Medical Ethics PDF

MEDICAL ETHICS By Dr.Elaf Yousif Beram M.B.CH.B, F.I.M.S/ FM Learning Objectives: 1. To identify the principles of medical ethics. 2. To understand the legal obligations for reporting communicable diseases and informing partners. Medical Ethics: Medical ethics is an applied...

MEDICAL ETHICS By Dr.Elaf Yousif Beram M.B.CH.B, F.I.M.S/ FM Learning Objectives: 1. To identify the principles of medical ethics. 2. To understand the legal obligations for reporting communicable diseases and informing partners. Medical Ethics: Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. Principles of medical ethics: 1. Autonomy. 2. Beneficence. 3. No maleficence. 4. Justice to guide clinical decisions to maintain confidentiality. Autonomy: Is the quality or state of being independent, free, and self-directing. autonomy should involve respect for the patient's wishes, choices, and beliefs when deciding what is best for the patient. Knowing the intricacies of the family dynamic may also help the clinician and the patient develop solutions to aid in disclosure of very important health-related issues. for example, a patient autonomously decides to undergo a complicated surgery, we can reasonably consider her as autonomous with respect to that surgery even though she does not autonomously choose each action performed during the operation. Beneficence: Beneficence is a concept in research ethics that states that researchers should have the welfare of the research participant as a goal of any clinical trial or other research study. an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. All professionals have the foundational moral imperative of doing right. No maleficence: Implies that the physician will do nothing to harm the patient, which includes emotional and psychological harm. Failure to maintain confidentiality may result in some emotional distress for the patient. Moreover, the physician should not apply the same moral standards to every patient. Some teens are more mature than others and the physician should use his or her judgment with each adolescent patient. In addition, the treating physician should apply the principle of beneficence, which requires action to further a patient's welfare. In other words, do the right thing for the patient. Maintaining confidentiality may aid in full disclosure of symptoms, life situations, and so on. Full disclosure of pertinent medical information can help the physician provide the most comprehensive care to the patient. An example of a non-maleficent action would be stopping a medication known to be harmful or refusing to give a medication to a patient if it has not been proven to be effective. Justice: Implies the fair and unbiased treatment of the patient regardless of age, sex, or ethnicity. Consequently, adolescent patients should be given the same level of care as adults, without having the fear of disclosure, when they are mentally capable of receiving care.  In most cases, every attempt should be provided to ensure confidentiality. However, there are instances when it would be in the best interest of the patient to disclose medical information. Examples of these situations could include patients with homicidal or suicidal ideation or serious chemical dependence, and in suspected cases of abuse. Disclosure of medical information should only be considered when the life of the adolescent must be protected. It is also important to point out that, in most cases, adolescents are not responsible for payment of medical services. The parent usually has to assume the responsibility for payment. Thus, the maintenance of confidentiality in these cases is an issue. Because there are no clear- cut guidelines in this situation, it is important to encourage open dialogue between the patient and the patient's parent. However, in instances when this is not possible the physician must use his or her own clinical judgment while considering ethical issues and must act in the best interest of the patient. Informed consent: Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed. informed consent requires a clear appreciation and understanding of the facts, implications, and consequences of an action. To give informed consent, the individual concerned must have adequate reasoning faculties and possess all relevant facts. Impairments to reasoning and judgment that may preclude informed consent include intellectual or emotional immaturity, high levels of stress such as post-traumatic stress disorder or a severe intellectual disability, severe mental disorder, intoxication, severe sleep deprivation, Alzheimer's disease, or coma. Obtaining informed consent is not always required. If an individual is considered unable to give informed consent, another person is generally authorized to give consent on their behalf for example, the parents. There are 4 components of informed consent including decision capacity, documentation of consent, disclosure, and competency. Legal Considerations: There are laws in place to protect the confidentiality of health-care information. In general, the law requires the consent of the parent when health care is provided to minors; there are, however, exceptions, such as emergencies, care for the "mature minor," and when the minor is legally entitled to consent to their own medical treatment. Laws that allow minors to consent to medical treatment vary from state to state. In some states minors are allowed to consent to medical therapy based on status, such as marriage, pregnancy, living apart from parents. According to this we must determine that a minor is deemed mature, which determination is based on various factors, including age, ability, experience, education and/ or training, degree of maturity and/ or judgment exhibited conduct and demeanor, and capacity to understand the risk and benefits of medical treatment. In some states, consent to health care may be based on the type of care the adolescent is seeking. Examples of the types of health-care services that may be obtained without parental consent may include maternity services, contraceptive management, treatment and diagnosis of sexually transmitted infections or other reportable diseases, treatment of drug or alcohol problems, and care related to sexual assault or mental health services. These provisions are very important because they allow the necessary assessment and treatment of important health-related issues. Moreover, research shows that adolescents are more likely to seek medical care if confidentiality is protected. Reportable Diseases: Reporting STD, HIV, and other reportable illnesses can be stressful for the patient. This may be particularly stressful for the adolescent. The information may be reported by the physician. All those involved in the oversight of blood products, including clinical laboratories or blood banks, are also required to report STD and other reportable conditions to the state's health department. In addition, it is mandatory that the information be disclosed to partners. Partner reporting is a way to control the spread of disease and to ensure prompt and proper diagnosis and treatment of all those who may be affected. Partner notification can occur in either of two ways: by patient referral or by the department of health staff. The patient can contact his/her partner for referral, diagnosis, and treatment. Alternatively, the partner may be notified and counseled by department of health staff, if the patient is unwilling to inform them. In the setting where a patient is unwilling to inform his/her partner of a reportable illness that places the partner at risk, the health-care provider has a legal and ethical obligation to inform the partner that they are at risk. Teenage Pregnancy and Confidentiality: Issues regarding teenage pregnancy and consent to disclose information regarding pregnancy are quite controversial. Laws for reporting vary by country. However, studies demonstrate that failure to maintain confidentiality in "sensitive" health-related issues may inhibit appropriate health-care delivery to the adolescent. Moreover, in most country, an adolescent younger than 18 years cannot give consent to abortion services without the consent and/ or notification of one or both parents. Emergency contraception (EC) when taken after sexual intercourse can prevent pregnancy by disrupting or delaying ovulation or fertilization. Some states allow EC to be accessed without a prescription in individuals 17 years and older. Certain states require that EC be given in emergency departments. There are significant discrepancies from state to state and future changes are expected. Pregnancy-related care, abortion services, and reportable illnesses are complex issues and a clinician should seek legal advice when appropriate. However, in general, it is preferable to protect the confidentiality of the minor unless it is unreasonable or unsafe to do so. It is also important to educate teens and parents of the importance of open communication and issues related to confidentiality in medical care.  Summary: Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. Principles of medical ethics are: 1. Autonomy. 2. Beneficence. 3. No maleficence. 4. Justice to guide clinical decisions to maintain confidentiality.  Quiz: In which of the following situations may a physician keep information confidential from parents or other authority ? A. The physician finds injuries consistent with physical abuse while examining a 13 years old, but the patient fears further injury if the abuse is reported. B. A depressed teenager reports a strong desire to kill herself and that she has secretly obtained a gun that she keeps in her bedroom. C. An undocumented immigrant patient has active tuberculosis and fears deportation if the illness is reported. D. A 19-year-old female, who is still on her parents' insurance plan , diagnose with simple UTI, but does not want her parents to know. THANK YOU