3. • Rules of Ethics:
They are mandatory and descriptive standards
of minimally-acceptable professional conduct.
4. • Pretreatment Assessment:
Treatment shall be recommended only after a careful
consideration of the patient's physical, social, emotional
and occupational needs.
The ophthalmologist must evaluate the patient and assure
that the evaluation accurately documents the ophthalmic
findings and the indications for treatment.
Recommendation of unnecessary treatment or withholding
of necessary treatment is unethical.
5. • Procedures and Materials:
Ophthalmologists should order only those
laboratory procedures, optical devices or
pharmacological agents that are in the best
interest of the patient.
Ordering unnecessary procedures or materials
or withholding necessary procedures or
materials is unethical.
6. • Commercial Relationships:
An ophthalmologist's clinical judgment and
practice must not be affected by economic
interest in, commitment to, or benefit from
professionally-related commercial enterprises.
7. • Conflict of Interest:
A conflict of interest exists when professional
judgment concerning the well-being of the
patient has a reasonable chance of being
influenced by other interests of the provider.
• Confidentiality:
An ophthalmologist shall respect the confidential
physician-patient relationship and safeguard
confidential information consistent with the law.
8. ETHICAL DECISION MAKING
• Gather the medical, social, and all other
relevant facts of the case.
• Identify all relevant values including but not
limited to those of the patient, family and
physician, nurse, other health care professionals,
the health care institution, and society.
Determine the values in conflict.
• Propose possible solutions to resolve the conflict.
• Choose the better solutions for the particular
case, justify, them, and respond to possible
criticisms.
9. DOES A PATIENT HAVE A RIGHT TO BE TOLD
WHICH SURGEON IS PERFORMING THE
SURGERY?
10. • The ophthalmology department at University Hospital
has an extensive residency program. In order to
complete the program, residents must perform various
surgical procedures, so that they will develop the skills
they need to be competent ophthalmologists.
However, patients are not always told when a resident
is performing the surgery as first surgeon, because the
faculty believe that patients might object and possibly
refuse the surgery. Besides, faculty are always present
either as first surgeon or as assistant during the
operations to ensure that the patient's welfare is
promoted and protected.
11. • One day a new patient, S.R., complaining of “flashing
lights and floaters” presents to the hospital's clinic and
is discovered to have a macula-threatening retinal
detachment. When she is scheduled for scleral buckling
surgery she asks Dr. A., the faculty member who
examined her, whether he will be performing the
procedure. “I know this is a university hospital, and
that sometimes the students do the operations,” she
tells him.
• “I will be there for you,” he responds, knowing that a
second-year resident may actually be performing the
surgery as first surgeon.
12. • (1) Yes, the physician should tell the patient who may be performing
surgery. Whose eye is it, anyway?
• (2) No, the physician should not tell the patient who the primary
surgeon may be. The specific activities in the operating room are
too complex to explain in great detail to the patient, and it would
only upset the patient if the attempt to explain were made.
• (3) It would not be wrong if the physician told the patient, but the
physician is not morally obligated to do so. Patients do not need to
know the particulars of who is performing surgery.
• (4) It depends on the circumstances.
13. In order to practice the general principles of
standards, the ophthalmologist ought :
(1) to ensure that the patients are treated with
dignity, honesty and integrity, and act in the best
interests of the patient at all times
(2) to ensure that ophthalmic care is the highest
quality possible
(3) to be a responsible member of their
professional community by maintaining
standards, avoiding conduct that would bring
the community and its members into dispute
14. (4) to be conscious of and observe the ethical, legal
and scientific criteria for medical research
(5) to ensure that communications to the public
reflect their social responsibilities
(6) to ensure that fees for ophthalmological services
do not exploit patients or others who pay for the
services, that economic and non-economic
conflicts of interest do not interfere with the
delivery of the highest quality care; and that the
advertising should reflect information and not
commercial criteria.
15. Being technically competent and respecting
patients' rights are necessary but
not sufficient conditions of being a good
ophthalmologist.
Developing the professional virtues of kindness,
compassion, and a sense of justice, among
others, also plays an important role in the
moral life of the professional.
17. • D.M. is a 73-year-old woman who has been blind for 12
years. She lives with her 54-year-old daughter, and
although she is able to manage her affairs, Ms. M. has not
accepted her handicap. The patient has glaucoma and
advanced cataracts, which brings her to her
ophthalmologist, Dr. B. Ms. M. has heard of advances in
ophthalmology, such as lens implantation, same-day
surgery, and small incisions leaving minimal scarring, and
she would very much like to try them. However, tests reveal
extensive optic nerve damage, which indicate that there is
no possibility of visual improvement. For this reason, Dr. B.
does not recommend surgery, and instead suggests Ms. M.
consider a rehabilitation program.
18. • Nevertheless, Ms. M. wants to have surgery.
She can pay for the procedure and claims,
“These are my eyes, and I have a right to
surgery.” Because the patient is already blind,
Dr. B. recognizes that there is little risk in a
surgical intervention.
• Should Dr. B. perform the procedure?
