Medical EthicsBy

Dr. Rizwan Saeed(MBBS,MPH,DOMS,MBA)

Learning Objectives & Intended Outcomes

Good Concepts of Medical Ethics

Background Concepts and components

National recommended guidelines

Code of Medical Ethics Components (essential)

Learning Objectives

Intended outcomes

To have good understanding of:• Core concepts of medical ethics terminologies• The International code of medical ethics• Ethics and law

Background Concepts &

Components

Ethics are standards of conduct (or social norms) that prescribe behavior

Knowledge (cognition) Skill

Behaviour

Attitude

Attitude

A hypothetical construct of like or dislike (expression of favor or disfavor) toward a person, place, thing, idea or event .

Behaviour

behaviour is the range of actions and

mannerisms made by organisms, systems,

or artificial entities in conjunction with

their environment

Medical ethics

• Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine.

• As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.

• Ethics in relation to the practice of medicine had continuity from the time of Hippocrates

460-377 BC 1970s 2013

Background

• the physician-patient relationship • moral obligations of beneficence and non-

maleficence. • In the 1970s developments such as in vitro

fertilization (IVF) created concerns about the adequacy of these long-established moral obligations.

Background

• Helsinki Declaration (1964) on the protection of human subjects had influence on the establishment of ethics committees worldwide

• shift toward focusing on the moral obligation of respecting informed consent of research subjects

• GMC Good medical practice (2013)

Background

Medical ethics recommended guide lines

I. essential rules of international health organizations

II. Medical-ethic guidelines regarding different questions:

1. research examinations on men 2. Euthanasia3. Transplantation4. artificial insemination 5. sterilization, especially the operative sterilization of

mentally handicapped persons6. medical-ethical committees.

Code of Medical Ethics

• The nine Principles of Medical Ethics are the primary component of the Code. They describe the core ethical principles of the medical profession

• A single Principle should not be read in isolation from others; the overall intent of the nine Principles, read together, guides physicians’ behavior.

Principles of medical ethics

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

Principles of medical ethicsIII. A physician shall respect the law and

also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

Principles of medical ethics

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

• Adopted by the AMA's House of Delegates June 17, 2001.

Principles of medical ethics

Autonomy

• The patient has the right to refuse or choose their treatment

• Autonomy can be defined as the ability of the person to make his or her own decisions. This faith in autonomy is the central premise of the concept of informed consent and shared decision making

Beneficence

A practitioner should act in the best interest of the patient

Non-maleficence

"first, do no harm“ Many consider that should be the main or

primary consideration Much harm has been done to patients as a result, as in the saying, "The treatment was a success, but the patient died."

It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient.

Justice

• concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

Respect for persons

The patient (and the person treating the patient) have the right to be treated with dignity.

Truthfulness and honesty

Euthanasia

refers to the practice of intentionally ending a life in order to relieve pain and suffering. mercy killing

The British House of Lords Select Committee on Medical Ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering

Informed consent

a person must be fully informed about and understand the potential benefits and risks of their choice of treatment.

Confidentiality

• conversations between doctors and patients. This concept is commonly known as patient-physician privilege.

Ethics committees

• These bodies are composed primarily of health care professionals, but may also include philosophers, lay people, and clergy - indeed, in many parts of the world their presence is considered mandatory in order to provide balance.

Referral

• doctors who receive income from referring patients for medical tests have been shown to refer more patients for medical tests

Truth-telling

Some cultures do not place a great emphasis on informing the patient of the diagnosis, especially when cancer is the diagnosis

Ethics Over view

To distinguish between Ethics and Law

(1) some actions that are illegal may not be unethical (kill)

(2) some actions that are unethical may not be illegal (secret)

(3) laws can be unethical or immoral (Nazi’s)

we use different kinds of mechanisms to express, teach, inculcate, and enforce laws and ethics.

SUGGESTED BOOKS: BIOETHICS (F.M.KAMM) ; ABORTION (SUSAN A MARTINEL-FERNENEZ) ;

MEDICAL ETHICS BASIS (CAMBELL) ; MALPRACTICE (KAMM) ; INFORMED CONCENT (DEBORAH BOWMAN, REHANA IQBAL)

QUIZ

1. the patient has the right to refuse or choose their treatment

2. a practitioner should act in the best interest of the patient

3. "first, do no harm” 4. concerns the distribution of scarce health

resources, and the decision of who gets what treatment (fairness and equality)

Autonomy

Beneficence

Non-maleficence

Justice

Thank you

Reflection of understanding