Medical ethics

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Medical ethics

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Medical ethics

  1. 1. MEDICAL ETHICS WE TOO NEED ONE DAY ??? Dr.T.V.Rao MDDR.T.V.RAO MD 1
  2. 2. A HISTORY OF ETHICS PRINCIPLES460-377 B.C Hippocrates of Cos1792 Percival: Manchester Infirmary Committee1803 Percival: Medical Ethics: A Code of Ethics and Institutes Adopted to the Professions of Physic and Surgery1808 Boston Medical Society (self-regulation)1847 AMA: “Code of Ethics”1903 AMA: “Principles of Medical Ethics”1912 AMA: revised “Principles”1957 AMA: concise “Principles”, “Opinions”1980 AMA: FTC-imposed Principles revision1981 AAPS: “Principles of Medical Ethics”1980s-1990s ACP Code, and many others DR.T.V.RAO MD 22001 AMA: revised “Principles”
  3. 3. WHAT ARE MEDICAL ETHICS• 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.DR.T.V.RAO MD 3
  4. 4. Why Should doctors have to swear an oath when they qualify? The Hippocratic Oath.docModern Hippocratic Oath.docTo save self and Others tooDR.T.V.RAO MD 4
  5. 5. PATENTS ARE DEMANDING UNLIKE PAST- FOLLOW ETHICS• Patients are entitled to good standards of practice and care from their doctors .Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligationsDR.T.V.RAO MD 5
  6. 6. DEFINITION OF MEDICAL ETHICS• 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 professional’s responsibility to each patient and the professional, collective obligation to all who need medical care.DR.T.V.RAO MD 6
  7. 7. BASIC RIGHTS AND ETHICAL DUTIES• Human Rights Human Dignity• Access to health care• Right to non-discrimination• Right to privacy and confidentiality• Right to environment that is not harmful to health or well beingDR.T.V.RAO MD7
  8. 8. PRINCIPLES OF MEDICAL ETHICSThe good of the patient is paramount • TRUST must be nurtured before all else • Avoid conflicts of interest (COI) • Avoid perception of COI • Respect rights of patient • safeguard confidentiality • respect self-determination • communicate honestly with all • maintain competence
  9. 9. TYPES OF ETHICS• Medical Ethics: Clinical obligations • fidelity first to patients’ interests • telling the truth (cancer, errors)• Professional Ethics: Obligations of the profession • self-regulation • education of self and others• Bioethics: Guides for public policy • gene technology, stem cell research • health system reform
  10. 10. WHAT IS THE 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. DR.T.V.RAO MD 10
  11. 11. ETHICAL PRINCIPLES• Autonomy: Respect for an individual’s autonomy or ability to make decisions for him/herself • includes respect for their privacy and confidentiality • need to provide sufficient information for them to make informed choices • truth telling • protection of persons with diminished or impaired autonomy. DR.T.V.RAO MD 11
  12. 12. ETHICAL PRINCIPLES• Justice: This refers to the need to treat all people equally and fairly• Society uses a variety of factors as a criteria for distributive justice, including the following: • to each person an equal share • to each person according to need • to each person according to effort • to each person according to contribution • to each person according to merit • to each person according to free-market exchanges• We should strive to provide some decent minimum level of health care for all citizens, regardless of ability to pay DR.T.V.RAO MD 12
  13. 13. ETHICAL PRINCIPLES• Beneficence: This refers to the tradition of acting always in the patients’ best interest to maximise benefits and minimise harm.• Non-malfeasance: This principle ensures that treatment or research ought not to produce harm • Negligence • Misconduct DR.T.V.RAO MD 13
  14. 14. ETHICAL VS. LEGAL OBLIGATIONS• Medical ethics and the law are not the same, but often help define each other• Breach of ethical obligation may not necessarily mean breach of law• Breach of ethical obligation may be used to prove medical malpractice or medical negligence DR.T.V.RAO MD 14
  15. 15. MICRO LEVEL ETHICAL PRINCIPLES• I. Respect for Autonomy (or Person)• Respect the decisions of autonomous persons and protect persons who lack decision-making capacity (e.g., confused patients, mentally ill).• Recognize the capacity of mentally and legally competent patients : • To think and make decisions independently • To act on the basis of their decisions • To communicate their wishes to health workers• Uphold patient confidentiality DR.T.V.RAO MD 15
  16. 16. ETHICAL PRINCIPLES• II. Non-Maleficence (Not inflicting harm)• Health professionals should not inflict harm on patients• III. Beneficence• Act in the best interests of patients or research participants.• Contribute to patient welfare – help patients further health interests DR.T.V.RAO MD 16
  17. 17. HEALTHCARE PROFESSIONAL ROLE• Paternalistic model • Emphasizes health and well-being (beneficence) over respect for autonomy and patient choice • Patient is selectively given information• Evolution of newer decision-making models • Independent choice vs. enhanced autonomy • Paternalistic vs. informative vs. interpretive vs. deliberative DR.T.V.RAO MD 17
  18. 18. LEARNING ABOUT ETHICAL ISSUES REQUIRES….• An understanding of the issue-the science and knowledge base• An understanding of ethical frameworks and principles-not just case studies and anecdotes• An understanding of one’s own values• Ability to think through the issue-logic and argument• Recognition of uncertainty-limits to knowledge DR.T.V.RAO MD 18
  19. 19. WE ARE CONFUSED MANY TIMES ABOUT TRUTH ???• Should doctors always tell patients their diagnosis? • What about uncertainty in diagnosis? Is it right to make patients share this? • Is it ever right to suppress diagnoses – what about stigmatising diagnoses, e.g. MS, dementia, HIV, psychiatric diagnoses? • What if relatives ask doctors not to disclose diagnoses to patients? DR.T.V.RAO MD 19
  20. 20. INFORMED CONSENT• Definition: A patient’s willing acceptance of a medical intervention after adequate disclosure from their MD of the nature of the intervention, risks, benefits and alternative treatment options• What constitutes informed consent? • Disclosure: information to allow reasonable person to make a decision • Understanding: comprehension of the information given • Voluntary: no coercion or incentive to accept or deny a treatment • Agreement: verbal or written (preferred) to discussed intervention • Many are screening patients for HIV without informed consent ? • Many are doing sex determination in fetus even it is prohibited ??? DR.T.V.RAO MD 20
  21. 21. THE RELATION BETWEEN LAW AND ETHICS• Ethical values have often been influenced by and influenced legal doctrine and legal principles are closely related to ethical principles.• Ethical obligations exceed legal duties• Law serves to demarcate the limits of individual autonomy in the interests of society. It also protects the rights of individuals DR.T.V.RAO MD 21
  22. 22. KNOWLEDGE CREATES CONFLICT SO THE DOCTORS FIGHT • In much wisdom is much grief :and he that increaseth knowledge increaseth sorrows” (Ecclesiastics 1,18)DR.T.V.RAO MD 22
  23. 23. MEDICAL ETHICS CREATE BETTER PHYSICIANS Medical Ethics Virtues Good of the patient Excellent physicianbiological-medical good self-understood good
  24. 24. PRACTICE GOOD PRACTICES YOU WILL FLOURISH Ethics Virtues Values Flourishing lifeBasic template for professions:– identify distinguishing characteristic– rank virtues for particular profession– define professional excellence
  25. 25. WHAT IS YOUR CHOICE MAKES DIFFERENCE ??? • Medicine is about : “Can we?” • Ethics is about: “Should we?”DR.T.V.RAO MD 25
  26. 26. PRACTICING ETHICS IS EXPENSIVE ?????DR.T.V.RAO MD 26
  27. 27. SOLUTIONS TO ETHICAL PROBLEMS• Not simple• Ethics not like science• Is ethics arbitrary? Or• Can we discover an ethic for medicine?DR.T.V.RAO MD 27
  28. 28. • Programme created by Dr.T.V.Rao MD for Medial Professionals with Major resources from American Medical association who constantly thrive to improve the standards in Medical Profession to benefit the patients • Email • doctortvrao@gmail.comDR.T.V.RAO MD 28

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