Medical ethics

MBBS curriculum

1. OR

2. Dr Nikita Prabhakaran MBBS, MD Senior Resident

3. Medical ethics Deals with the moral principles which should guide the members of medical profession In their dealings with each other, their patients and the State .

4. Medical etiquette Conventional laws of courtesy observed between the members of medical profession

5. MEDICAL JURISPRUDENCE Is the study of law in relation to medicine. It deals with the legal aspects of medicine such as legal rights, privileges, and obligations of medical practitioner

6. DIFFERENT CODES OF ETHICS HIPPOCRATIC OATH -OLDEST ONE DECLARATION OF GENEVA –1948 INTERNATIONAL CODE OF MEDICAL ETHICS-1949

7. INDIAN MEDICAL DEGREES ACT -1919 INDIAN MEDICAL COUNCIL ACT –1933, 1956 MCI Amendment Act 2010 NATIONAL MEDICAL COMMISSION ACT –2019

8. INDIAN MEDICAL COUNCIL CONSTITUTION  1 member  from each state (nominated by central Govt)  1 member  from each university-medical faculty  1 member from each state  7 members from persons in any SMR  8 members  nominated by central government Among themselves Term of 5 years

9. FUNCTIONS OF INDIAN MEDICAL COUNCIL Recognition of medical qualification 2. Supervision of undergraduate & postgraduate medical education 3. Recognition of foreign medical qualification

10. 4. Recognition of medical institutions 5. Warning notice 6. Appeal against disciplinary action

11. Warning notice IMC and SMC gives examples of offences which constitutes serious professional misconduct but it stresses the fact that it is not a complete list. Each case has to be decided on its specific facts and merits

12. NATIONAL MEDICAL COMMISSION Passed in Lok Sabha in July 29, 2019 NMC came into force from September 25, 2020 Consists of 33 members  A chairperson –a medical professional  10 ex officio members  22 part time members (law, research, public representatives)

13. National medical commission Chairman – Dr Suresh Chandra Sharma (former HOD, ENT, AIIMS) for 3 years Secretary – Dr Rakesh Kumar Vats (former secretory of board of governors of IMC) for 3 years

14. Registered medical practitioner may be known as ‘ Graduate medical practitioner’

15. Ensuring compliance by SMC with the regulations made under the bill Framing guidelines for determining the fee for up to 50% seats in Private medical Colleges Functions of NMC

16. Regulatory boards under NMC 4 autonomous boards The Under Graduate Medical Education Board (UGMEB) Post Graduate Medical Education Board (PGMEB) The Medical Assessment and Rating Board (MARB)  licensing new institutions, maintenance of standards The Ethics and Medical Registration Board  misconduct

17. Community Health Providers WHO standard Doctor : Population ratio = 1:1000 India in Jan 2018 Doctor : Population ratio = 1: 1655 This gap is to be filled by Community health providers who are licensed mid level medical practitioners provided by NMC They prescribe specific medicines in Primary and Preventive health care Uniform NEET(National Eligibility cum Entrance Test) National Exit Test Common final year undergraduate exam for students graduating from medical institutions To obtain license for practice Serve as the basis for admission to postgraduate courses

18. State Medical Council Constituted by  Medical teachers  Registered medical practitioners  State government nominees Functions  Medical register  Disciplinary control

19. Judicial Proceedings in SMC Acquital Warning Temporary removal Permanent erasure

20. Act of a medical man in the pursuit of his profession, with regard to which it would be reasonably regarded as Disgraceful or dishonourable by his professional brethren of Go od repute & Competence .

21. 6 ‘A’s Abortion Addiction Adultery Advertising Association Conviction by court of law Refusing treatment on religious grounds Sex determination tests Dichotomy – splitting of fee Touting -selling Issuing false certificates Schedule H and L drugs Clinical trials without consent

22. PUNISHMENT Warning –minor offence Penal erasure

23. PENAL ERASURE / PROFESSIONAL DEATH SENTENCE Serious professional misconduct  name is removed from the register temporarily/ permanently Permanent removal of name from the medical register  PENAL ERASURE Death of practitioner Entries made in error Professional misconduct Not traceable in his address

24. RIGHTS & PRIVILEGES OF RMP Choose the patient Use title &description of qualification Appointment in public & local hospital Prescribe & dispense medicine

25. Realize fee &expenses Issue medical certificates &ml reports Give evidence in a court of law Removal of organ for transplantation Perform MTP

26. Duties of medical practitioner 1.To uphold dignity of honour of profession 2.To exercise reasonable degree of skill and knowledge 3.With regard to attendance and examination 4.To furnish proper and suitable medicines

27. 5.To give instructions 6.To control and warn 7.To third parties 8.Towards children and adults incapable of taking care of themselves

28. 9. Inform patients of risks 10 . With regards to poison 11.To notify certain diseases 12. With regards to operations 13. With regards to consultations 14. In connection with X-ray examination 15. Professional secrecy 16. Previleged communication

29. PROFESSIONAL SECRECY Doctor is obliged to keep as secrets all that he comes to know about his patient during treatment Implied term of contract Disclosure without genuine reasons  professional misconduct

30. PRIVILEGED COMMUNICATION Doctor can reveal certain information about a patient to protect the interest of public or state. Better to get the consent of the patient

31. 1. V eneral diseases  spouse 2. Infectious diseases  hostel 3.Notifiable diseases  COVID 19 4. In patients interest 5. Suspected crime  criminal case 6. Courts of Law  offences 7. Insurance reports

32. Duties of a patient Furnish the doctor with complete past medical history , family history of diseases and the facts and circumstances related to the disease He should strictly adhere to the instructions of the doctor with regard to diet, medicines, life style changes He should pay reasonable fee to the doctor

33. Privileges and Rights of patients Choice Access Dignity Privacy Confidentiality Information Safety Right to know Right to refuse Second opinion Records Continuity Comfort Complaint Compensation

34. Lets add smiles !!!!!!!!!!!!!!