M. E DILEMMAS.ppt public health and co 2025

medical professional ethics

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 behaviour of 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 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:
Sharing of gifts as an
expression of gratitude is a
common norm in nearly all
societies, especially ours.

17. In certain subcultures, in fact the gift
giver may feel insulted if his offerings
are not accepted.
A clear set of guidelines should
therefore be followed by health
professionals which may then
become a well-known custom of the
medical community in the society.

18. Citizens would then also gradually start to follow these customs.
A safe recommendation in this
regard is to accept a parting gift
at the end of a successful
treatment, as long as it is in form of
a bouquet of flowers, or a box of
sweets or chocolates.

19. You may accept this graciously.
The patient who brings gifts during
the treatment may cause
problem. It may be an expression
of the patient’s need for “more
than usual” attention, need to
develop a personal friendship, or
be part of your non-professional
life.

20. Extravagant and expensive gifts
must never be accepted as it
means that the patient is putting
you under a heavy obligation or
has elevated you to an
extraordinary pedestal.

21. Both scenarios can land the doctor
into serious trouble in the long run.
If a patient does so it is safe to
return the gifts saying “ I will not be
able to accept these gifts, as it is
against my professional ethics.

22. I assure you that my care and
concern for your health will
continue to remain the same.”.

23. c). Sexual boundaries
violation:
(Sexual relationships In medical
settings)
Doctors operate in odd hours, in
close and sometimes intimate
setting for long hours and without
clearly defined boundaries of age,
gender and social class.

24. They work with fellow, senior and
junior colleagues, nurses,
paramedics, patients and their
families and visitors. They may also
become associated with
professionals from departments of
sociology, social work, psychology,
NGOs, the pharmaceutical industry,
and, other related organizations.

25. All forms of liaisons and
relationships involving
personal intimacy of
sexual nature in the
hospital settings are
considered unethical and
illegal.

26. This is to protect the sanctity of the
medical professional and the
hospital. A sexual liaison between
a patient and his or her doctor is
prohibited by law and the
regulations governing the
profession, the world over.

27. At a psychological level such a
relationship is considered at par
with incest. The same rule applies
to a medical student working with
a patient.

28. The patients are vulnerable to
develop erotic attachment with
their doctor or to a medical
student involved in their care and
they may even declare their
passion.

29. This can be handled by explaining in no uncertain terms that it is
impossible for you to continue as a carer in such a situation. Medical
students themselves run the risk of being exploited by senior
professionals and even teachers in the hospital and college 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
The medical profession has traditionally been a service with no
primary commercial interest. With the privitization of the health
services and involvement of health insurance in some capitalist
countries the delivery of service is nearly always assocaited with
financial transactions, albeit not always directly at the point of
delivery.

34. With the changing times, the
privatization of health services and
involvement of health insurances
in some of the capitalist countries,
the delivery of service is nearly
always associated with financial
transactions, albeit not always
directly at the point of delivery.

35. While it is not unethical to charge
a fee for a consultation, procedure
or an intervention, it is against the
customs and norms to based the
doctor-patient relationship on their
capacity to pay.

36. The charges should also be never
flamboyant, or vary from one set
for the poor and another for the
rich. A simple ethical rule is to
determine a fee structure that
does not reader a doctor, a
procedure or an intervention ,
beyond the reach of an ordinary
and an average citizen.

37. Traditionally, doctors are not
expected to charge from their
colleagues, teachers, medical
students or paupers.

38. e. Relationship with
pharmaceutical industry
The doctors and the pharmaceutical industry need to have a
congenial, and a professional relationship aimed at mutual pooling
or resources to promote welfare of health institutions and patients and
to invest in research.

39. The use of this relationship for
personal gains or profiteering is
however, unethical. The doctors
cannot seek financial assistance
from the pharmaceutical industry,
for their holidays, travel abroad,
material benefits for themselves or
their families.

40. They may however seek support in scientifically valid research
pursuits; the research must never be aimed at promoting a particular
product of the sponsor; they may also receive travel grants from the
sponsor, if they are traveling to present findings of the research in a
conference or a n academic forum.

41. Grants from the industry toward
setting up or improving a health
facility, or a service aimed
exclusively at the welfare of the
patients are also acceptable.

42. A doctor must always protect
himself against becoming biased
by the promotional literature
distributed by the pharmaceutical
representatives and must regularly
updated himself through collecting
peer-reviewed evidence base
about the product before
attempting to prescribe it.

43. A doctor must also refrain from
luncheons, dinners, and meeting
held at holiday resorts or hotels in
the grab of or under the cover f
academic activities such as
‘panel discussion’ and ‘ lecture’
etc.

44. The relationship of a doctor with the pharmaceutical industry walks
on a very tight rope. If used prudently it can enhance the image of
the medical professional and bring great advantages for research
and welfare of patients.

45. A minor slip on the part of the
doctor or an overenthusiastic
nonprofessional interaction on the
other hand can cause him great
harm.

46. The single agenda that should
drive a doctor in his
prescription drugs has to be the
benefit and cure circumstances
must prescribe those drugs that
are most cost effective, the
must efficacious and those
supported by most evidence-
base.

47. f) Media and Medicine
The last two decades have
witnessed a rapid growth of the
print and electronic media. This
has resulted in our excessive
dependence on the media for all
kinds of information.

48. Whether it’s the latest
development in politics or the
day’s weather, the addictive
nature of media technology
keeps most people glued to
their TV or computer screens
for considerable lengths of
time each day.

49. The news media are also an
important source of
information on health and
medical therapies. However
there is widespread concern
regarding the fact that some
media coverage of scientific
issues may be inaccurate
and over-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 medical 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