Principles of Medical Ethics PDF

Principles of medical Ethics  Content What is ethics Definitions Why is Ethics Important?  What Is Ethics? “A set of principles of right conduct” A system of moral principles governing the appropriate conduct for a person or group Doing the right th...

Principles of medical Ethics  Content What is ethics Definitions Why is Ethics Important?  What Is Ethics? “A set of principles of right conduct” A system of moral principles governing the appropriate conduct for a person or group Doing the right thing Being honest and straightforward not lying or cheating A code of conduct Every aspect of medical practice is governed by sets of ethical standards Employs the faculty of reasoning in tackling the important question of what makes an upright life. Defined as principles of conduct governing an individual or a group.  Definitions Ethics – The systematic study of rightness and wrongness of human conduct and character as known by natural reason. Morals – Generally accepted customs, principles, or habits of right living and conduct in a society and the individual’s practice in relation to these. Values – Ideals & customs of a society toward which the members of a group have an affective regard; a value may be a quality desirable as an end in itself.  Why is Ethics Important? “Patients are entitled to good standards of practice and care from their doctors. Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligations.” From Good Medical Practice, GMC.  Medical Law and Ethics Knowledge of Medical Law and Ethics provides insight into The rights, responsibilities, and concerns of health-care consumers The legal and ethical issues facing society, patients, and health-care professionals as the world changes The impact of rising costs on the laws and ethics of health- care delivery Medical Law and Ethics (cont.) A law is a rule of conduct EEthics is a standard of or action. behavior. Governments enact laws to Moral values serve as the maintain order and public basis for ethical conduct. safety. Family, culture, and society Criminal and civil laws help form an individual’s pertain to health-care moral values. practitioners. Be able to discern the risks involved in the application of medical breakthroughs. Be competent and aware of the procedures the patients have to undertake. GENERAL It deals with the basic ETHICS principles which are the morality of human acts. SOCIAL It tackles the basic ETHICS principles affecting man as a member of society.  Professional ethics It is a branch of moral science concerned with the obligations which a member of a profession owes to the public, to his profession, & to his clients. The Main Objectives of the Professional Code of Ethics 1. To define professional privileges, behaviours and responsibilities towards the members of the community in general 2. To promote professional quality, professional conduct and a moral method of procedures 3. To defend private professions from undue interference by the government or by other agencies. The Main Objectives of the Professional Code of Ethics 4. To preserve the dignity of the profession and the confidence of the public 5. To defend clients from unscrupulous individuals 6. To fix certain standards of the compensations for services or work Who is Responsible for Ethics? EVERYONE! Medical Laboratory Technician Doctors Nurses Clerks Secretary Driver, cleaners and workers  Ethical practice Ethical practice can be regarded as good technical practice accompanied by proper attitudes and behavior. In deciding what is proper, reference is often made to moral values voluntarily adhered to within the community and to standards espoused in various codes of professional practice.  Ethical Dilemma Situation requiring moral judgment between two or more equally “right” alternatives. There are two or more competing norms. Four components to solve an ethical dilemma: 1. Identify the problem 2. Develop alternative solutions 3. Select the best solution 4. Defend your selection  Code of conduct The best known modern version is the Declaration of Geneva, adopted by the World Medical Association (WMA) in 1948 and subsequently amended in 1968, 1983 and 1994 The International Code of Medical Ethics of the World Medical Association-1949 was adopted by the WMA at London in October 1949 and has been used as the basis for various codes of ethical practice adopted by different national medical associations  Principles 1. Beneficence 2. Non-Maleficence 3. Autonomy 4. Veracity (Truth telling) 5. Confidentiality 6. Fidelity (being faithful) 7. Justice  Beneficence and Non-Maleficence Questions: 1. Is the patient your only concern? (possible conflict with utility) 2. Do we always know what is good for the patient? (patient’s view may differ from ours)  1. Beneficence The technician should act in “the best interest” of the patient - the procedure be provided with the intent of doing good to the patient  1. Beneficence This needs health care provider to: Develop and maintain skills and knowledge by continually updating training Consider individual circumstances of all patients  Constraints on Beneficence 1. Need to respect autonomy-patient and doctor may have different views regarding Management 2. Need to ensure health is not bought at too high a price 3. Need to consider rights of others  Euthanasia Active: an active intervention to end life Passive: deliberately with holding treatment that might help a patient live longer Voluntary: euthanasia is performed following a request from a patient Doctor assisted suicide: a doctor prescribes a lethal drug which is self administered by the patient Non-voluntary: ending the life of a patient who is not capable of giving permission Involuntary: ending life against a patients will  2. Non maleficence “Above all, do no harm,“ – Make sure that the procedure does not harm the patient or others in society  2. Non maleficence When interventions undertaken by physicians create a positive outcome while also potentially doing harm it is known as the "double effect." Eg: the use of morphine in the dying patient. Eases pain and suffering while hastening the demise through suppression of the respiratory drive  2. Non maleficence Physicians are obligated not to prescribe procedures they know to be harmful Some interpret this value to exclude the practice of euthanasia Violation of non-maleficence is the subject of medical malpractice litigation  Medical malpractice (negligence) An act or omission by a health care provider that deviates from accepted standards of practice in the medical community which causes injury to the patient  3. Autonomy Patient has freedom of thought, intention and action when making decisions regarding health care procedures For a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success. INFORMED CONSENT  3. Autonomy Always respect the autonomy of the patient - then the particular patient is free to choose Such respect is not simply a matter of attitude, but a way of acting so as to recognize and even promote the autonomous actions of the patient. The autonomous person may freely choose loyalties or systems of religious belief that may adversely affect him  3. Autonomy The patient must be informed clearly the consequences of his action that may affect him adversely. Desiring to "benefit" the patient, the physician may strongly want to intervene believing it to be a clear "medical benefit." The physician has a duty to respect the autonomous choice of the patient, as well as a duty to avoid harm and to provide a medical benefit.  3. Autonomy But the physician should give greater priority to the respect for patient autonomy than to the other duties. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals.  3. Autonomy In the case of a child, the principle of avoiding the harm of death, and the principle of providing a medical benefit that can restore the child to health and life, would be given precedence over the autonomy of the child's parents as surrogate decision makers. In case of mental incapacity – a guardian is the person who takes the decision or the next of kin  4. Veracity (Truth Telling) Doctors should tell the truth at all times If you override it you endanger doctor/patient relationship(based on trust) You offend against the principle of autonomy (Dr.C Mooreland) At times there are good reasons for overriding the truth telling principle  The case for deception is founded on three fallacies 1. Hippocratic obligations 2. Not in a position to know the truth 3. Patients do not want the truth if the news is bad  5. Confidentiality Privacy – about people and our sense of being in control of others access to ourselves or to information about ourselves with others. Confidentiality – treatment of identifiable, private information that has been disclosed to others; usually in a relationship of trust and with the expectation that it will not be divulged except in ways that have been previously agreed upon.  Maintaining Confidentiality It is important to: Keep all client/patient information private Secure all records / logbooks Restrict access to testing areas People often violate ethics not Warning because they mean to, but because they are careless. As a matter of fact, they sometimes act with good intentions. Methods to Maintain Confidentiality Restrict access to data (password protect, lock) If data stored on a computer; maintain on a standalone computer; no network connection Use encryption software, if data is accessed it is unable to be deciphered Minimize storage of subject identifiable data on a laptop computer which can be lost or stolen Certificates of Confidentiality – protects data from being subpoenaed  6. Fidelity (being faithful) Definition of improper practice: A scientifically unsound or technically unjustified omission, manipulation, or alteration of procedures or data that bypasses the required quality control parameters, making the results appear acceptable.  7. Justice How to allocate scarce healthcare resources? 1. Medical need 2. Medical Benefits 3. Social worth-discriminates against underprivileged 4. Merits/contribution to society-very contentious 5. Market Forces 6. A lottery  7. Justice The four main areas that Health care provider must consider when evaluating justice are: 1. Fair distribution of scarce resources 2. Competing needs 3. Rights and obligations 4. Potential conflicts with established legislations  7. Justice The distribution of scarce health resources, and the decision of who gets what treatment “fairness and equality” The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society  Key Messages Ethical issues are important. We must constantly remind ourselves of the code of conducts and ensure we do the right thing. Ethical issues are often hard to deal with because they create dilemmas. People often violate ethics not because they mean to, but because they are careless. As a matter of fact, they sometimes act with good intentions. *+