AETCOM 2 BENEFICENCE & ROLE OF PHYSICIAN - Copy.pptx

BENEFICENCE & ROLE OF PHYSICIAN

1. ROLE OF BENEFICENCE OF A GUIDING PRINCIPLE IN PATIENT CARE Dr Bhavika patel MBBS,MD Microbiology,DIPC Assistant Professor Department of microbiology GMERS MC, Valsad .

2. Comes from two Latin words: ‘bonus’ where bene was taken to mean ‘good’ ‘fic’ where fiche was taken to mean ‘to act or do’ Literally – “Being charitable or doing good” Where a doctor should act in the “best interests ” of the patient, the procedure be provided with the intent of doing good to the patient BENEFICENCE

3. In the language of medicine, this principle highlights the duty of health provider to do good and take positive steps, such as prevention, removal of harm to the patient Beauchamp and Childress and Pesche believed that Beneficence could be seen through the associated acts of kindness, charity, humanity, altruism and love BENEFICENCE

4. The ethical principle of beneficence requires healthcare professionals to treat their patients in a way that provides maximum benefit to that patient These duties are viewed as self-evident and viewed as the proper goals of medicine These goals are applied to both the patient, and to the good of society as a whole Example- Vaccinations for disease prevention BENEFICENCE

5. Promotes patient "Best interest" by: Understanding patient perspective Address misunderstandings and concern Try to persuade patient Negotiate a mutually acceptable plan of care Ultimately let the patient decide BENEFICENCE

6. The principle of beneficence “asserts the duty to help others further their important and legitimate interests” Under the principle of beneficence One ought to prevent evil or harm One ought to remove evil or harm One ought to do or promote good P rinciple of Beneficence

7. According to Beauchamp and Childress, the principle of beneficence supports a number of more specific rules, including the following: Protect and defend the rights of others Prevent harm from occurring to others Remove conditions that will cause harm to others Help persons with disabilities Rescue persons in danger BENEFICENCE

8. Beauchamp and Childress distinguish between specific beneficence and general beneficence Specific beneficence General beneficence BENEFICENCE

9. Obligatory beneficence Refers to those positive obligations (i.e., duties to act) we owe to others to further their important and legitimate interests We owe a duty of specific beneficence, for example, to our children, and, as HCPs, to our patients As HCPs, we are obligated not merely to refrain from harming our patients (under the principle of non-maleficence ), but to act in their best medical interest Specific B eneficence

10. Directed beyond those special relationships to all persons Ideal beneficence—that is, although moral ideals encourage us to act affirmatively so as to help others with whom we do not find ourselves in a special relationship, we are not obliged to do so by the moral rules Beauchamp and Childress argue that, even apart from special relationships, a person X owes an obligatory duty of beneficence toward a person Y if each of the following conditions is true: General beneficence

11. Y is at risk of significant loss of or damage to life or health or some other major interest X’s action is needed (singly or in concert with others) to prevent this loss or damage X’s action (singly or in concert with others) has a high probability of preventing it X’s action would not present significant risks, costs or burdens to X The benefit that Y can be expected to gain outweighs any harms, costs, or burdens to X that is likely to occur General B eneficence

12. To refrain from causing harm, but they have an obligation to help their patients. { On all possible occasions } The goal is to promote the welfare of patients & should possess skills and knowledge that enable them to assist others It also include protecting and defending the rights of others, rescuing persons who are in danger and helping individuals with disabilities. Beneficence – Clinical applications

13. What does it mean in practice “to act for the good of patients” ? What is medically “good” ? Beneficence – Approach

14. B e n e f i c e n c e – 1 s t – Act in g i n t h e pt ’ s in t e r e s t Very straight forward Situations - e.g. patient with chest pain / meningitis. Complicated Situations - conflict between - Health interests and other important interests that patient might have. e.g. employment interests, religious interests. In secondary and tertiary care, health problems can be urgent and overwhelming that patient interests shrunk to coincide with his health interests. Doctors have to appreciate and negotiate these contending interests so that the patient sees the primary of the health interest like others.

15. Be n ef i c e nc e – 2 nd Onus on doctor to check which treatment are effective or not. Role of EBM (Evidence-Based Medicine) to clarify issues.

16. B e n e f i c e n c e – L i m i t s Pt ’ s driv e n c o n st rai nt s Normally motivated by health interests. Conflicts arise when patient’s aim diverge from doctor. Patients reject treatment but they must understand fully, implication of their decisions.

17. T re a tm e n t R ef u s a l – Do c t or’ s R ol e Approach to Patient Physician’s act Patient’s competence Enough information to be provided Voluntary effort

18. T re a tm e n t R ef u s a l Approach to patient Physicians act Listening - Demonstrates a commitment to care & trustworthiness Correct misunderstandings and misconceptions Refusal is fully informed

19. B e n e f i c e n c e – L i m i t s Pr ac titi o n e r - d ri v e n con str a i n t & m e d i ca l r e s p on si b i l i t y Patients request medical services, which doctor consider unnecessary Use of EBM guidelines not in the best interest for patients.

20. Ex te r n a l c o n st rai n t s Lack of resources - e.g. waiting list for investigations, referral and treatments. Access to specialists care takes a long time leading to ethical issues - eg. patients dying while waiting for treatment, paying patients by passing public patients for treatment. B e n e f i c e n c e – L i m i t s

21. Illustrative case The health care where principle of beneficence is given priority over the principle of respect of autonomy which is in the Emergency Room: Patient is incapacitated by the grave nature of accident or illness We presume that the reasonable person would want to be treated aggressively and we rush to provide beneficent intervention

22. BENEFICENCE vs AUTONOMY The physician cannot be required to violate fundamental personal values, standards of scientific or ethical practice, other law If the physician is unable to carry out the patient's wishes, the physician must withdraw and transfer care of the patient

23. Beneficence , starts with preventing harm from happening to anyone and sees to it that any individual will not be harmed physically, emotionally, psychologically and spiritually Non-maleficence , focuses mainly on the subject of not inflicting harm intentionally BENEFICENCE vs NON-MALFICENCE

24. CONFLICTS BETWEEN AUTONOMY AND BENEFICENCE/NON-MALEFICENCE Autonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare 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 Beneficence without respect of an individual's autonomy may lead to actions that are not really beneficial as they try to promote the other person's well-being against his/her will

25. There is a delicate balance between autonomy and beneficence Autonomy and beneficence can get in conflict with the principle of autonomy For example, physicians have a moral responsibility to listen to the patient's wishes (if autonomous) or to the patient's surrogates (if non-autonomous), but they also have the responsibility to do what is “good” for the patient It is the role of a physician to find balance between autonomy and beneficence in case and take the right decision CONFLICTS BETWEEN AUTONOMY AND BENEFICENCE/NON-MALEFICENCE

26. A doctor may want to prefer autonomy because refusal to please the patient's self-determination would harm the doctor-patient relationship Individuals ' capacity for informed decision-making might come into question during resolution of conflicts between autonomy and beneficence CONFLICTS BETWEEN AUTONOMY AND BENEFICENCE/NON-MALEFICENCE

27. CONCLUSION To sum up, there seems no perfect answer to an ethical dilemma It is hard to justify the use of one principle over another Yet the ethical decision making process provides a guide to take a step ahead and apply the best possible principle

28. However, it may not be the perfect choice but it may result in maximum beneficence and minimum harm which could be avoided Nevertheless , in any such situation, pros and cons and risks and benefits should be weighed against to get to the best possible solution which would be in favor of the patient The potential benefits of any intervention must outweigh the risks in order for the action to be ethical CONCLUSION

29. ROLE OF A PHYSICIAN IN HEALTH CARE SYSTEM

30. You should know the rules of physician as suggested by NMC You should know some other roles of physician in the health care system correctly Objectives

31. Preventive Promotive Curative Palliative Holistic care with compassion Role as a Clinician

32. Preventive role Immunization RCH (Reproductive and child health) ANC check up Post natal check up Family planning Vector control Nutrition Health education Role as a Clinician

33. Promotive role Health promotion is the process of enabling people to increase control over and to improve their health It moves beyond a focus on individual behavior towards a wide range of social and environmental interventons Health promotion= Health education* Health public policy (Tones and Tilford , 1994) Role as a Clinician

34. Curative role Diagnosis- History taking, examination, investigation Treatment- Non pharmacological, pharmacological, surgical Role as a Clinician

35. Palliative care Treatment of the discomfort, symptoms and stress of serious illness like cancer HIV, chronic respiratory and cardiovascular disease etc. It provides relief from distressing symptoms including- Pain Shortness of breath Fatigue Constipation Nausea Loss of appetite Role as a Clinician

36. Holistic care Greek word- holes, meaning “whole” Holistic health views the following aspects of a person’s life as an integrated whole Physical Intellectual Sociocultural Psychological Spiritual aspects This five espects cannot be separated or isolated; anything that affects one aspect of a person’s life also affects the other aspects. Example from movies: Bhool bhulaiya , dear jindagi etc. Role as a Clinician

37. Physician should be able to- Collect health data appropriately Analyze health data appropriately Synthesize health data appropriately Communicate health data appropriately Leader and member of the health care team and system

38. Mortality rate of different department in a tertiary care hospital Department Mortality rate ( jan-june 2021) Medicine 2.2% Surgery 4.4% OBG 1.6% pediatrics 0.3%

39. Communicator with patients, families, colleagues and community It is the manner of communication which is important as compared to information Effective patient-physician communication- equivalent to drugs The physician who can communicate bad news in a direct and compassionate way help the patient cope, strengthen the therapeutic relationship, endures and further extends healing process Role of physician as communicator

40. Physician should become competent in five key communication skills Listening effectively Eliciting information using effective questioning skills Providing information using effective explanatory skills Counselling and educating patients Making informed decisions based on patient information and preferences Role of physician as communicator

41. Life long learner committed to continuous improvement of skills and knowledge Adding more degrees and courses Undergoing training, workshops Attending CME, conferences Research papers-writing, reading and presentation (MBBS student ca do ICMS STS projects) Continous upgradation of knowledge with books, internet and other sources Life long learner

42. Committed to excellence Ethical- Follow ethical cole as defined by NMC/ state medical council Responsive- Treat patient in empathetic way Professional

43. Accountable to patients, community, profession and society Medical negligence Rule of law/court Consumer protection act RTI Citizen charter

44. Medical science changes each week and it will change in fundamental ways during our careers We must continuously read and evaluate the literature, discuss it with colleagues and formulate opinions that impact our practices The physician-scientist thus has a contribution that unique from scientists who do not receive medical training Role of physician as researcher/scientist

45. Physicians are now routinely involved in issues affecting the entire hospital- strategic planning, capital and operating budgets, information systems design and quality improvement Role of physician as Manager

46. As a manager, the physician is expected to be responsible for the Selection of the other staff members Providing him or her with orientation to the role Assigning work Evaluating performance Providing training

47. The physician’s medical expertise, experience at the bedside and status in society can provide invaluable perspective and influence in formatting the policy process The doctor-patient relationship offers unique insight into the lives and needs of a vast cross-section of the public Role of physician as Policy maker

48. BENEFICENCE AND NON-MALEFICENCE S A N T I A G O , J O D I N E K I M B E R L Y M . S A L V A D O R , I S A B E L L E M . M A N Z O , C O R A Z O N M U H A M M E D ,. R ole of physician in health care system.pptx; Deepak Bansal; Slide share References: