Ethics in Family Practice

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Questions and Answers

What has contributed to the complicated physician-patient relationship?

  • Emergence of new medical technologies (correct)
  • Decline in the quality of healthcare services
  • Reduction in medical practitioners
  • Increased patient awareness of medical rights

What does the term 'Bioethics' refer to?

  • The intersection of biology and ethics (correct)
  • A study focused solely on ethical issues in business
  • A concept unrelated to medical practices
  • A set of rules for medical practice

What does the Declaration of Geneva emphasize?

  • Services to humanity and respect for patient secrets (correct)
  • The importance of medical research over patient care
  • Patient autonomy over physician decisions
  • The physician's financial interests

Which year was the Declaration of Geneva adopted?

<p>1948 (C)</p> Signup and view all the answers

What is one role of a medical council?

<p>To erase a practitioner’s name from the register for disgraceful conduct (D)</p> Signup and view all the answers

Which of the following is NOT included in the principles of medical ethics?

<p>Ignoring patient confidentiality when necessary (A)</p> Signup and view all the answers

What is a primary focus of modern medical ethics?

<p>The development of ethical theories and codes of conduct (C)</p> Signup and view all the answers

Which body is responsible for enforcing medical ethics through disciplinary actions?

<p>Medical syndicate (B)</p> Signup and view all the answers

Under what circumstances can confidentiality be disclosed for the sake of the public?

<p>When there is an imminent danger of serious crime or infectious disease (D)</p> Signup and view all the answers

What is a key ethical consideration when dealing with terminally ill patients refusing treatment?

<p>Respecting the patient's autonomy is vital (C)</p> Signup and view all the answers

When is it acceptable for a physician to disclose a patient’s confidential information for their own protection?

<p>When accused of malpractice (B)</p> Signup and view all the answers

What principle of medical ethics focuses on respecting a patient's individual choices?

<p>Autonomy (A)</p> Signup and view all the answers

In cases of brain death, when is it generally considered appropriate to turn off life support?

<p>When brain death is confirmed and no recovery is possible (A)</p> Signup and view all the answers

Which of the following is NOT a reason for disclosing patient confidentiality?

<p>To participate in a research study without consent (C)</p> Signup and view all the answers

What is often a dilemma faced by physicians concerning patients in vegetative states?

<p>Whether to continue artificial life support despite minimal chances of survival (A)</p> Signup and view all the answers

What ethical question arises with the administration of pain medication to cancer patients?

<p>Is it appropriate to prioritize pain control over the potential for dependency? (A)</p> Signup and view all the answers

What does the principle of beneficence emphasize in medical ethics?

<p>Doing good for the patient (D)</p> Signup and view all the answers

Which principle of medical ethics focuses on the obligation to avoid causing harm?

<p>Non-maleficence (A)</p> Signup and view all the answers

How can lack of medical competence lead to a violation of non-maleficence?

<p>Through negligence and poor patient care (C)</p> Signup and view all the answers

What does the principle of justice in medical ethics address?

<p>Providing equal treatment to all patients (A)</p> Signup and view all the answers

Respect for autonomy entails which of the following?

<p>Allowing patients to make their own healthcare decisions (C)</p> Signup and view all the answers

Informed consent is mainly associated with which principle of medical ethics?

<p>Respect for autonomy (B)</p> Signup and view all the answers

What is a primary reason unethical medical practices occur despite established codes and rules?

<p>There can be gaps between ethical theories and real-life dilemmas (A)</p> Signup and view all the answers

Which statement accurately reflects the application of the four principles of medical ethics?

<p>They provide a comprehensive framework for addressing ethical dilemmas. (C)</p> Signup and view all the answers

What is a crucial element of informed consent?

<p>Respect for confidentiality (A)</p> Signup and view all the answers

Which of the following is NOT an element of informed consent?

<p>Expected duration of treatment (B)</p> Signup and view all the answers

Informed consent is considered invalid if it is given under which of the following conditions?

<p>The patient is misled about the nature of the procedure (C)</p> Signup and view all the answers

Which type of consent involves an explicit agreement, either orally or in writing?

<p>Express Consent (B)</p> Signup and view all the answers

What is necessary to ensure regarding the information provided during the informed consent process?

<p>The patient should understand it clearly (C)</p> Signup and view all the answers

Which of the following is true about confidentiality in medical ethics?

<p>Health professionals must maintain patient confidentiality. (A)</p> Signup and view all the answers

In which situation is implied consent commonly applicable?

<p>In emergency situations (D)</p> Signup and view all the answers

Which of the following conditions might make consent legally invalid?

<p>The operation is deemed unnecessary (C)</p> Signup and view all the answers

What is a significant ethical dilemma faced by the family physician when a patient reveals a serious health condition?

<p>maintaining the patient's confidentiality. (D)</p> Signup and view all the answers

Which of the following principles is essential when practicing medical ethics?

<p>Beneficence towards the patient. (C)</p> Signup and view all the answers

In the context of the patient's request to not disclose their hypertension (HTN) status, what should be the physician's primary concern?

<p>Maintaining the patient's trust and confidentiality. (D)</p> Signup and view all the answers

What is one of the historical factors that has influenced the development of medical ethics?

<p>Religious teachings and philosophical theories. (A)</p> Signup and view all the answers

Which of the following best describes the concept of 'do no harm' in medical ethics?

<p>The physician should avoid actions that may cause unnecessary harm to patients. (B)</p> Signup and view all the answers

What key aspect must a family physician consider when filling out a medical certificate for a patient with a serious condition?

<p>The patient's wish to hide their condition. (C)</p> Signup and view all the answers

Which scenario directly involves a conflict between patient confidentiality and public health safety?

<p>A patient with HCV not wanting their spouse informed of their condition. (B)</p> Signup and view all the answers

What is primarily required for practicing ethics in daily family practice?

<p>Knowledge of traditional norms and moral values. (C)</p> Signup and view all the answers

What is the primary ethical dilemma concerning patients with terminal conditions?

<p>To seek exhaustive treatment despite minimal chances of survival (C)</p> Signup and view all the answers

Is organ donation permitted in medical ethics?

<p>It is generally permitted with appropriate consent (A)</p> Signup and view all the answers

Is receiving animal-sourced organs for transplantation permitted?

<p>Yes, especially from pigs due to their physiological similarities (D)</p> Signup and view all the answers

What is the ethical position on fetal tissue transplants?

<p>They are permissible under specific conditions (C)</p> Signup and view all the answers

What is a common ethical consideration regarding abortion in cases of genetic diseases?

<p>The mother can choose to have an abortion if genetic abnormalities are present (B)</p> Signup and view all the answers

What does the Golden Rule in medical ethics emphasize?

<p>Doing unto others as one would want done to oneself (C)</p> Signup and view all the answers

How should a doctor who opposes certain procedures uphold their values?

<p>By refusing to perform any procedures that conflict with their beliefs (B)</p> Signup and view all the answers

In what way can medical ethics impact research and progress?

<p>They can slow down research in some contexts to ensure safety and ethics (B)</p> Signup and view all the answers

Flashcards

Ethical Dilemma

A situation where a healthcare professional faces conflicting ethical principles, making it difficult to choose the right course of action.

Medical Ethics

The branch of ethics that deals with moral principles and values that guide medical professionals in their practice.

Medical Ethics Code

A set of principles and rules that govern the conduct of medical professionals in their interactions with patients, colleagues, and society.

Beneficence

Actions taken to benefit the patient's well-being, even if it requires effort or sacrifice.

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Non-maleficence

The obligation to avoid causing harm to patients.

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Patient Autonomy

Respecting the patient's right to make decisions about their own healthcare, even if those decisions are not in line with the doctor's recommendations.

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Confidentiality

Maintaining the confidentiality of personal information shared by patients with healthcare professionals.

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Truthfulness

The ethical duty of healthcare professionals to be truthful and honest with patients about their medical condition and treatment options.

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Declaration of Geneva

The declaration of Geneva is an updated version of the Hippocratic Oath, emphasizing patient care and ethical conduct.

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Justice in Healthcare

The principle that ensures fair treatment of patients and equitable distribution of healthcare resources.

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Truth-telling

The ethical obligation of healthcare professionals to provide accurate and honest information to the patient about their medical condition and treatment options.

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Confidentiality in Healthcare

The ethical duty of healthcare professionals to safeguard the confidentiality of personal information shared by patients.

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Patient Empowerment

The ethical principle that emphasizes the importance of empowering patients through ongoing education and training, enabling them to participate actively in their own health management.

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Disclosure of Confidentiality

When a doctor shares a patient's medical information without their consent, except in specific circumstances.

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Respect for Autonomy

The ethical principle that respects a patient's right to make decisions about their own healthcare.

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Disclosure of Confidentiality to Another Doctor

When a patient's medical information is shared with a doctor for consultation or a second opinion.

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Disclosure of Confidentiality for Public Safety

When a patient's information is shared with authorities due to potentially harmful infectious diseases or serious crimes.

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Disclosure of Confidentiality in Malpractice Cases

When a doctor can share a patient's information to defend against accusations of malpractice.

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Disclosure of Confidentiality as an Expert Witness

A doctor can share a patient's information when they are called as an expert witness in a legal case, such as a medical examination of a prisoner.

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Fetal Tissue Transplant

The ethical dilemma concerning the use of fetal tissue for transplantation, considering questions of consent, morality, and potential benefits.

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Brain Death and Life Support

The ethical dilemma of whether it's okay to end life support for irreversibly brain-damaged patients.

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Cloning Permissibility

The ethical debate surrounding cloning, including considerations of morality, safety, and potential misuse of the technology.

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End-of-Life Issues

The ethical challenges surrounding end-of-life decisions, such as the use of euthanasia for terminally ill patients.

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Informed Consent

The patient's agreement to a medical procedure or treatment, given after understanding the risks, benefits, and alternatives. It ensures the patient's autonomy is respected and that they make informed choices about their healthcare.

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Elements of Informed Consent

Explaining the patient's medical condition, the proposed treatment plan, its potential benefits, risks, and alternative therapies, using language they can understand.

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Express Consent

Consent given verbally or in writing, clearly expressing agreement to the procedure.

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Implied Consent

Consent inferred from a patient's actions or behavior, implied by their participation in the procedure.

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Invalid/Illegal Consent

Situations where consent is missing, invalid, or illegal, making medical interventions potentially unethical or unlawful. Examples include performing an illegal abortion without consent, operating on a minor without parental approval, or misrepresenting a simple procedure as life-saving.

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Confidentiality in Medical Ethics

Maintaining the confidentiality of personal information shared between the physician and patient during treatment, safeguarding sensitive details.

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Maintaining Confidentiality

The duty to protect patient information, ensuring that disclosures are only made with the patient's consent or when legally required. This applies to all medical professionals, including nurses, pharmacists, technicians, and students.

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Breach of Confidentiality

A breach of confidentiality, potentially damaging the patient's reputation and trust.

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Study Notes

Ethics in Family Practice

  • Presented by Dr. Mosleh A. Ismail, MD Family Medicine
  • Focus on ethical dilemmas in family medicine practice

Patient's Problem

  • Male patient (61 years old) known to the practice
  • Periodic check-up; investigations requested
  • FBS 200mg/dl, 2HPP 350 mg/dl
  • Patient requested confidentiality of HCV status from spouse
  • Wants treatment in secrecy

Ethical Dilemma

  • Patient with HCV infection requests confidential treatment
  • Physician faces a choice between patient confidentiality and preventing harm to spouse
  • How to handle this conflict?

Ethical Dilemma (Driver)

  • Male patient (61 years old) known to practice
  • Periodic check-up (required for work renewal)
  • Working as a driver
  • Patient requests concealing hypertension to avoid renewal issues
  • Physician's ethical behavior in this scenario?

Outline of Presentation

  • Why Medical Ethics?
  • Definition of Medical Ethics
  • Principles of Medical Ethics
  • Classification of medical ethics
  • Who is involved with Medical Ethics?
  • Practicing Ethics in daily family practice

Why Medical Ethics? (Evolution of ME)

  • Medical ethics and codes are ancient
  • Moral requirements are fundamental like laws of nature
  • Traditional values (love, justice, honor, beneficence)
  • Inherited through religion, philosophy and social workers

Why Medical Ethics? (Modern Era)

  • 20th-century medical practice evolved more complex
  • Legal issues arose, straining physician-patient relationship
  • E.g., organ donation, euthanasia, illegal abortion, medical certificates

Why Medical Ethics? (Technological Advancements)

  • Introduction of new technologies (like mechanical ventilation)
  • Medical techniques (like organ transplantation, genetic engineering)
  • Social concerns (like human experimentation or abuse of patient rights)

What do you mean by Ethics?

  • Ethics is a discipline or process for examining and resolving moral issues.
  • "Bio" means life
  • "Ethics" means codes and principles for resolving right and wrong (morality)
  • Ethics deals with guiding principles in conduct.
  • Morality addresses societal conventions regarding right and wrong.

Who is Concerned with Medical Ethics?

  • Medical syndicates/associations (licences, registers, removal of registration, and restoration services)
  • Medical councils (disgraceful conducts, removal of names from register)
  • Disciplinary committees (punishing misconduct)

Why Medical Ethics - Modern Ethics

  • Dominated by the development of ethical theories and rules
  • Declaration of Geneva (1948), Medical World Association Conferences (1949)
  • Concept of four main principles developed in USA (1968)

Professional Conduct

  • Declaration of Geneva (1948): Updated version of Hippocratic Oath
  • Services to humanity/patients
  • Respect patient secrets related to religion, nationality, politics, social standing considerations that interferes with patient's welfare.
  • Respect human rights/laws.

Why Medical Ethics? (Professional Codes/Rules of Conduct)

  • World medical association's international code of medical ethics (1949)
  • Adherence to the declaration of Geneva
  • Maintain high professional and clinical standards related to patient care and collegial relations

Why Medical Ethics (Unethical Practices Continue)?

  • Insufficient or inadequate codes/rules that ignore important issues
  • Gap between theoretical ethics and real-life dilemmas.

Why Medical Ethics (Filling the Gap)

  • Idea of Four Principles to bridge the theoretical gap and resolve clinical dilemmas
  • Developed since 1968 in the United States

Principles of Medical Ethics (1. Beneficence)

  • Doing good
  • Physician's duty is to promote health and cure the patient
  • Preventing harm to the community (such as by research)

Principles of Medical Ethics (2. Non-Maleficence)

  • Avoiding harm to patients
  • Duty to avoid physical and emotional harm
  • Negligence, lack of competence can invite harm (e.g., surgical errors, inappropriate medications.)

Principles of Medical Ethics - (3. Justice)

  • Fair/equitable treatment and distribution of resources

Principles of Medical Ethics (4. Respect for Autonomy)

  • Self-Rule, Individuals' rights to make decisions ("free will")
  • Informed consent (patients must receive all relevant information before making decisions)
  • Includes truth-telling, respect for confidentiality
  • Patient agreement required before any investigation (or treatment)

Principles of Medical Ethics (Informed Consent - Elements)

  • Description of patient's condition
  • Description of proposed treatment(s)
  • Possible benefits and risks of the treatment
  • Alternative therapies
  • Implied consent (emergency situations)
  • Express consent (oral or written)
  • Invalid - unlawful/unnecessary operations, abortions, artificial insemination, fraud involving the consent, given by a minor, or insane patient.

Principles of Medical Ethics. Confidentiality

  • Secrecy between doctor and patient
  • All medical personnel must maintain confidentiality
  • Publishing patient info in scientific publications must be carefully considered.

Principles of Medical Ethics—Disclosure of Confidentiality

  • Patient's request to disclose
  • Patient's safety (mental health issues, possible danger to self/others)
  • Public safety issues (epidemics, crimes)

Principles of Medical Ethics—Disclosure of Confidentiality (Specific Cases)

  • Cases involving malpractice allegations
  • Testimony as an expert witness, legal cases
  • Sharing with other doctors or consulting with colleagues

Ethical Dilemmas Challenging Family Physicians

  • End-of-life issues (brain death, euthanasia)
  • Organ transplantation
  • Moral issues related to abortion, adoption, and bio-technical reproduction
  • Genetic manipulation
  • Prenatal screening, termination
  • Child abuse, discipline
  • Ethical issues related to HIV/AIDS patients
  • Medical certificates

Ethical Dilemmas Challenging Family Physicians -Questions

  • Cardiopulmonary resuscitation (CPR)
  • Withdrawing life support for patients without cerebral function
  • When patients reject treatment due to faith-based beliefs/will
  • Definition of 'dead'(brain death vs. brain-stem death)
  • Patient in vegetative states
  • Cancer/pain management - Patient's requests and patients' rights
  • Newborn/congenital anomalies and life-saving treatments.
  • Organs for transplant/ethical concerns (animal sources)
  • Donor consent for organ retrieval & fetal tissue transplants
  • Ethical considerations contraception vs abortion
  • Genetic diagnosis vs abortion decisions
  • Ethical choices in cases of rape
  • Is cloning permissible
  • Refusing patient who request treatments contrary to one's own moral beliefs.
  • Does medical ethics hinder medical research?

Golden Rule

  • Preservation of life
  • Maintaining intellect and integrity
  • Protecting property
  • Freedom of belief
  • Judging actions by intent
  • Preventing harm
  • Avoiding jeopardizing oneself
  • Empathy (e.g., 'love for another like you love for yourself.')

Conclusion

  • Medical ethics is a process for resolving moral dilemmas
  • Medical practices and issues are getting more complex
  • Unethical medical practices may still occur despite rules and codes
  • Family physicians need strong ethical standards for daily practices not just unusual circumstances
  • Respecting human life and integrity is central to all major religions.

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