

of the institution. The conflict may bebetween two patients of the physician

such as when maternal and fetal

interests conflict. Physicians involved inclinical trials have conflicting dual roles

of physicians and investigators.


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REGULATIONS

OF MEDICAL PROCEDURES

Dr H Tatang Kartawan2009


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EXAMINATION AND

INVESTIGATION

Patient consent is necessary for history takingotherwise it is considered trespassing onprivacy and spying. History taking providesan opportunity to discuss diseases of the

heart that underlie physical disease.

The physician is not obliged to report criminalinformation to the authorities unless there isdemonstrable immediate public interest andnecessity.


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Physical clinical examination also

requires informed consent. A patient

can only be examined against his or her

consent only if there is a necessityrelating to the life of the patient or to

public interest such as criminal

investigation.Mental patients can are not legally

competent to give consent; the

necessary consent could be obtained


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Examination by a caregiver of the

opposite gender requires special

consideration. It is always preferable

that physicians of the same gendercarry out the examination. A physician

of the opposite gender can be used only

if a situation of necessity arises. Achaperone must be present.

Examination limited to what is

necessary.


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The results of laboratory investigations havethe same requirements for confidentiality ashistory and clinical examination. The resultsof radiological investigations are confidential.

Invasive investigations carry a higher risk tothe patient; their benefits should be carefullyweighed against the benefits. Theseinvestigations should be carried out only ifthere is a clear necessity.


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MEDICAL TREATMENTMedical treatment may involve

destruction (antibiotics, cytotoxics, anti-

metabolites, antagonists, antitoxins, and

detoxification), replacement (hormones,fluids, electrolytes), biological

modification & modulation, psycho-

active therapy, and supportivetreatment (diet, rest, analgesia etc).


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SURGICAL TREATMENT

Permitted surgical procedures include

resection, restorative/reconstructive

surgery, transplantation, blood

transfusion, anesthesia, and criticalcare. Transfusion of whole blood or

blood components is widely accepted

and raises few legal or ethical issues.Blood donation is analogous to organ

donation by a living donor.


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Attempts must be made to minimize

inappropriate mixing of male and

female health care personnel in a small

confined space of the operating theater.


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In emergency treatment/critical care,

financial considerations complicate the

picture when destitute patients who

cannot pay present at the emergency

room.


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OTHER TREATMENTS

Prayers are spiritual treatments.

Immunization and other preventivemeasures are treatment before disease.

Various traditional, alternative, andcomplementary therapies are permittedif they are of benefit.

Other permitted treatment modalities areirradiation, immunotherapy, andgenetic therapy.


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REGULATIONS OF PHYSICIAN AND REGULATONS OF MEDICAL PROCEDURES.ppt