This document discusses ethical issues in healthcare. It begins by defining ethics and bioethics. It then outlines the basic principles of medical ethics including autonomy, veracity, privacy/confidentiality, fidelity, beneficence, non-maleficence, and justice. Several case studies are presented that illustrate challenges with applying these principles in practice. Major ethical issues like physician assisted suicide and euthanasia, organ transplants, abortion, and ethical decision making are also examined. Finally, the document discusses how a pharmacist can protect a patient's right to privacy by obtaining consent, only collecting necessary information, and providing limited disclosure.

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2. Ethical Issues in Healthcare
Presented by: MUHAMMAD ABUBAKAR
1st semester (M.Phil. Pharmacy Practice)2

3. •What are Ethical Issues in health care?
•How a pharmacist can respect patient’s
Right to Privacy?
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Ethics
“Moral principles that control or influence a
person’s behavior or beliefs and principles about
what is “right” and what is “wrong”.
Bioethics is a way of understanding and examining
what is “right” and what is “wrong” in biomedical
research and practice.

5. Code of Ethics
• 460-377 B.C Hippocrates of CoE
• 1792 Percival: Manchester Infirmary Committee
• 1803 Percival: Medical Ethics: A Code of Ethics and Institutes Adopted
to the Professions of Physic and Surgery
• 1808 Boston Medical Society (self-regulation)
• 1847 AMA: “Code of Ethics”
• 1903 AMA: “Principles of Medical Ethics”
• 1912 AMA: revised “Principles”
• 1948 WMA: “Declaration of Geneva”
• 1957 AMA: concise “Principles”, “Opinions”
• 1980 AMA: FTC-imposed Principles revision
• 1981 AAPS: “Principles of Medical Ethics”
• 1980s-1990s ACP Code, and many others
• 2001 AMA: revised “Principles” 5

6. Basic Principles of Medical Ethics
• Autonomy
• Veracity
• Privacy/confidentiality
• Fidelity
• Beneficence
• Non maleficence
• Justice
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7. Autonomy
• 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.
• Says that each individual:
Is unique and free;
Has the right and capacity to decide;
Has value and dignity; and
Has the right to informed consent.
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8. Veracity
• The duty to tell the truth.
• Truth-telling, honesty.
• Benevolent Deception
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9. Case• A male patient named KAMRAN, who is 45 years old was diagnosed with
kidney failure one year ago.
• For the past year, he has been admitted to the hospital 8 times with
multiple problems related to the kidneys. He also developed severe anemia
requiring transfusions, and recurrent pneumonia.
• He now performs at-home peritoneal dialysis each night, and has just
returned to work after being on disability for the past year. He feels his life
is now returning to some form of normalcy.
• Doctor has just received lab test results showing a new infection.
• The doctor is aware that the antibiotic can be added to the bags of fluid,
which he uses for dialysis. The doctor does not want to upset him by telling
him about a new complication.
• The doctor decides to just tell KAMRAN that the medication added to the
bags of dialysis fluid are just “standard procedure from time-to-time.” The
doctor believes this is for Kamran's own good.
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10. Privacy/Confidentiality
• Respecting privileged knowledge.
• Respecting the “self” of others.
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11. Case
• A patient with AIDS who has had a significant other in his life
for almost one year. The significant other lives with the
patient, and is visiting the patient every day.
• Is it justified, or not, to inform the significant other of the
patient’s condition?
• Although rules of confidentiality must be broken, rules of
harm require that information be shared with the significant
other.
• AMA code now states that a physician MAY reveal
confidences and medical deficiencies if necessary to protect
a vulnerable individual, or the community.
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12. Fidelity
• “the unfailing fulfillment of one’s duties and
obligations and the keeping of one’s words or vows.”
• Act only within the scope
• FAKHRA AHMED
• MEDICAL NEGLIGENCE CASE
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13. Beneficence
• The practitioner should act in “the best interest” of
the patient - the procedure be provided with the
intent of doing good to the patient
• Advance directives:
• LIVING WILL
• POWER OF ATTORNEY
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15. Non Maleficence
•“Above all, DO NO HARM,“ – Make sure that the
procedure does not harm the patient or others
in society.
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16. • When interventions undertaken by physicians create
a positive outcome while also potentially doing harm
it is known as the "double effect."
• E.g. the use of morphine in the dying patient, eases
pain and suffering while hastening the demise
through suppression of the respiratory drive
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17. Justice
• The distribution of scarce health resources, and the
decision of who gets what treatment “fairness and
equality”
• The burdens and benefits of new or experimental
treatments must be distributed equally among all groups in
society
• Comparative Justice: Making a decision based on criteria
and outcomes. i.e. How to determine who qualifies for one
available kidney.
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HIPAA
Health Insurance Portability and Accountability Act of 1996
(Implementation April 2003)
• Ensures privacy and confidentiality of medical records (a legal
document that identifies the patient, diagnoses, and
justification for treatment).

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Ethics Committees
• Usually twelve to fifteen members
• Multidisciplinary members
• A representative from the Board of Trustees
• The facility administrator
• The facility’s director of Nursing
• A staff nurse
• A physician
• An area clergy
• A Social Worker
• An Attorney
• An Ethicist (Usually a philosophy or theology professor)
• Lay Person from the community

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Functions of the Committee
• Education
• To committee members themselves
• Continuing education and in service to facility’s staff
• To the community
• Development and review of laws, standards of care,
institutional policies and guidelines
• About withdrawing and withholding nutrition and hydration
• Do Not Resuscitate
• Utilization of facility’s/communities resources

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Functions continued
• Case Consultation with:
• Family members
• Patients
• Health care providers
• Staff
• And their own clergy

22. Ethical Dilemmas
“Deciding People’s Fate”
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 Situations necessitating a choice between two
equal (usually undesirable) alternatives.
Ethical Dilemma

24. Ethical dilemma
• When you have to judge
what is right or wrong
• Choosing between options
• Deciding whether to do
something or do nothing
• Should I or shouldn’t I?
• Weighing up the potential impact
of your decisions or actions
• A dilemma – making a difficult choice
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25. Factors Causing Ethical Issues
• Confidentiality
• protection of private patient information and medical records
• Transmission of diseases
• protect yourself while still making the patients feel at ease.
• Aggressive marketing practices
• main goal of the hospital should be patient care, not marketing schemes
• Do not recommend unnecessary services to a patient just for the sake of
profit
• Provided information
• accurate and honest information should be provided to the patient
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26. Factors Causing Ethical Issues
• Terminally ill patients
• terminally ill patients may have specific wishes for the manner in which they
want their lives to end. Dealing with an issue such as euthanasia should be
considered carefully
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27. Sexual Harassment
• rules should be very strict about sexual harassment of any kind at the
healthcare facility.
• Sexual ethics
(branch of ethics committee)
should be involved in case
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28. Major Ethical Issues
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29. Physician Assisted Suicide and Euthanasia
• Results in death to alleviate suffering or when there
is no hope for recovery
• Many healthcare professionals feel
euthanasia is contrary to their
professional ethics
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31. Case study
• A woman was diagnosed with motor neuron disease.
• A condition that destroys motor nerves, making control of
movement impossible, while the mind is virtually unaffected.
• People with motor neuron disease normally die within 4 years of
diagnosis from suffocation due to the inability of the inspiratory
muscles to contract.
• The woman's condition has steadily declined. She is not expected
to live through the month, and is worried about the pain that she
will face in her final hours.
• She asks her doctor to give her DIAMORPHINE for pain if she
begins to suffocate or choke. This will lessen her pain, but it will
also hasten her death. About a week later, she falls very ill, and is
having trouble breathing. 31

32. Questions for Case
• Does she have a right to make this choice? Especially in view of the
fact that she will be dead in a short while (say six hours)?
• Is there an ethical difference between her dying in 6 hours and
dying in a week? What about a year, and how do you draw this
distinction?
• She clearly cannot kill herself. She can't move, but should someone
be FORCED to help her, or to find someone to help her?
• Should the money used to care for this woman be taken into
account?
• Will people feel that they need to end their lives earlier to save
money?
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33. Organ Transplant
• Organ donations come at a time of crisis when somebody
dies
• Illegal to transplant organs without patient or family
permission
• Who gets the organ?
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34. Who Gets The Donated Organ?
• Criteria
• Likelihood of benefit
• Urgency of need
• Change in quality of life (improved?)
• Duration of benefit
Hypothetical case of a common
man with some High Profile Person
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35. Abortion
• Should a woman be allowed an abortion for any reason?
OR
• Should parents be allowed to abort a child?
• Should such procedures be carried out in healthcare
facilities?
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Ethical Decision Making Model
• Step 1. Identify the ethical dilemma.
• Step 2. List all persons involved.
• Step 3. Identify all applicable ethical principles.
• Step 4. the person responsible for making the final decision.
• Step 5. Summarize the role of Healthcare Professionals involved in
the case.
• Step 6. Consider the alternatives along with the short-term and
long-term consequences of each.
• Step 7. Make a decision for the best possible outcome.
• Step 8. Follow the case to observe the consequences.

41. Pharmacist Role In Protecting
Patient Right To Privacy
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42. Guiding Principles to Protect the
Patient's Right to Privacy
inform the patient of the anticipated use or disclosure of
personal health information.
only use or disclose personal health information with the
consent of the patient.
collect and use personal health information only for the
purposes of providing pharmacy services.
disclose personal health information only to those who have
a legitimate need for that information.
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43. The patient can revoke consent at any time, but such
revocation is not retroactive.
Document the Consent or revocation, given verbally or in
writing.
Provide access to the patient to his own records. Where the
patient requests an amendment, the pharmacist shall
document it.
establish policies governing the retention, security and
destruction of personal health information
Before using or disclosing personal health information,
ensure that the information is accurate, complete and not
misleading.
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44. Disclosure of Information
The patient consents to release of the information.
Written consent from the patient should be obtained.
Otherwise, inferred consent is sufficient.
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45. • Disclosure for healthcare system
• Disclosure to law enforcements
• Logging disclosure
• Research disclosure
• Disclosure upon the patient’s own request
• Disclosure to the patient’s family
• Disclosure to the person providing continuing care of the
patient
• Disclosure for the audit team
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46. “PROVIDE AS LIMITED
INFORMATION AS NEEDED”
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