- 1. Introduction to Medical Ethics Dr Md. Yunus Additional
Professor & Co-ordinator of Medical Education Unit, NEIGRIHMS,
Shillong
2. 2 3. Disclaimer Im not an ethicist but I do ethics 4.
Nowadays, conflicts of interests between the government &
medical institutions, between medical institutions and medical
personnel, between physicians and patients are getting more and
more serious and complex. Why Ethics Become Important? 5. High
technologies not only brought us hopes of cure but have also
created a heavy economic burden. The ethical dilemmas of high
technology medicine-brain death, organ transplantation, and
concerns about quality of life-have become increasingly prominent.
6. Ethics are not Ethics is not the same as feelings Ethics is not
religion Ethics is not following the law Ethics is not following
culturally accepted norms Ethics is not science 7. Ethics are Moral
Principles What is good and bad What is right and wrong Based on
value system Ethical norms are not universal depends on the sub
culture of the society 8. Ethics are Ethics refers to standards of
behavior that tell us how human beings ought to act in the many
situations in which they find themselves as friends, parents,
children, citizens, businesspeople, teachers, professionals, and so
on. 9. Historically Medical ethics may be traced to guidelines on
the duty of physicians such as the Hippocratic oath 10. What is
Ethics? Ethics are standards of conduct (or social norms) that
prescribe behavior. Ethics as a field of study is a normative
discipline whose main goals are prescriptive and evaluative rather
than descriptive and explanatory. So Ethicists are different from
social scientists. Ethicists (or moral philosophers) study
standards of conduct. 11. Four basic Principles of Medical Ethics
Autonomy Beneficence Non maleficience Justice 12. Autonomy
Paramount Being self-governing Able to exercise free will in making
a personal decision A right to withhold consent Applicable to
anyone who has capacity 13. Beneficence Literally being charitable
or doing good Performing care so as to maximise patient wellbeing
Exercising clinical judgement Going beyond the minimum standards
required 14. Beneficence The practitioner should act in the best
interest of the patient - the procedure be provided with the intent
of doing good to the patient 15. This needs health care provider
to, -Develop and maintain skills & knowledge by continually
updating training - Consider individual circumstances of all
patients 16. Non maleficence Above all, do no harm, Make sure that
the procedure does not harm the patient or others in society 17.
Non-malificence Doing no harm Avoidance of putting a person at risk
of avoidable harm A 1st step towards beneficence Defined under the
Hippocratic oath 18. Medical malpractice An act or omission by a
health care provider that deviates from accepted standards of
practice in the medical community which causes injury to the
patient. 19. Justice No single definition Usually distributive
justice when applied to medical ethics Fairness Equity Method of
righting wrongs 20. Justice The distribution of scarce health
resources, and the decision of who gets what treatment fairness and
equality The burdens and benefits of new or experimental treatments
must be distributed equally among all groups in society 21.
Limitations Very simplistic Autonomy trumps the other principles
Role of justice No coherent approach to resolving conflicting
principles 22. Other factors Patient expectations Family
expectations Genuine uncertainty Wishes of patient Wishes of family
Cultural values Religious values Preferences of professionals Power
balance within the healthcare team Trust policies Financial issues
Legal issues 23. To distinguish between Ethics and Policy Political
standards focus on the conduct of groups or social institutions,
whereas ethical and moral standards focus on the conduct of
individuals. Political standards take a macro-perspective on human
affairs; ethical and moral standards adopt a micro-perspective.
However, the distinction between ethics and politics is not
absolute since many actions, institutions, and situations can be
evaluated from an ethical or political point of view. 24.
Professional Ethics Professional ethics are standards of conduct
that apply to people who occupy a professional occupation or role.
A person who enters a profession acquires ethical obligations
because society trusts them to provide valuable goods and services
that cannot be provided unless their conduct conforms to certain
standards. Professionals who fail to live up to their ethical
obligations betray this trust. Professional ethics studied by
ethicists include medical ethics. 25. Medical ethics The
expressions professional ethics and medical ethics were coined by
Thomas Percival. Medical ethics is a special kind of ethics only as
it relates to a particular realm of facts and concerns and not
because it embodies or appeals to some special moral principles or
methodology. 26. Bioethics Bioethics could be defined as the study
of ethical issues and decision-making associated with the use of
living organisms Bioethics includes both medical ethics and
environmental ethics. Bioethics is learning how to balance
different benefits, risks and duties. 27. Clinical ethics Clinical
ethics is a practical discipline that provides a structured
approach for identifying ,analyzing, and resolving ethical issues
in clinical medicine. 28. Clinical medical ethics is a practical
& applied discipline that aims to improve patient care and
patient outcomes by focusing on reaching a right and good decision
in individual cases. It focuses on the doctor-patient relationship
and takes account of the ethical and legal issues that patients,
doctors, and hospitals must address to reach good decisions for
individual patients. 29. Clinical ethics emphasizes that in
practicing good clinical medicine, physicians must combine
scientific and technical abilities with ethical concerns for the
personal values of the patients who seek their help. 30. The
content of clinical ethics includes specific issues such as
truth-telling, informed consent, end of life care, palliative care,
allocation of clinical resources, and the ethics of medical
research. the study of the doctor-patient relationship, including
such issues as honesty, competence, integrity, and respect for
persons. 31. Ethical Issues in Modern Healthcare In modern
healthcare and research, value conflicts arise where often there
appears to be no clear consensus as to the Right thing to do. These
conflicts present problems requiring moral decisions, and
necessitates a choice between two or more alternatives. Examples:
Should a parent have a right to refuse immunizations for his or her
child? Does public safety supersede an individuals right? 32.
Ethical Questions, Cont. Should children with serious birth defects
be kept alive? Should a woman be allowed an abortion for any
reason? Should terrorists be tortured to gain information possibly
saving hundreds of lives? Should health care workers be required to
receive small pox vaccination? Who should get the finite number of
organs for transplantation? 33. Ethical Theories: Ideas and Actions
Deontology (duty) Consequentialism (actions) Virtue
Ethics/Intuition (morals and values) Beliefs Rights Ethics
(individuality and the American culture) 34. Two questions when
faced with a dilemma: Behavior: What should I do? Motivation: Why
should I do it? 35. What Are Ethical Principles, and How Do They
Help With Decision Making? 36. Ethical Principles Autonomy/Freedom
Veracity Privacy/Confidentiality Beneficence/Nonmaleficence
Fidelity Justice 37. Veracity The duty to tell the truth.
Truth-telling, honesty. 38. Privacy/Confidentiality Respecting
privileged knowledge Respecting the self of others. 39. Fidelity
Strict observance of promises or duties. This principle, as well as
other principles, should be honored by both provider and client.
40. Ethical Communication How to explore positive communication
techniques which can be used in obtaining consent for treatments
(Feature Benefit Check)! 41. Ethics Committees Decision making in
health care often involves more than just medical facts of the case
Ethical principles and values will be the determining factor in
which course of action to take. Many health care facilities have
established Ethics committees. 42. Ethics Committees Found in most
health care facilitys Usually Ten to Twelve members
Multidisciplinary members A representative from the Board of
dirctor The Administrator A physician An area clergy A Social
Worker A Judge An Ethic ist (Usually a philosophy or Sociology
professor) Lay persons from the community 43. Functions of the
Committee Education To committee members themselves Continuing
education and inservice to facilitys staff To the community 44.
Functions continued Development and review of laws, standards of
care, institutional policies and guidelines About withdrawing and
withholding nutrition and hydration Do Not Resuscitate Utilization
of facilitys/communities resources 45. Functions continued Case
Consultation with: Family members Patients Health care providers
Staff 46. Case Consultation May: Provides information about ethical
principles relevant to the case under discussion Help clarify what
options are open Provide information about relevant policies of the
facility Make a recommendation that is advisory in nature 47.
Changing Scope of Ethics Committees Committees are expanding their
scope of their activity to include organizational ethics,
considering questions regarding: Finances Administration
Organization Human Resource 48. Informed Consent Origins of the
Informed Consent Doctrine Right to be free from nonconsensual
interference with ones person Morally wrong to force one to act
against his or her will Serves six functions Protect individual
autonomy Protect patient status as human being Encourage physicians
to carefully consider decisions Avoid fraud or duress Foster
rational decision-making by patients Increase public involvement in
medicine 49. Informed Consent Legal framework for Informed Consent
Historically was based on Battery Theory Unwanted touching Not
operative today in almost all jurisdictions May be operative if
there is no consent at all (i.e. operating on the wrong knee)
Negligence: Operative in virtually all jurisdictions Prima facie
case based on: Duty to disclose information Failure to disclose
(unless statutory exception met) If information had been disclosed,
patient would not have consented to procedure Injury and damages
50. Informed Consent Duty to disclose standards Professional
Standard Physician has disclosed information that a reasonable or
prudent doctor would have disclosed under similar circumstances
Patient-need standard What a reasonable person would want to know;
information that would be material to a patient States with
statutes usually adopt the Professional Standard Case law is split
50-50 on which standard to follow 51. Informed Consent What must be
disclosed The condition or diagnosis Nature and purpose of
treatment Risk of treatment Treatment alternatives which includes:
Things that are already known Things that everybody should know
Option of no treatment All alternatives do not have to be disclosed
52. Informed Consent Exceptions to the General Rule of Disclosure
Patient is unconscious or otherwise incapable of consenting
(Emergency treatment) Harm from failure to treat is imminent
Outweighs any harm threatened by proposed treatment Therapeutic
Privilege Risk disclosure poses such a threat of detriment to a
patient as to become unfeasible or contraindicated from a medical
point of view Does not accept the paternalistic notion that the
physician may remain silent because divulgence might prompt the
patient to forego therapy the doctor believes the patient must
receive 53. Informed Consent Causation Issues Disclosure of
information would have caused the patient to refuse to undergo the
treatment Subjective: The patient states that if s/he had known,
s/he would have refused the intervention. This standard is
impossible to prove because anyone could say they would have
refused if they had known something they claim was not disclosed.
Objective: One must prove that a reasonable patient would not have
agreed to the intervention if s/he had known. Most states have
adopted the objective standard 54. World Medical Association
Declaration of Geneva I SOLEMNLY PLEDGE to consecrate my life to
the service of humanity; I WILL GIVE to my teachers the respect and
gratitude that is their due; I WILL PRACTISE my profession with
conscience and dignity; THE HEALTH OF MY PATIENT will be my first
consideration; I WILL RESPECT the secrets that are confided in me,
even after the patient has died; I WILL MAINTAIN by all the means
in my power, the honour and the noble traditions of the medical
profession; MY COLLEAGUES will be my sisters and brothers; I WILL
NOT PERMIT considerations of age, disease or disability, creed,
ethnic origin, gender, nationality, political affiliation, race,
sexual orientation, social standing or any other factor to
intervene between my duty and my patient; I WILL MAINTAIN the
utmost respect for human life; I WILL NOT USE my medical knowledge
to violate human rights and civil liberties, even under threat; I
MAKE THESE PROMISES solemnly, freely and upon my 55. MEDICAL ETHICS
CREATE BETTER PHYSICIANS 55 Medical Ethics VirtuesGood of the
patient Excellent physician Self understood goodBiological-medical
good 56. GOOD PRACTICE YOU WILL FLOURISH Basic template for
professions: identify distinguishing characteristic Rank virtues
for particular profession Define professional excellence 56 Ethics
Values Virtues Flourishing life 57. WHAT IS YOUR CHOICE MAKES
DIFFERENCE ??? Medicine is about : Can we? Ethics is about: Should
we? 57 58. Created by Dr Md. Yunus for Learning & Development
of Post Graduate Medical Student Email: [email protected] Web:
www.neigrihms.nic.in
