Health Professional - Patient Relationship

Health Professional - Patient Relationship

• The health professional-patient relationship is the cornerstone of medical practice and medical ethics.
• The Declaration of Geneva emphasizes the health of the patient as the top priority for physicians.
• The International Code of Medical Ethics states that physicians owe their patients complete loyalty and all resources of their expertise.
• The chapter covers six particularly challenging topics for health professionals: respect and equal treatment, communication and consent, decision-making for incompetent patients, confidentiality, beginning-of-life issues, and end-of-life issues.

Respect and Equal Treatment

• The Universal Declaration of Human Rights (1948) states that all humans are born free and equal in dignity and rights.
• Other international and national bodies have created statements outlining rights for all people, specific citizens, or certain groups (e.g., children's rights, patient rights).
• Although human rights are not universally respected, physicians are instructed not to permit considerations of age, disease, disability, creed, ethnicity, gender, nationality, political affiliation, race, sexual orientation, or social standing to interfere with their duty to their patients.
• Physicians have also claimed the right to refuse patients, except in emergencies. This can potentially lead to discrimination without accountability.
• A physician's conscience or disciplinary authorities may be the only means of preventing human rights abuses.
• The only valid reason for ending a physician-patient relationship may be when the patient requires another physician with differing skills.
• Physicians should not permit consideration of any factors that could lead to inappropriate discrimination of patients.

Communication and Consent

• Informed consent is a central concept in medical ethics.
• Patients have a legal and ethical right to make healthcare decisions.
• The patient's rights declaration states: patients have the right to self-determination and to make free decisions.
• The physician must inform patients of the consequences of their decisions.
• Competent adult patients have the right to refuse or accept any diagnostic procedure or therapy.
• The patient has a right to the information required to make personal decisions
• The patient must clearly understand the purpose of any test or treatment, the results implied, and the implications of refusing consent.
• Public health law in Palestine mandates patient access to emergency care, clear treatment explanations, and choice in research/training participation. Patients also have a right to respect for privacy, dignity, and religious/cultural beliefs, as well as the right to file complaints against the health institution.

Decision-Making for Incompetent Patients

• Many patients (e.g., young children, individuals with certain psychiatric or neurological conditions, temporarily unconscious or comatose individuals) may lack the competency to make decisions.
• These situations require substitute decision-makers, either the physician or another person (e.g., spouse, adult children, or siblings).
• Physicians only make decisions for patients when a designated substitute cannot be found, often in emergency situations.

Confidentiality

• All identifiable medical information (condition, diagnosis, prognosis, treatment, and personal details) about a patient should be kept confidential, even after death.
• Relatives may have a right to access information regarding health risks.
• Confidential information can only be shared with others if the patient provides explicit consent or if legally permitted.
• Information must be disclosed only on a strictly "need to know" basis for healthcare providers unless the patient provides explicit consent.
• Identified patient data must be protected appropriately, including all mediums the data exists, and data derived from human substances.

Beginning-of-Life Issues

• Prominent medical ethics issues center on the start of human life (e.g., contraception, assisted reproduction, prenatal genetic screening).
• These issues are complex and involve extensive analysis by medical associations, ethicists, and government advisory bodies, and are addressed by laws and regulations in various countries.
• Contraception is permissible if the husband and wife agree, as there is no prohibition in the Quran or Sunnah.
• Any birth control method destroying the developing human life is prohibited in Islam.
• Assisted reproduction is permissible for couples unable to conceive naturally and includes techniques like artificial insemination, IVF, and embryo transfer. Surrogate/substitute gestation is prohibited by use of fertilized egg in another woman.

Prenatal Genetic Screening

• Genetic tests identify whether embryos or fetuses are affected by genetic abnormalities or sex.
• Results influence the decision whether to continue the pregnancy.
• Physicians are responsible for determining when to offer such tests and for explaining the results to patients.

Abortion

• Abortion is a highly contentious issue in medical ethics and public authorities.
• Physicians should not induce abortion except when the mother's health or life is threatened.
• Abortion is permissible before the fourth month if continued pregnancy endangers the mother's health.
• The decision must be confirmed by a medical committee of at least three specialists, one familiar with the disease that calls for termination of pregnancy.
• The committee confirms the risk to the mother if the pregnancy is continued. Confirmed cases of pregnancies from rape are referred to the appropriate Islamic authorities and legislation.

Severely Compromised Neonates

• Extreme prematurity and congenital abnormalities produce extremely poor prognoses for some neonates.
• Difficult decisions are often required: attempt to prolong life or allow the infant to die.

End-of-Life Issues

• Euthanasia involves intentionally ending a life, including specific elements:
  • The subject is a competent, informed person with an incurable illness who has voluntarily asked to have their life ended;
  • The agent knows about the subject's condition, desires, and primary intention;
  • The act is undertaken with compassion and without personal gain.
• Assistance in suicide involves knowingly and intentionally assisting someone in taking their own life, such as providing information about or accessing lethal drugs, or counselling.
• Euthanasia and assistance in suicide are outside the scope of the medical profession. A physician should not participate in ending a patient's life, even at the patient's request or the request of a guardian.
• A physician should strongly encourage patients to endure a hopeless, incurable disease or severe, unbearable pain that cannot be relieved with standard pain killers.