Medical Ethics - Lecture 2

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MEDICAL ETHICS

DR AHMED A. OMER
2. PRINCIPLES OF MEDICAL ETHICS
There are four basic principles of medical ethics. Each addresses a value
that arises in interactions between providers and patients. The
principles address the issue of fairness, honesty, and respect for fellow
human beings.

Autonomy:
 People have the right to control what happens to their bodies.

 This principle simply means that an informed, competent adult patient


can refuse or accept treatments, drugs, and surgeries according to
their wishes.
 People have the right to control what happens to their bodies because
they are free and rational.
 And these decisions must be respected by everyone, even if those
decisions aren’t in the best interest of the patient.
PRINCIPLES OF MED. ETHICS CONT……..

Beneficence:
 Simply, this means taking actions that serve the best
interests of patients.
 All healthcare providers must strive to improve their
patient’s health, to do the most good for the patient in
every situation.
 But what is good for one patient may not be good for
another, so each situation should be considered
individually.
 And other values that might conflict with beneficence
may need to be considered.
PRINCIPLES OF MED. ETHICS CONT……..
Non-maleficence:
 “First, do no harm” is the bedrock of medical ethics.

 In every situation, healthcare providers should avoid


causing harm to their patients.
 This principle implies that it is more important not to harm
your patient, than to do them good.
 This is partly because enthusiastic practitioners are prone
to using treatments that they believe will do good, without
first having evaluated them adequately to ensure they do
no harm.
 Much harm has been done to patients as a result, as in the
saying, "The treatment was a success, but the patient
died."
PRINCIPLES OF MED. ETHICS CONT……..
Justice:
 The fourth principle demands that you should try to be as
fair as possible when offering treatments to patients and
allocating scarce medical resources. You should be able to
justify your actions in every situation.

Other Principles:
 Dignity: the patient have the right to be treated with dignity

 Truthfulness and honesty: The patient deserves the truth


about his/her condition and progress of recovery or disease
PRINCIPLES OF MED. ETHICS CONT……..
Conflicting issues in Principles of medical ethics
A. Conflict between beneficence and non-maleficence
 Double effect

 Double effect refers to two types of consequences which


may be produced by a single action
 In medical ethics, it is usually regarded as the combined
effect of beneficence and non-maleficence
 E.g. use of morphine or other analgesic in the dying
patient. Such use of morphine can have the beneficial
effect of easing the pain and suffering of the patient, while
simultaneously having the maleficent effect of hastening
the death of the patient through suppression of the
respiratory system.
PRINCIPLES OF MED. ETHICS CONT……..
B. Conflicts between autonomy and beneficence/non-
maleficence
 Autonomy can come into conflict with beneficence
when patients disagree with recommendations that
health care professionals believe are in the patient's
best interest.
 When the patient's interests conflict with the patient's
welfare, different societies settle the conflict in a wide
range of manners.
PRINCIPLES OF MED. ETHICS CONT……..
 Western medicine generally defers to the wishes of a
mentally competent patient to make his own decisions,
even in cases where the medical team believes that he is
not acting in his own best interests.
 However, many other societies prioritize beneficence over
autonomy.
 Examples include when a patient does not want a
treatment because of, for example, religious or cultural
views.
 In the case of euthanasia, the patient, or relatives of a
patient, may want to end the life of the patient.
 Also, the patient may want an unnecessary treatment, as
can be the case in hypochondria or with cosmetic surgery
3. THE PROFESSIONAL CODE OF CONDUCT
 A code of professional conduct is a necessary component to
any profession to maintain standards for the individuals within
that profession to adhere

Features of Professions
 Specialized knowledge

 Some commitment to service or altruism

 Self Regulation

 Personal identification with occupational role

 Special respect from clients or patients


PROFESSIONALISM IN MEDICINE
 Patients need good doctors. Good doctors make the care of
their patients their first concern: they are competent, keep
their knowledge and skills up to date, establish and maintain
good relationships with patients and colleagues, are honest
and trustworthy, and act with integrity and within the law.

 You must use your judgment in applying the principles to the


various situations you will face as a doctor

 Good doctors work in partnership with patients and respect


their rights to privacy and dignity

 It is your responsibility to be familiar with Good medical


practice and the explanatory guidance which supports it
PROFESSIONALISM IN MEDICINE
 To maintain your license to practice, you must
demonstrate, through the revalidation process, that you
work in line with the principles and codes of your
respective medical board/agency.
PROFESSIONALISM IN MEDICINE
Develop and maintain your professional performance
 You must be competent in all aspects of your work, including
management, research and teaching
 You must keep your professional knowledge and skills up to
date.
 You must regularly take part in activities that maintain and
develop your competence and performance
 You should be willing to find and take part in structured support
opportunities offered by your employer or contracting body
 You must be familiar with guidelines and developments that
affect your work.
 You must take steps to monitor and improve the quality of your
work.
PROFESSIONALISM IN MEDICINE
Apply knowledge and experience to practice
 You must recognize and work within the limits of your
competence.
 You must provide a good standard of practice and care

 You must be satisfied that you have consent or other valid


authority before you carry out any examination or
investigation, provide treatment or involve patients or
volunteers in teaching or research
 You must make good use of the resources available to you
PROFESSIONALISM IN MEDICINE
Record your work clearly, accurately and legibly
 Documents you make (including clinical records) to
formally record your work must be clear, accurate and
legible.

 You must keep records that contain personal


information about patients, colleagues or others
securely, and in line with any data protection
requirements
PROFESSIONALISM IN MEDICINE
To help keep patients safe you must:
 Contribute to confidential inquiries

 Contribute to adverse event recognition

 Report adverse incidents involving medical devices that


put or have the potential to put the safety of a patient,
or another person, at risk
 Report suspected adverse drug reactions

 Respond to requests from organizations monitoring


public health

When providing information for these purposes you should


still respect patients’ confidentiality
PROFESSIONALISM IN MEDICINE
Communicate effectively
 You must listen to patients, take account of their views,
and respond honestly to their questions.
 You must give patients the information they want or
need to know in a way they can understand.
 You must be considerate to those close to the patient
and be sensitive and responsive in giving them
information and support.
 When you are on duty you must be readily accessible to
patients and colleagues seeking information, advice or
support.
PROFESSIONALISM IN MEDICINE
Work collaboratively with colleagues to maintain or
improve patient care
 You must work collaboratively with colleagues,
respecting their skills and contributions.
 You must treat colleagues fairly and with respect.

 You must be aware of how your behaviour may


influence others within and outside the team.
PROFESSIONALISM IN MEDICINE
Teaching, training, supporting and assessing
 You should be prepared to contribute to teaching and
training doctors and students.
 You must make sure that all staff you manage have
appropriate supervision.
 You must be honest and objective when writing
references, and when appraising or assessing the
performance of colleagues, including locums and students.
 You should be willing to take on a mentoring role for more
junior doctors and other healthcare professionals.
 You must support colleagues who have problems with
their performance or health.
PROFESSIONALISM IN MEDICINE
Establish and maintain partnerships with patients
 You must be polite and considerate.

 You must treat patients as individuals and respect their


dignity and privacy.
 You must treat patients fairly and with respect whatever
their life choices and beliefs.
 You must work in partnership with patients, sharing with
them the information they will need to make decisions
about their care.
 You must treat information about patients as confidential.
This includes after a patient has died.
 You must explain to patients if you have objection to a
particular procedure
PROFESSIONALISM IN MEDICINE
Honesty in financial dealings
 You must be honest in financial and commercial dealings with
patients, employers, insurers and other organizations or
individuals
 You must not allow any interests you have to affect the way you
prescribe for, treat, refer or commission services for patients.
 If you are faced with a conflict of interest, you must be open
about the conflict, declaring your interest formally
 You must not ask for or accept – from patients, colleagues or
others – any inducement, gift or hospitality that may affect or
be seen to affect the way you prescribe for, treat or refer
patients or commission services for patients. You must not offer
these inducements.

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