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Ethics and Medico-legal issues in
Critical care
Dr Saurabh Debnath
What is Ethics
• Ethics is the study of how one ought to
behave.
• In contrast, the law defines how one must
behave to avo...
Medical Ethics
Relationship between :
• healthcare practitioners and patients
• in-between healthcare practitioners
• heal...
Ethical framework
• Autonomy : right to self determination
• Beneficence : “doing good”
• Nonmaleficence : “primum non noc...
Ethical conflicts in Critical Care
Commonly it is the end-product of
…………….“clash of values”
End of Life management
• Critical care : progress in capacity and
capability
• Greater demand for resources
• Life support systems : “stalemate s...
• Life is valuable : offset when it is brief, painful
and non-interactive
• Death when imminent : deferment at any cost
se...
• The “collective” has a Ethical right to choose
access to “therapy”
• The Intensivist doesn’t have Ethical right to
unila...
• Dying in discomfort
• Receiving unwanted unhelpful therapy
• Dying with lack of dignity
• Patient wishes are commonly un...
Practical considerations
• Burden vs Benefit
• Based on “probability” than “certainty”
• Decision making is an evolving pr...
Advance directives
• Not common
• Legal standing is variable
• Self determination : considerable Ethical
validity
• Warran...
Euthanasia
• Active termination of life
• Usually at the request of a patient
• Terminal / Debilitating / Incurable illnes...
Informed Consent
• Treatment and Research
• General consent
• Procedure / Investigation / Therapy
• Principle of Autonomy
...
Rationing
• Removed from bedside
• Treatment must not be withdrawn or withheld
because there is a “more deserving” patient...
Professionalism
• Unique, usually a privileged position
• Well covered “Code of Conduct”
• Hippocratic oath
• Maintenance ...
Industry and Conflict of Interest
• Doctors vs Med Tech vs Pharmaceutical
• Complex interaction
• Interdependent
• Doctors...
Research
• Critically ill patients are rarely in a position to
consent
• But in a position to derive benefit from earlier
...
• Ethical conflicts most commonly arise when
there is a clash of values or interests
• Resolution is often difficult becau...
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Ethics and medico legal issues in icu

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Ethics and medico legal issues in icu

  1. 1. Ethics and Medico-legal issues in Critical care Dr Saurabh Debnath
  2. 2. What is Ethics • Ethics is the study of how one ought to behave. • In contrast, the law defines how one must behave to avoid punishment • Ethics is concerned with differentiating right from wrong behaviour • “Innate”
  3. 3. Medical Ethics Relationship between : • healthcare practitioners and patients • in-between healthcare practitioners • health care practitioners and society
  4. 4. Ethical framework • Autonomy : right to self determination • Beneficence : “doing good” • Nonmaleficence : “primum non nocere” • Fidelity : duties and obligations • Distributive justice : impartiality • Utility : most good for most • Confidentiality
  5. 5. Ethical conflicts in Critical Care Commonly it is the end-product of …………….“clash of values”
  6. 6. End of Life management
  7. 7. • Critical care : progress in capacity and capability • Greater demand for resources • Life support systems : “stalemate situation” • Not to confuse with : “financial exhaustion”
  8. 8. • Life is valuable : offset when it is brief, painful and non-interactive • Death when imminent : deferment at any cost seems inappropriate • Futile prolongation of life may challenge the rights of salvageable and in need
  9. 9. • The “collective” has a Ethical right to choose access to “therapy” • The Intensivist doesn’t have Ethical right to unilaterally select or withhold • Communication is the “key”
  10. 10. • Dying in discomfort • Receiving unwanted unhelpful therapy • Dying with lack of dignity • Patient wishes are commonly unknown • Variation of practice • Gradual treatment limitation
  11. 11. Practical considerations • Burden vs Benefit • Based on “probability” than “certainty” • Decision making is an evolving process • CollaborativeCommon desireConsensus • Nurses to participate in discussions • Withdraw treatment : not Care • Palliative plan
  12. 12. Advance directives • Not common • Legal standing is variable • Self determination : considerable Ethical validity • Warrants respect
  13. 13. Euthanasia • Active termination of life • Usually at the request of a patient • Terminal / Debilitating / Incurable illness • “Physician assisted suicide” • Legal in small number of countries • NOT LEGAL IN INDIA
  14. 14. Informed Consent • Treatment and Research • General consent • Procedure / Investigation / Therapy • Principle of Autonomy • Voluntary : free from coercion • Patient interest is paramount • Teaching consent • Waived for emergency
  15. 15. Rationing • Removed from bedside • Treatment must not be withdrawn or withheld because there is a “more deserving” patient but because it would always be withdrawn or withheld under the particular clinical circumstances
  16. 16. Professionalism • Unique, usually a privileged position • Well covered “Code of Conduct” • Hippocratic oath • Maintenance of competancy • Appropriate professional relationship • Respect for patient and staff confidentiality • Respect for the tenets of law
  17. 17. Industry and Conflict of Interest • Doctors vs Med Tech vs Pharmaceutical • Complex interaction • Interdependent • Doctors are entitled to fair consideration for their skills and effort • Overt and scrutinised • Diverse nature of rewards : direct and indirect
  18. 18. Research • Critically ill patients are rarely in a position to consent • But in a position to derive benefit from earlier research projects • Surrogate decision maker • “slippery slope” • Careful scrutiny
  19. 19. • Ethical conflicts most commonly arise when there is a clash of values or interests • Resolution is often difficult because of entrenched positions and convictions • Ethics committee has an important role in establishing framework
  20. 20. Thank you

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