Ethics SAQ (1) PDF

1. Define ethics Ethics: principles & rules that give standards of good & bad , right or wrong 2. Differentiate between ethics and law Ethics and law are related but distinct concepts. While ethics focuses on moral principles and values, law is a system of rules and regulations enforced by a gove...

1. Define ethics Ethics: principles & rules that give standards of good & bad , right or wrong 2. Differentiate between ethics and law Ethics and law are related but distinct concepts. While ethics focuses on moral principles and values, law is a system of rules and regulations enforced by a governing authority. Ethics provides guidelines for morally acceptable behavior, whereas law establishes legal requirements and consequences for actions. 3. Define principlism / autonomy / beneficence / non maleficence / justice Principlism : The application of ethical principles as the basis for making moral rational decisions Autonomy (self - government): The right of competent adults to make informed decisions about their own medical care Beneficence: promoting well being & acting in the patient’s best interest Non-maleficence: To intentionally avoid harming or injuring others Justice : To treat equitably & distribute benefits fairly 4. Mention the 4 fundamental principles of medical ethics (elements of principlism). ( Autonomy - beneficence - non-maleficence - justice ) 5. Mention the three key elements for taking consent. CIV ( Capacity / Competence - informed - voluntary ) 6. What are the items of doctrine of informed consent 7 items : Nature of illness Aim & the nature of the treatment / procedure Benefits & risks of the treatment / procedure Benefits & risks of alternative treatment Possibility of success or failure Prognosis ( in the absence of intervention ) Acceptance or refusal 7. What are the exceptions for taking consent? Emergencies ( danger to life or limb ) Loss of capacity ( temporary or permenant ) Mass immunizations Medico-legal autopsy Treatment of notifiable & infectious diseases Psychiatric examination or treatment ( court order )  Examination of an arrested accused ( court - police ) Therapeutic waiver 8. List causes of invalid consent Not informed ( misrepresentation or withholding information ) Given by someone that lacks capacity ( minor - mentally ill ) Obtained by pressure, fraud or deception ‫خداع‬ Given to commit an illegal act ( criminal abortion ) 9. Differentiate between therapeutic privilege and waiver. Therapeutic privilege refers to the withholding of information from a patient when the physician believes that disclosing it would harm the patient's well-being. Waiver, on the other hand, involves the patient voluntarily choosing to forgo certain rights or protections ( right to Informed consent ) 10. List 1 examples where informed refusal is rational and accepted and another example could affect patient safety and not medically approved. Example where informed refusal is rational and accepted: - A late stage cancer patient (chronic disease) refusing further aggressive treatments (chemotherapy) and opting for palliative care. Example where informed refusal could affect patient safety and not medically approved: - A patient refusing life-saving treatment for a serious and treatable condition without reasonable justification. 11. Mention 3 different examples for privileged communication or when the physician legally divulges patient secrets. 1- on request of the patient himself : The patient requested the doctor to discuss the diagnosis and treatment options with the patient’s family 2- for the sake of the public: The patient has a dangerous infectious disease COVID-19, AIDS,TB or cholera / The patient has a disability preventing him from driving or working certain jobs 3- in cases of expert witness: The medico-legal expert is asked to give a report on a certain problem 12. Mention general rules advised to maintain patients’ confidentiality 1. Use anonymised or coded information whenever possible 2. Discuss situations on an anonymous basis with colleagues. 3. Raise patient awareness that data may be used for secondary purpose and inform him about the aim. 4. Inform the patient and he should agree that his personal data might be disclosed for the sake of his own care. 5. Obtain patient’s written informed consent before disclosure for purposes other than their care 6. Keep disclosure to the minimum necessary data. 13. How medical decision is taken for patients with limited autonomy? Substitute decision maker Best interest Prospective autonomy / advance directives Court of law 14. List types of physician patient relationship. 1- Therapeutic relationship: Direct relationship between a healthcare professional and the patient 2- Formal relationship: mostly Includes a third party for a disinterested medical examination 15. Mention examples for formal physician patient relationship Includes a third party for a disinterested medical examination : Pre-employment Insurance policy Yearly medical checkups Psychiatric treatment or examination ( court - police ) Rape & crimes ( medico-legal cases ) 16. Illustrate causes of refusing to treat a patient. Beyond the doctor’s competence or skills (another speciality) Patient demands specific drugs (drug seeking behavior) Unaccompanied minor or female patient Patient refuses to give consent or doesn’t follow instructions Doctor or family member is ill Patient is under the responsibility of another doctor Doctor is engaged in a more serious case 17. Define personalized medicine Personalised medicine: The process of tailoring medical decisions and interventions to an individual person. moving away from the one-size-fits-all approach and instead customising treatments for individuals. 18. Demonstrate examples for negative aspects of health globalization Health inequalities between developing and highly developed countries Decreased economic growth in the developing countries Poor public health in the developing countries Rapid spread of infectious diseases 19. List the positive aspects of health globalization 1. Emergency aid (Red Cross & Red Crescent Societies) 2. Surgical campaigns to deal with cataracts or cleft palates. 3. Visiting faculty appointments in medical schools. 4. Medical research projects. 5. Provision of medicines & medical equipment. 20. Enumerate approaches for distribution of justice and specify the use of each one of them. 1. Libertarian: resources are distributed according to market principles (individual choice & ability to pay) 2. Utilitarian: resources are distributed according to the maximum benefit for all 3. Egalitarian: resources are distributed strictly according to need (equality) 4. Restorative: resources are distributed to favour the historically disadvantaged 21. Give reasons: physicians may have frustration in practicing their profession 1. Limited resources. 2. Obstacles of health care delivery. 3. Problematic media reports of medical errors & unethical physician conduct. 4. Challenges to their authority & skills by patients and /or others. 22. Enumerate 4 reasons for overlooking the health care needs of a physician 1. Lack of insight. 2. A culture of guilt about taking sick leave. 3. Long-established taboos & anxiety make physicians fearful to disclose illness. 4.discrimination or stigma especially in case of, mental health problems and drug use. 5. A sense of isolation, confusion about where to seek help. 6. fear about career risks in acknowledging health problems. 23. What are the negative consequences of breaches of professionalism? 1. Patient complaints. 2. Negative media reports about health-care providers. 3- Loss of trust 4- - Adverse effects on patient’s health & treatment 24. Define professionalism / altruism / respect / responsibility / integrity Professionalism: The skills, competence & conduct displayed by an individual of a certain profession. Altruism: Acting for the good of others without self-interest (may require self-sacrifice) Integrity: Maintaining professional soundness & reliability of intention & action. Responsibility: Dealing with roles, tasks, actions and their ensuing consequences Respect: treating others with dignity, acknowledging their autonomy, and valuing their opinions and perspectives. 25. What are the four pillars of professionalism? Define one of them AIRR ( altruism / integrity / respect / responsibility ) Altruism: Acting for the good of others without self-interest 26. Mention types of memory Sensory memory Short term memory Long term memory 27. Mention 4 tips to improve memory Use Mnemonics Relate information to what you already know Use spaced repetition Test Yourself & revise Work out your mind with Brain exercises Have Good sleeping habits 28. What are the spiritual / internal / external causes of stress? Spiritual: Poor religious interest and reflection time. Unable to understand what is the will of God in our lives. Internal: Frustration (failure to cope with daily demands of life) Conflict (relationship difficulties). Inability / unwillingness to resolve conflict Pressure (too much work, being too busy). Poor time management Financial/money management Major life Changes External: Financial and daily difficulties, work related demands Family or marital problems Death of a loved one, any traumatic events Marriage, birth Chronic illness 29. What are physical / cognitive / emotional / behavioural effects of stress? Physical: Fatigue & Nausea Being sick e.g headaches, stomach pain, muscle aches and stiffness. Chest pain & increased heart rate (palpitation). Difficulty sleeping. Loss or decreased sexual drive. Irregular menstrual cycles Cognitive: Memory problems & Inability to concentrate Poor judgment Seeing only the negative Anxious or racing thoughts (Constant worrying) Emotional: Irritability, nervousness, anger, anxiety Feeling of guilt Increased sensitivity/Moodiness Depression/general unhappiness Sense of loneliness/isolation Behavioral: Drug or alcohol abuse. Eating more or less (food abuse). Isolating self from others. Sleeping too much or too little. Delaying or neglecting responsibilities 30. Define defamation / plagiarism / fraud / libel / slander Fraud: The intentional falsification or fabrication of methods, data, results or reported findings. ///misrepresentation of medical care in the medical record, medical billing or overinflating the results that a patient can expect from a given treatment. Plagiarism (academic theft): using another’s author property, language, visuals, photos or others in one’s own writing without giving proper credit to the source. Defamation: the act of making an unjustified statement about a person or organisation which could harm their reputation. Libel: false, harmful, defamatory statements about an individual that is written (including digital). Slander: an untrue defamatory statement about an individual that is spoken orally. 31. Differentiate between libel and slander Libel is false, harmful, defamatory statements about an individual that is written (including digital). Slander is an untrue defamatory statement about an individual that is spoken orally. 32. How to avoid plagiarism? Mention 4 tips. 1- Effective paraphrasing 2- Use quotation marks 3- properly citing sources & references 4- ask an expert 5- use plagiarism checkers 33. List the negative consequences of using eHeath and social media like Facebook and Instagram in healthcare provision. 1. Patient confidentiality violation. Disclosing patients information without consent. 2. Discriminatory or impolite rude language. 3. Description of illegal drugs (result in official warnings from medical schools and dismissal). 4. Failing to declare conflicts of interest could undermine public trust. 5. Defamation: making unjustified statements about a person or organisation which could harm their reputation. 34. List benefits of electronic communication Extreme speed in transfer of information. Data could be permanent, easily tracked Reaches patients anywhere 35. Mention 4 ethical guidelines for using social media in healthcare. 1. Physicians should separate professional from personal communication portals. 2. Electronic communication should be specifically protected by encryption & other security measures. 3. Ensure patient confidentiality & privacy; pay attention to disclosure of conflict of interest 4. Always use authentication methods such as electronic signature. assure recipients that the email is from you (genuine). 5. Know the guidelines of your institution and the medical association policies. 6. Informal relationships & discussions with patients should be avoided. 7. Doctors & medical students who receive ‘friend requests’ from patients are advised to decline to avoid losing professional formality. 36. What are the types of malpractice and what is the difference 1- Professional misconduct (infamous conduct): disgraceful or dishonorable behaviors of the physicians. 2- Incompetence: It is lack of reasonable medical skills (failure to follow the basic medical principles which are not a subject of any discussion. 3- Medical negligence: Lack of reasonable standard of care (inadequate or careless) in diagnosis, treatment & follow up resulting in serious injury (harm/loss of function) or death of the patient. 37. What are the four requirements for claiming malpractice against doctors? (1) The doctor owed the patient a duty of care. (2) The doctor breached the duty of adequate care. (3) The doctor’s action caused the patient’s injury. (4) The patient suffered a direct injury that resulted in damage. 38. Give examples for medical errors. 1- Surgery-related: leaving a towel or scissor after operation. 2. Medication-related: incorrect drug, wrong dose or inadequate instructions. 3. Diagnostic error leading to an incorrect therapy. 4. Body-fluid-related: blood transfusion administered too quickly (may result in heart failure & death). 5. Equipment failure: dead batteries. 6. Errors of medical reports or file errors 39. What is the definition of near miss? Near miss: medical errors that doesn’t cause any harm; either because the error was detected & corrected in time or because the patient was just lucky. 40. Mention examples for misconduct. Disclose professional secrets. Publish patients’ photographs/case reports without their consent Claims to be a specialist when he has no special qualification in that branch. Use agents to attract patients. Perform an illegal operation (e.g., illegal abortion). Providing falsified & misleading information. Sexual act with mentally ill, unconscious or anaesthetized patient.