Dr. Pooja Pandey discusses medical ethics in a document containing several sections. She begins with introductions to medical ethics and bioethics, then discusses the evolution of ethics including landmark documents like the Hippocratic Oath and Nuremberg Code. She explains why ethics has become increasingly important and outlines principles of medical ethics including autonomy, beneficence, confidentiality, non-maleficence, and justice. She also discusses concepts like informed consent, veracity, fidelity, and ethical dilemmas. The document provides an overview of key topics in medical ethics.

1. Dr Pooja Pandey
PG Resident 1st Year
MS General Surgery
Mayo Institute Of Medical
Sciences,Barabanki

2. CONTENTS
• Introduction
• Medical ethics vs bioethics
• Evolution of ethics
• Why Ethics becomes important?
• ABCDE of Ethics
• Veracity
• Fidelity
• Ethical dilemma
• Research Ethics

3. INTRODUCTION
The Greek word ethike means habit ,action and character.
In simple words -The oldest scientific and philosophical
discipline

4. Ethics is not
• Merely obeying the law
• Compliance
Although in many instances laws are statements of considered ethical
positions and most of the time obeying the law is an element of ethical
behavior.

5. • Ethics is a very large and complex field of study with
many branches or subdivisions.
• Medical Ethics is the branch of ethics that deals with
moral issues in medical practice.
• Medical ethics is closely related ,but not identical
to ,biomedical ethics

6. Medical Ethics Biomedical Ethics
Focuses primarily on
issue arising out of the
practice of medicine
Focuses on moral issues
raised by developments in
the biological sciences

7. HISTORY OF MEDICAL ETHICS

8. Hippocratic Oath
• One of the earliest document in medical ethics -5th
century B.C.
• All doctors recite this oath at swearing in.

10. Nuremberg code -1947

12. Declaration of
Geneva
• Adopted at WMA in 1948
which was amended in
1968,1984,1994,2005 and
2006.
• Declaration of physicians’
dedication to the
humanitarian goals of
medicine.

13. Helsinki Declaration-1964
64th WMA General Assembly ,Fortaleza (Brazil) , October 2013

16. International code of Medical Ethics-2006

18. Why Ethics Becomes Important ?
• Now a days ,conflict of interests between the government and medical institutions
,between medical personnel and medical institution ,between physicians and
patients are getting more and more serious and complex.
• High technologies has not only brought us hopes of cure but have also created a
heavy economic burden .
• The ethical dilemmas of brain death ,organ transplantation ,and concerns about
quality of life have become increasingly prominent.
• Integration of the traditional medical ethics with modern principles and values.

19. • 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.

20. AUTONOMY
BENEFICENCE
CONFIDENTIALITY
DO NOT HARM/
NON MALEFICENCE
EQUITY OR JUSTICE PRINCIPLE
OF
MEDICAL
ETHICS
ABCDE OF Medical Ethics

21. AUTONOMY
• Right to Choose
• Respect the autonomy of their patients and
their ability to make choices about their
treatments , and to evaluate the potential
outcomes in light of other life plans .

22. Desiring to benefit the patient ,physician strongly
want to provide Blood Transfusion – believing it
to be medical benefit.
Patient must be so informed –
Consequences of refusing blood transfusion –death due
to blood loss.
Properly and compassionately informed
Patient is free –to Accept BT or Refuse BT

23. INFORMED CONSENT

24. BENEFICENCE

25. PRINCIPLE OF BENEFICENCE

26. CONFIDENTIALITY
• Right to Privacy
Respect for autonomy does not entail only the right
of capacitous patients to consent to treatment .
Their autonomous right extends to control over
their confidential information and doctors must to
respect
their privacy ,not communicate information
revealed
in the course of treatment to anyone else without
consent.

27. Why CONFIDENTIALITY is Important?

28. 5 C’s Exception to CONFIDENTIALITY

29. DO NOT HARM /NON -MALEFICIENCE
• Not to intentionally create a harm or injury to the patient,
either through acts of commission or omission .
• The Principle affirms the need for medical competence.
• Medical mistakes may occur ,however , the principle articulate a
fundamental commitment as the part of health care
professionals to protect their patient from harm .
• Eg - Most would be willing to experience some pain if the
procedure said would prolong life.
PRIMUM NON NOCERE
(above all DO NOT HARM)

30. PRINCIPLE OF DOUBLE EFFECT
When intervention undertaken by physicians create positive
outcome while also potentially doing harm it is known as the
“Double Effect”.
Single action- two effects
Good effect
BAD effect

31. • In palliative care of patient whose pain is increasingly
difficult to control.
• There may come a point in the management of pain when
effective palliation is possible at the risk of shortening a
patient’s life because of respiratory effect of the palliative
drugs .
• This is a “Double Effect”- both relief of pain and death
might follow from such an action.

32. EQUITY OR JUSTICE

33. EUTHANASIA
• Some American physicians interpret the Non- Maleficience
principle to exclude the practice of euthanasia , though not
all concur.
• The most extreme example in recent history of the violation
of the Non- Maleficence Dictum was Dr. Jack Kevorkian ,who
was convicted of second –degree homicide in Michigan in
1998 after demonstrating active euthanasia on TV news
show,60 Minutes

34. Most controversial issue in modern health care
• Who has the right to health care ?
• As a society we want to be beneficient and provide
some descent minimum level of health care for all
citizen regardless of ability to pay.

35. • The demand of the principle of justice
must apply at the bed side of the
individual patients but also systemically
in the laws and policies of society that
govern the access of a population to
health care

36. VERACITY
• The duty to tell
the truth .
• Truth telling,
Honesty

37. FIDELITY

38. ETHICAL DILEMMA

39. • Situations necessitating a choice
between two equal (usually
undesirable) alternatives.
• A conflict between two or more
ethical principles.
• In an ethical dilemma there is no
“correct” decision.

40. Major Types of Ethical Dilemma
• Euthanasia
• Refusal of Treatment
• Scarcity of Resources

41. Intentional action
or lack of action
that causes the
merciful death of
someone
suffering from a
terminal illness or
incurable
condition.

42. Types of Euthanasia
Active
An active
intervention
to
end life
Passive
Deliberately
withholding
treatment to
end the life
Voluntary
Request
from a
patient
Involuntary
Against a
patient will
Non-
voluntary
Patient is
not
capable of
giving
permissio
n
Doctor
assisted
suicide
Prescribes a
lethal drug
which is self
administere
d by the
patient
Aruna Shanbaug case
Karnataka

43. Refusal of Treatment
• Based on the principle of autonomy .
• A patient’s rights to refuse treatment and to
die often challenge the values of most health
care providers .

44. Scarcity of Resources
The allocation of scarce resources
(eg-Organ ,Specialists)is emerging as a
major medical dilemma.

46. Ethical Decision Making Model

49. Ethics Committee

51. Functions of Ethical Committee

52. The patient and the person
treating the patient have
the right to be treated with
dignity

53. Questions
Q1)Which of the following statements are true regarding the informed
consent ?
A . Consent should be obtained by the person doing the operation.
B . The written communication material must always be in English.
C . Consent is necessary before physical examination of a patient .
D . Every possible hazard , however remote the possibly , should be
explained in detail.
E . Legally, a signed consent from a patient is proof that valid consent has
been properly obtained.
ANS-A,C

54. Q2)In a matter of life and death ,which of the following
are true statements?
A.The surgeon is always obliged to provide life
sustaining treatment .
B. Decision to with hold treatment should be taken
along with another senior clinician and recorded in
detail.
C. In palliation for pain in advanced malignancy ,a
potential lethal dose of analgesia is appropriate.
D. Confidentiality is absolute.
Ans- B,C

55. REFERENCES
• Manual of Medical Ethics –World Medical
Association 2009
• MCI Ethical Guidelines -2002,2019.
• ICMR guidelines for biomedical research ,2006
• Research Ethics –National Institute of Health ,USA
• The Contribution of Ethics to Public Health –
Bulletin of WHO
• Bailey and love 27th edition
• Sabiston text book of surgery
• Google images