2. objectives
■ What is the medical ethics ?
■ What are the principles of medical ethics ?
■ the which extent the medical ethics applied by physicians ?
■ What are the perplexing ethical problems that the physicians faced ?
■ What is the medical legal issues ?
■ How can you reflect on medical ethical issues ?
3. Medical ethics
■ Medical ethics is a system of
moral principles that apply
values to the practice of clinical
medicine and in scientific
research.
4. What are the principles of medical ethics ?
■ Autonomy: People have the right to control what happens to their bodies.
■ Beneficence: All healthcare providers must strive to improve their patient’s
health, to do the most good for the patient in every situation.
■ Nonmaleficence: “First, do no harm” is the bedrock of medical ethics. In
every situation, healthcare providers should avoid causing harm to their
patients.
■ Justice: The fourth principle demands that you should try to be as fair as
possible when offering treatments to patients and allocating scarce medical
resources.
6. What are the perplexing ethical problems
that the physicians faced ?
■ Withholding treatment to meet an organization's budget, or because of insurance policies;
■ Accepting money from pharmaceutical or device manufacturers;
■ Upcoding to get treatment covered;
■ Getting romantically involved with a patient or family member;
■ Covering up a mistake;
■ Cherry-picking patients;
■ Prescribing a placebo;
■ Practicing defensive medicine to avoid malpractice lawsuits;
■ Dropping insurers;
■ Breaching patient confidentiality owing to a health risk.
Upcoding is fraudulent
medical billing in which
a bill sent for a health
service is more
expensive than it should
have been based on the
service that was
performed.
7. Legal issues in medicine
■ The student should be in familiar with doctor environment and how
they dealing with these cases especially the police case.
■ And issues of taken consent before any intervention.
■ The student should be expand their knowledge about any situation
had legal issues and how should be the doctors dealing with these
case by asking the specialist who had more experience in these
problems.
8. What are the legal issues should be
the students reflect on ?
■ Reflect on police cases (e.g. RTA cases).
■ Reflect on local regulation of our medical institutions.
■ Reflect on our duties and responsibilities in medical institutions.
■ Reflect on issues of patient discharge.
■ Reflect on presence of doctors in the call and if they documentation their
action.
9. Reflection on medical ethics & legal issues
example:
■ 43 years old female patient come to the emergency department one day
ago with RTA and suffer from multiple trauma (chest, abdomen and pelvis
trauma),the patient was conscious but confused and disoriented doing the
ABC for the patient and found there is decrease air entry in the right side of
the chest so, doing chest tube in the right side that take off bloody
discharge during this time insert two wide pore cannula and given fluid then
doing head, chest and pelvic x-ray and abdominopelvic CT scan, the result
was fracture of the 4th,5th ribs in the left side of the chest and fracture of
bilateral ischial-pubic bone rami and there is splenic hematoma, open chart
for blood discharge from chest drain and for O2 saturation and blood
pressure and pulse rate and respiratory rate.
10. ■ In the second day the SOB increase, one of the doctor suspected happen
pulmonary embolism and prescribe heparin for the patient, so after some hours
later the O2 saturation of the patient decrease to 70% with disturb level of
consciousness and decrease the air entry in the left side and the patient was
undetected pulse periphery and cold extremities and become hypotensive
■ The anaestheologist resident was doing endotracheal intubation and doing
manual ventilation and recommend to transport the patient to RCU, the head of
the RCU refuse receive this patient due to there is no available bed, so, this make
the relative very angary, in spite of that one of the medical staff said in English
language “we dealing with dead case” but one of the relative for this patient
understand the English language and made him very angary.
■ Then after short time and provide bed for the patient, she was sent to the RCU
and the specialist come to the patient, he suspected there is hemothorax in the
left side and when doing chest tube immediately take off 1500 ml of collected
blood, this was because of given heparin and patient diagnosed with pulmonary
contusion rather than pulmonary embolism.
■ After doing the proper resuscitation and treatment the patient improved and the
patient become well and discharge after 8 day later .
11. ■ My reflections on the legal issue in this case is related to the medical error
when the resident prescribe inappropriate drug (heparin) according to own
diagnosis and should be counseling with specialist before doing any
decision in this critical case, I will be in the future more alerted and
counselling my decision for the critical cases with the specialist one in
order to decrease the medical error.
■ While my reflection on ethical issues related this case, is when the medical
staff said sensitive words in front of the relative even in English language,
should be always serve the patient for the last moment and respect him
and must be doing every things we can do for the patient, this our
responsibility and should be do it.
