Introduction to Medical Ethics Lecture 5 PDF

PCM LECTURE - 5 0 INTRODUCTION TO MEDICAL EThICs D EFINITION OF E THICS ▪ It is the principles and rules that give standards of good & bad, rig...

PCM LECTURE - 5 0 INTRODUCTION TO MEDICAL EThICs D EFINITION OF E THICS ▪ It is the principles and rules that give standards of good & bad, right & wrong.. D EFINITION OF M EDICAL E THICS ▪ System of moral principles that apply values & judgments to THE PRACTISE OF MEDICINE. ▪ IMPORTANCE:  Knowledge of medical ethics → would aid a physician in making decisions during the care they provide with due consideration to ethical principles. ❶ ETHICS ❷ LAW Unenforceable norms & values guide Values are written into enforceable behavior standards of behavior DEFINITION There are no specific laws Laws are enforced by the justice system Dr. Ziad Mahana 1  PCM LECTURE - 5 ❶  Autonomy has replaced paternalism in medical ethics: AUTONOMY PATERNALISM The practice of a person or institution of authority The patient’s right to decide & act for oneself making decisions for a person without his (The patient can accept or refuse the knowledge/consent with the belief that it is in examination or the treatment) their best interest ❷ Essential to understand & weigh up the options to make a choice IMPORTANCE (Essential for autonomy) ▪ WHO HAS MENTAL CAPACITY (can make his own decisions) → An adult patient. MENTAL CAPACITY ▪ WHO LACKS MENTAL CAPACITY: ASSESSMENT ① Unconscious patient ② Mentally retarded patient. ❸  The doctor must be honest & act with integrity.  The doctor’s actions should never be intended to deceive. ❹ DEFINITION ▪ To keep the patient’s information secret & to tell such information to a third party. All patients have the right of confidentiality BUT… EXCEPTIONS ▪ Confidentiality is not absolute, especially if other people are at serious risk of harm. Dr. Ziad Mahana 2  PCM LECTURE - 5 ❺  People should be treated fairly: ▪ People with equal needs → should be given equal consideration ▪ People should not be discriminated against in the provision of health services.  Fairness & equity are closely linked with the practical priority of using scarce resources (distributive justice).  Many ways may approach justice & equality (trying to treat all similar cases the same): ▪ This includes → The sufficiency view (everyone has essential care - what is essential can vary). ▪ However, doctors’ judgments may be affected by many factors.  Equity is to establish/achieve the desired outcome for each individual patients & distributing the resources according to this aim. Dr. Ziad Mahana 3  PCM LECTURE - 5 ❻  Maximizing benefit & minimizing harm are important ethical issues.  Medical interventions are ordinarily justified where the anticipated benefits exceed the harms. ❼  Definition → It is understanding & concern for another person’s problems.  The physician must identify → ① The patient complaints ② The underlying causes. ❽  The doctor should be competent.  How to ensure competence → Physicians undergo a long training period.  Competence includes → Appropriate knowledge, clinical reasoning & technical skills. D EFINITION OF P RINCIPLISM ▪ An established approach in Biomedical ethics, based on a set of values that medical professionals can refer to in the case of confusion or conflict. The 4 pillars of principlism are: ❶ Respect for Autonomy Descussed earlier “In page 3” A physician should act in the best interest of the patient ❷ Beneficence (Doing good & promotes well-being) ❸ Non-maleficence Not to do harm. ❹ Justice Treat equitably & distribute benefits fairly.  It applies these principles to determine what is the right thing to do, taking into account both rules & consequences. Dr. Ziad Mahana 4  PCM LECTURE - 5  It is of 2 types:  A doctor is free to accept or refuse to treat a patient, except in emergencies.  He may refuse to treat the patient in following circumstances: ① Beyond his practicing hours. ② Not belonging to his specialty. ③ Illness beyond the competence & qualification of the doctor ④ Doctor or any other family member is ill. Therapeutic ⑤ Doctor having important social function in family. ❶ relationship ⑥ Doctor having alcohol. ⑦ Patient is malingering. ⑧ Patient has been defaulting in payment. ⑨ Patient or his relatives are abusive/uncooperative. ⑩ Patient refuses to give consent. ⑪ An unaccompanied minor or female patient. ⑫ When doctor remains engaged with an emergency or more serious case.  A THIRD PARTY has referred the patient for medical examination: ① Pre-employment. Formal ② Insurance policy. ❷ relationship ③ Yearly medical checkups. ④ Cases of rape or victims of crimes or Medico-legal cases. ⑤ In certain psychiatric illnesses referred by court/ police. Dr. Ziad Mahana 5