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Introduction to Medical Ethics

• Ethics involves principles and rules that define good and bad, right and wrong.
• Medical ethics is a system of moral principles that guide the practice of medicine by applying values and judgments.
• Understanding medical ethics helps physicians in making informed decisions during patient care while considering ethical principles.
• Ethics are unenforceable norms and values guiding behavior, while laws are written standards of behavior enforced by the justice system.

Autonomy vs. Paternalism

• Autonomy in medical ethics prioritizes the patient's right to make their own decisions, including accepting or declining medical care.
• Paternalism refers to a person or authority making decisions for another without their consent, believing it's in the best interest of the person.
• Understanding and weighing options for making decisions are crucial for patient autonomy.

Mental Capacity

• An adult patient is deemed to have mental capacity and can make their own decisions.
• Lack of mental capacity is recognized in unconscious and mentally retarded patients.

Honesty and Integrity

• Doctors are expected to be honest and act with integrity.
• Deceptive actions by a doctor are unethical.

Confidentiality

• Patient confidentiality requires doctors to keep their information private and avoid disclosing it to third parties.
• Exceptions to confidentiality exist when there is a serious risk of harm to others.

Fairness and Equity

• All people with equal needs deserve equal consideration in healthcare.
• Discriminating against patients in providing healthcare services is unethical.
• Fairness and equity are closely linked to distributive justice, which involves allocating scarce resources justly.
• Sufficiency View: Everyone should have access to essential care, with a variable definition of what is essential.

Maximizing Benefit and Minimizing Harm

• Ethical practice emphasizes maximizing benefit and minimizing harm in medical interventions.
• Interventions are justified when the anticipated benefits outweigh the potential harms.

Compassion and Empathy

• Empathy involves understanding and concern for another person's problems.
• Doctors should identify both the patient's complaints and the underlying causes of those complaints.

Competence

• Doctors are obligated to be competent in their field.
• Long training periods ensure competence, encompassing appropriate knowledge, clinical reasoning, and technical skills.

Principlism

• Principlism is a prominent approach in biomedical ethics, relying on a set of values for guidance in cases of ethical confusion or conflict.
• The four pillars of principlism are:
  • Respect for Autonomy: Prioritizes the patient's right to make their own decisions.
  • Beneficence: Requires doctors to act in the best interests of their patients, promoting well-being.
  • Non-maleficence: Prohibits causing harm to patients.
  • Justice: Encourages equitable treatment and fair distribution of benefits.
• Principlism applies these principles to determine the right course of action, considering both rules and consequences.

Therapeutic vs. Formal Relationship

• Therapeutic Relationship: A doctor has the freedom to accept or refuse to treat a patient, except in emergencies. Reasons for refusal include:
  • Beyond practicing hours.
  • Outside the doctor's specialty.
  • Illness beyond the doctor's competency and qualifications.
  • Doctor or a family member is ill.
  • Doctor has an important social function.
  • Doctor is under the influence of alcohol.
  • Patient is malingering.
  • Patient has defaulted on payments.
  • Patient or relatives are abusive or uncooperative.
  • Patient refuses to give consent.
  • Unaccompanied minor or female patient.
  • Doctor is engaged with an emergency or more serious case.
• Formal Relationship: A third party refers the patient for medical examination:
  • Pre-employment.
  • Insurance policy.
  • Yearly medical checkups.
  • Cases of rape or victims of crimes or Medico-legal cases.
  • Certain psychiatric illnesses referred by court or police.

Introduction to Medical Ethics

• Ethics are the principles and rules that define good and bad, right and wrong behavior.
• Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine.
• Understanding medical ethics helps physicians make decisions during patient care, considering ethical principles.
• Ethics are unenforceable norms and values that guide behavior, while the law codifies values into enforceable standards of behavior.

Autonomy vs. Paternalism

• Autonomy emphasizes the patient's right to make decisions for themselves, including accepting or refusing treatment.
• Paternalism involves an authority figure making decisions for a person without their knowledge or consent, believing it's in their best interest.
• Autonomy has largely replaced paternalism in medical ethics.

Mental Capacity

• Mental Capacity refers to a patient's ability to make their own decisions.
• Adults are generally presumed to have mental capacity.
• Those lacking mental capacity include unconscious patients and those with mental retardation.

Honesty and Integrity

• Doctors must be honest and act with integrity.
• Their actions should never be intended to deceive.

Confidentiality

• Patients have a right to confidentiality, meaning their information should be kept secret and not shared with third parties without consent.
• This right is not absolute. Exceptions include when disclosing information is necessary to prevent serious harm to others.

Fairness and Equity

• People with equal needs should receive equal consideration in healthcare.
• Discrimination in healthcare provision is ethically wrong.
• Fairness and equity are linked to the priority of using scarce resources justly (distributive justice).
• Doctors may consider various approaches to justice and equality, including the sufficiency view, where everyone receives essential care.
• Equity aims to achieve the desired outcome for each patient by distributing resources appropriately.

Beneficence and Non-Maleficence

• Maximizing benefit and minimizing harm are central ethical concerns.
• Medical interventions are generally justified when the anticipated benefits outweigh the risks.

Compassion

• Compassion involves understanding and concern for another person's problems.
• Physicians must identify the patient's complaints and underlying causes to provide compassionate care.

Competence

• Doctors should be competent, demonstrating appropriate knowledge, clinical reasoning, and technical skills.
• Competence is ensured through extended training periods, clinical experience, and continuing education.

Principlism

• Principlism is a framework in biomedical ethics based on core values for medical professionals.
• The four pillars of principlism are:
  • Respect for Autonomy: as discussed above.
  • Beneficence: Acting in the best interest of the patient, promoting their well-being.
  • Non-maleficence: Avoiding harm to the patient.
  • Justice: Treating patients equitably and distributing benefits fairly.

Therapeutic and Formal Relationships

• Doctors can accept or refuse to treat patients, except in emergencies.

• Therapeutic Relationships are between a doctor and patient

  • Reasons for refusal include:
    • Out of practice hours
    • Not within the doctor's specialty
    • Illness beyond the doctor's competence
    • Illness of the doctor or their family
    • Important social function
    • Alcohol consumption by the doctor
    • Patient malingering (faking illness)
    • Patient defaulting on payment
    • Abusive or uncooperative patient or relatives
    • Patient refusing consent
    • Unaccompanied minor or female patient
    • Doctor's engagement with a more serious emergency case.

• Formal Relationships involve a third party referring the patient:

  • Pre-employment
  • Insurance policy
  • Yearly medical checkups
  • Rape or crime victims / medico-legal cases
  • Certain psychiatric illnesses referred by the court or police.

This quiz explores the foundational principles of medical ethics, including autonomy, paternalism, and mental capacity. Understanding these concepts is crucial for healthcare professionals to make informed decisions and respect patient rights. Engage with key ethical dilemmas faced in medical practice.