Medical ethics

it contains all the dimensions of ethics along with description on research ethics.

1. Dr Pooja Pandey PG Resident 1 st Year MS General Surgery Mayo Institute Of Medical Sciences,Barabanki

2. CONTENTS Introduction Medical ethics vs bioethics Evolution of ethics Why Ethics becomes important? ABCDE of Ethics Veracity Fidelity Ethical dilemma Research Ethics

3. INTRODUCTION The Greek word ethike means habit ,action and character . In simple words -The oldest scientific and philosophical discipline

4. Ethics is not M erely obeying the law Compliance Although in many instances laws are statements of considered ethical positions and most of the time obeying the law is an element of ethical behavior.

5. Ethics is a very large and complex field of study with many branches or subdivisions. Medical Ethics is the branch of ethics that deals with moral issues in medical practice. Medical ethics is closely related ,but not identical to ,biomedical ethics

6. Medical Ethics Biomedical Ethics Focuses primarily on issue arising out of the practice of medicine Focuses on moral issues raised by developments in the biological sciences

7. HISTORY OF MEDICAL ETHICS

8. Hippocratic Oath One of the earliest document in medical ethics -5 th century B.C. All doctors recite this oath at swearing in.

9. Nuremberg code -1947

10. Declaration of Geneva Adopted at WMA in 1948 which was amended in 1968,1984,1994,2005 and 2006. Declaration of physicians’ dedication to the humanitarian goals of medicine.

11. Helsinki Declaration-1964 64 th WMA General Assembly ,Fortaleza (Brazil) , October 2013

12. International code of M edical Ethics-2006

13. Why Ethics Becomes Important ? Now a days , conflict of interests between the government and medical institutions ,between medical personnel and medical institution ,between physicians and patients are getting more and more serious and complex. High technologies has not only brought us hopes of cure but have also created a heavy economic burden . The ethical dilemmas of brain death ,organ transplantation ,and concerns about quality of life have become increasingly prominent. Integration of the traditional medical ethics with modern principles and values.

14. The study of ethics prepares medical professionals to recognize difficult situations and to deal with them in a rational and principled manner. Ethics is also important in physicians’ interactions with society and their colleagues and for the conduct of medical research.

15. AUTONOMY BENEFICENCE CONFIDENTIALITY DO NOT HARM/ NON MALEFICENCE EQUITY OR JUSTICE PRINCIPLE OF MEDICAL ETHICS ABCDE OF Medical Ethics

16. AUTONOMY Right to Choose Respect the autonomy of their patients and their ability to make choices about their treatments , and to evaluate the potential outcomes in light of other life plans .

17. Desiring to benefit the patient ,physician strongly want to provide Blood Transfusion – believing it to be medical benefit. Patient must be so informed – Consequences of refusing blood transfusion –death due to blood loss. Properly and compassionately informed Patient is free –to Accept BT or Refuse BT

18. INFORMED CONSENT

19. BENEFICENCE

20. PRINCIPLE OF BENEFICENCE

21. CONFIDENTIALITY Right to Privacy Respect for autonomy does not entail only the right of capacitous patients to consent to treatment . Their autonomous right extends to control over their confidential information and doctors must to respect their privacy ,not communicate information revealed in the course of treatment to anyone else without consent.

22. Why CONFIDENTIALITY is Important?

23. 5 C’s Exception to CONFIDENTIALITY

24. DO NOT HARM /NON -MALEFICIENCE Not to intentionally create a harm or injury to the patient, either through acts of commission or omission . The Principle affirms the need for medical competence. Medical mistakes may occur ,however , the principle articulate a fundamental commitment as the part of health care professionals to protect their patient from harm . Eg - Most would be willing to experience some pain if the procedure said would prolong life. PRIMUM NON NOCERE (above all DO NOT HARM)

25. PRINCIPLE OF DOUBLE EFFECT When intervention undertaken by physicians create positive outcome while also potentially doing harm it is known as the “Double Effect”. Single action- two effects Good effect BAD effect

26. In palliative care of patient whose pain is increasingly difficult to control. There may come a point in the management of pain when effective palliation is possible at the risk of shortening a patient’s life because of respiratory effect of the palliative drugs . This is a “Double Effect” - both relief of pain and death might follow from such an action.

27. EQUITY OR JUSTICE

28. EUTHANASIA Some American physicians interpret the Non- Maleficience principle to exclude the practice of euthanasia , though not all concur. The most extreme example in recent history of the violation of the Non- Maleficence Dictum was Dr. Jack Kevorkian ,who was convicted of second –degree homicide in Michigan in 1998 after demonstrating active euthanasia on TV news show,60 Minutes

29. Most controversial issue in modern health care Who has the right to health care ? As a society we want to be beneficient and provide some descent minimum level of health care for all citizen regardless of ability to pay.

30. The demand of the principle of justice must apply at the bed side of the individual patients but also systemically in the laws and policies of society that govern the access of a population to health care

31. VERACITY The duty to tell the truth . Truth telling, Honesty

32. FIDELITY

33. ETHICAL DILEMMA

34. Situations necessitating a choice between two equal (usually undesirable) alternatives. A conflict between two or more ethical principles. In an ethical dilemma there is no “correct” decision.

35. Major Types of Ethical Dilemma Euthanasia Refusal of Treatment Scarcity of Resources

36. Intentional action or lack of action that causes the merciful death of someone suffering from a terminal illness or incurable condition.

37. Types of Euthanasia Active An active intervention to e nd life Passive Deliberately withholding treatment to end the life Voluntary Request from a patient Involuntary Against a patient will Non- voluntary Patient is not capable of giving permission Doctor assisted suicide Prescribes a lethal drug which is self administered by the patient Aruna Shanbaug case Karnataka

38. Refusal of Treatment Based on the principle of autonomy . A patient’s rights to refuse treatment and to die often challenge the values of most health care providers .

39. Scarcity of Resources The allocation of scarce resources ( eg -Organ ,Specialists)is emerging as a major medical dilemma.

40. Ethical Decision Making Model

41. Ethics Committee

42. Functions of Ethical Committee

43. The patient and the person treating the patient have the right to be treated with dignity

44. Questions Q1)Which of the following statements are true regarding the informed consent ? A . Consent should be obtained by the person doing the operation. B . The written communication material must always be in English. C . Consent is necessary before physical examination of a patient . D . Every possible hazard , however remote the possibly , should be explained in detail. E . Legally, a signed consent from a patient is proof that valid consent has been properly obtained. ANS-A,C

45. Q2)In a matter of life and death ,which of the following are true statements? The surgeon is always obliged to provide life sustaining treatment . B. Decision to with hold treatment should be taken along with another senior clinician and recorded in detail. C. In palliation for pain in advanced malignancy ,a potential lethal dose of analgesia is appropriate. D. Confidentiality is absolute. Ans - B,C

46. REFERENCES Manual of Medical Ethics –World Medical Association 2009 MCI Ethical Guidelines -2002,2019. ICMR guidelines for biomedical research ,2006 Research Ethics –National Institute of Health ,USA The Contribution of Ethics to Public Health –Bulletin of WHO Bailey and love 27 th edition Sabiston text book of surgery Google images