Ethical, Medico legal And Ethical, Medico legal And Administrative issues in Managing Administrative issues in Managing
EmergenciesEmergencies
bybyProf. Adnan AlbarProf. Adnan Albar
Conflict of interest in dealing and Conflict of interest in dealing and Emergency casesEmergency cases
Paid Vs. FreePaid Vs. Free
Gov. Vs. PrivateGov. Vs. Private
Issues related to justiceIssues related to justice
RationingRationing
DutyDuty
Moral Issues in Disaster MedicineMoral Issues in Disaster Medicine
ResearchResearch
TeachingTeaching
Clinical teachingClinical teachingBurdenBurdenPrivacyPrivacy
Teaching by simulationTeaching by simulation
Proceedures on the newly deadProceedures on the newly dead
Relationship with Biomedical Relationship with Biomedical IndustryIndustry
Thank YouThank You
الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم
“ “ On the name of Allah most On the name of Allah most graceores most merciful “graceores most merciful “
Confidentiality : Justified Confidentiality : Justified disclosuredisclosure
Reporting related to public healthReporting related to public healthVital statisticsVital statisticsContagious diseasesContagious diseasesChild / Women / elder abuseChild / Women / elder abuseCriminally inflicted injuriesCriminally inflicted injuriesPoisoningPoisoningLoss of consciousness (the independent)Loss of consciousness (the independent)
Confidentiality : Justified Confidentiality : Justified disclosuredisclosure
Legal / justice proceedingsLegal / justice proceedings
Quality assurance reviewQuality assurance review
Protection of a third party from mortal Protection of a third party from mortal harmharm
Truth telling and communicationTruth telling and communication
Communicating bad newsCommunicating bad newsProtection of human subjects in Protection of human subjects in
biomedical and behavioural researchbiomedical and behavioural researchConsidering the therapeutic privilege is Considering the therapeutic privilege is
morally licit when there is a significant morally licit when there is a significant probability of causing harm by truth probability of causing harm by truth telling ( e.g stressful news)telling ( e.g stressful news)
Compassion and empathyCompassion and empathy::
Empathy is the ability to feel the Empathy is the ability to feel the anguish of illness and struggle and anguish of illness and struggle and treating the anguish if not the illness .treating the anguish if not the illness .
it’s the feeling of “I am you” or “I could it’s the feeling of “I am you” or “I could be you“be you“
The emergency rule to The emergency rule to informed consentinformed consent
Unconscious pt. or otherwise incapable Unconscious pt. or otherwise incapable of cons.of cons.
Harm from a failure to treat is imminent Harm from a failure to treat is imminent compared to the and proposed compared to the and proposed treatment.treatment.
Lack for a substituted consentLack for a substituted consent
A valid informed refusal of A valid informed refusal of care requirescare requires
The patient must have a decision The patient must have a decision making capacity .making capacity .
Comprehension.Comprehension.
VolantarnessVolantarness
The determination of decision The determination of decision making capacity requires thatmaking capacity requires that::
1.1. The pt. appreciates that he or she has the The pt. appreciates that he or she has the power to wake decision on his or her behalf power to wake decision on his or her behalf
2.2. The pt. understands the medical situation The pt. understands the medical situation and prognosis, the nature of the and prognosis, the nature of the recommended evaluation or care the recommended evaluation or care the a a alternatives, the risks and benefits of each alternatives, the risks and benefits of each and the likely consequencesand the likely consequences
3.3. The patients decision is stable over time The patients decision is stable over time and is consistent with his or her life values and is consistent with his or her life values or goalsor goals
Compassion and empathy improve Compassion and empathy improve patient and physician satisfaction bypatient and physician satisfaction by
Promoting communicationPromoting communication
Minimizing conflict Minimizing conflict
Maximizing patient confidence in the Maximizing patient confidence in the Dx and Rx planDx and Rx plan
Distributive justice seeks a Distributive justice seeks a morally correct distribution of morally correct distribution of benefits and burdens in society .benefits and burdens in society .It requires equitable but not It requires equitable but not necessarily equal allocation of necessarily equal allocation of resourcesresources
Distributive justice affects Distributive justice affects allocation of health care resources allocation of health care resources
at 3 levelsat 3 levels
1.1. At the societal interest level At the societal interest level ( competes with education interest ( competes with education interest social services .etc )social services .etc )
2.2. At allocating health care resources At allocating health care resources rationallyrationally
3.3. At institutional level of care At institutional level of care departmental and bedside leveldepartmental and bedside level
Gatekeepers / Limiters (third Party)Gatekeepers / Limiters (third Party)
Laws / eligibility Laws / eligibility
InsuranceInsurance
Managed careManaged care
Moral issues in disaster medicineMoral issues in disaster medicine
Triage is based on the ethical principle Triage is based on the ethical principle of providing the greatest benefit to the of providing the greatest benefit to the greatest numbergreatest number
Priority to the personnel who might be Priority to the personnel who might be able to return to the rescue effort and able to return to the rescue effort and to those injuries most amenable to to those injuries most amenable to treatment treatment
The 4 Principle of health care ethicsThe 4 Principle of health care ethics
Autonomy i-e self ruleAutonomy i-e self rule
BeneficenceBeneficence
Non maleficenceNon maleficence
Justice is Treating equals equally and Justice is Treating equals equally and Treating non equals non equally.Treating non equals non equally.
Physicians must not act is away Physicians must not act is away which in detrimental to patients.which in detrimental to patients.
Beneficence requires physicians to act Beneficence requires physicians to act to the best interests of their patients.to the best interests of their patients.
They must balance goods and potential They must balance goods and potential harms.harms.
Ethical decisions can be made by Ethical decisions can be made by considering four factorsconsidering four factors
Medical indicatorsMedical indicators Equity of lifeEquity of life Patients preferencePatients preference FeaturesFeatures
3 rules for ethical decision3 rules for ethical decision
ImpartialityImpartiality
UniversabilityUniversability
Impersonal justifiabilityImpersonal justifiability
Informed consents involve two Informed consents involve two dutiesduties
Disclose information to patientsDisclose information to patients
Obtain patients consentObtain patients consent
It is the health care provider'sIt is the health care provider's
responsibility to assure that the patient responsibility to assure that the patient
can meaningfully participate in the can meaningfully participate in the
decisionsdecisions
Shared decision making requires that Shared decision making requires that the patient possess correct and the patient possess correct and complete information and that the complete information and that the decision promote the patients goal decision promote the patients goal and life valuesand life values
There are 3 elements in the There are 3 elements in the consent processconsent process
InformationInformation
ComprehensionComprehension
VolantarinessVolantariness
The concept of Legal CompetenceThe concept of Legal Competence
Advanced directiveAdvanced directive
A written document which explains the A written document which explains the future wishes of a patient when future wishes of a patient when he/she becomes unable to participate he/she becomes unable to participate in the decision directly in the decision directly
e.g -The terminally ille.g -The terminally ill
- The Suicide attemptlor- The Suicide attemptlor
End of life decisionsEnd of life decisions
Limiting resuscitationLimiting resuscitation
Don’t resuscitate order “DNR”Don’t resuscitate order “DNR”
FutilityFutility
The physician – patient - The physician – patient - relationshiprelationship
ConfidentialityConfidentiality
Truth telling and communication Truth telling and communication
Compassion and empathyCompassion and empathy
Ensuring availability of Essential Ensuring availability of Essential structuralstructural
(Design ,Space ,Manpower ,ambulance , (Design ,Space ,Manpower ,ambulance , equipment ,supplies,…ete ) and process equipment ,supplies,…ete ) and process ( policies , procedures , job description , ( policies , procedures , job description , job distribution , referral …… ete ) job distribution , referral …… ete ) requirement for the provision of requirement for the provision of effective emergency care serviceseffective emergency care services
Dealing with emergencies in the Dealing with emergencies in the private medical facilitiesprivate medical facilities
AvailabilityAvailability
SuitabilitySuitability
Problems of coverageProblems of coverage
Problems and InsuranceProblems and Insurance
Sources of profusion ethic in Sources of profusion ethic in IslamIslam
شيء ) )) من الكتاب في فرطنا شيء ) ما من الكتاب في فرطنا ما
ورضيت( نعمتي عليكم وأتممت دينكم لكم أكملت ورضيت( اليوم نعمتي عليكم وأتممت دينكم لكم أكملت اليوم( & دينا اإلسالم & )لكم دينا اإلسالم لكم
األخالق( ) مكارم ألتمم بعث األخالق( )إنما مكارم ألتمم بعث إنما
Characteristic of the professional Characteristic of the professional ethics in Islamethics in Islam
Define sourcesDefine sources
Worship intentWorship intent
ConstantConstant
Based on clear fundamental ruleBased on clear fundamental rule
Self accountabilitySelf accountability
Issues in dealing with Psychiatric Issues in dealing with Psychiatric emergenciesemergencies
EthicalEthical
Administrative / legislativeAdministrative / legislative
Medic legalMedic legal
Security and safetySecurity and safety
Ethical Issues in dealing with Ethical Issues in dealing with police emergency casespolice emergency cases
Financial Issues in dealing with Financial Issues in dealing with emergency casesemergency cases
Payment Payment
Extent of coverageExtent of coverage
Approval and third partyApproval and third party
Human rights in managing Human rights in managing emergencies and disastersemergencies and disasters