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Ethics for Ophth. Residents 2

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Ethics for Ophth. Residents 2

  1. 1. -‫رتبه‬‫نخست‬‫چهارمین‬‫المپیاد‬‫دانشجویان‬‫علوم‬‫پزشکی‬ ،‫کشور‬‫حیطه‬‫اخالق‬،‫پزشکی‬‫شهریور‬1391 -‫مجری‬‫راند‬‫دانشجویی‬‫اخالق‬،‫پزشکی‬‫مرکز‬‫رشد‬ ‫استعدادهای‬‫درخشان‬‫دانشگاه‬‫علوم‬‫پزشکی‬،‫تهران‬1391 ‫تا‬1393 -‫تدوین‬‫پرسشنامه‬‫بومی‬‫ارزیابی‬‫حساسیت‬‫اخالقی‬‫دان‬‫شجویان‬ ‫پزشکی‬‫در‬،‫ایران‬1392(‫پایان‬‫نامه‬‫دوره‬‫پزشکی‬ ‫عمومی‬)
  2. 2. • Rules of Ethics: They are mandatory and descriptive standards of minimally-acceptable professional conduct.
  3. 3. • Pretreatment Assessment: Treatment shall be recommended only after a careful consideration of the patient's physical, social, emotional and occupational needs. The ophthalmologist must evaluate the patient and assure that the evaluation accurately documents the ophthalmic findings and the indications for treatment. Recommendation of unnecessary treatment or withholding of necessary treatment is unethical.
  4. 4. • Procedures and Materials: Ophthalmologists should order only those laboratory procedures, optical devices or pharmacological agents that are in the best interest of the patient. Ordering unnecessary procedures or materials or withholding necessary procedures or materials is unethical.
  5. 5. • Commercial Relationships: An ophthalmologist's clinical judgment and practice must not be affected by economic interest in, commitment to, or benefit from professionally-related commercial enterprises.
  6. 6. • Conflict of Interest: A conflict of interest exists when professional judgment concerning the well-being of the patient has a reasonable chance of being influenced by other interests of the provider. • Confidentiality: An ophthalmologist shall respect the confidential physician-patient relationship and safeguard confidential information consistent with the law.
  7. 7. ETHICAL DECISION MAKING • Gather the medical, social, and all other relevant facts of the case. • Identify all relevant values including but not limited to those of the patient, family and physician, nurse, other health care professionals, the health care institution, and society. Determine the values in conflict. • Propose possible solutions to resolve the conflict. • Choose the better solutions for the particular case, justify, them, and respond to possible criticisms.
  8. 8. DOES A PATIENT HAVE A RIGHT TO BE TOLD WHICH SURGEON IS PERFORMING THE SURGERY?
  9. 9. • The ophthalmology department at University Hospital has an extensive residency program. In order to complete the program, residents must perform various surgical procedures, so that they will develop the skills they need to be competent ophthalmologists. However, patients are not always told when a resident is performing the surgery as first surgeon, because the faculty believe that patients might object and possibly refuse the surgery. Besides, faculty are always present either as first surgeon or as assistant during the operations to ensure that the patient's welfare is promoted and protected.
  10. 10. • One day a new patient, S.R., complaining of “flashing lights and floaters” presents to the hospital's clinic and is discovered to have a macula-threatening retinal detachment. When she is scheduled for scleral buckling surgery she asks Dr. A., the faculty member who examined her, whether he will be performing the procedure. “I know this is a university hospital, and that sometimes the students do the operations,” she tells him. • “I will be there for you,” he responds, knowing that a second-year resident may actually be performing the surgery as first surgeon.
  11. 11. • (1) Yes, the physician should tell the patient who may be performing surgery. Whose eye is it, anyway? • (2) No, the physician should not tell the patient who the primary surgeon may be. The specific activities in the operating room are too complex to explain in great detail to the patient, and it would only upset the patient if the attempt to explain were made. • (3) It would not be wrong if the physician told the patient, but the physician is not morally obligated to do so. Patients do not need to know the particulars of who is performing surgery. • (4) It depends on the circumstances.
  12. 12. In order to practice the general principles of standards, the ophthalmologist ought : (1) to ensure that the patients are treated with dignity, honesty and integrity, and act in the best interests of the patient at all times (2) to ensure that ophthalmic care is the highest quality possible (3) to be a responsible member of their professional community by maintaining standards, avoiding conduct that would bring the community and its members into dispute
  13. 13. (4) to be conscious of and observe the ethical, legal and scientific criteria for medical research (5) to ensure that communications to the public reflect their social responsibilities (6) to ensure that fees for ophthalmological services do not exploit patients or others who pay for the services, that economic and non-economic conflicts of interest do not interfere with the delivery of the highest quality care; and that the advertising should reflect information and not commercial criteria.
  14. 14. Being technically competent and respecting patients' rights are necessary but not sufficient conditions of being a good ophthalmologist. Developing the professional virtues of kindness, compassion, and a sense of justice, among others, also plays an important role in the moral life of the professional.
  15. 15. Case Two • IS THERE A RIGHT TO UNNECESSARY SURGERY?
  16. 16. • D.M. is a 73-year-old woman who has been blind for 12 years. She lives with her 54-year-old daughter, and although she is able to manage her affairs, Ms. M. has not accepted her handicap. The patient has glaucoma and advanced cataracts, which brings her to her ophthalmologist, Dr. B. Ms. M. has heard of advances in ophthalmology, such as lens implantation, same-day surgery, and small incisions leaving minimal scarring, and she would very much like to try them. However, tests reveal extensive optic nerve damage, which indicate that there is no possibility of visual improvement. For this reason, Dr. B. does not recommend surgery, and instead suggests Ms. M. consider a rehabilitation program.
  17. 17. • Nevertheless, Ms. M. wants to have surgery. She can pay for the procedure and claims, “These are my eyes, and I have a right to surgery.” Because the patient is already blind, Dr. B. recognizes that there is little risk in a surgical intervention. • Should Dr. B. perform the procedure?
  18. 18. Thank You Who wants to watch a short animation?

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