The document discusses various ethical issues in adult and child neurology. It begins by defining ethics and clinical ethics. It then covers subdisciplines like biomedical ethics and neuroethics. It discusses ethical theories like consequentialism, deontology, and virtue ethics. It also discusses ethical principles like respect for autonomy, non-maleficence, beneficence, justice, and more. The document covers ethical issues like informed consent, privacy, conflicts of interest, medical errors, euthanasia, and more. It also discusses ethical considerations specifically in pediatric neurology.
Basic principles, interview style, various components and their significance, how to take history of present illness, past history,family and personal history, substance history, premorbid personality
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
Basic principles, interview style, various components and their significance, how to take history of present illness, past history,family and personal history, substance history, premorbid personality
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
Ethical issues in medicine and research:Special reference to IndiaJishnu Lalu
A detailed discussion on Ethical consideration concerning physician, patient, co-workers and research. It also discusses publication ethics and Ethics in India
Medical Ethics is what every physician and healthcare worker should know. We need to understand Ethics and its application in various cultures, societies and its changes according to norms and values. Once society will be given health education regarding Medical Ethics many issues can be resolved in a decent manner. It ultimately gives a very positive impression of all the actions which a healthcare worker performs otherwise at times seems inappropriate by society. This is not for the sake of healthcare worker or for the patients it is primarily for the whole community.
What are the rights of patient? role of ethical committee and parameters of a physician all need to be addressed properly.
Ethical Issues in Obtaining Informed Consent.pptxAhmed Mshari
Medical ethics is a set of moral principles, beliefs and values that guide decisions about patient care.
It is an integral part of good medical practice.
The health care professional uses knowledge, experience, and judgment and considers the ethical principles to make decisions on management recommendations.
CONCEPT OF NODOPATHIES AND PARANODOPATHIES.pptxNeurologyKota
emergence of autoimmune neuropathies and role of nodal and paranodal regions in their pathophysiology.
Peripheral neuropathies are traditionally categorized into demyelinating or axonal.
dysfunction at nodal/paranodal region key for better understanding of patients with immune mediated neuropathies.
antibodies targeting node and paranode of myelinated nerves have been increasingly detected in patients with immune mediated neuropathies.
have clinical phenotype similar common inflammatory neuropathies like Guillain Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy
they respond poorly to conventional first line immunotherapies like IVIG
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Entrapment Syndromes of Lower Limb.pptxNeurologyKota
This presentation contains information about the various Entrapment syndromes of Lower limb in descending order of topography. It also contains information about etiology, clinical features and management of each of these entrapment syndromes with special emphasis on electrodiagnostic confirmation.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. ETHICAL ISSUES IN ADULT
AND CHILD NEUROLOGY
Dr. Shubham Garg
SR Neurology
GMC Kota
2. INTRODUCTION
• Ethics is the study of actions taken by moral
agents, to determine if they are good
(praiseworthy) or bad (blameworthy).
• Clinical ethics is the application of ethical
theories, principles, rules, and guidelines to
clinical situations in medicine.
• Clinical ethics is the branch of medical ethics that
applies to practitioners involved in caring for
patients.
3. • Ethical and moral dilemmas are common in
clinical practice, especially in neurology practice.
• Guidelines are few, and there are often
conflicting opinions on various issues.
• It is important to understand or discuss the
ethical issues so as:-
To satisfy patients or families
To keep our conscience clear and
To prevent medical law suits .
4. SUBDISCIPLINES WITHIN ETHICS
• Biomedical ethics (bioethics) : deals with the ethical
implications of biology in patient care, research and
policy development.
• Neuro-ethics : are the ethical, legal and social policy
implications of neurosciences, including clinical care and
neuroscience research (Illes and Bird, 2006).
• Most of the ethical issues that the neurologist will
encounter fall within the classification of clinical ethics,
although some issues will extend beyond traditional
medical situations .
5. • Virtue-based ethics, with its emphasis on the
moral character of the physician, may be of
particular interest.
• It focuses attention on the motivations behind
and the behavior that make up a physician’s
practice of medicine.
• Activities that enhance the physician’s virtuous
behavior will result in greater good for the
patient.
6. INTERPLAY BETWEEN ETHICS AND LAW
• Ethical statements are neither binding nor
enforceable in contrast, laws are both binding and
enforceable.
• Overlap between ethics and law is related to three
factors:
i. The purpose of each discipline,
ii. The character of medicine as a traditional profession,
iii. Societal responses to past ethical abuses by
physicians and scientists.
9. ETHICS MANIFESTED IN LAW EXAMPLES
RELEVANT TO NEUROLOGY PRACTICE
• Non-maleficence : voluntary active euthanasia
and physician-assisted suicide
• Beneficence : - ending a patient–physician
relationship
- conflict of interest
• Respect for autonomy: Informed consent
• Justice
10. NON MALEFICENCE
• It refers to the physician’s responsibility not to harm his or
her patient.
• It is a prominent ethical principle that underlies laws
about physicians’ involvement in voluntary active
euthanasia and physician-assisted suicide. (in end-of-
life care )
• It is also a core principle with a extremely common
aspect of everyday neurologic practice - respect for
patient privacy.
11. • Active voluntary (after consent from
patients/relatives) euthanasia is legal only in
Netherlands, Belgium, Columbia and Luxembourg.
• It requires administration of an agent to hasten
death.
• Passive euthanasia involves withdrawal/withholding
of supportive treatments (such as antibiotics,
adrenaline, ventilator, etc) and is legal in US.
12. Reasons for the prohibition of voluntary active
euthanasia in codes of professional behavior includes-
• The possibility that the practice might be extended
to unwilling persons,
• The potential for coercion of members of vulnerable
populations
• The potential for reduced trust in the medical
profession
13. EUTHANASIA IN INDIA
• Active euthanasia by administering an injection is illegal in India
• Passive euthanasia is legal in India after a March 2011 judgment by
Supreme Court. (Aruna Shanbaug case)
• It is permitted by Supreme Court in two situations-
1. Brain dead patient, where the ventilator can be switched off.
2. Persistent vegetative state, where the feeds/water can be tapered
off, along with addition of pain-managing palliatives.
14. • Guidelines as laid down by the Supreme Court:
1. The decision can be taken by parents, spouse, other relatives, or
friend. Can be taken even by the doctor. It should be in the best
interest of the patient.
2. Even if the decision to withdraw life supports has been taken by
close relatives, prior approval from High Court is required to execute
the decision.
3. Chief Justice of High Court would constitute a bench of at least two
judges, who would decide to grant approval or not.
15. PHYSICIAN-ASSISTED SUICIDE
• Physician’s active assistance in implementing a patient’s
suicide plan, usually through prescribing drugs that will
be used in the suicide and possibly providing instruction
on their use for that purpose.
• It is legal in Switzerland and the US states California,
Oregon, Washington, Montana and Vermont.
16. PRIVACY
• The obligation of physicians to respect patient privacy, including the
embedded obligation to maintain patient confidentiality, was
articulated in the Hippocratic Oath (Hippocrates, 2002).
• Arguments supporting respect of privacy include -
• The deontologic rationale ( as a result of their special relationship,
with special knowledge about patient not available to the general
public)
• The utilitarian rationale ( patients will make full disclosures to their
physicians, when they are confident that the private aspects of their
lives will remain private) .
17. • The requirements that physicians respect privacy
and maintain confidentiality are not legal (or
ethical) absolutely
• Because there are legal rules that balance a
physician’s duty to protect patient privacy with
society’s need to have information for public
health and safety.
18. BENEFICENCE
• It is the ethical duty of physicians to act in the
patient’s best interest.
• Beneficence may involve actions to prevent
harm or actions to accomplish good.
• These include advocating for a patient’s needs,
caring for a difficult patient, seeing a patient
outside usual office hours, and avoiding conflicts
of interest.
19. Professional conduct
• Initiation of the physician- patient relationship
• Communication
• Therapeutic privilege
• Disclosure of medical errors
• Electronic communication
• Confidentiality
20. Professional misconduct
• Termination of the physician- patient relationship
• Conflicts of interest
• Disclosure of conflicts
• Reporting impaired physicians
21. Initiation of the physician- patient relationship
• Free to decide whether to undertake particular
patient
• Not decline on basis of race, religion, nationality,
sexual orientation, gender
• Provide care until care complete, patients ends
the relationship or is referred back to referring
physician
22. Communication
• Duty to communicate effectively with patient
• Convey relevant information
• Allow patients to raise question
23. Therapeutic privilege
• Withholding of relevant health information from the patient if
nondisclosure is believed to be in the best interests of the
patient.
• Disclosure ethically required in all but in extreme situations,
not mandatory disclose all information immediately.
• Physician’s own discomfort in delivering difficult news and to
avoid emotional suffering for the patient can never justify
withholding.
24. Disclosure of medical errors
• A medical error is the failure of a planned action to be completed as
intended or the use of a wrong plan to achieve an aim.
• Ethical obligation to disclose the error in a timely fashion
• Disclosure should include :
i. Explicit acknowledgment that an error has occurred,
ii. A description of the circumstances surrounding the error (including
what it was and how it happened),
iii. A description of how similar errors will be prevented in the future,
and
iv. An apology
25. • prompt and honest disclosure of errors
i. Increases patient satisfaction,
ii. Trust in medical system,
iii. And positive emotional responses ,
iv. Reduce the likelihood of legal action in the event
of an error.
26. • Failure to disclose medical errors is driven by a variety of
factors.
i. Fear of litigation,
ii. Lack of training in disclosure ,
iii. Physician’s perception of an error’s severity,
iv. Perceived responsibility for the error,
v. Fear that disclosure might distress the family or patient,
vi. Confusion about how much information to disclose
27. CONFIDENTIALITY
• Physicians have a primary ethical obligation to maintain
confidentiality of patient medical information
• This includes
i. Handling written documentation,
ii. Avoiding use of the patient’s identifiable health
information in general discussions with colleagues,
iii. Patients anonymous when discussing their medical
information in conferences or other educational forums
28. ELECTRONIC COMMUNICATION
• Physicians increasingly are using electronic forms of communication to
communicate with patients.
• Physicians should explain
i. What type of electronic communication is acceptable for that patient.
ii. The limitations of providing medical advice over electronic media.
iii. Quickly patients can reasonably expect the physician to respond to
electronic communication
iv. Physicians must take proper steps to protect the confidentiality of
information that is conveyed electronically, including, for example, properly
encrypting electronic devices
29. DUAL RELATIONSHIPS AND
PROFESSIONAL BOUNDARIES
• Physician maintain appropriate professional
boundaries by avoiding dual relationships that risk
excessive emotional proximity
• Unethical for a physician to engage in a sexual
relationship with a current patient.
• Physician’s position of authority and the patient’s
position of vulnerability raise the risk of exploitation
of the patient by the physician
30. • Sexual relationships between physicians and former
patients similarly unethical.
• Other potentially problematic dynamics include
business transactions between physicians and
patients and the acceptance of gifts by physicians.
• Should avoid accepting any gift that has the potential
to create an expectation of favoritism.
31. TERMINATION OF PHYSICIAN- PATIENT
RELATIONSHIP
• When there is a mutual decision on the part of the patient and
the physician to end a treatment relationship, no issue occurs.
• A patient may unilaterally end the professional relationship
with a physician at any time for any reason and without
permission or notice.
• Ethical statements note that the physician should attempt
to salvage the relationship even with a difficult patient.
32. • A patient should be dismissed from a physician’s
practice only for good reasons and after adequate notice
and identification of an alternative care provider.
• Legally, if a physician does not properly release a patient
from his or her practice, physician may be found liable for
patient abandonment.
• Can lead to investigation and disciplinary action by the
medical board of the state in which the
physician practices.
33. Conflict of Interest
• A conflict of interest occurs when a physician’s
professional judgment or actions toward a patient
(the physician’s primary interest) is unduly influenced
by circumstances that includes
i. Money (financial conflict of interest)
ii. Personal relationships,
iii. Stock ownership, gifts, meals,
iv. Desire for status, and feelings of obligation .
34. • Conflicts are to be avoided whenever
possible and managed.
• The goal in avoiding and managing conflicts of
interest is:
a) To avoid any actual wrong-doing or
b) To avoid perception that result in patient
discomfort or lack of trust in a physician.
35. RESPECT FOR AUTONOMY
• Respect for autonomy requires a physician to
foster and respect an individual patient’s right of
self determination.
• Informed medical decision making ( informed
consent ) is a fundamental ethical doctrine
grounded in the principle of respect for
autonomy.
36. • Patient competence consists of two parts: legal
competence and clinical competence.
• Adult patients and emancipated minor is legally
competent for all medical decision-making.
• In clinical competence, the patient can understand
information, formulate a decision, and communicate that
decision.
37. • Neurologists are often involved in the care of
patients for whom a question of clinical
competence exists.
• It may fluctuate across time, on the basis of
disease process, medication, and even time of
day.
38. Reporting impaired Physician
• Physicians may hesitate to intervene when
colleagues impaired by alcohol abuse, drug
abuse, or psychiatric or medical illness
• This place patients at risk. However, society
relies on physicians to regulate themselves.
• If colleagues of an impaired physician do not
take steps to protect patients, no one else may
be in a position to do so.
39. Responsibilities Of Physician To Each Other
Dependence of Physicians on each other
• Should consider it as a pleasure and privilege to
render gratuitous service to all physicians and their
immediate family dependants.
Conduct in consultation
• Respect should be observed towards the physician in-
charge of the case and no statement or remark be
made.
40. Appointment of the substitute
• only when he has the capacity to reduce 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.
41. Physicians as citizens
• Should particularly co-operate with the authorities in the
administration of sanitary/public health laws and
regulations.
Public and community health
• Should enlighten the public concerning quarantine
regulations and measures for the prevention of epidemic
and communicable diseases.
Pharmacists/nurses
• Should promote and recognize their services and seek their
cooperation.
42. INFORMED CONSENT
• The purpose of informed consent is to promote
patient autonomy through shared decision-making
between the patient and the physician.
• For that four requirements must be met –
i. The patient must be competent.
ii. The patient must be given adequate information on
which to base a decision.
iii. There must be no duress, the patient’s decision
must be made voluntarily.
iv. The patient must agree to the propose intervention.
43. EXCEPTION
• In emergency situations (Comatose patients after severe
head injury or massive brain stroke, or suicidal attempts) in
which the patient cannot provide consent and no surrogate
decision-maker, treatment should proceed.
• The physician’s therapeutic privilege to the treatment without
consent.
• When a patient is not competent to make medical decisions, a
surrogate decision-maker becomes responsible for
making decisions on behalf of the patient.
44. JUSCTICE
The ethical principle of justice embodies several
concepts:
• Fairness to persons within and across groups,
• Similar treatment of similar situations, and
• The allocation of scarce resources across society
in equitable manner.
45. Ethical considerations in pediatric
neurology
• Pediatric neurologists are entrusted with
considerable responsibility at multiple levels. This
includes
• planning and implementation of advanced and
complex investigations and therapies,
• individual and family counseling,
• longitudinal follow-up from fetal life throughout
childhood and adolescence,
• shepherding the transition to adult care,
• and societal advocacy on behalf of populations with
special needs.
46. Evidence-based medicine
• Practicing evidence based medicine and
maintaining continuing medical education have
become professional ethical responsibilities for
neurologists.
• Greatest challenge posed by evidence-based
medicine lies precisely in the application of
evidence obtained from research into clinical
practice.
47. Clinical practice and research
• Scientific responsibility neurologists may create
confusion between two distinct roles that may at
times be conflicting – namely the tension between
the neurologist’s healthcare duties toward individual
patients and their obligations as scientists to
contribute to knowledge.
• Both roles are justified and important, it is essential
that the neurologist as well as the patient and family
know which role is being adopted at any specific
moment, especially when decision-making is
involved.
48. • part of a study (i.e., not knowing which treatment
is being administered), or undergoing procedures
that are not proven essential for individual care,
are acceptable options only as part of clear
approved research protocols that comply with
ethical rules (including informed consent).
50. Societal role
• Society has accorded physicians, including neurologists ,a level of privileged
trust, thereby imposing additional ethical and social obligations. Examples of
our broader professional duties include
(1) advocacy regarding social equality,
(2) support of lay patient organizations,
(3) education of the public including knowledge translation for many audiences,
(4) provision of evidence-based guidance to the courts and public policy makers,
(5) monitoring the quality of the ever-growing but often uncritical medical news
stories,
(6) interacting in a constructive and accountable engagement with journalists
and news media to ensure objective communications
(7) anticipating the social impact of potential new technologies, and
(8) whistle-blowing regarding neglect or abuse of vulnerable populations with
disability.
51. Research ethics
Principles in Ethical Research
Social Value –
• The study should help researchers determine how to
improve people’s health or well-being.
Scientific Validity –
• The research should be expected to produce useful
results and increase knowledge .
52. Fair Subject Selection
Favorable risk-Benefit ratio-
• Any risks must be balanced by the benefits to subjects,
and/or the important new knowledge society will gain.
Independent review –
• A group of people who are not connected to the research
are required to give it an independent review.
53.
54. • Ethical dilemmas are common in routine neurology
practice .
• Good knowledge of laws regarding these issues is
needed.
• Patient/family should be properly counseled.
• Informed consent is a must.
• Further debates among public and lawmakers are
needed to further resolve the issues.
55.
56. REFERENCE
1. American Academy of Neurology (2005). AAN
Qualifications and Guidelines for the Physician Expert
Witness.
2. Bernat J (2008). Ethical Issues in Neurology. 3rd edn.
AAN Press, Lippincott Williams & Wilkins, Philadelphia.
3. Handbook of Clinical Neurology, Vol. 118 (3rd series)
Ethical and Legal Issues in Neuroloy.
4. Ethical Issues in Clinical Medicine.Harrisons Principles of
Editor's Notes
if an action produces good effects, it is ethical, whereas if an action produces evil or bad effects, it is unethical
individuals have moral obligations to others and, if they fulfill those obligations, they are acting ethically; if they do not, they are acting unethically.
,to be ethical is to cultivate in oneself appropriate character traits, such as honesty, altruism, courage, and perseverance, and also to work to cultivate such character traits in others
Respect for patient autonomy means that each individual patient has the right to determine which medical interventions he or she will accept or refuse
Deception includes statements and actions intended to mislead the
listener, whether or not they are literally true. For example, a physician
might sign a disability form for a patient who does not meet disability
criteria. Although motivated by a desire to help the patient, such
deception is ethically problematic because it undermines physicians’
credibility and trustworthiness.
This principle refers to the duty of physicians to act in the best interests of their patients, i.e., to act for the good of their patients.
principle of nonmaleficence refers to the requirement to avoid harming patients
Principle of justice is generally considered to have two components: equitability and distributive justice
Equitability means that persons in like circumstances should be treated similarly
Voluntary active euthanasia is the administration, by the physician, of a lethal agent (or the administration of a therapeutic agent at a lethal dose), with the intent to cause a patient’s death for the purpose of relieving intolerable, intractable, and incurable pain.
Physicianassisted suicide is a physician’s active assistance in implementing a patient’s suicide plan, usually through prescribing drugs that will be used in the suicide andpossibly providing instruction on their use for that purpose