Dr.T.V.Rao MD

MEDICAL ETHICS WE TOO NEED ONE DAY ???

DR.T.V.RAO MD 1

A HISTORY OF ETHICS PRINCIPLES 460-377 B.C Hippocrates of Cos

1792 Percival: Manchester Infirmary Committee

1803 Percival: Medical Ethics: A Code of Ethics and Institutes Adopted

to the Professions of Physic and Surgery

1808 Boston Medical Society (self-regulation)

1847 AMA: “Code of Ethics”

1903 AMA: “Principles of Medical Ethics”

1912 AMA: revised “Principles”

1957 AMA: concise “Principles”, “Opinions”

1980 AMA: FTC-imposed Principles revision

1981 AAPS: “Principles of Medical Ethics”

1980s-1990s ACP Code, and many others

2001 AMA: revised “Principles” DR.T.V.RAO MD 2

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 3

Why Should doctors have to

swear an oath when they

qualify?

The Hippocratic Oath.doc

Modern Hippocratic Oath.doc

To save self and Others too

DR.T.V.RAO MD 4

• 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

PATENTS ARE DEMANDING

UNLIKE PAST- FOLLOW ETHICS

DR.T.V.RAO MD 5

• 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 professional’s responsibility to each patient and the professional, collective obligation to all who need medical care.

DEFINITION OF MEDICAL ETHICS

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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

Human

Dignity

DR.T.V.RAO MD

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 invokes an ethical decision as well.

• 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 individual’s 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 DR.T.V.RAO MD 12

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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• 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

ETHICAL VS. LEGAL OBLIGATIONS

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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

DR.T.V.RAO MD

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 one’s 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 patient’s willing acceptance of a medical

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

• 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

• Many are screening patients for HIV without informed consent ?

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

DR.T.V.RAO MD

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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• In much wisdom is

much grief :and he

that increaseth

knowledge

increaseth

sorrows”

(Ecclesiastics 1,18)

KNOWLEDGE CREATES CONFLICT

SO THE DOCTORS FIGHT

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Medical Ethics

Good of the patient

Virtues

biological-medical good self-understood good

Excellent physician

MEDICAL ETHICS CREATE BETTER

PHYSICIANS

Values

Virtues

Flourishing life

Ethics

Basic template for professions:

– identify distinguishing characteristic

– rank virtues for particular profession

– define professional excellence

PRACTICE GOOD PRACTICES YOU WILL

FLOURISH

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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• Not simple

• Ethics not like

science

• Is ethics arbitrary?

Or

• Can we discover an

ethic for medicine?

SOLUTIONS TO ETHICAL PROBLEMS

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DR.T.V.RAO MD 28

• 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