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