Medical Ethics Overview

Medical Ethics

• Respect Autonomy (free decision): Patient must indicate approval and willingness to accept proposed treatment, indicating decision-making capacity.
• Capacity/Competency: Individual's ability to weigh up information, compare options, and choose. Competency is a legal term.
• Protect life and health: Clinicians should practice medicine to high standards to benefit patients and others.
• Fairness & Justice: Concerns fair distribution of medical services.
• Compassion: Understanding and concern for distress, essential for medical practice.
• Doctor's Responsibilities: Duty to patients, public, law enforcers, profession, and colleagues.

Patient-Physician Relationship

• Initiating/discontinuing: Physician not obligated to provide care to all individuals, except in cases of communities without other physicians or emergency treatment required.
• Abandonment: Improper termination of the relationship.
• Confidentiality: Respecting patient autonomy & right to control health information.
• Breaking confidentiality: Doctor may disclose information under specific conditions like patient request, expert witness, community concern, or past violent behavior.
• Consent and Informed Consent: Deliberate & voluntary agreement to procedures, including implied, expressed, and informed consent.

Duty to Public

• Medical help during natural disasters.
• Compulsorily notify authorities of births, deaths, infectious diseases, food poisoning.
• Notify authorities suspecting epidemics
• Inform police, etc., about injuries, illegal abortions, suicides, homicides, poisonings, etc.

Duty to Profession

• Maintain professional conduct and appearance.
• Lifelong learning
• Avoid conduct that compromises honesty and integrity in patient interactions
• Treat colleagues and their families with professional respect, avoiding unnecessary fees.

Ethical/Legal Issues in Medicine

• Assisted reproduction
• Gender correction procedure
• Organ transplantation
• Terminal illnesses & dying patients

Medical Certificates

• Physicians can issue certificates regarding their patient's condition needed by the patient, but not to outsiders like the patient's husband/wife.

Medical Malpractice

• Failure to adhere to accepted standards of practice that results in harm to the patient.

Medicolegal Aspects of Death

• Death: Cessation of physical life in a living organism.
• Clinical Death (Somatic Death): Irreversible cessation of all body functions(including circulation, respiration, and brain function).
• Brain Death: Irreversible cessation of brain activity, including the brain stem.
• Molecular Death: Cessation, (death of individual organs and tissues, subsequent to cessation of circulation.
• Molecular Life: Time between somatic and cellular death where components continue to function.
• Suspended Animation (Apparent Death): Temporary cessation of vital signs with potential for resuscitation.
• Persistent Vegetative State (PVS): Unresponsive state with absent awareness.
• Causes of Sudden Death: Trauma, poisoning, pre-existing diseases.
• Postmortem Changes: Processes occurring after death (e.g., cooling, lividity, rigor mortis, putrefaction).
• Medicolegal Significant of Postmortem Changed: Assessing time of death, and determining injuries vs post-mortem issues.
• Primary Flaccidity: Initial relaxation of muscles after death, before rigor mortis.
• Contact Flattening: Loss of elasticity in muscles from body weight and external compression.
• Ocular Changes: Discoloration and changes in appearance of eyes after death..

Professional Misconduct

• Guidelines for Professional Conduct: Covers advertising, associations, addiction, and adultery.

Conditions Simulating Rigor Mortis

• Cadaveric Spasm (instantaneous rigor): Muscle stiffening at death.
• Heat stiffening: Coagulation of muscle proteins due to high temperature.

Secondary Flaccidity

• Muscles becoming soft and unresponsive after rigor mortis.

Putrefaction

• Body decomposition.
• Autolysis: Tissue self-digestion by enzymes.
• Bacterial Action: Decomposition from bacteria.

Mummification

• Modified putrefaction, body dehydration.
• Forensic implications of mummification : Identifying issues, injuries, determining post-mortem interval.

Adipocere Formation

• (Saponification): Fatty tissue converting to a greasy, wax-like substance.
• Forensic implication related to estimation of the time of death.

Conditions Replacing Putrefaction