MEDICAL ETHICS

WE TOO NEED ONE DAY

???

Dr.T.V.Rao MD

DR.T.V.RAO MD

A HISTORY OF ETHICS PRINCIPLES

460-377 B.C

Hippocrates of Cos

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

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

DR.T.V.RAO MD
AMA: revised
Principles

WHAT ARE MEDICAL ETHICS

Medical ethics refers
Chiefly to the rules of etiquette adopted
by the medical profession to regulate
professional conduct with each other,
but also towards their individual
patients and towards society, and
includes considerations of the motives
behind that conduct.
DR.T.V.RAO MD

Why Should doctors

have to swear an oath

when they qualify?
The Hippocratic Oath.doc
Modern Hippocratic
Oath.doc
To save self and Others
too
DR.T.V.RAO MD

PATIENTS ARE DEMANDING

UNLIKE PAST- FOLLOW ETHICS
Patients are entitled to
good standards of
practice and care from
their doctors .Essential
elements of this are
professional competence,
good relationships with
patients and colleagues
and observance of
professional ethical
obligations

DR.T.V.RAO MD

DEFINITION OF MEDICAL ETHICS

The practice of medicine is
rooted in a covenant of trust
among patients, healthcare
professionals, and society.
The ethics of medicine must
seek to balance the
healthcare professionals
responsibility to each patient
and the professional,
collective obligation to all
who need medical care.

DR.T.V.RAO MD

BASIC RIGHTS AND ETHICAL DUTIES

Human
Human Rights
Dignity
Access to health care
Right to non-discrimination
Right to privacy and confidentiality
Right to environment that is not harmful to
health or well being

DR.T.V.RAO
MD
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PRINCIPLES OF MEDICAL ETHICS

The good of the patient is paramount
TRUST must be nurtured before all else
Avoid conflicts of interest (COI)
Avoid perception of COI
Respect rights of patient
safeguard confidentiality
respect self-determination

communicate honestly with all

maintain competence

TYPES OF ETHICS
Medical Ethics: Clinical obligations
fidelity first to patients interests
telling the truth (cancer, errors)

Professional Ethics: Obligations of the

profession
self-regulation
education of self and others

Bioethics: Guides for public policy

gene technology, stem cell research
health system reform

WHAT IS THE NEED FOR MEDICAL

ETHICS?
The practice of medicine and the practice of
ethics are inseparable.
Every clinical decision invokes an ethical
decision as well.
In many instances, the ethical issue may not be
readily apparent.
In others conflicts arise between ethical principles
and medical decisions, which require the clinician to
be well versed with the former in order to guide the
latter.
DR.T.V.RAO MD

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ETHICAL PRINCIPLES
Autonomy: Respect for an individuals autonomy or
ability to make decisions for him/herself

includes respect for their privacy and

confidentiality
need to provide sufficient information for them
to make informed choices
truth telling
protection of persons with diminished or impaired
autonomy.
DR.T.V.RAO MD

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ETHICAL PRINCIPLES
Justice: This refers to the need to treat all people
equally and fairly

Society uses a variety of factors as a criteria for distributive justice,

including the following:

to each person an equal share

to each person according to need

to each person according to effort

to each person according to contribution

to each person according to merit

to each person according to free-market exchanges

We should strive to provide some decent minimum

level of health care for all citizens, regardless of ability
to pay
DR.T.V.RAO MD

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ETHICAL PRINCIPLES
Beneficence: This refers to the tradition of
acting always in the patients best interest to
maximise benefits and minimise harm.

Non-malfeasance: This principle ensures

that treatment or research ought not to
produce harm
Negligence
Misconduct
DR.T.V.RAO MD

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ETHICAL VS. LEGAL OBLIGATIONS

Medical ethics and the law
are not the same, but often
help define each other
Breach of ethical obligation
may not necessarily mean
breach of law
Breach of ethical obligation
may be used to prove
medical malpractice or
medical negligence
DR.T.V.RAO MD

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MICRO LEVEL ETHICAL PRINCIPLES

I. Respect for Autonomy (or Person)
Respect the decisions of autonomous persons and protect persons
who lack decision-making capacity (e.g., confused patients,
mentally ill).
Recognize the capacity of mentally and legally competent
patients :
To think and make decisions independently
To act on the basis of their decisions
To communicate their wishes to health workers

Uphold patient confidentiality

DR.T.V.RAO
MD
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ETHICAL PRINCIPLES
II. Non-Maleficence (Not inflicting harm)
Health professionals should not inflict harm on
patients
III. Beneficence
Act in the best interests of patients or research
participants.
Contribute to patient welfare help patients further
health interests
DR.T.V.RAO
MD
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HEALTHCARE PROFESSIONAL ROLE

Paternalistic model
Emphasizes health and well-being (beneficence) over
respect for autonomy and patient choice
Patient is selectively given information
Evolution of newer decision-making models
Independent choice vs. enhanced autonomy
Paternalistic vs. informative vs. interpretive vs. deliberative

DR.T.V.RAO
MD
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LEARNING ABOUT ETHICAL ISSUES

REQUIRES.
An understanding of the issue-the science and
knowledge base
An understanding of ethical frameworks and
principles-not just case studies and anecdotes
An understanding of ones own values
Ability to think through the issue-logic and
argument

Recognition of uncertainty-limits to
knowledge
DR.T.V.RAO MD

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WE ARE CONFUSED MANY TIMES

ABOUT TRUTH ???
Should doctors always tell patients their
diagnosis?
What about uncertainty in diagnosis? Is it
right to make patients share this?
Is it ever right to suppress diagnoses
what about stigmatising diagnoses, e.g.
MS, dementia, HIV, psychiatric diagnoses?
What if relatives ask doctors not to
disclose diagnoses to patients?

DR.T.V.RAO MD

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INFORMED CONSENT
Definition: A patients willing acceptance of a medical
intervention after adequate disclosure from their MD of the nature
of the intervention, risks, benefits and alternative treatment options

What constitutes informed consent?

Disclosure: information to allow reasonable person to make a decision
Understanding: comprehension of the information given
Voluntary: no coercion or incentive to accept or deny a treatment
Agreement: verbal or written (preferred) to discussed intervention
Many are screening patients for HIV without informed consent ?
Many are doing sex determination in fetus even it is prohibited ???

DR.T.V.RAO
MD
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THE RELATION BETWEEN LAW AND ETHICS

Ethical values have often been influenced
by and influenced legal doctrine and legal
principles are closely related to ethical
principles.
Ethical obligations exceed legal duties
Law serves to demarcate the limits of
individual autonomy in the interests of
society. It also protects the rights of
individuals
DR.T.V.RAO MD

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KNOWLEDGE CREATES CONFLICT

SO THE DOCTORS FIGHT
In much wisdom is
much grief :and he
that increaseth
knowledge
increaseth
sorrows
(Ecclesiastics 1,18)

DR.T.V.RAO MD

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MEDICAL ETHICS CREATE BETTER

PHYSICIANS

Medical Ethics
Virtues
Good of the patient

biological-medical good

self-understood good

Excellent physician

PRACTICE GOOD PRACTICES YOU WILL

FLOURISH

Ethics
Virtues
Values

Basic template for professions:

identify distinguishing characteristic
rank virtues for particular profession
define professional excellence

Flourishing life

WHAT IS YOUR CHOICE MAKES

DIFFERENCE ???

Medicine is about :
Can we?
Ethics is about:
Should we?
DR.T.V.RAO MD

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PRACTICING ETHICS IS
EXPENSIVE ?????

DR.T.V.RAO MD

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SOLUTIONS TO ETHICAL PROBLEMS

Not simple
Ethics not like
science
Is ethics arbitrary?
Or
Can we discover an
ethic for medicine?

DR.T.V.RAO MD

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 Programme created by Dr.T.V.Rao MD for Medial

Professionals with Major resources from American
Medical association who constantly thrive to improve
the standards in Medical Profession to benefit the
patients
Email
doctortvrao@gmail.com

DR.T.V.RAO MD

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