Medical Ethics: Values and Principles
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Questions and Answers

Which of the following are traditional values of medical ethics?

  • Autonomy (correct)
  • Beneficence (correct)
  • Justice (correct)
  • Non-maleficence (correct)

    • What is the definition of medical ethics?

    A system of moral principles applicable to clinical medicine and scientific research.

    The principle of veracity in medical ethics emphasizes honesty and full disclosure of information to patients.

    True

    What is autonomy defined as?

    <p>The personal rule of the self that is free from both controlling interferences by others and from personal limitations</p> Signup and view all the answers

    The concept of justice involves the equitable distribution of _______ among all socio-economic groups.

    <p>resources</p> Signup and view all the answers

    Physicians are encouraged to uphold patient's autonomy and respect the patient as an individual.

    <p>True</p> Signup and view all the answers

    Match the following principles with their descriptions:

    <p>Informed Consent = Process of disclosing information to enable patient choice Confidentiality = Maintaining trust by keeping information private Fiduciary = Acting in the best interest of another with duty of care</p> Signup and view all the answers

    What are the three conditions required for a decision to be regarded as autonomous?

    <p>capacity, information disclosure, voluntary decision</p> Signup and view all the answers

    ___ Competence is a term used to determine whether a child is able to consent to their own medical treatment without parental permission.

    <p>Gillick</p> Signup and view all the answers

    What are the four key principles in medical ethics?

    <p>The four key principles in medical ethics are beneficence, non-maleficence, justice, and autonomy.</p> Signup and view all the answers

    What is the principle of Justice concerned with in the medical context?

    <p>Equitable distribution of benefits and burdens</p> Signup and view all the answers

    Social justice aims to ensure that all individuals have equal rights and opportunities.

    <p>True</p> Signup and view all the answers

    ______ justice refers to the fairness in processes and transparency in actions when resolving disputes and allocating resources.

    <p>Procedural</p> Signup and view all the answers

    Match the following types of justice with their descriptions:

    <p>Commutative Justice = Owed between individuals in business transactions Distributive Justice = Equitable distribution of scarce resources among population groups Procedural Justice = Fairness in legal processes and dispute resolution</p> Signup and view all the answers

    What does beneficence mean in the context of medical ethics?

    <p>Beneficence means taking actions that benefit others by preventing harm, improving situations, and promoting welfare.</p> Signup and view all the answers

    Define non-maleficence in medical ethics.

    <p>Non-maleficence means to 'do no harm,' where physicians must refrain from providing ineffective treatments or acting maliciously towards patients.</p> Signup and view all the answers

    Which of the following are examples of beneficent actions? (Select all that apply)

    <p>Resuscitating a drowning victim</p> Signup and view all the answers

    The Principle of Nonmaleficence is commonly known by the Latin phrase 'Primum non nocere.'

    <p>True</p> Signup and view all the answers

    According to the Doctrine of Double Effect, if doing something morally good has a morally bad side-effect, it's ethically OK to do it as long as the ____________ wasn't intended.

    <p>bad side-effect</p> Signup and view all the answers

    What are some of the responsibilities of doctors towards their patients?

    <p>Having good communication skills and soft skills during consultations and ward rounds, observing proper dress code, following the requirements for a proper practice place, ensuring that calling cards are according to guidelines</p> Signup and view all the answers

    Why is medical insurance essential for doctors?

    <p>All of the above</p> Signup and view all the answers

    What is distributive justice primarily concerned with?

    <p>Equitable distribution of resources</p> Signup and view all the answers

    Which type of justice focuses on fairness in resolving disputes and allocating resources?

    <p>Procedural justice</p> Signup and view all the answers

    Define informed consent.

    <p>Informed consent is the process by which the physician or health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment.</p> Signup and view all the answers

    Which type of justice is based on the concepts of human rights and equality?

    <p>Social justice</p> Signup and view all the answers

    What does autonomy refer to in health-care ethics?

    <p>Autonomy refers to the most basic principle in all health-care ethics, emphasizing the patient's right to make decisions about their own healthcare.</p> Signup and view all the answers

    Which of the following reflects distributive justice's impact on societal functioning?

    <p>Equal distribution encourages a sense of responsibility and partnership</p> Signup and view all the answers

    According to the principles of distributive justice, what is the impact of equal distribution and equity on individual motivation in society?

    <p>Equal distribution fosters a sense of responsibility and partnership</p> Signup and view all the answers

    Why is informed consent necessary in medical practice?

    <p>All of the above.</p> Signup and view all the answers

    Beneficence can be a substitute for informed consent in medical procedures.

    <p>False</p> Signup and view all the answers

    Which of the following is a doctor's responsibility when communicating with patients?

    <p>Being accurate in writing prescriptions</p> Signup and view all the answers

    What should a doctor do if they receive a request for a patient's medical records?

    <p>Verify the identity of the requester before providing the records</p> Signup and view all the answers

    In which situations may a doctor disclose patient information without consent?

    <p>When disclosing information about a patient is for medical teaching or research</p> Signup and view all the answers

    Which of the following is against the rules of Dr. Ahmed's employment upon his return to work at the hospital?

    <p>Denying Dr. Ahmed a promotion only due to his back injury</p> Signup and view all the answers

    Which of the following applies to HIV-positive working doctors?

    <p>They have the right to work as long as they do not endanger others at work</p> Signup and view all the answers

    What action should the hospital take upon Dr. Kong's return to work after sustaining a major trauma?

    <p>Assigning tasks that align with Dr. Kong's physical limitations</p> Signup and view all the answers

    Study Notes

    Medical Ethics

    • Medical ethics is a system of moral principles that are applicable to clinical medicine and scientific research.
    • The values of medical ethics include autonomy, beneficence, non-maleficence, and justice.

    Traditional Principles of Medical Ethics

    • Autonomy: the right to decide, self-determination, free will, and accord.
    • Beneficence: refers to actions that promote the well-being of others, means taking actions that serve the best interest of patients.
    • Non-maleficence: the concept of "first do no harm", respect the sanctity of life, and calculate the risk-benefit ratio.
    • Justice: a complex concept based on numerous fields, including morality, law, religion, and theology, and concerns fairness, peace, and genuine respect for people.

    Need for Medical Ethics

    • The present clinical environment is "patient-centered" and requires practicing doctors to cultivate a different mindset.
    • The practice of medicine has changed, patients are better educated, and there is easy access to the internet.
    • Higher standards of care, higher levels of investigations, and rising costs of hospitalization require effective and affordable treatment.

    Importance of Ethics in Life

    • Ethics in life is a system of principles that helps differentiate between right and wrong, good and bad.
    • Ethics in life is a study of what is morally right and what is not, and provides practical guidance in daily life.

    Principles in Medical Ethics

    • The related principles of medical ethics include veracity, confidentiality, informed consent, and fiduciary.
    • Veracity refers to truth telling, full and honest disclosure, and promotes a better patient-doctor relationship.
    • Confidentiality is based on loyalty and trust, and maintains the confidentiality of all personal, medical, and treatment details.
    • Informed consent is the process by which the attending physician discloses appropriate information to a competent patient to enable the patient to make a voluntary choice.
    • Fiduciary refers to a person who has the power to act on behalf of another person, and acts in someone else's best interest.

    The Principle of Autonomy

    • Autonomy is the "personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice."
    • Autonomous individuals act intentionally, with understanding, and without controlling influences.
    • The principle of autonomy grants every competent adult the right to do what they want with their own healthcare.

    The Value of Autonomy

    • Autonomy is rooted in society's respect for an individual and their ability to make decisions.
    • The physician is encouraged to uphold patient autonomy, respect the patient as an individual, empower the patient to take control over their health problems, and encourage full participation in decision-making.
    • The law says that an adult patient who suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment.### Reasonable Physician Standard vs. Reasonable Patient Standard
    • The reasonable physician standard is often inadequate and inconsistent with informed consent as the focus is on the physician rather than the patient's needs.
    • The reasonable patient standard focuses on what the average patient needs to know to be an informed participant in the decision.

    Subjective Standard

    • The subjective standard considers what a particular patient in their unique circumstances and conditions needs to know to make an informed decision.
    • This approach is difficult to follow and requires the physician to know what the patient needs to know.

    Physicians' Problem with Autonomy

    • Physicians often struggle with patients making inferior choices, including wrong choices, and must balance respecting autonomy with doing what is best for the patient.
    • The physician's role is to inform and educate, not to take over decision-making for the patient.

    Patient's Best Interest Standard

    • The best interest principle is used when making decisions on behalf of an incapacitated patient.
    • The goal is to act in the patient's best interests, considering their previously expressed preferences and cultural, religious, or employment considerations.

    Best Interests Principle

    • The principle is used to decide what options are reasonable for a patient who lacks capacity for informed consent.
    • Factors to consider include:
      • Clinically indicated treatments
      • Previously expressed preferences
      • Doctor's knowledge of the patient's background
      • Views of third parties with knowledge of the patient
      • Which option least restricts the patient's future choices

    Autonomy and Confidentiality

    • Respect for autonomy has been widely accepted and applied in clinical and research settings.
    • Confidentiality is essential, with exceptions for explicit consent or legal requirements.

    Conflict of Interest

    • A conflict of interest arises when professional judgment or actions may be unduly influenced by secondary interests.

    Case Studies

    • Case 1: A pregnant woman refuses a life-saving procedure for her fetus; the court may intervene to protect the fetus.
    • Case 2: A dementia patient's best interests must be assessed, considering the needs of her carer.

    Medical Ethics

    • Beneficence: action done for the benefit of others, with obligatory and ideal beneficence.
    • Non-maleficence: "do no harm," with the goal of promoting the patient's welfare.
    • Balancing beneficence and non-maleficence is essential in decision-making.

    Paternalism and Therapeutic Privilege

    • Paternalism can be justified if it prevents significant harm or obtains a benefit, with the least autonomy-restrictive alternative used.
    • Therapeutic privilege allows withholding information if it may cause harm, but this is rarely justified.

    Balancing Autonomy and Beneficence

    • Physicians must respect patients' autonomous decisions while promoting their best interests.
    • A patient's decision may conflict with the physician's beneficent duty.

    The Ends of Medicine

    • Beneficence is central to the goals and nature of medicine as a social practice.
    • The category of medical benefits should not include items like fertility control, cosmetic surgery, or assisting in a merciful death.

    Primum Non Nocere and the Doctrine of Double Effect

    • "First, do no harm" is a corollary to beneficence.
    • The doctrine of double effect allows for a morally good act with a bad side-effect, providing the bad effect is not intended.

    Quality of Life and Proportionality

    • Quality of life is a consideration in treatment decisions, but it does not justify withholding treatment from mentally retarded or severely disabled neonates.
    • Proportionality demands that the probable benefits outweigh the infringed moral considerations.

    Steps of Ethical Reasoning

    • Identify and frame the moral conflict
    • Identify relevant ethical principles and their specifications
    • Gather all relevant information
    • Weigh conflicting principles and their specifications
    • Conclude and propose a solution### Confidentiality in Medical Fraternity
    • Definition: Confidentiality refers to the assurance that a patient's personal information shared with a physician will be kept private and not disclosed to anyone else.
    • Importance: Maintaining confidentiality enhances the patient-doctor relationship, encouraging patients to share information necessary for good medical care.

    Principles of Confidentiality

    • Protection of information: Ensure that patient information is adequately protected when stored, transmitted, received, or disposed of.
    • Consent for disclosure: Obtain patient's expressed/written consent for disclosure, ensuring they understand what will be disclosed, the reasons for disclosure, and the likely consequences.
    • Respecting patient rights: Respect patients' rights to be informed about how their information will be used and to have access to or copies of their health records.

    Precautions

    • Maintain confidentiality: Ensure that patient information is not discussed in public areas or left accessible to others.
    • Technology: Take steps to ensure that patient confidentiality is maintained when using technology to communicate health information.

    Duration of Confidentiality

    • The duty of confidentiality continues even after the patient has stopped seeing or being treated by the doctor.
    • The duty survives the patient's death.

    Breach of Confidentiality

    • Definition: Breach of confidentiality occurs when confidential information is disclosed to a third party without the patient's knowledge or consent.
    • Exceptions: Disclosure is allowed if required by law, with the patient's consent, or in the public interest.

    Disclosure of Patient Information

    • When disclosure is allowed:
      • With patient consent.
      • Within a healthcare team treating the patient.
      • If the assessment is done by the employer or insurance company.
      • If the information is in the interest of others or to protect the public.
      • If the patient refuses consent but it is in the medical interest of the patient.
      • If it is to the court or required by the law.
    • Disclosure requirements:
      • Use anonymized or coded information if possible.
      • Ensure the patient understands the potential disclosure and has not objected.
      • Keep disclosures to the necessary minimum.
      • Keep up to date with and observe relevant legal requirements.

    Disclosures Required by Law

    • Notification of infectious diseases: Disclosure is required to satisfy specific statutory requirements.

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    Explore the fundamental values and principles of medical ethics, including morality and traditional principles in medical practice.

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