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Marc Imhotep Cray, M.D.
Shaping Professionalism:
Medical Oaths and Codes of Ethics IIPrepared and presented by
Marc Imhotep Cray, M.D.Basic Medical Sciences and Clinical Knowledge (CK) Teacher
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Marc Imhotep Cray, M.D.
Ethical Scenario
Should physicians use surgical placebo
controls (subjects undergo surgical
procedures that have the appearance of
therapeutic intervention but during which theessential therapeutic maneuver is omitted)
when assessing the efficacy of a surgical
intervention?
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Marc Imhotep Cray, M.D.
Surgical Placebo Controls
The use of placebo control is not justifiedwhen testing a surgical technique that
represents a minor improvement of an
existing surgical procedure.
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Marc Imhotep Cray, M.D.
Surgical Placebo Controls (2)
When a new surgical procedure is developed
with the prospect of treating a condition for
which no known surgical therapy exists, using
surgical "placebo" controls may be justified butmust be evaluated in light of whether the
current standard of care includes a non-
surgical treatment and the benefits, risks, and
side effects of that treatment.
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Marc Imhotep Cray, M.D.
Surgical Placebo Controls (3)
During the informed consent process, careful
explanation of the risks of the operation must
be disclosed.
Additional safeguards may include using aneutral third party to provide information and
obtain consent.
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Marc Imhotep Cray, M.D.
Ethical Scenario
What are a physicians reporting responsibilities
if a patients medical problems impair his or her
ability to drive safely?
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Impaired Drivers and Their
Physicians
Physicians should use their best judgment
when determining when to report impairments
that could limit a patients ability to drive.
In situations where there is a strong threat topatient and public safety, and where the
physicians advice to discontinue driving is
ignored, it is desirable and ethical to notify the
states Department of Motor Vehicles.
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Ethical Scenario
Results of an experiment that does not meetcontemporary standards of human subjects
protection is submitted for publication in a
medical journal.
What should the editors do?
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Information from Unethical
Experiments If data from unethical experiments can be
replaced by other sources of sound data, then
the results should not be published.
If data from unethical experiments arescientifically valid and are the only data
available and necessary in order to save lives,
then publication of such information may be
appropriate.
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Information from Unethical
Experiments (2)
If the results are published, the editors
should include a disclaimer that:
clearly describes the unethical nature of
the experiment; clearly states that the publication of the
data is needed to save lives;
pays respect to the victims;
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Information from Unethical
Experiments (3)
If the results are published, the editors should
include a disclaimer that:
avoids trivializing trauma suffered by the
participants; acknowledges the unacceptable nature of
the experiments; and
endorses adoption of higher ethical
standards for human subjects protection.
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Ethical Scenario
A student is uncomfortable about medical
students performing procedures on each
other for educational purposes. How should
the physician-educator respond to thestudents concerns?
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Medical Students Performing
Procedures on Fellow Students
Instructors should explain to students how the
procedures will be performed, making certain
that students are not placed in situations that
violate their privacy or sense of propriety. Students should be given the choice of
whether to participate prior to entering the
classroom.
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Medical Students Performing
Procedures on Fellow Students
(contd) There should be no requirement that the
students provide a reason for their
unwillingness to participate.
Students should not be penalized for refusal
to participate.
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Ethical Scenario
When residents or medical students are partof a health care team, what considerations
must be taken into account by the attending
physician when billing for services?
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Billing for Housestaff and Student
Services
When a physician assumes responsibility for
the services rendered to a patient by a
resident or student, the physician can bill for
services which were performed under thesupervisory physicians direct personal
observation, direction, and supervision.
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Ethical Scenario
Should consent be obtained before filmingpatients for commercial programs that will be
publicly broadcast?
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Filming Patients in Health Care
Settings
Filming patients without consent for
commercial purposes is a violation of the
patients privacy.
Consent is therefore ethically required for bothinitial filming and subsequent broadcast.
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Ethical Scenario
A contract research organization is recruitingphysicians to participate in clinical trials that
involve patients to whom they provide care.
What ethical issues do physicians have to
consider?
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Managing Conflicts of Interest in the
Conduct of Clinical Trials
Physicians should only participate in trials
that are scientifically sound and that have
been approved by an appropriate IRB.
The informed consent process must
differentiate the physicians roles as clinician
and investigator, and this is best achieved
when someone other than the treatingphysician obtains consent.
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Is it ethically permissible to accept gifts from
pharmaceutical representatives?
Ethical Scenario
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Gifts to Physicians from Industry
Any gift accepted by a physician should
primarily entail a benefit to patients and should
not be of substantial value.
Individual gifts of minimal value arepermissible as long as they relate to the
physicians work.
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Marc Imhotep Cray, M.D.
Ethical Scenario
Is it ethically permissible for physicians to sell
nonhealth-related goods from their offices?
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Marc Imhotep Cray, M.D.
Sale of NonHealth-Related
Goods from Physicians Offices
Physicians may sell nonhealth-related goods
from their offices for the benefit of community
organizations if:
the goods are low cost; the physician earns no profit;
such sales are not a regular part of the
physicians business;
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Marc Imhotep Cray, M.D.
Sale of NonHealth-Related Goods
from Physicians Offices (contd)
Physicians may sell nonhealth-related goods
from their offices for the benefit of
community organizations if:
such sales are conducted in a dignifiedmanner; and
patients are not pressured into making
purchases.
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Marc Imhotep Cray, M.D.
Ethical Scenario
Is it appropriate to use terms such as student
doctor to identify medical students who are
caring for patients?
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Marc Imhotep Cray, M.D.
Medical Student Involvement in
Patient Care
Patients should be informed of the training
status of individuals involved in their care.
Terms that may be confusing when
describing the training status of studentsshould not be used.
Physicians should relate the benefits of
student participation to patients and shouldensure that they are willing to permit such
participation.
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Marc Imhotep Cray, M.D.
Ethical Scenario
A medical error has occurred in the course of
caring for a patient. Should the treating
physician disclose this information to the
patient?
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Marc Imhotep Cray, M.D.
Patient Information
When a patient suffers significant medical
complications that may have resulted from a
physicians error, the physician is ethicallyrequired to inform the patient of all the facts
necessary to ensure understanding of what
has occurred.
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Marc Imhotep Cray, M.D.
Ethical Scenario
In the context of managed care, should
physicians disclose financial incentives that
raise potential conflicts of interest to their
patients?
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Marc Imhotep Cray, M.D.
Referral of Patients:
Disclosure of Limitations
Physicians must assure disclosure of any
financial inducements that may tend to limit
the diagnostic and therapeutic alternativesthat are offered to patients.
Physicians may satisfy this obligation by
assuring that the managed care plan makes
adequate disclosure to patients enrolled inthe plan.
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Marc Imhotep Cray, M.D.
Ethical Scenario
Should medical trainees perform procedures
such as endotracheal intubation on the newly
deceased patient?
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Marc Imhotep Cray, M.D.
Performing Procedures on the Newly
Deceased Patient
In the absence of previously expressed
preferences, physicians should request
permission from the family before performingprocedures.
Without such permission, physicians should
not perform procedures for training purposes
on the newly deceased patient.
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Marc Imhotep Cray, M.D.
Ethical Scenario
Should physicians treat themselves or
members of their own families?
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Marc Imhotep Cray, M.D.
Self-Treatment or Treatment of
Immediate Family Members Professional objectivity may be compromised
when an immediate family member of the
physician is the patient.
In emergency or isolated settings, physicians
can treat themselves or family members until
another physician becomes available.
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Marc Imhotep Cray, M.D.
Ethical Scenario Should physicians use strikes as a tactic in
collective bargaining?
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Marc Imhotep Cray, M.D.
Collective Action
and Patient Advocacy Collective action should not be
conducted in a manner that jeopardizes
the health and interests of patients. Physicians should refrain from the use
of the strike as a bargaining tactic.
Alternative tactics available includeinformational campaigns and non-
disruptive public demonstrations.
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Marc Imhotep Cray, M.D.
Ethical Scenario
A resident has concerns that an attending
physicians order is reflective of poor clinical
judgment. How should this situation behandled?
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Marc Imhotep Cray, M.D.
Disputes Between Medical
Supervisors and Trainees
Trainees should refuse to participate in
patient care ordered by their supervisors in
those rare cases in which they believe theorders reflect serious errors in clinical or
ethical judgment, or physician impairment,
that could result in a threat of imminent harm
to the patient or to others.
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Marc Imhotep Cray, M.D.
Disputes Between Medical
Supervisors and Trainees (contd) Trainees may withdraw from the care ordered
by the supervisor, provided withdrawal does
not itself threaten the patients immediatewelfare. The trainee should communicate his
or her concerns to the physician issuing the
orders and, if necessary, to the appropriate
persons for mediating such disputes.
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Marc Imhotep Cray, M.D.
Disputes Between Medical
Supervisors and Trainees (contd)
Third-party mediators of such disputes
may include the chief of staff of the
involved service, the chief resident, adesignated member of the institutional
grievance committee, or, in large
institutions, an institutional
ombudsperson largely outside of thehospital staff hierarchy.
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Marc Imhotep Cray, M.D.
Disputes Between Medical
Supervisors and Trainees
(contd)
Retaliatory or punitive actions against
trainees who raise complaints are unethicaland are a legitimate cause for filing a
grievance with the appropriate institutional
committee.
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Marc Imhotep Cray, M.D.
Strengthening Professionalism
Reaffirm core values and principles in
medicine through oath taking
Increase awareness and
understanding of medical codes
Promote mechanisms to encourage
compliance with ethical guidelines Foster lifelong mentoring and the
importance of role models
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Marc Imhotep Cray, M.D.
Future of Professionalism
For the benefit of patients and the public,
the future vitality of professionalism
depends on physicians:
Upholding and promoting the integrity of
professional self-regulation and autonomy
Supporting the deliberative process bywhich professional associations establish
and promote standards for medicine
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Marc Imhotep Cray, M.D.
Declaration of
Professional Responsibility
Humanity is faced with unprecedented
threats to its health and well-being
While these threats are new, physicians
response is guided by their historical
commitment to care for the sick and the
suffering A recommitment to professionalism
underscores it as the foundation for the
publics trust in medicine45
Reference Resources and
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Reference Resources andFurther Study
Bioethics Online Study RecoursesNIH - Bioethics Resources
University of Toronto - Joint Center for BioethicsWorld Medical Association - Medical Ethics Manual
Virtual Mentor
Video Education (drimhoteptv)
IVMS-MEDICAL ETHICS & PROFESSIONALISM12 videos, 3 hrs. and 16 min.http://www.youtube.com/playlist?list=PL08E700EA3F8313EB
E-TextbookMedical Ethics Today: The BMAs handbook of ethics
and law Books; 3 edition (January 30, 2012)Updateshttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-today
Best Price $148.33or Buy New $181.49
http://bioethics.od.nih.gov/http://www.jointcentreforbioethics.ca/http://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://virtualmentor.ama-assn.org/http://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/user/drimhoteptvhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttps://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/dp/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=as1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&http://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/watch?v=EpKG0VbZTGo&list=PL08E700EA3F8313EBhttp://www.youtube.com/user/drimhoteptvhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://virtualmentor.ama-assn.org/http://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://www.imhotepvirtualmedsch.com/Top Related