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Medical ethics
Medical ethics
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  2. 2.  Introduction  Importance of Medical Ethics  Principles of Medical Ethics  Ethical Codes  Medical Negligence  Liabilty  Acts Contribute to Negligence  Ingredients of Medical Negligence  Misconduct  Duties & Responsiblities of Physicians in general  Duties of Physicians to their patient  Duties of Physicians in consultation  Responsibilities to each other  Punishment & Disciplinary Action
  3. 3.  Ethics is concerned with moral principles,values and standards of conduct.(WHO)  Ethics is the study of morality “careful and systematic reflection on and analysis of moral decisions and behavior”. In simple words, Ethics is a set of philosophical beliefs and practices concerned with the distinction between right and wrong.  Medical Ethics is the branch of ethics that deals with moral issues in medical practices.  Medical ethics is closely related to, but not identical to, bioethics.
  4. 4.  Whereas medical ethics focuses primarily on issues arising out of the practice of medicine,bioethics is a very broad subject that is concerned with the moral issues by developments in the biological sciences more generally.  In recent times, medical ethics has been greatly influenced by developments in human rights.
  5. 5.  Ethical principles such as respect for person, informed consent and confidentiality are basic to the physician-patient relationship.  The study of ethics prepares medical professionals to recognize difficult situations and to deal with them in a rational and principled manner.  Ethics is also important in physicians interactions with society and their colleagues and for the conduct of medical research.
  7. 7.  Patient has freedom of thought,intention and action when making decisions regarding health care procedures.  For a patient to make a fully informed decision,she/he must understand all risks and benefits of the procedure and the likelihood of success.
  8. 8.  The practitioner should act in “the best interest” of the patient – the procedure be provided with the intent of doing good to the patient.  Patient’s welfare is the first consideration.
  9. 9.  Based on loyality and trust.  Maintain the confidentiality of all personal,medical and treatment information.  Introduction to be revealed for the benefit of the patient and when ethically and legally required.
  10. 10.  “Above all,do not harm”.  Make sure that the procedure doesnot harm the patient or others in society.  When interventions undertaken by physicians create a positive outcome while also potentially doing harm it is known as “DOUBLE EFFECT”  Eg.. The use of morphine in the dying patient, eases pain and suffering while hastening the demise through suppression of the respiratory drive.
  11. 11.  Fair and equal distribution of scarce health resources and the decision of who gets what treatment.  The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society.
  12. 12.  Hippocratic Oath – 5th century BC  Nuremberg Code – 1948  Declaration of Geneva – 1948  Universal Declaration of Human Rights – 1948  Helsinki Declaratiom – 1964  International Code of Medical ethics  Indian Medical Council Regulations,2002
  13. 13.  One of the earliest document in medical ethics – 5th century BC.  Traditionally all doctors recite this oath at swearing in.It is considered sacred for its religious foundation and sancity.
  14. 14.  Voluntary informed consent  Likelihood of some good resulting  Based on prior research  Avoidance of physical or psychological injury or harm  Benefits should outweigh risks  Right to withdraw consent  Research must stop if harm is resulting
  15. 15.  The Nuremberg Code is set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trial at the end of the Second World War
  16. 16.  Adopted at World Medical Association General Assembly in 1948.  Amended in 1968,1984,1994,2005 and 2006.  Declaration of physician’s dedication to the humanitarian goals of medicine.
  17. 17.  Set of ethical principles regarding human experimentation developed by the World Medical Association in 1964.  Undergone 6 revisions since then.Last revision in 2008.  More specifically addressed clinical research,reflecting changes in medical practice from the term “HUMAN EXPERIMENTATION” used in the Nuremberg Code.
  18. 18.  “The well-being of the human subject should take precedence over the interests of science and society”.  Consent should be in writing.  Use caution if participant is in dependent relationship with researcher.  Limit use of placebo.  Participants benefits from research.
  19. 19.  Given by World Medical Association  The code applies both in peace and war  It codifies the duties of physician in general,duties to patients and colleagues
  20. 20.  The Medical Council of India notified the “Indian Medical Council Regulations,2002” on 11 March 2002.  Last amended in 2010.
  21. 21. DEFINITION:  It is the failure to execute  Reasonable degree of skill and care  Or wilful negligence of a medical practitioner which causes some harm or bodily injury or death to the patient  It is the act or omission in treatment of a patient by a medical professional,which deviates from the accepted medical
  22. 22.  “No doctors knows everything.There’s reason why it’s called “practising medicine”.(ANONYMOUS)  “In my opinion,our health care system has failed when a doctor fails to treat an illness that is possible.”(KEVIN ALAN LEE)  “The important question isn’t how to keep bad physicians from harming patient;it’s how to keep good physicians from harming patients.(ATUL GAWANDE)
  23. 23. The liabilty of the person committing the wrong can be of three types depending on the harm or the injury suffered by the injured person they are:  CIVIL LIABILITY: Civil liabilty usually includes the claim for damages suffered in the form of compensation. If there is any breach of duty of care while operating or while the patient is under the supervision of the hospital or the medical professional they are held to be vicariously liable for such wrong committed.  CRIMINAL LIABILTY: There may be an occasion when the patient has died after the treatment and criminal case is filed under Section 304A of the Indian Penal Code for allegedly causing death by rash or negligent act.
  24. 24.  Further,In Dr. Suresh Gupta’s Case – Supreme Court of India,2004 – the court held that the legal position was quite clear and well settled that whenever a patient died due to medical negligence,the doctor was liable in civil law for paying the compensation.Only when the negligence was so gross and his act was as reckless as to endanger the life of the patient,criminal law for offence under section 304A of Indian Penal Code,1860 will apply. Indian Penal Code 1860 sections 52,80,81,83,88,90,91,92 304A,337 and 338 contain the law of medical malpractice in India.
  25. 25.  The conduct of medical malpractice was brought under the Consumer Protection Act,1986,due to the landmark case of the Indian Medical Association vs. V.P. Shantha & others.The judgement in this case defined medical care as a “service” that was covered under the Act,and also clarified that a person seeking medical attention may be considered a consumer if certain criteria were met.  The service provided was not free of charge or for a nominal registration fee;  If free,charges were waived because of the patient’s inability to pay;
  26. 26.  It is not stated that doctors are negligent or irresponsible but while performing the duty which requires a lot of patience and care, often many practitioners fail or breaches their responsibility towards the patient.  Medicine which is one of the noblest professions requires setting a realm which can benefit the victims of various diseases.  Many doctors even the specialist sometimes neglects small things to be taken care of while practicing which may result in damages to the patients that could have been avoided or sometimes even the death of the patient.
  27. 27.  This type of professional negligence needs more focus than to include it in other laws or statutes. An independent and unique legislature shall be set up to govern the malpractice.In our country recently in a case Krishna Iyer v.State of Tamilnadu and Others the Apex Court awarded a compensation of 1.8 crores on july 1,2015 as she lost her eyes in 1996. This is highest amount of compensation awarded in the country.Many activists and the victims of medical negligence have been alleging to get redressal against malafied acts of medical practitioners and doctors.
  28. 28.  Operation on a wrong patient on a wrong part  Loss of hand due to prolonged splinting  Forgotten instruments  Mismatch transfusion  Improper administration of medicines  Performing the wrong or inappropriate type of surgery  Not giving proper medical advice  Leaving any object in the body of the patient such as sponge or bandage,etc.after surgery
  29. 29.  ACT OF COMMISSION(doing something wrong)  ACT OF OMISSION(failing to do the right thing)
  30. 30.  4D’s • Duty of care • Dereliction of duty of care • Direct causation • Damage
  31. 31.  Violation of regulations  Adultery or improper conduct  Conviction in court of law  Sex determination test  Signing false professional certificates,reports and other documents
  32. 32.  CHARACTER OF PHYSICIAN:  Uphold dignity and honour of his profession.  Render service to humanity.  Person with recognized qualification can only practice modern system of medicine.  MAINTAINING GOOD MEDICAL PRACTICE:  Render service to humanity with full respect for the dignity of profession and man.  Display of registration numbers.  Use of Generic names of drugs.
  33. 33.  MAINTENANCE OF MEDICAL RECORDS:  Maintain the medical records pertaining to his/her indoor patients for a period of 3 years.  Records to be given within 72 hours.  Maintain a register of medical certificates giving full details of certificates issued.  Highest Quality Assurance in patient care.  Explosure of Unethical Conduct.
  34. 34.  OBLIGATIONS TO THE SICK: • Always respond to the cells of the sick. • Ailment not within range of experience he can refuse treatment & refer.  PATIENCE,DELICACY & SECRECY: • Patience and delicacy should characterize the physician. • Secrecy of patients to be maintained except when required by laws of the state and no protect healthy individuals.  PROGNOSIS: • Neither exaggerate or minimize gravity of patient’s condition.
  35. 35.  DO NOT NEGLECT THE PATIENT: • Physician free to choose. • Once undertaken should not neglect the case. • Respond to request in emergency.
  36. 36.  AVOID UN-NECESSARY CONSULTATION: • Consulting pathologist,radiologist or asking for lab investigation should be done judiciously.  Consultation for patient benefit  Statement to patient after consultation  Treatment after consultation  Punctuality in consultation  Patient reffered to specialist  Fees and other charges
  37. 37.  Consultant not to take the charge of the case  APPOINTMENT OF THE SUBSTITUTE: • Only when he has the capacity to discharge the additional responsibility along with his/her other duties.  VISITING ANOTHER PHYSICIAN’S CASE: • Avoid remarks upon the diagnosis or the treatment that has been adopted.
  38. 38.  Complaint is first heard by appropriate medical council.  During the enquiry the full opportunity is given to registered medical practitioner to be heard in person or by pleader.  The decision has to be taken within 6 months.  Appropriate medical council gives decision according to the case.  Complaints heard by Medical Council of India(MCI)-as an apex body.
  39. 39.  The punishment given by the appropriate medical council or MCI includes: • Warning • Reprimand – official action • Cancellation of registration  Temporary- for specific period of time  Permanent