Medical Ethics

Medical Ethics

1. CSJM UNIVERSITY KANPUR University Institute of Pharmacy TOPIC-MEDICAL ETHICS Presented By: RUCHI PAL M. Pharm. ( PhARMACEUTICs ) 3 rd Sem.2019-20 Batch

2. CONTENT INTRODUCTION BASIC RIGHTS AND NEED OF MEDICAL ETHICS VALUES IN MEDICAL ETHICS IMPORTANCE OF COMMUNICATION CONTROL AND RESOLUTION GUIDELINES ETHICS COMMITTEES ETHICAL CODES CULTURAL CONCERNS TRUTH TELLING ONLINE BUSINESS PRACTICES CONFLICTS OF INTEREST REFERRAL VENDOR RELATIONSHIPS TREATMENT OF FAMILY MEMBERS SEXUAL RELATIONSHIP FATALITY REFERENCES 2

3. INTRODUCTION Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. Medical ethics refers “Chiefly to the rules of etiquette adopted by the medical profession to regulate professional conduct with each other , but also towards their individual patients and towards society, and includes considerations of the motives behind that conduct. The practice of medicine is rooted in a covenant of trust among patients, healthcare professionals, and society. The ethics of medicine must seek to balance the healthcare professionals responsibility to each patient and the professional, collective obligation to all who need medical care. 3

4. BASIC RIGHTS AND ETHICAL DUTIES Human Rights Access to health care Right to non-discrimination Right to privacy and confidentiality Right to environment that is not harmful to health or well being. NEED FOR MEDICAL ETHICS- The practice of medicine and the practice of ethics are inseparable. Every clinical decision invokes an ethical decision as well. In many instances, the ethical issue may not be readily apparent. In others conflicts arise between ethical principles and medical decisions, which require the clinician to be well versed with the former in order to guide the latter. 4

5. VALUES IN MEDICAL ETHICS Six of the values that commonly apply to medical ethics discussions are:- Autonomy- The patient has the right to refuse or choose their treatment. Beneficence- A practitioner should act in the best interest of the patient. Non-maleficence- ”First, do not harm”. Justice(Fairness and equality)- Concerns the distribution of scarce health resources, and the decision of who gets what treatment. Dignity- The patient(and the person treating the patient)have right to dignity. Truthfulness and honesty- The concept of informed consent has increased in importance since the historical events of the doctors’ Trial of the Nuremburg trials and Tuskegee Syphilis study. 5

6. VALUES IN MEDICAL ETHICS Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community( i.e , the hospital and its staff)conflict with the values of the individual patient , family, or larger non-medical community. Conflicts can also arise between health care provides, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era. 6

7. IMPORTANCE OF COMMUNICATION Many so-called “ethical conflicts” in medical ethics are traceable back to a lack of communication. Communication breakdowns between patients and their healthcare team, between family members, or between members of medical community, can all lead to disagreements and strong feelings. These breakdown should be remedied, and many apparently insurmountable “ethics” problems can be solved with open lines of communication. 7

8. CONTROL AND RESOLUTION To ensure that appropriate ethical values are being applied within hospitals, effective hospital accreditation requires that ethical considerations are taken into account, for example with respect to physician integrity, conflicts of interest, research ethics and organ transplantation ethics. 8

9. GUIDELINES There are various ethical guidelines. For example, the Declaration of Helsinki is regarded as authoritative in human research ethics. In the United Kingdom, General Medical Council provides clear overall modern guidance in the form of it’s ‘Good Medical Practice’ statement. Other organizations, such as the Medical protection society and a number of university departments, are often consulted by British doctors regarding issues relating to ethics. 9

10. ETHICS COMMITTEES Often, simple communication is not enough to resolve a conflict, and hospital ethics committee must convene to decide a complex matter. These bodies are composed primarily of health care professionals, but may also include philosophers, lay people, and clergy-indeed, in many parts of the world their presence is considered mandatory in order to provide balance. U.S. recommendations suggest that Research and Ethical Boards (REBs0 should have five or more members, including at least one scientist, one non-scientist, and one person not affiliated with the institution. The REB should include people knowledgeable in the law and standards of practice and professional conduct. Special memberships are advocated for handicapped or disabled concerns, if required by the protocol under review. 10

11. ETHICAL CODES Hippocrates Oath-5 th century BC Nuremberg Code-1948 Declaration of Geneva-1948 Universal Declaration of Human Rights-1948 Helsinki Declaration-1964 International Code of Medical ethics Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulations,2002 . 11

12. CULTURAL CONCERNS Culture differences can create difficult medical ethics problems. Some cultures have spirited or magical theories about the origins of disease, for example, and reconciling these beliefs with the tenets of Western medicine can be difficult. Multicultural concerns cover a broad range of topics and identities including race, religion, ethnicity, culture, sexual orientation, and/or disability. People from different cultural groups may be negatively stereotyped or heavily discriminated against because of their differences from a main culture. 12

13. TRUTH-TELLING Some cultures do not place a great emphasis on informing the patient of the diagnosis, especially when cancer is the diagnosis. Even American culture did not emphasize truth-telling in a cancer case, up until the 1970s. In American medicine, the principle of informed consent takes precedence over ethical values, and patients are usually at least asked whether they want to know the diagnosis. 13

14. ONLINE BUSINESS PRACTICES Research which utilizes the internet to collect information through an online tool and studies about how people use the internet, e.g , through collecting data and/or examining any online environment; and/or, uses of online datasets, databases, or repositories. Being mobile-friendly is key. Directly connect a patient to the provider. Mill ennials do everything online-appointment booking. Online medical center. Collection of health-care providers from one community grouped together into one website. Plastic surgery , medical equipment, dental, family practitioners and home-care providers. 14

15. CONFLICTS OF INTEREST Physicians should not allow a conflict of interest to influence medical judgment. In some cases, conflicts are hard to avoid, and doctors have a responsibility to avoid entering such situations. Unfortunately, research has shown that conflicts of interests are very common among both academic physicians and physicians in practice. Patients and the public benefit when physicians and researchers collaborate with pharmaceutical ,medical device, and biotechnology companies to develop products that benefit individual and public health. At the same time, concerns are growing that wide-ranging financial ties to industry may unduly influence professional judgments involving the primary interests and goals of medicine. Such conflicts of interest threaten the integrity of scientific investigations, the quality of patient care, and the public’s trust in medicine. 15

16. REFERRAL For example, doctors who receive income from referring patients for medical tests have been shown to refer more patients for medical tests. This practice is proscribed by the American College of Physicians Ethics Manual. Fee splitting and the payments of commissions to attract referrals of patients is considered unethical and unacceptable in most parts of the world. 16

17. VENDOR RELATIONSHIPS Studies show that doctors can be influenced by drug company inducements, including gifts and food. Industry-sponsored continuing medical education (CME) programs influence prescribing patterns. Many patients surveyed in one study agreed that physician gifts from drug companies influence prescribing practices. A growing movement among physicians is attempting to diminish the influence of pharmaceutical industry marketing upon medical practice, as evidenced by Stanford University’s ban on drug company-sponsored lunches and gifts. Other academic institutions that have banned pharmaceutical industry-sponsored gifts and food include the Johns Hopkins Medical Institutions, University of Michigan, University of Pennsylvania, and Yale University. 17

18. TREATMENT OF FAMILY MEMBERS The American Medical Association (AMA) states that “Physicians generally should not treat themselves or members of their immediate family”. This code seeks to protect patients and physicians because professional objective can be compromised when the physicians is treating a loved one. Studies from multiple health organizations have illustrated that physician-famil y member relationships may cause an increase in diagnostic testing and costs. Many doctors still treat their family members. Doctors who do so must be vigilant not to create conflicts of interest or treat inappropriately. Physicians that treat family members need to be conscious of conflicting expectations and dilemmas when treating relatives, as established medical ethical principles may not be morally imperative when family members are confronted with serious illness. 18

19. SEXUAL RELATIONSHIP Sexual relationship between doctors and patients can create ethical conflicts, since sexual consent may conflict with the fiduciary responsibility of the physician. Out of the many disciplines in current medicine, there are studies that have been conducted in order to ascertain the occurrence of Doctor-Patient sexual misconduct. Results from those studies appear to indicate that certain disciplines are more likely to be offenders than others. Psychiatrists and Obstetrician-Gynecologists for example, are two disciplines noted for having a higher rate of sexual misconduct. The violation of ethical conduct between doctors and patients also has an association with the age and sex of doctor and patient. In the early 1990s it was estimated that 2-9% of doctors had violated this rule. 19

20. FUTILITY The concept of medical futility has been an important topic in discussions of medical ethics. What should be done if there is no chance that a patient will survive but the family members insist on advanced care? Previously, some articles defined fut ility as the patient having less that a one percent chance of surviving. Some of these cases win d up in the courts. Advanced directives include living wills and durable powers of attorney for health care. “Substituted judgment” is the concept that a family member can give consent for treatment if the patient is unable(unwilling) to give consent himself. 20

21. FUTILITY In some hospitals, medical futility is referred to as treatment unable to benefit the patient. An important part of practicing good medical ethics is by attempting to avoid futility by practicing non-maleficence. What should be don e if there is no chance that a patient will survive or benefit from a potential treatment but the family members insist on advanced care? 21

22. REFERENCES Research methodology and biostatistics- D r. Vinod k umar , page no.196-201. Ethical issues in cross-cultural research-Suzanne Batten and Anne Marshall. Research gate. Medical errors; Moral and ethical considerations-Wilfred Bonney, Journal of Hospital Administration, 2014, Vol.3, page no.2. Manual of Medical Ethics-World Medical Association(2009) MCI ethical guidelines-2002 M.D Loewy, H Erich “Textbook of MEDICAL ETHICS” Springer Science. 22

23. THANKYOU BE PATIENT WITH PATIENTS WHO ARE NOT PATIENT 23