This document discusses medical ethics as they relate to otorhinolaryngology (ENT). It outlines several key principles of medical ethics including putting patient interests first, treating patients with respect and honesty, maintaining confidentiality, and obtaining informed consent. It also discusses some specific ethical issues that ENT doctors may face, such as discussing cancer diagnoses and treatment options sensitively, handling congenital abnormalities compassionately, and serving as expert witnesses objectively. Overall, the document emphasizes that ENT doctors must practice with competence, integrity and with the well-being of patients as the top priority.

1. Medical Ethics in Otorhinolaryngology
DR.RAJENDRA KUMAR GOLA
JUNIOR RESIDENT III
DEPARTMENT OF ENT & HNS
MLN MEDICAL COLLEGE & SRN HOSPITAL PRAYAGRAJ

3. WHAT IS ETHICS ?
“ The purpose of ethical reflection is to help us to decide
how to act in the real world, all things considered. This means
ethical reflection must take into account all aspects of a proposed
course of action, it must rely on good factual evidence and on an
understanding of the social and legal contexts in which action has
to take place ’’

4. • Medical ethics deals with moral issues in medical field.
• It is greatly influenced by developments in Human rights.
• The patient's right to participate in the treatment process must be
recognized and promulgated by the doctors.
• The doctors shall be free to choose whom to serve according to their
proficiency, however discrimination against a patient on the basis of race,
colour, gender, age, sexual orientation, socioeconomic status, religion or
national origin is inappropriate

5. Principles which provide guidance to us in acting
honorably and professionally toward our patients :-
• The best interest of the patient must be the foremost concern of the
physician in all circumstances.
• The patient must be treated with competence, respect, dignity and
honesty.
• Confidentiality /privacy should be kept except as required by law.

6. • The Doctors must maintain proficiency and competence
through continuing study and be diligent in the administration
of patient care.
• The impaired physician must withdraw from that part of the
practice that is affected by the impairment.
• The doctors should assist in complying with these principles

7. UNETHICAL ?
‘Every human being of adult
age and sound mind has a right
to determine what shall be done
with his own body; and a
surgeon who performs an
operation without his patient’s
consent, commits an assault’
and is unethical. Patient to doctor

8. UNETHICAL ?
Patients identity- Confidentiality
• Confidentiality of patient information is to be maintained, within the constraints of the
law and the obligation to protect the welfare of the individual and the community.
• The doctor must establish and
maintain appropriate relational
boundaries, avoiding exploitation
of patient vulnerability and
specifically avoiding sexual
misconduct with patients.

9. Conflicts of interest undermine the trust
that patients place in their physician.
For this, conflicts that develop between a physician's
financial interests and the physician's responsibilities to the
patient should be resolved to the benefit of the patient.

10. Research
• All research work should respect the dignity and sanctity of human life.
• The goal of research should be the betterment of mankind, the alleviation
of suffering, and the ultimate improvement of medical practice.
•
• Research that knowingly and unnecessarily jeopardizes the health, safety,
or longevity of human subjects is unethical.
• All human research subjects should be fully informed of the benefits and
risks of the research being conducted and should give their informed
consent prior to participating as a subject in any prospective trial

11. Impairment
• Impairment represents a potential hazard to
patients and to the affected doctor.
• The doctor should withdraw from any
component of practice that adequate
assessment deems impaired. Appropriate
management, including counselling, should
follow.

12. Community Relations
• We should realize that we are subject to all civil and
criminal statutes applicable to the region in which
we practice.

13. ETHICAL PROBLEMS IN OTORHINOLARYNGOLOGY
• Ethical problems in Otorhinolaryngology may be both general and
specific.
• Cancer in the head and neck, otologic abnormalities, certain severe
congenital conditions, life-extending techniques and the treatment of
psychosomatic otolaryngological complaints are but few of the clinical
condition that pose ethical and moral situations to our group.
• Cancer poses the problem of the patient’s right to know the diagnosis,
to understand the ‘proper’ treatment and the possible alternate
methods of management.

14. • Patient must be apprized of the consequences of the
treatment with its frequent disfigurements and
dysfunctions.
• Some doctors feel this information is harmful to the
patient, and consequently withhold it or misrepresent
the true nature of the illness.
• It is recognized that a sickness of this gravity is life-
threating, humiliating and, in some instances,mutilating
and crippling.
• These human responses are rationalized with our ethical
statutes and the law, but our responsibility is to
question the rightness of this tactic.

15. • The otolarynologist may be confronted by severe
congenital abnormalities about the face and neck. These
distortions of Nature’s handiwork may represent a tragic
situation that kindles the doctor’s compassion and
challenges his talent.
• This stimulation may bring out his highest skills, and yet
an awareness that there are limits in all types of surgery,
and that some congenital abnormalities are beyond
complete rehabilitation.
• The moral issue in these cases deals with what is
possible, what compromises are necessary, what the risks
are, as well as the possible results.

16. Expert Witness Qualifications and Testimony
We as healthcare experts (otorhinolaryngologist) believe that it is
important for us to serve as expert witnesses in legal proceedings to
assist in the administration of justice. So we should be thoroughly
prepared with relevant facts so that we can do the best of our ability &
can provide the court with opinions that are accurate and capable of
substantiation with respect to the matters at hand.

17. • Our medical profession is losing control of its facility to third
party forces that are extraneous to it but can dominate it.
• These forces consist of government, insurance companies,
industry, unions, health recipients and the legal profession.
• We are also in disarray frequently as to what is right, why it is
right, and what to do about it.
• This is not unnatural in a public structure which depends upon
man’s good will in a materialistic society of unbridled freedom
and independence.
• This agitative climate creates debate and polarization, yet none
of these factors can prevent us from professing to help the sick
in a high ethical manner.