MEDICAL ETHICS

WE TOO NEED ONE DAY ???

Dr.T.V.Rao MD

DR.T.V.RAO MD

A HISTORY OF ETHICS PRINCIPLES

460-377 B.C 1792 1803 1808 Hippocrates of Cos Percival: Manchester Infirmary Committee Percival: Medical Ethics: A Code of Ethics and Institutes Adopted
to the Professions of Physic and Surgery

Boston Medical Society (self-regulation)

1847
1903 1912

AMA: Code of Ethics

AMA: Principles of Medical Ethics AMA: revised Principles

1957
1980 1981 1980s-1990s 2001

AMA: concise Principles, Opinions

AMA: FTC-imposed Principles revision AAPS: Principles of Medical Ethics ACP Code, and many others AMA: revised Principles
DR.T.V.RAO MD

WHAT ARE MEDICAL ETHICS

Medical ethics refers
Chiefly to the rules of etiquette adopted by the medical profession to regulate professional conduct with each other, but also towards their individual patients and towards society, and includes considerations of the motives behind that conduct.
DR.T.V.RAO MD

swear an oath when they qualify? The Hippocratic Oath.doc Modern Hippocratic Oath.doc To save self and Others too
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Why Should doctors have to

PATIENTS ARE DEMANDING UNLIKE PAST- FOLLOW ETHICS

Patients are entitled to good standards of practice and care from their doctors .Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligations

DR.T.V.RAO MD

DEFINITION OF MEDICAL ETHICS

The practice of medicine is rooted in a covenant of trust among patients, healthcare professionals, and society. The ethics of medicine must seek to balance the healthcare professionals responsibility to each patient and the professional, collective obligation to all who need medical care.

DR.T.V.RAO MD

BASIC RIGHTS AND ETHICAL DUTIES Human Rights Access to health care Right to non-discrimination Right to privacy and confidentiality Right to environment that is not harmful to health or well being
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Human

Dignity

PRINCIPLES OF MEDICAL ETHICS

The good of the patient is paramount
TRUST must be nurtured before all else
Avoid conflicts of interest (COI)

Avoid perception of COI

Respect rights of patient
safeguard confidentiality

respect self-determination

communicate honestly with all maintain competence

TYPES OF ETHICS
Medical Ethics: Clinical obligations
fidelity first to patients interests telling the truth (cancer, errors)

Professional Ethics: Obligations of the profession

self-regulation education of self and others

Bioethics: Guides for public policy

gene technology, stem cell research health system reform

WHAT IS THE NEED FOR MEDICAL ETHICS?

The practice of medicine and the practice of ethics are inseparable. Every clinical decision decision as well. invokes an ethical

In many instances, the ethical issue may not be readily apparent.

In others conflicts arise between ethical principles and medical decisions, which require the clinician to be well versed with the former in order to guide the latter.
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ETHICAL PRINCIPLES
Autonomy: Respect for an individuals autonomy or ability to make decisions for him/herself

includes respect for their privacy and confidentiality

need to provide sufficient information for them to make informed choices

truth telling protection of persons with diminished or impaired autonomy.
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ETHICAL PRINCIPLES
Justice: This refers to the need to treat all people equally and fairly
Society uses a variety of factors as a criteria for distributive justice, including the following:
to each person an equal share

to each person according to need

to each person according to effort to each person according to contribution to each person according to merit

to each person according to free-market exchanges

We should strive to provide some decent minimum level of health care for all citizens, regardless of ability to pay
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ETHICAL PRINCIPLES
Beneficence: This refers to the tradition of
acting always in the patients best interest to maximise benefits and minimise harm.

Non-malfeasance: This principle ensures

that treatment or research ought not to produce harm
Negligence
Misconduct
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ETHICAL VS. LEGAL OBLIGATIONS

Medical ethics and the law are not the same, but often help define each other Breach of ethical obligation may not necessarily mean breach of law Breach of ethical obligation may be used to prove medical malpractice or medical negligence
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MICRO LEVEL ETHICAL PRINCIPLES

I. Respect for Autonomy (or Person)
Respect the decisions of autonomous persons and protect persons who lack decision-making capacity (e.g., confused patients, mentally ill). Recognize the capacity of mentally and legally competent patients : To think and make decisions independently To act on the basis of their decisions To communicate their wishes to health workers

Uphold patient confidentiality

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ETHICAL PRINCIPLES
II. Non-Maleficence (Not inflicting harm)
Health professionals should not inflict harm on patients

III. Beneficence
Act in the best interests of patients or research participants.

Contribute to patient welfare help patients further health interests

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HEALTHCARE PROFESSIONAL ROLE

Paternalistic model
Emphasizes health and well-being (beneficence) over respect for autonomy and patient choice Patient is selectively given information Evolution of newer decision-making models Independent choice vs. enhanced autonomy

Paternalistic vs. informative vs. interpretive vs. deliberative

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LEARNING ABOUT ETHICAL ISSUES REQUIRES.

An understanding of the issue-the science and knowledge base An understanding of ethical frameworks and principles-not just case studies and anecdotes An understanding of ones own values Ability to think through the issue-logic and argument

Recognition of uncertainty-limits to knowledge

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WE ARE CONFUSED MANY TIMES ABOUT TRUTH ???

Should doctors always tell patients their diagnosis? What about uncertainty in diagnosis? Is it right to make patients share this? Is it ever right to suppress diagnoses what about stigmatising diagnoses, e.g. MS, dementia, HIV, psychiatric diagnoses? What if relatives ask doctors not to disclose diagnoses to patients?

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INFORMED CONSENT
Definition: A patients willing acceptance of a medical What constitutes informed consent?
Disclosure: information to allow reasonable person to make a decision Understanding: comprehension of the information given Voluntary: no coercion or incentive to accept or deny a treatment Agreement: verbal or written (preferred) to discussed intervention

intervention after adequate disclosure from their MD of the nature of the intervention, risks, benefits and alternative treatment options

Many are screening patients for HIV without informed consent ?

Many are doing sex determination in fetus even it is prohibited ???

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THE RELATION BETWEEN LAW AND ETHICS

Ethical values have often been influenced by and influenced legal doctrine and legal principles are closely related to ethical principles. Ethical obligations exceed legal duties Law serves to demarcate the limits of individual autonomy in the interests of society. It also protects the rights of individuals
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KNOWLEDGE CREATES CONFLICT SO THE DOCTORS FIGHT

In much wisdom is much grief :and he that increaseth knowledge increaseth sorrows (Ecclesiastics 1,18)

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MEDICAL ETHICS CREATE BETTER PHYSICIANS

Medical Ethics
Virtues Good of the patient Excellent physician

biological-medical good

self-understood good

PRACTICE GOOD PRACTICES YOU WILL FLOURISH

Ethics
Virtues

Values

Flourishing life

Basic template for professions:

identify distinguishing characteristic rank virtues for particular profession define professional excellence

WHAT IS YOUR CHOICE MAKES DIFFERENCE ???

Medicine is about : Can we?

Ethics is about: Should we?
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PRACTICING ETHICS IS EXPENSIVE

?????

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SOLUTIONS TO ETHICAL PROBLEMS

Not simple
Ethics not like science

Is ethics arbitrary? Or
Can we discover an ethic for medicine?
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 Programme created by Dr.T.V.Rao MD for Medial Professionals with Major resources from American Medical association who constantly thrive to improve the standards in Medical Profession to benefit the patients
Email

doctortvrao@gmail.com

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