Common Ethical Dilemmas in a Health Professional's Life..ppt

Ethical dilemmas in medicine.

2. Q:. The four major principles of
medical ethics are:
a. Autonomy, beneficence, non-malfeasance and
justice
b. Privacy, autonomy, beneficence and justice
c. Autonomy, beneficence, universality and
justice
d. Autonomy, beneficence, non-malfeasance and
morality

3. Ans: A) Autonomy, beneficence, non-
malfeasance and justice

4. A written statement of policies and
principles that guides the behaviourof all
employees is called
a)Code of ethics
b)Word of ethics
c)Ethical dilemma
d)None of the above

5. Ans: A) Code of ethics

6. Common Ethical Dilemmas in a
Health Professional’s life
On account of their unique position in
society, doctor have access to the most
intimate areas of people’s lives. They are,
therefore, likely to come across unusual
social situation.

7. The doctor is not accepted to respond to
these situations like other members of
society and minor stumble on their part
may compromise their position.

8. Some of the common situations where he
needs to show prudence and not take the
obvious course are discussed below:

9. a. Euthanasia
Euthanasia or physician assisted suicide can be
considered one of the most prevalent problems
when dealing with the ethics of patient
treatment. A worldwide debate continues to rage
on this subject of the “right to die” Should
people have the right to end their own lives
when prolonging it will only cause them more
pain?

10. Should families who love someone so
much, that they don’t want to lose
them, cause them more pain by
keeping them alive?

11. From the Greek term for “good death”,
euthanasia means compassionately
allowing, hastening or causing the death of
another.
Generally someone resorts to euthanasia to
relieve suffering, maintain dignity and
shorten the process of dying when death
appears inevitable.

12. Euthanasia can be voluntary if the patient has
requested it or involuntary if the decision in
made without the patient’s consent. Euthanasia
can be passive-simply withholding heroic life
saving measures or active-deliberately taking a
person’s life. Euthanasia assumes that the intent
of the physician is to aid and abet the patient’s
wish to die.

13. Most of the medical, religious and legal
groups in both the United States and UK
are against euthanasia. The World Medical
Association issued the following
declaration on euthanasia in October 1987:

14. “Euthanasia, that is the act of deliberately
ending the life of a patient, even at his own
request or at the request of his close relatives, is
unethical. This does not prevent the physician
from respecting the will of a patient to allow the
natural process of death of follow its course in
the terminal phase of sickness.”

15. It should be noted that the Pakistan Medical and
Dental Council also holds the same view on
euthanasia and practice of euthanasia by the
doctor is considered as a criminal act.

16. b) Accepting gifts from patients:
Sharingofgiftsasanexpressionof
gratitudeisacommonnormin
nearlyallsocieties,especiallyours.

17. Incertainsubcultures,infactthegiftgiver
mayfeelinsultedifhisofferingsarenot
accepted.
Aclearsetofguidelinesshouldthereforebe
followedbyhealthprofessionalswhich
maythenbecomeawell-knowncustomof
themedicalcommunityinthesociety.

18. Citizenswouldthenalsograduallystartto
followthesecustoms.
Asaferecommendationinthisregardisto
acceptapartinggiftattheendofa
successfultreatment,aslongasitisin
formofabouquetofflowers,oraboxof
sweetsorchocolates.

19. Youmayacceptthisgraciously.The
patientwhobringsgiftsduringthe
treatmentmaycauseproblem.Itmaybean
expressionofthepatient’sneedfor“more
thanusual”attention,needtodevelopa
personalfriendship,orbepartofyour
non-professionallife.

20. Extravagantandexpensivegiftsmust
neverbeacceptedasitmeansthatthe
patientisputtingyouunderaheavy
obligationorhaselevatedyoutoan
extraordinarypedestal.

21. Bothscenarioscanlandthedoctorinto
serioustroubleinthelongrun.Ifapatient
doessoitissafetoreturnthegiftssaying“
Iwillnotbeabletoacceptthesegifts,asit
isagainstmyprofessionalethics.

22. Iassureyouthatmycareandconcern
foryourhealthwillcontinuetoremain
thesome.”.

23. c). Sexualboundaries violation:
(Sexual relationships In medical settings)
Doctorsoperateinoddhours,inclose
andsometimesintimatesettingfor
longhoursandwithoutclearlydefined
boundariesofage,genderandsocial
class.

24. Theyworkwithfellow,seniorand
juniorcolleagues,nurses,paramedics,
patientsandtheirfamiliesandvisitors.
Theymayalsobecomeassociatedwith
professionalsfromdepartmentsof
sociology,socialwork,psychology,
NGOs,thepharmaceuticalindustry,
and,otherrelatedorganizations.

25. Allformsofliaisonsandrelationships
involvingpersonalintimacyofsexual
natureinthehospitalsettingsare
consideredunethicalandillegal.

26. Thisistoprotectthesanctityofthe
medicalprofessionalandthehospital.
Asexualliaisonbetweenapatientand
hisorherdoctorisprohibitedbylaw
andtheregulationsgoverningthe
profession,theworldover.

27. Atapsychologicallevelsucha
relationshipisconsideredatparwith
incest.Thesameruleappliestoa
medicalstudentworkingwithapatient.

28. Thepatientsarevulnerabletodevelop
eroticattachmentwiththeirdoctoror
toamedicalstudentinvolvedintheir
careandtheymayevendeclaretheir
passion.

29. Thiscanbehandledbyexplaininginno
uncertaintermsthatitisimpossibleforyou
tocontinueasacarerinsuchasituation.
Medicalstudentsthemselvesruntheriskof
beingexploitedbyseniorprofessionalsand
eventeachersinthehospitalandcollege
settings.

30. They must always report the matter to
the Dean or Principal and to do so with
immediate effect, withour fear and
prejudice.

31. It is useful to remember that a predator or
exploiter who threatens dire consequences if you
inform a concerned authority is essentially a
coward.

32. Never feel fearful or overwhelmed by such
an individual or a group.

33. d) Charges and Fee: Patient,
Colleagues, Teacher, Medical Students
Themedicalprofessionhastraditionally
beenaservicewithnoprimarycommercial
interest.Withtheprivitizationofthehealth
servicesandinvolvementofhealthinsurance
insomecapitalistcountriesthedeliveryof
serviceisnearlyalwaysassocaitedwith
financialtransactions,albeitnotalways
directlyatthepointofdelivery.

34. Withthechangingtimes,the
privatizationofhealthservicesand
involvementofhealthinsurancesin
someofthecapitalistcountries,the
deliveryofserviceisnearlyalways
associatedwithfinancialtransactions,
albeitnotalwaysdirectlyatthepointof
delivery.

35. Whileitisnotunethicaltochargeafee
foraconsultation,procedureoran
intervention,itisagainstthecustoms
andnormstobasedthedoctor-patient
relationshipontheircapacitytopay.

36. Thechargesshouldalsobenever
flamboyant,orvaryfromonesetforthe
poorandanotherfortherich.Asimple
ethicalruleistodetermineafee
structurethatdoesnotreaderadoctor,
aprocedureoranintervention,beyond
thereachofanordinaryandanaverage
citizen.

37. Traditionally,doctorsarenotexpected
tochargefromtheircolleagues,
teachers,medicalstudentsorpaupers.

38. e. Relationship with pharmaceutical
industry
Thedoctorsandthepharmaceutical
industryneedtohaveacongenial,anda
professionalrelationshipaimedatmutual
poolingorresourcestopromotewelfareof
healthinstitutionsandpatientsandtoinvest
inresearch.

39. Theuseofthisrelationshipforpersonal
gainsorprofiteeringishowever,
unethical.Thedoctorscannotseek
financialassistancefromthe
pharmaceuticalindustry,fortheir
holidays,travelabroad,material
benefitsforthemselvesortheir
families.

40. Theymayhoweverseeksupportin
scientificallyvalidresearchpursuits;the
researchmustneverbeaimedatpromoting
aparticularproductofthesponsor;they
mayalsoreceivetravelgrantsfromthe
sponsor,iftheyaretravelingtopresent
findingsoftheresearchinaconferenceora
nacademicforum.

41. Grantsfromtheindustrytoward
settinguporimprovingahealth
facility,oraserviceaimedexclusively
atthewelfareofthepatientsarealso
acceptable.

42. Adoctormustalwaysprotecthimself
againstbecomingbiasedbythe
promotionalliteraturedistributedby
thepharmaceuticalrepresentativesand
mustregularlyupdatedhimselfthrough
collectingpeer-reviewedevidencebase
abouttheproductbeforeattemptingto
prescribeit.

43. Adoctormustalsorefrainfrom
luncheons,dinners,andmeetingheld
atholidayresortsorhotelsinthegrab
oforunderthecoverfacademic
activitiessuchas‘paneldiscussion’and
‘lecture’etc.

44. Therelationshipofadoctorwiththe
pharmaceuticalindustrywalksonavery
tightrope.Ifusedprudentlyitcanenhance
theimageofthemedicalprofessionaland
bringgreatadvantagesforresearchand
welfareofpatients.

45. Aminorsliponthepartofthe
doctororanoverenthusiastic
nonprofessionalinteractiononthe
otherhandcancausehimgreatharm.

46. Thesingleagendathatshoulddrivea
doctorinhisprescriptiondrugshasto
bethebenefitandcurecircumstances
mustprescribethosedrugsthatare
mostcosteffective,themust
efficaciousandthosesupportedby
mostevidence-base.

47. f) Media and Medicine
Thelasttwodecadeshavewitnesseda
rapidgrowthoftheprintandelectronic
media.Thishasresultedinour
excessivedependenceonthemediafor
allkindsofinformation.

48. Whetherit’sthelatestdevelopmentin
politicsortheday’sweather,the
addictivenatureofmediatechnology
keepsmostpeoplegluedtotheirTVor
computerscreensforconsiderable
lengthsoftimeeachday.

49. Thenewsmediaarealsoanimportant
sourceofinformationonhealthand
medicaltherapies.Howeverthereis
widespreadconcernregardingthefact
thatsomemediacoverageofscientific
issuesmaybeinaccurateandover-
enthusiastic.

50. Journalist and media managers have
been criticized by scientists and
physicians for misleading the public
over important medical issues.

51. For example in 1997 survey of scientists
found that the majority of them believed
that reporters do not understand statistics
well enough to explain new scientific
findings, do not understand the nature of
science and technology, and are more
interested in sansataionalism than in
scientific truth.

52. For instance, sensatationlized reports on
the hazards of calcium channel blockers
may have led some patients to stop taking
their prescribed antihypertensive
medications, while optimistic coverage of
stem cell therapy resulted in patients
requesting this unproven treatment.

53. Similarly the internet hosts thousands of web
pages offering all kind of medical advice to the
vulnerable user. Where e-medicine and e-
consultations have effectively bypassed the
hurdle of distance, they still remain vulnerable to
exploitation by quacks and impersonators.

54. Despite the controversy, an effective and
judicious use of electronic and print media
along with internet can be made in regard
to prevention of illnesses and promotion
of health.

55. The concept of e-health offers many
opportunities for prevention, choice, home
based care, and chronic disease management,
and it has the potential to widen access to health
care for most patients.

56. Continues Medical Education (CME) is being
effectively imparted to a wide section of medical
professionals through authentic medical
websites such as ‘Medscape’ and video
teleconferencing is an effective tool for sharing
information through long distances today.

57. The use of electronic and print media to
improve health literacy is a noble public health
pursuit. Such opportunities do, however, run the
risk of misinformation.

58. They also have the potential to be used for
personal projection by health professionals.
Patients and their families may exploit such
opportunities for seeking free advice with
adverse and dangerous consequences.

59. Health literacy programmes cannot be used for
advertising a particular drug or intervention or
for provision of specific advice to viewers or
callers on the show.

60. The use of internet and e-Health can be brought
to ethical use through organizing health
promotion seminars and vidoe conferencing to
run CME (continues medical education) and
CPD (continuous professional development)
activities.

61. h. E-Consultations & Telemedicine
E-Consultations and telemedicine has
become a reality. Telemedicine is currently
linking far flung areas and cities like Gilgit
and Skardu wit Islamabad.

62. The phenomenon of telemedicine is being
practiced without boundaries around the world,
and with video calling features available in every
social media app.

63. it is likely to spread even more. Surgical
interventions can now be monitored by experts
in the field from a distance through video links,
especially in war torn areas.

64. it is likely to spread even more. Surgical
interventions can now be monitored by experts
in the field from a distance through video links,
especially in war torn areas.

65. The appearance of doctors on television
channels is an important way to promote health
literacy. It is however unethical to attempt to
diagnose and treat patients during these
interactions.

66. Medical advice should not be given out to
people “calling in” to television shows.
It is also not ethically correct to attempt to
diagnose and treat patient on video calls.

67. h. Technology-assisted Medical Services
E-consultations and tele-medicine has become a
reality. Tele-medicine is currently linking far
flung areas and cities like Gilgit and skardu with
Islamabad.

68. The phenomenon of telemedicine is being
practiced without boundaries around the world
and with video calling features available in every
social media app, it is likely to spread even more.

69. Surgical interventions can now be monitored by
experts in the field from a distance through
video links, especially in war torn areas.

70. The appearance of doctors on television channel
is an important way to promote health literacy.
It is, however, unethical to attempt to diagnose
and treat patients during these interactions.

71. Medical advice should not given out to people
“calling in” to television shows. This is ethically
incorrect.

72. i. Declaration by a Medical Student
or a Trainee Health Professional
It is mandatory for all medical students and
trainee health professionals to declare their exact
role and identity. It is unethical for medical
students to pose as ‘junior doctor’ or ‘doctor on
duty’ in front of an ignorant patient or a family
member.

73. Trainee psychologists, clinical psychologists and
other health professionals working in hospital
settings can be mistaken for doctors.

74. They often do not object when addressed by the
patients or their families as “doctor”. This
tendency must be curbed, in favour of revealing
your exact identity and role in the health team
and taking pride in it.

75. Most patients enjoy talking to medical students
and trainees from other health disciplines as they
have more time for them and are more
interested in their condition.

76. According to the rules of the Pakistan medical
and dental council euthanasia is:
a. Unprofessional
b. Empathic
c. Criminal
d. Unethical
e. Merciful

77. Ans: C) Criminal

78. Doctor should If you as a doctor are
approached by a pharmaceutical company
who offers financial help you can accept it
if:
a)For their holidays
b)To travel abroad
c)To buy new home furniture
d)To purchase a big TV for the clinic
e)For scientifically valid pursuits

79. Asn: E) For scientifically valid pursuits