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AbdulazizAlkaabba

Heath Ethics in Private Sectors it is for Health care providers who works in private sectors

Health & Medicine
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Health Ethics in Private Sector ‫الخاص‬ ‫القطاع‬ ‫في‬ ‫العمل‬ ‫أخالقيات‬ ( ‫التوفيق‬ ‫هللا‬ ‫نسأل‬ ‫للجميع‬ ‫هدية‬ ‫المحاضرات‬ ‫هذه‬ ) Dr EZIZ ALFAHD afkaabba@gmail.com
‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫قال‬ ‫وسلم‬ ( ( ‫األخالق‬ ‫مكارم‬ ‫ألتمم‬ ‫بعثت‬ ‫إنما‬ ( ‫القيامة‬ ‫يوم‬ ‫مجلسا‬ ‫مني‬ ‫وأقربكم‬ ‫إلي‬ ‫أحبكم‬ ‫إن‬ ‫أخالقا‬ ‫أحاسنكم‬ ) ( ‫من‬ ‫القيامة‬ ‫يوم‬ ‫المؤمن‬ ‫ميزان‬ ‫في‬ ‫أثقل‬ ‫شئ‬ ‫مامن‬ ‫حسن‬ ‫خلق‬ ) ( ‫خلقا‬ ‫أحسنهم‬ ‫هللا‬ ‫الى‬ ‫هللا‬ ‫عباد‬ ‫أحب‬ ) ( ‫أخالقا‬ ‫احاسنكم‬ ‫خياركم‬ ‫أن‬ )
10 Important Ethical Issues in Private Health Care Services  Acceptance of patients to their services ?  Health insurance ?  Financial Ethical issues between providers ?  Patients and Family rights ?  Health care providers professionalism ?  Maintaining confidentiality ?  Why patients need private Sectors ?  Ethical Issues During Medical Consultation ?  Ethical Issues Related to other Medical Services ?  Emergency Cases ?
4 INTRODUCTION ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬ BASIC INFORMMATION
What is professional behavior? Professionalism …… ‫المهنية‬  Appropriate behaviours and actions within the context of medical practice and training and bioethics and culture
Professionalism Professionalism  It is a collection of behaviours that include multiple dimensions of the clinical context. It involves relation of the physician with hir/her oneself, relation with colleagues in the workplace, relation with the patients, and relation with the community.
How Are You Judged As A Professional? – Your Communication and Relations – Your Image and Appearance – Your Competence – Your characters – Your Appearance – Your Behavior – Your Attitude – Your commitment 7
( ‫للعالمين‬ ‫رحمة‬ ‫إال‬ ‫أرسلناك‬ ‫وما‬ ) We have sent you not but as a Mercy for the Worlds 1-Religion; 2-Mind; 3-Soul (self); 4- Wealth; & 5- Progeny.
‫المبادئ‬ ‫مدرسة‬ Principlism  ‫اإلنسان‬ ‫ذاتية‬ ‫احترام‬ Respect for autonomy  ‫اإليذاء‬ ‫عدم‬ ( ‫المفاسد‬ ‫درء‬ ) Non-maleficence  ‫الخير‬ ‫عمل‬ ( ‫المنفعة‬ ‫جلب‬ ) Beneficence  ‫والفوائ‬ ‫الفرص‬ ‫توزيع‬ ‫في‬ ‫الناس‬ ‫بين‬ ‫العدالة‬ ‫د‬ ‫والمخاطر‬ Justice
‫وأنظمتها‬ ‫المهنة‬ ‫أخالقيات‬ ‫أخالقيات‬ ‫المهنة‬ (code of Ethics ) : ‫هي‬ ‫توجيهات‬ ‫مستمدة‬ ‫من‬ ‫القيم‬ ‫والمبادئ‬ ‫تعنى‬ ‫بكيفية‬ ‫التصر‬ ‫ف‬ ‫الالئق‬ ‫أثناء‬ ‫ممارسة‬ ‫األنشطة‬ ‫المهنية‬ ‫المختلفة‬ . Are guidelines derived from values and principles intended for the appropriate behavior while practicing various professional activates ‫أما‬ ‫أنظمة‬ ‫المهنة‬ (code of conduct ) : ‫فهي‬ ‫مجموعة‬ ‫من‬ ‫القواعد‬ ‫والتشريعات‬ ‫التي‬ ‫تنظم‬ ‫عمل‬ ‫الممارسين‬ ‫للمهنة‬ ‫ويترتب‬ ‫على‬ ‫انتهاكها‬ ‫عقوبات‬ ، ‫فهي‬ ‫نوع‬ ‫من‬ ‫القوانين‬ . Are set of rules and legislations that regulate the work of practitioners ,the violation of which imposes consequent penalties they are kind of law.
11 Health Ethics in Private Sector -A- Introduction
“ Are we supporting our patients ??
Before we start …. Is our patients our priorities ? Patient Doctor Lab./X- ray Social worker Nurse Manager Educator Doctors Are NOT the focus of the healthcare
Our Duties Towards Patients  Respect for Patient ‫المريض‬ ‫احترام‬  Respect for Privacy ‫المريض‬ ‫خصوصية‬ ‫ضمان‬  Comprehensive care ‫للمريض‬ ‫الشاملة‬ ‫الرعاية‬  Respect for patient’s autonomy ‫المريض‬ ‫استقاللية‬ ‫احترام‬  Inform the patient about his/her condition  ‫لزم‬ ‫اذا‬ ‫وذويه‬ ‫وتثقيفه‬ ‫مرضه‬ ‫بطبيعة‬ ‫المريض‬ ‫تبصير‬  Protect patient's interests ‫المريض‬ ‫مصلحة‬ ‫حماية‬  Keep the patients’ secrets ‫المريض‬ ‫سر‬ ‫كتمان‬ Source: Islamic Code of Medical & Health Ethics
Privacy vs. Confidentiality Privacy  About people  Sense of being in control of access that others have to ourselves  A Right to be Protected  Respect patient Body Confidentiality  Extension of privacy  About identifiable data  Agreement about maintenance and who has access to identifiable data  protects patients from inappropriate disclosures of ( Health Information)
-when ‫األسرار‬ ‫تفشى‬ ‫متى‬ ‫؟‬ Patients care ‫المريض‬ ‫رعاية‬ ‫غرض‬ Teaching purpose ‫التعليم‬ ‫لغرض‬ Medical Research ‫العلمي‬ ‫البحث‬ ‫لغرض‬ Medical Fitness ‫الطبية‬ ‫اللياقة‬ For patients Family ‫العائلة‬ ‫ألفراد‬
“ Are we supporting our patients ??
20 Health Ethics in Private Sector B - Ethical Issues during Clinical Consultation
ETHICS DURING CONSULTATION as Example of Patient Rights - ‫تجنب‬ ‫التعالي‬ ‫على‬ ‫المريض‬ ‫مهما‬ ‫كان‬ ‫مستواه‬ ‫العلمي‬ ‫أو‬ ‫االجت‬ ‫ماعي‬ . ‫حسن‬ ‫االستقبال‬ ‫والتبسم‬ ‫واحترام‬ ‫الكبير‬ ‫ورحمة‬ ‫الصغير‬ - To avoid sense of arrogance and superiority, or down look upon, mock or ridicule the patient irrespective of his educational or social status .
During consultation - ‫المساواة‬ ‫في‬ ‫المعاملة‬ ‫بين‬ ‫جميع‬ ‫المرضى‬ ‫وعدم‬ ‫التفر‬ ‫يق‬ ‫بينهم‬ ‫في‬ ‫الرعاية‬ ‫الطبية‬ ‫بسبب‬ ‫تباين‬ ‫مراكزهم‬ ‫ا‬ ‫لعلميه‬ ‫والعملية‬ ‫االجتماعية‬ ‫أو‬ ‫شعوره‬ ‫الشخصي‬ ‫نحوهم‬ . - equality of treatment for all patients avoiding distinction in medical care by reason of variation of their literal or social statuses or due to personal feelings against them.
‫المرض‬ ‫تاريخ‬ ‫أخذ‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (HISTORY( ‫من‬ ‫واجب‬ ‫الطبيب‬ ‫نحو‬ ‫مريضه‬ ‫حسن‬ ‫معاملته‬ ‫في‬ ‫كل‬ ‫األحوال‬ , ‫ويشمل‬ ‫ذلك‬ ‫األمور‬ ‫التالية‬ : ‫معاناته‬ ‫وفهم‬ ‫المريض‬ ‫لشكوى‬ ‫االستماع‬ ‫حسن‬ . The careful lessening of patient’s complaint and understanding his suffering.
‫المرض‬ ‫تاريخ‬ ‫أخذ‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (HISTORY( - ‫احترام‬ ‫وجهة‬ ‫نظر‬ ‫المريض‬ , ‫خاصة‬ ‫في‬ ‫األمور‬ ‫التي‬ ‫تتعلق‬ ‫ب‬ ‫ه‬ ‫شخصيا‬ ‫وال‬ ‫يمنع‬ ‫ذلك‬ ‫من‬ ‫توجيه‬ ‫المريض‬ ‫التوجيه‬ ‫المن‬ ‫اسب‬ . - to respect patient’s point of view especially in respect of personal matters, but that does not mean to properly direct or advice him.
‫عليه‬ ‫الطبي‬ ‫الفحص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (physical examination) - ‫الرفق‬ ‫بالمريض‬ ‫عند‬ ‫الفحص‬ ‫وأخذ‬ ‫أذن‬ ‫ه‬ ، ‫وعدم‬ ‫الفحص‬ ‫على‬ ‫مناطق‬ ‫في‬ ‫جسمه‬ ‫لي‬ ‫س‬ ‫لها‬ ‫حاجة‬ ‫للفحص‬ ‫عليها‬ . - to gently conduct medical examination on the patient, take his permission and explain what you will do .
(physical examination) - ‫أخذ‬ ‫اذن‬ ‫المريض‬ ‫قبل‬ ‫الكشف‬ ‫عليه‬ ‫وشرح‬ ‫تفاصيل‬ ‫الك‬ ‫شف‬ ‫وماذا‬ ‫سوف‬ ‫يعمل‬ ‫الطبيب‬ ‫أثناء‬ ‫الكشف‬ . - ‫عدم‬ ‫ارتكاب‬ ‫مخالفة‬ ‫شرعية‬ ‫مثل‬ ‫الخلوة‬ ‫باألجنبيات‬ ‫أو‬ ‫ال‬ ‫كشف‬ ‫عن‬ ‫العورات‬ ‫الخاصة‬ ‫بالمريض‬ ‫أو‬ ‫المريضة‬ ‫اال‬ ‫عند‬ ‫وجود‬ ‫محرم‬ ‫أو‬ ‫ممرض‬ . To refrain from commission of violations contrary to Shari a rules of teachings, such as seclusion with female foreigners or patient, or uncovering intimate or private parts or other organs as a pretext of a professional procedure during medical examination.
‫والتشخيصية‬ ‫الطبية‬ ‫الفحوصات‬ ‫طلب‬ (Investigation) - ‫إجراء‬ ‫الفحوصات‬ ‫الطبية‬ ‫الالزمة‬ ‫فقط‬ ‫للمريض‬ . - ‫وعدم‬ ‫إضافة‬ ‫فحوصات‬ ‫ال‬ ‫تطلبها‬ ‫حالته‬ ‫الصحية‬ . To perform or request only the necessary medical or laboratory tests which the patient’s condition requires, without requesting any additional unnecessary tests.
(Investigation) - ‫االمتناع‬ ‫عن‬ ‫أي‬ ‫ممارسات‬ ‫قد‬ ‫تضر‬ ‫بالمريض‬ ‫مثل‬ ‫استخد‬ ‫ام‬ ‫طرق‬ ‫تشخيصية‬ ‫أو‬ ‫عالجية‬ ‫غير‬ ‫متعارف‬ ‫عليها‬ ‫أو‬ ‫معتر‬ ‫ف‬ ‫بها‬ ‫علميا‬ . - to refrain from any such practices that may harm the patient as usage of uncommonly known diagnostic or therapeutic methods, or which are scientifically unrecognized.
‫التشخيص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Diagnosis) - ‫و‬ ‫عمليا‬ ‫تشخيصا‬ ‫مريضه‬ ‫يشخص‬ ‫أن‬ ‫الطبيب‬ ‫على‬ ‫يجب‬ ‫وأن‬ ‫دقيقا‬ ‫ومرض‬ ‫تشخيصه‬ ‫المريض‬ ‫يتفهم‬ ‫لكي‬ ‫ذلك‬ ‫للمريض‬ ‫يشرح‬ ‫وال‬ ‫ه‬ ‫نادره‬ ‫حاالت‬ ‫في‬ ‫اال‬ ‫التشخيص‬ ‫المريض‬ ‫على‬ ‫يخفي‬ . Physician should tell the patients about his case and diagnosis and there Disease
‫التشخيص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Diagnosis) - ‫تحري‬ ‫الصدق‬ ‫في‬ ‫إخبار‬ ‫المريض‬ ‫أو‬ ‫من‬ ‫ينوب‬ ‫عن‬ ‫ه‬ ‫بالحالة‬ ‫المرضية‬ ‫وأسبابها‬ ‫ومضاعفاتها‬ , ‫وفائد‬ ‫ة‬ ‫االجراءات‬ ‫التشخيصية‬ ‫والعالجية‬ , ‫وتعريفهم‬ ‫ب‬ ‫البدائل‬ ‫المناسبة‬ ‫للتشخيص‬ ‫أو‬ ‫للعالج‬ ‫بأسلوب‬ ‫واضح‬ . 2-To be honest by informing the patient or his guardian about the actual condition of his disease, the causes of such disease, complications, and the benefits of diagnostic or therapeutic procedures.
‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Treatment) - ‫االقتصار‬ ‫في‬ ‫وصف‬ ‫الدواء‬ ‫أوالعالج‬ ‫أو‬ ‫إجراء‬ ‫العمليات‬ ‫الجراحية‬ ‫على‬ ‫ما‬ ‫تتط‬ ‫لبه‬ ‫حالة‬ ‫المريض‬ ‫فقط‬ . - To prescribe only the medicine, or perform the surgical operation which the patient’s condition requires only.
‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Treatment, Education) - ‫تثقيف‬ ‫المريض‬ ‫عن‬ ‫مرضه‬ ‫خصوصا‬ ‫وصحته‬ ‫عموما‬ , ‫ووقاي‬ ‫ته‬ ‫من‬ ‫األمراض‬ ‫بالطرق‬ ‫المناسبة‬ ‫والفعالة‬ , ‫ومن‬ ‫أهمها‬ ‫التثقيف‬ ‫المب‬ ‫اشر‬ ‫وجها‬ ‫لوجه‬ ‫أو‬ ‫استخدام‬ ‫الوسائل‬ ‫الفعالة‬ ‫األخرى‬ ‫متى‬ ‫توفرت‬ ‫له‬ . - To educate the patient about his disease, and about his health condition in general, explaining the appropriate and effective ways by which he could preserve his health and protect himself against diseases.
‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Treatment) ‫تخفيف‬ ‫آالم‬ ‫المريض‬ ‫بكل‬ ‫ما‬ ‫يستطيعه‬ ‫وما‬ ‫يتاح‬ ‫له‬ ‫من‬ ‫وسائ‬ ‫ل‬ ‫عالجية‬ ‫نفسية‬ ‫ومادية‬ , ‫وإشعار‬ ‫المريض‬ ‫بحرصه‬ ‫على‬ ‫العناية‬ ‫به‬ ‫ور‬ ‫عايته‬ . - Try to do the best to relieve the patient’s sufferings using all possible psychological, social and medical thereby causing the patient to be in good concern.
‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Treatment) - ‫بم‬ ‫المتعلقة‬ ‫الشرعية‬ ‫المخالفات‬ ‫بعض‬ ‫منه‬ ‫لوحظ‬ ‫إذا‬ ‫المريض‬ ‫نصح‬ ‫من‬ ‫رضه‬ ‫يك‬ ‫أن‬ ‫قبل‬ ‫مسلمة‬ ‫هي‬ ‫الطبيبة‬ ‫أو‬ ‫مسلم‬ ‫هو‬ ‫الطبيب‬ ‫ألن‬ ‫الطبيب‬ ‫قبل‬ ‫طبيب‬ ‫ون‬ ‫طبيبة‬ ‫تكون‬ ‫أو‬ (. ‫والكحول‬ ‫االدمان‬ ) Educate your patient about his disease and any other issues related to his life related to his disease
‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫االستمرار‬ ‫في‬ ‫تقديم‬ ‫الرعاية‬ ‫الطبية‬ ‫المناسبة‬ ‫للمر‬ ‫ضى‬ ‫المصابين‬ ‫بأمراض‬ ‫غير‬ ‫قابلة‬ ‫للعالج‬ ‫أو‬ ‫مستعصي‬ ‫ة‬ ‫أو‬ ‫مميتة‬ ‫حتى‬ ‫في‬ ‫اللحظات‬ ‫األخيرة‬ ‫من‬ ‫حياتهم‬ . - to continue providing the appropriate medical care for those patients suffering from chronic untreatable, or incurable, or even fatal (terminal) diseases, until the last moments of their lives.
‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫التأكد‬ ‫من‬ ‫أن‬ ‫المريض‬ ‫يتلقى‬ ‫العناية‬ ‫الطبي‬ ‫ة‬ ‫الالزمة‬ ‫أثناء‬ ‫غياب‬ ‫الطبيب‬ . 2 - to make sure that the patient receives the necessary medical care during the absence of the physician.
‫إحالته‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Patient Referral) - ‫إحالة‬ ‫المريض‬ ‫إلى‬ ‫طبيب‬ ‫مختص‬ ‫بنوع‬ ‫مرضه‬ ‫أو‬ ‫إلى‬ ‫طبيب‬ ‫لديه‬ ‫وس‬ ‫ائل‬ ‫أكثر‬ ‫فعالية‬ ‫إذا‬ ‫استدعت‬ ‫حالة‬ ‫المريض‬ ‫ذلك‬ , ‫وال‬ ‫يجوز‬ ‫للطبيب‬ ‫أن‬ ‫ي‬ ‫تباطأ‬ ‫في‬ ‫اإلحالة‬ ‫متى‬ ‫ما‬ ‫كان‬ ‫ذلك‬ ‫في‬ ‫مصلحة‬ ‫المريض‬ . - to refer the patient to the physician specialized in the type of his disease, or to the physician who has more advanced and effective means if the condition of the patient so requires.
‫إحالته‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Patient Referral) - ‫عند‬ ‫رغبة‬ ‫المريض‬ ‫في‬ ‫استشارة‬ ‫طبيب‬ ‫آخر‬ ( ‫فيما‬ ‫يخص‬ ‫مرضه‬ ) , ‫فعلى‬ ‫الطبيب‬ ‫أال‬ ‫يمتنع‬ ‫عن‬ ‫تحقيق‬ ‫رغبة‬ ‫المري‬ ‫ض‬ , ‫وأن‬ ‫يسهل‬ ‫على‬ ‫المريض‬ ‫الحصول‬ ‫على‬ ‫التقارير‬ ‫والمعلومات‬ ‫ال‬ ‫الزمة‬ ‫لذلك‬ . - when a patient wishes to consult another physician (in respect of the condition of his disease), the physician should not refuse Patient Right.
‫الطبية‬ ‫للتقارير‬ ‫طلبه‬ ‫عند‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Medical Report) - ‫إدراك‬ ‫أن‬ ‫للمريض‬ ‫الحق‬ ‫في‬ ‫أن‬ ‫يغير‬ ‫طبيبه‬ , ‫وأن‬ ‫ل‬ ‫ه‬ ‫الحق‬ ‫في‬ ‫الحصول‬ ‫على‬ ‫المعلومات‬ ‫المدونة‬ ‫بسجل‬ ‫ه‬ ‫الطبي‬ ‫أو‬ ‫الحصول‬ ‫على‬ ‫التقرير‬ ‫الطبي‬ ‫الالزم‬ ‫ا‬ ‫لذي‬ ‫يشرح‬ ‫حالته‬ ‫المرضية‬ . - to realize the fact that the patient is entitled for the right of consulting another physician, and also for the right of obtaining the recorded information in his medical record or the necessary medical report describing the condition of his disease.
‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫االستمرار‬ ‫في‬ ‫تقديم‬ ‫العالج‬ ‫الالزم‬ ‫للمريض‬ ‫في‬ ‫الح‬ ‫االت‬ ‫اإلسعافية‬ ‫حتى‬ ‫تزول‬ ‫الحاجة‬ ‫إليه‬ ‫أو‬ ‫حتى‬ ‫تنتقل‬ ‫ر‬ ‫عايته‬ ‫إلى‬ ‫طبيب‬ ‫كفء‬ . - (in emergency unit) to continuously provide the necessary treatment for emergency cases until necessary emergency medical aid from his part until the patient is referred to the care of another specialized physician.
44 Health Ethics in Private Sector -C- Financial
Outline and Introduction Examples of financial issues in clinical practice in private sectors: A- Healthcare Practitioner’s Fee B- Practicing in Private Sector C- Advertisements and Publicity D- Participation in the Media E- Gifts and Benefits F- Relationships with Pharmaceutical and Medical Equipment Companies G- Other issues 
Brainstorming…  Is it okay for doctor s to: – Think about money? – Talk about money? – Work for money?
We deal with money in Health practice We get paid (fees/salary and other payments) More than one practice Participation in advertisements Paid media appearances We may receive gifts
Legal guidance on doctor ’s Financial fees  Article 10 of the Law of Practicing Healthcare Professions states that, “A healthcare professional is prohibited from advertising or promoting himself, directly or indirectly, except in cases provided for in the Implementing Regulations.”  The concept of the ‘fee of the similar’ (‫المثل‬ ‫)أجرة‬ represents the fees that would have been paid to a similar doctor with similar qualifications in the same conditions.
(A) Healthcare Practitioner’s Fee 1- The doctor is allowed to take fair fees (determined by the responsible authority or by following ongoing customs . 2- It is not permissible to exaggerate in the set fees, or abuse the patient’s condition to achieve material or moral benefit. 3- It is not permissible to coerce the patient to obtain additional money on top of the fees for him or for someone else.
(A) Healthcare Practitioner’s Fee 4- It is not permissible to expose the patient to investigations or medical procedures without a clear medical indication. ‫فقط‬ ‫التكسب‬ ‫اجل‬ ‫من‬ ‫يحتاجها‬ ‫ال‬ ‫فحوصات‬ ‫عمل‬ ‫المريض‬ ‫على‬ ‫التعرض‬ 5- Doctors are prohibited to take or give financial when referring a patient to somewhere else, or for prescribing medications or medical equipment or others. ‫المرضى‬ ‫تحويل‬ ‫على‬ ‫عمولة‬ ‫اخذ‬ ‫الطبيب‬ ‫على‬ ‫يمنع‬ 6- The doctor should disclose to the institution any financial or commercial relations that the doctor or his family members have with the institution(s) . ‫تجاريه‬ ‫عالقة‬ ‫أي‬ ‫عن‬ ‫االفصاح‬ ‫الطبيب‬ ‫على‬ ‫المعدات‬ ‫أو‬ ‫االدوية‬ ‫بشركات‬ ‫اسرته‬ ‫الفراد‬ ‫أو‬ ‫له‬
(B) Practicing in Private Sector the doctor should not under any circumstance give priority to his personal interests, financially or socially, above the interests of the patient. The patient or the (walk-in) visitors should be informed about the estimated fees for the healthcare before initiating the provision of service.
(C) Participation in the Media When talking to the media the doctor should: 1- Refrain ( ‫عن‬ ‫اإلمتناع‬ ) from advertising himself or his working place. 2- Tell his professional status or scientific degree along with his area of medical specialization. 3- Refrain ‫عن‬ ‫اإلمتناع‬ ) ) from praising his expertise and achievements 4- Be considerate of the responsibility to provide medical information that is professionally authentic and acceptable.
Gifts and Benefits Is it OK for doctor s to accept gifts?
Gifts and Benefits  A Health care providers GIFT is :  anything that could be given to the doctor from individuals or ( companies )enterprises or others on top of his pre- determined fees (salary) at his work place, with the intention of achieving unjustified benefits.  These benefits include but are not limited to: – financial payments . – Free Travel and trip for conferences . – Any-kind of benefits . – morale like obtaining services, facilities, hospitality, food, training services, loans, or compensation, etc.
Gifts and Benefits  Individuals’ gifts 1- Any form of bribe should not be taken or given in any form, regardless whether they were cheap or expensive. 2- Any form of expensive in-kind gifts should not be accepted. Inexpensive gifts ( if it is not personally ) that people usually exchange among themselves as an expression of passion and cordiality can be accepted, ( if it will be not affect his or her decisions like: – Pens – Scientific books – Medical journals – Simple food
Gifts and Benefits  Corporate gifts ( Should be officially only through your Institution ). 1- It is not permissible personally for Health care providers to accept or give bribes 2- It is not permissible for the doctor to accept gifts, loans, equipment, instruments, or cash from the commercial companies for whatever justification. 3- Medical Institutions can accept educational grants and financial support to attend training courses, conferences, or other activities of public interests.
57 Health Ethics in Private Sector -D- Special Ethical
Conditions for Practicing in Private Sector If the system permits the doctor to work in the private sector, in addition to his work in the public sector, the following should be observed: 1- his work in the private sector does not affect his governmental work. 2- This work should be officially through his original work . 3- his work in the public sector should NOT be used as means/bridge to his private work
Conditions for Practicing in Private Sector If the system permits the doctor to work in the private sector, in addition to his work in the public sector, the following should be observed: 4- When referring a patient from the private sector to the governmental (public) health facility for which the doctor works; the doctor should not discriminate this patient from other patients in terms of appointments, or provision of care. 5- patients Rights should be always priorities .
Thank You

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Heath Ethics in Private Sectors.ppt

  • 1. Health Ethics in Private Sector ‫الخاص‬ ‫القطاع‬ ‫في‬ ‫العمل‬ ‫أخالقيات‬ ( ‫التوفيق‬ ‫هللا‬ ‫نسأل‬ ‫للجميع‬ ‫هدية‬ ‫المحاضرات‬ ‫هذه‬ ) Dr EZIZ ALFAHD afkaabba@gmail.com
  • 2. ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫هللا‬ ‫رسول‬ ‫قال‬ ‫وسلم‬ ( ( ‫األخالق‬ ‫مكارم‬ ‫ألتمم‬ ‫بعثت‬ ‫إنما‬ ( ‫القيامة‬ ‫يوم‬ ‫مجلسا‬ ‫مني‬ ‫وأقربكم‬ ‫إلي‬ ‫أحبكم‬ ‫إن‬ ‫أخالقا‬ ‫أحاسنكم‬ ) ( ‫من‬ ‫القيامة‬ ‫يوم‬ ‫المؤمن‬ ‫ميزان‬ ‫في‬ ‫أثقل‬ ‫شئ‬ ‫مامن‬ ‫حسن‬ ‫خلق‬ ) ( ‫خلقا‬ ‫أحسنهم‬ ‫هللا‬ ‫الى‬ ‫هللا‬ ‫عباد‬ ‫أحب‬ ) ( ‫أخالقا‬ ‫احاسنكم‬ ‫خياركم‬ ‫أن‬ )
  • 3. 10 Important Ethical Issues in Private Health Care Services  Acceptance of patients to their services ?  Health insurance ?  Financial Ethical issues between providers ?  Patients and Family rights ?  Health care providers professionalism ?  Maintaining confidentiality ?  Why patients need private Sectors ?  Ethical Issues During Medical Consultation ?  Ethical Issues Related to other Medical Services ?  Emergency Cases ?
  • 5. What is professional behavior? Professionalism …… ‫المهنية‬  Appropriate behaviours and actions within the context of medical practice and training and bioethics and culture
  • 6. Professionalism Professionalism  It is a collection of behaviours that include multiple dimensions of the clinical context. It involves relation of the physician with hir/her oneself, relation with colleagues in the workplace, relation with the patients, and relation with the community.
  • 7. How Are You Judged As A Professional? – Your Communication and Relations – Your Image and Appearance – Your Competence – Your characters – Your Appearance – Your Behavior – Your Attitude – Your commitment 7
  • 8. ( ‫للعالمين‬ ‫رحمة‬ ‫إال‬ ‫أرسلناك‬ ‫وما‬ ) We have sent you not but as a Mercy for the Worlds 1-Religion; 2-Mind; 3-Soul (self); 4- Wealth; & 5- Progeny.
  • 9. ‫المبادئ‬ ‫مدرسة‬ Principlism  ‫اإلنسان‬ ‫ذاتية‬ ‫احترام‬ Respect for autonomy  ‫اإليذاء‬ ‫عدم‬ ( ‫المفاسد‬ ‫درء‬ ) Non-maleficence  ‫الخير‬ ‫عمل‬ ( ‫المنفعة‬ ‫جلب‬ ) Beneficence  ‫والفوائ‬ ‫الفرص‬ ‫توزيع‬ ‫في‬ ‫الناس‬ ‫بين‬ ‫العدالة‬ ‫د‬ ‫والمخاطر‬ Justice
  • 10. ‫وأنظمتها‬ ‫المهنة‬ ‫أخالقيات‬ ‫أخالقيات‬ ‫المهنة‬ (code of Ethics ) : ‫هي‬ ‫توجيهات‬ ‫مستمدة‬ ‫من‬ ‫القيم‬ ‫والمبادئ‬ ‫تعنى‬ ‫بكيفية‬ ‫التصر‬ ‫ف‬ ‫الالئق‬ ‫أثناء‬ ‫ممارسة‬ ‫األنشطة‬ ‫المهنية‬ ‫المختلفة‬ . Are guidelines derived from values and principles intended for the appropriate behavior while practicing various professional activates ‫أما‬ ‫أنظمة‬ ‫المهنة‬ (code of conduct ) : ‫فهي‬ ‫مجموعة‬ ‫من‬ ‫القواعد‬ ‫والتشريعات‬ ‫التي‬ ‫تنظم‬ ‫عمل‬ ‫الممارسين‬ ‫للمهنة‬ ‫ويترتب‬ ‫على‬ ‫انتهاكها‬ ‫عقوبات‬ ، ‫فهي‬ ‫نوع‬ ‫من‬ ‫القوانين‬ . Are set of rules and legislations that regulate the work of practitioners ,the violation of which imposes consequent penalties they are kind of law.
  • 11. 11 Health Ethics in Private Sector -A- Introduction
  • 12. “ Are we supporting our patients ??
  • 13. Before we start …. Is our patients our priorities ? Patient Doctor Lab./X- ray Social worker Nurse Manager Educator Doctors Are NOT the focus of the healthcare
  • 14. Our Duties Towards Patients  Respect for Patient ‫المريض‬ ‫احترام‬  Respect for Privacy ‫المريض‬ ‫خصوصية‬ ‫ضمان‬  Comprehensive care ‫للمريض‬ ‫الشاملة‬ ‫الرعاية‬  Respect for patient’s autonomy ‫المريض‬ ‫استقاللية‬ ‫احترام‬  Inform the patient about his/her condition  ‫لزم‬ ‫اذا‬ ‫وذويه‬ ‫وتثقيفه‬ ‫مرضه‬ ‫بطبيعة‬ ‫المريض‬ ‫تبصير‬  Protect patient's interests ‫المريض‬ ‫مصلحة‬ ‫حماية‬  Keep the patients’ secrets ‫المريض‬ ‫سر‬ ‫كتمان‬ Source: Islamic Code of Medical & Health Ethics
  • 15.
  • 16.
  • 17. Privacy vs. Confidentiality Privacy  About people  Sense of being in control of access that others have to ourselves  A Right to be Protected  Respect patient Body Confidentiality  Extension of privacy  About identifiable data  Agreement about maintenance and who has access to identifiable data  protects patients from inappropriate disclosures of ( Health Information)
  • 18. -when ‫األسرار‬ ‫تفشى‬ ‫متى‬ ‫؟‬ Patients care ‫المريض‬ ‫رعاية‬ ‫غرض‬ Teaching purpose ‫التعليم‬ ‫لغرض‬ Medical Research ‫العلمي‬ ‫البحث‬ ‫لغرض‬ Medical Fitness ‫الطبية‬ ‫اللياقة‬ For patients Family ‫العائلة‬ ‫ألفراد‬
  • 19. “ Are we supporting our patients ??
  • 20. 20 Health Ethics in Private Sector B - Ethical Issues during Clinical Consultation
  • 21. ETHICS DURING CONSULTATION as Example of Patient Rights - ‫تجنب‬ ‫التعالي‬ ‫على‬ ‫المريض‬ ‫مهما‬ ‫كان‬ ‫مستواه‬ ‫العلمي‬ ‫أو‬ ‫االجت‬ ‫ماعي‬ . ‫حسن‬ ‫االستقبال‬ ‫والتبسم‬ ‫واحترام‬ ‫الكبير‬ ‫ورحمة‬ ‫الصغير‬ - To avoid sense of arrogance and superiority, or down look upon, mock or ridicule the patient irrespective of his educational or social status .
  • 23. ‫المرض‬ ‫تاريخ‬ ‫أخذ‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (HISTORY( ‫من‬ ‫واجب‬ ‫الطبيب‬ ‫نحو‬ ‫مريضه‬ ‫حسن‬ ‫معاملته‬ ‫في‬ ‫كل‬ ‫األحوال‬ , ‫ويشمل‬ ‫ذلك‬ ‫األمور‬ ‫التالية‬ : ‫معاناته‬ ‫وفهم‬ ‫المريض‬ ‫لشكوى‬ ‫االستماع‬ ‫حسن‬ . The careful lessening of patient’s complaint and understanding his suffering.
  • 24. ‫المرض‬ ‫تاريخ‬ ‫أخذ‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (HISTORY( - ‫احترام‬ ‫وجهة‬ ‫نظر‬ ‫المريض‬ , ‫خاصة‬ ‫في‬ ‫األمور‬ ‫التي‬ ‫تتعلق‬ ‫ب‬ ‫ه‬ ‫شخصيا‬ ‫وال‬ ‫يمنع‬ ‫ذلك‬ ‫من‬ ‫توجيه‬ ‫المريض‬ ‫التوجيه‬ ‫المن‬ ‫اسب‬ . - to respect patient’s point of view especially in respect of personal matters, but that does not mean to properly direct or advice him.
  • 25. ‫عليه‬ ‫الطبي‬ ‫الفحص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (physical examination) - ‫الرفق‬ ‫بالمريض‬ ‫عند‬ ‫الفحص‬ ‫وأخذ‬ ‫أذن‬ ‫ه‬ ، ‫وعدم‬ ‫الفحص‬ ‫على‬ ‫مناطق‬ ‫في‬ ‫جسمه‬ ‫لي‬ ‫س‬ ‫لها‬ ‫حاجة‬ ‫للفحص‬ ‫عليها‬ . - to gently conduct medical examination on the patient, take his permission and explain what you will do .
  • 26. (physical examination) - ‫أخذ‬ ‫اذن‬ ‫المريض‬ ‫قبل‬ ‫الكشف‬ ‫عليه‬ ‫وشرح‬ ‫تفاصيل‬ ‫الك‬ ‫شف‬ ‫وماذا‬ ‫سوف‬ ‫يعمل‬ ‫الطبيب‬ ‫أثناء‬ ‫الكشف‬ . - ‫عدم‬ ‫ارتكاب‬ ‫مخالفة‬ ‫شرعية‬ ‫مثل‬ ‫الخلوة‬ ‫باألجنبيات‬ ‫أو‬ ‫ال‬ ‫كشف‬ ‫عن‬ ‫العورات‬ ‫الخاصة‬ ‫بالمريض‬ ‫أو‬ ‫المريضة‬ ‫اال‬ ‫عند‬ ‫وجود‬ ‫محرم‬ ‫أو‬ ‫ممرض‬ . To refrain from commission of violations contrary to Shari a rules of teachings, such as seclusion with female foreigners or patient, or uncovering intimate or private parts or other organs as a pretext of a professional procedure during medical examination.
  • 27.
  • 28. ‫والتشخيصية‬ ‫الطبية‬ ‫الفحوصات‬ ‫طلب‬ (Investigation) - ‫إجراء‬ ‫الفحوصات‬ ‫الطبية‬ ‫الالزمة‬ ‫فقط‬ ‫للمريض‬ . - ‫وعدم‬ ‫إضافة‬ ‫فحوصات‬ ‫ال‬ ‫تطلبها‬ ‫حالته‬ ‫الصحية‬ . To perform or request only the necessary medical or laboratory tests which the patient’s condition requires, without requesting any additional unnecessary tests.
  • 30. ‫التشخيص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Diagnosis) - ‫و‬ ‫عمليا‬ ‫تشخيصا‬ ‫مريضه‬ ‫يشخص‬ ‫أن‬ ‫الطبيب‬ ‫على‬ ‫يجب‬ ‫وأن‬ ‫دقيقا‬ ‫ومرض‬ ‫تشخيصه‬ ‫المريض‬ ‫يتفهم‬ ‫لكي‬ ‫ذلك‬ ‫للمريض‬ ‫يشرح‬ ‫وال‬ ‫ه‬ ‫نادره‬ ‫حاالت‬ ‫في‬ ‫اال‬ ‫التشخيص‬ ‫المريض‬ ‫على‬ ‫يخفي‬ . Physician should tell the patients about his case and diagnosis and there Disease
  • 31. ‫التشخيص‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Diagnosis) - ‫تحري‬ ‫الصدق‬ ‫في‬ ‫إخبار‬ ‫المريض‬ ‫أو‬ ‫من‬ ‫ينوب‬ ‫عن‬ ‫ه‬ ‫بالحالة‬ ‫المرضية‬ ‫وأسبابها‬ ‫ومضاعفاتها‬ , ‫وفائد‬ ‫ة‬ ‫االجراءات‬ ‫التشخيصية‬ ‫والعالجية‬ , ‫وتعريفهم‬ ‫ب‬ ‫البدائل‬ ‫المناسبة‬ ‫للتشخيص‬ ‫أو‬ ‫للعالج‬ ‫بأسلوب‬ ‫واضح‬ . 2-To be honest by informing the patient or his guardian about the actual condition of his disease, the causes of such disease, complications, and the benefits of diagnostic or therapeutic procedures.
  • 32.
  • 33. ‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Treatment) - ‫االقتصار‬ ‫في‬ ‫وصف‬ ‫الدواء‬ ‫أوالعالج‬ ‫أو‬ ‫إجراء‬ ‫العمليات‬ ‫الجراحية‬ ‫على‬ ‫ما‬ ‫تتط‬ ‫لبه‬ ‫حالة‬ ‫المريض‬ ‫فقط‬ . - To prescribe only the medicine, or perform the surgical operation which the patient’s condition requires only.
  • 34. ‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Treatment, Education) - ‫تثقيف‬ ‫المريض‬ ‫عن‬ ‫مرضه‬ ‫خصوصا‬ ‫وصحته‬ ‫عموما‬ , ‫ووقاي‬ ‫ته‬ ‫من‬ ‫األمراض‬ ‫بالطرق‬ ‫المناسبة‬ ‫والفعالة‬ , ‫ومن‬ ‫أهمها‬ ‫التثقيف‬ ‫المب‬ ‫اشر‬ ‫وجها‬ ‫لوجه‬ ‫أو‬ ‫استخدام‬ ‫الوسائل‬ ‫الفعالة‬ ‫األخرى‬ ‫متى‬ ‫توفرت‬ ‫له‬ . - To educate the patient about his disease, and about his health condition in general, explaining the appropriate and effective ways by which he could preserve his health and protect himself against diseases.
  • 35. ‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Treatment) ‫تخفيف‬ ‫آالم‬ ‫المريض‬ ‫بكل‬ ‫ما‬ ‫يستطيعه‬ ‫وما‬ ‫يتاح‬ ‫له‬ ‫من‬ ‫وسائ‬ ‫ل‬ ‫عالجية‬ ‫نفسية‬ ‫ومادية‬ , ‫وإشعار‬ ‫المريض‬ ‫بحرصه‬ ‫على‬ ‫العناية‬ ‫به‬ ‫ور‬ ‫عايته‬ . - Try to do the best to relieve the patient’s sufferings using all possible psychological, social and medical thereby causing the patient to be in good concern.
  • 36. ‫العالج‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Treatment) - ‫بم‬ ‫المتعلقة‬ ‫الشرعية‬ ‫المخالفات‬ ‫بعض‬ ‫منه‬ ‫لوحظ‬ ‫إذا‬ ‫المريض‬ ‫نصح‬ ‫من‬ ‫رضه‬ ‫يك‬ ‫أن‬ ‫قبل‬ ‫مسلمة‬ ‫هي‬ ‫الطبيبة‬ ‫أو‬ ‫مسلم‬ ‫هو‬ ‫الطبيب‬ ‫ألن‬ ‫الطبيب‬ ‫قبل‬ ‫طبيب‬ ‫ون‬ ‫طبيبة‬ ‫تكون‬ ‫أو‬ (. ‫والكحول‬ ‫االدمان‬ ) Educate your patient about his disease and any other issues related to his life related to his disease
  • 37.
  • 38. ‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫االستمرار‬ ‫في‬ ‫تقديم‬ ‫الرعاية‬ ‫الطبية‬ ‫المناسبة‬ ‫للمر‬ ‫ضى‬ ‫المصابين‬ ‫بأمراض‬ ‫غير‬ ‫قابلة‬ ‫للعالج‬ ‫أو‬ ‫مستعصي‬ ‫ة‬ ‫أو‬ ‫مميتة‬ ‫حتى‬ ‫في‬ ‫اللحظات‬ ‫األخيرة‬ ‫من‬ ‫حياتهم‬ . - to continue providing the appropriate medical care for those patients suffering from chronic untreatable, or incurable, or even fatal (terminal) diseases, until the last moments of their lives.
  • 39. ‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫التأكد‬ ‫من‬ ‫أن‬ ‫المريض‬ ‫يتلقى‬ ‫العناية‬ ‫الطبي‬ ‫ة‬ ‫الالزمة‬ ‫أثناء‬ ‫غياب‬ ‫الطبيب‬ . 2 - to make sure that the patient receives the necessary medical care during the absence of the physician.
  • 40. ‫إحالته‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Patient Referral) - ‫إحالة‬ ‫المريض‬ ‫إلى‬ ‫طبيب‬ ‫مختص‬ ‫بنوع‬ ‫مرضه‬ ‫أو‬ ‫إلى‬ ‫طبيب‬ ‫لديه‬ ‫وس‬ ‫ائل‬ ‫أكثر‬ ‫فعالية‬ ‫إذا‬ ‫استدعت‬ ‫حالة‬ ‫المريض‬ ‫ذلك‬ , ‫وال‬ ‫يجوز‬ ‫للطبيب‬ ‫أن‬ ‫ي‬ ‫تباطأ‬ ‫في‬ ‫اإلحالة‬ ‫متى‬ ‫ما‬ ‫كان‬ ‫ذلك‬ ‫في‬ ‫مصلحة‬ ‫المريض‬ . - to refer the patient to the physician specialized in the type of his disease, or to the physician who has more advanced and effective means if the condition of the patient so requires.
  • 41. ‫إحالته‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Patient Referral) - ‫عند‬ ‫رغبة‬ ‫المريض‬ ‫في‬ ‫استشارة‬ ‫طبيب‬ ‫آخر‬ ( ‫فيما‬ ‫يخص‬ ‫مرضه‬ ) , ‫فعلى‬ ‫الطبيب‬ ‫أال‬ ‫يمتنع‬ ‫عن‬ ‫تحقيق‬ ‫رغبة‬ ‫المري‬ ‫ض‬ , ‫وأن‬ ‫يسهل‬ ‫على‬ ‫المريض‬ ‫الحصول‬ ‫على‬ ‫التقارير‬ ‫والمعلومات‬ ‫ال‬ ‫الزمة‬ ‫لذلك‬ . - when a patient wishes to consult another physician (in respect of the condition of his disease), the physician should not refuse Patient Right.
  • 42. ‫الطبية‬ ‫للتقارير‬ ‫طلبه‬ ‫عند‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ (Medical Report) - ‫إدراك‬ ‫أن‬ ‫للمريض‬ ‫الحق‬ ‫في‬ ‫أن‬ ‫يغير‬ ‫طبيبه‬ , ‫وأن‬ ‫ل‬ ‫ه‬ ‫الحق‬ ‫في‬ ‫الحصول‬ ‫على‬ ‫المعلومات‬ ‫المدونة‬ ‫بسجل‬ ‫ه‬ ‫الطبي‬ ‫أو‬ ‫الحصول‬ ‫على‬ ‫التقرير‬ ‫الطبي‬ ‫الالزم‬ ‫ا‬ ‫لذي‬ ‫يشرح‬ ‫حالته‬ ‫المرضية‬ . - to realize the fact that the patient is entitled for the right of consulting another physician, and also for the right of obtaining the recorded information in his medical record or the necessary medical report describing the condition of his disease.
  • 43. ‫حالته‬ ‫متابعة‬ ‫أثناء‬ ‫المريض‬ ‫معاملة‬ ‫حسن‬ : (Follow up) - ‫االستمرار‬ ‫في‬ ‫تقديم‬ ‫العالج‬ ‫الالزم‬ ‫للمريض‬ ‫في‬ ‫الح‬ ‫االت‬ ‫اإلسعافية‬ ‫حتى‬ ‫تزول‬ ‫الحاجة‬ ‫إليه‬ ‫أو‬ ‫حتى‬ ‫تنتقل‬ ‫ر‬ ‫عايته‬ ‫إلى‬ ‫طبيب‬ ‫كفء‬ . - (in emergency unit) to continuously provide the necessary treatment for emergency cases until necessary emergency medical aid from his part until the patient is referred to the care of another specialized physician.
  • 44. 44 Health Ethics in Private Sector -C- Financial
  • 45. Outline and Introduction Examples of financial issues in clinical practice in private sectors: A- Healthcare Practitioner’s Fee B- Practicing in Private Sector C- Advertisements and Publicity D- Participation in the Media E- Gifts and Benefits F- Relationships with Pharmaceutical and Medical Equipment Companies G- Other issues 
  • 46. Brainstorming…  Is it okay for doctor s to: – Think about money? – Talk about money? – Work for money?
  • 47. We deal with money in Health practice We get paid (fees/salary and other payments) More than one practice Participation in advertisements Paid media appearances We may receive gifts
  • 48. Legal guidance on doctor ’s Financial fees  Article 10 of the Law of Practicing Healthcare Professions states that, “A healthcare professional is prohibited from advertising or promoting himself, directly or indirectly, except in cases provided for in the Implementing Regulations.”  The concept of the ‘fee of the similar’ (‫المثل‬ ‫)أجرة‬ represents the fees that would have been paid to a similar doctor with similar qualifications in the same conditions.
  • 49. (A) Healthcare Practitioner’s Fee 1- The doctor is allowed to take fair fees (determined by the responsible authority or by following ongoing customs . 2- It is not permissible to exaggerate in the set fees, or abuse the patient’s condition to achieve material or moral benefit. 3- It is not permissible to coerce the patient to obtain additional money on top of the fees for him or for someone else.
  • 50. (A) Healthcare Practitioner’s Fee 4- It is not permissible to expose the patient to investigations or medical procedures without a clear medical indication. ‫فقط‬ ‫التكسب‬ ‫اجل‬ ‫من‬ ‫يحتاجها‬ ‫ال‬ ‫فحوصات‬ ‫عمل‬ ‫المريض‬ ‫على‬ ‫التعرض‬ 5- Doctors are prohibited to take or give financial when referring a patient to somewhere else, or for prescribing medications or medical equipment or others. ‫المرضى‬ ‫تحويل‬ ‫على‬ ‫عمولة‬ ‫اخذ‬ ‫الطبيب‬ ‫على‬ ‫يمنع‬ 6- The doctor should disclose to the institution any financial or commercial relations that the doctor or his family members have with the institution(s) . ‫تجاريه‬ ‫عالقة‬ ‫أي‬ ‫عن‬ ‫االفصاح‬ ‫الطبيب‬ ‫على‬ ‫المعدات‬ ‫أو‬ ‫االدوية‬ ‫بشركات‬ ‫اسرته‬ ‫الفراد‬ ‫أو‬ ‫له‬
  • 51. (B) Practicing in Private Sector the doctor should not under any circumstance give priority to his personal interests, financially or socially, above the interests of the patient. The patient or the (walk-in) visitors should be informed about the estimated fees for the healthcare before initiating the provision of service.
  • 52. (C) Participation in the Media When talking to the media the doctor should: 1- Refrain ( ‫عن‬ ‫اإلمتناع‬ ) from advertising himself or his working place. 2- Tell his professional status or scientific degree along with his area of medical specialization. 3- Refrain ‫عن‬ ‫اإلمتناع‬ ) ) from praising his expertise and achievements 4- Be considerate of the responsibility to provide medical information that is professionally authentic and acceptable.
  • 53. Gifts and Benefits Is it OK for doctor s to accept gifts?
  • 54. Gifts and Benefits  A Health care providers GIFT is :  anything that could be given to the doctor from individuals or ( companies )enterprises or others on top of his pre- determined fees (salary) at his work place, with the intention of achieving unjustified benefits.  These benefits include but are not limited to: – financial payments . – Free Travel and trip for conferences . – Any-kind of benefits . – morale like obtaining services, facilities, hospitality, food, training services, loans, or compensation, etc.
  • 55. Gifts and Benefits  Individuals’ gifts 1- Any form of bribe should not be taken or given in any form, regardless whether they were cheap or expensive. 2- Any form of expensive in-kind gifts should not be accepted. Inexpensive gifts ( if it is not personally ) that people usually exchange among themselves as an expression of passion and cordiality can be accepted, ( if it will be not affect his or her decisions like: – Pens – Scientific books – Medical journals – Simple food
  • 56. Gifts and Benefits  Corporate gifts ( Should be officially only through your Institution ). 1- It is not permissible personally for Health care providers to accept or give bribes 2- It is not permissible for the doctor to accept gifts, loans, equipment, instruments, or cash from the commercial companies for whatever justification. 3- Medical Institutions can accept educational grants and financial support to attend training courses, conferences, or other activities of public interests.
  • 57. 57 Health Ethics in Private Sector -D- Special Ethical
  • 58. Conditions for Practicing in Private Sector If the system permits the doctor to work in the private sector, in addition to his work in the public sector, the following should be observed: 1- his work in the private sector does not affect his governmental work. 2- This work should be officially through his original work . 3- his work in the public sector should NOT be used as means/bridge to his private work
  • 59. Conditions for Practicing in Private Sector If the system permits the doctor to work in the private sector, in addition to his work in the public sector, the following should be observed: 4- When referring a patient from the private sector to the governmental (public) health facility for which the doctor works; the doctor should not discriminate this patient from other patients in terms of appointments, or provision of care. 5- patients Rights should be always priorities .