MEDICAL ETHICS AND JURISPRUDENCE

Ethics
● Moral principles that govern a person's behaviors
● Ethics is universal in the sense of referring to what is right and wrong.
● However, ethics may sometimes be specific to the conduct of a particular activity. An
example of this is the code of medical ethics.

Jurisprudence
● The theory or philosophy of law
● A legal system
● Medical jurisprudence, specifically, is the legal aspect of medical practice
● Concerned with the aspect of law and legal concepts which has to do with the practice
of medicine

Although this course is specific to medicine, parallel concepts may be established with other
disciplines in the allied medical professions (dentistry, nursing, pharmacy, physical therapy,
occupational therapy)

Ethical Jurisprudence
- a field of philosophy that explores law from an ethical or moral standpoint. Ethical
jurisprudence deals with how the law should be in an ideal condition. It analyzes the
aim of legislation and how that purpose should be carried out. This field of study
combines moral philosophy with legal philosophy.

MEDICAL JURISPRUDENCE

Purpose of the Study of Medical Jurisprudence

1. To protect the public from charlatans and quacks.

2. To promote professionalism and foster professional interrelationships among those
concerned with the welfare of the patient.
3. To develop an awareness of the rights, duties, and obligations of both health providers
and patients.
4. As a countermeasure to control the increasing number of malpractice suits against
health providers.
5. To explain the purpose and procedure of specific legislation where medical science is
involved.
6. To study the need, repeal, or amendment of health care laws in harmony with recent
scientific and social development.

Sources of Laws
● The constitution
● Laws enacted by the legislative body
● Administrative acts, orders, rules, and regulations
● Local customs
● Generally accepted principles of international law
Goals of the practice of medicine
● To serve humanity
● To preserve life and maintain the health of the people regardless of race, creed, or
political affiliation
● To promote the quality of life

Control of The Quality of Medical Services

● Licensure Laws

● Code of Ethics

● Criminal Law

● Civil Law

● Public Opinion

● Hospital Rules and Regulation

● Medical Societies

Licensure and Regulatory Laws in the Practice of Medicine

Regulation of Medical Practice: Legal Basis

1. 1987 Constitution, Article II, Section 5 provides that:
● “The maintenance of peace and order, the protection of life, liberty and property, and
the promotion of the general welfare are essential for the enjoyment by all of the
blessings of democracy”
● “Police power of the state”
● “General welfare clause”

2. 1987 Constitution, Article II, Section 15

● “The State shall protect and promote the right to health of the people and as a policy
instill health consciousness among them”

Professional Regulatory Board of Medicine: Legal Basis

● The Medical Act of 1959 (RA 2382) Article I, Section 1. Objectives – This Act provides
for and shall govern:
a. the standardization and regulation of medical education
b. the examination for registration of physicians
c. the supervision, control and regulation of the practice of medicine in the
Philippines

● Legal Basis RA 8981: The PRC Modernization Act of 2000 Section 9. Powers,
Functions, and Responsibilities of the Various Regulatory Boards
a. To regulate the practice of the profession
b. To monitor the conditions affecting the practice….adopt such measures as may be
deemed proper for the enhancement of the profession….maintain high professional
standards
Legal Basis
● The PRC and the Professional Regulatory Boards are the only bodies expressly created
by law to regulate the professions.
● The Professional Regulatory Board of Medicine: supervision, control and regulation of
the practice of medicine

Clear Mandate for the PRBOM

● To maintain high professional standards
● No compromises because physicians deal with the health, and the lives of patients
● PRC Legal Division Statistics: Gross negligence and incompetence (60% of cases filed
against physicians)

Regulation of Medical Practice

● Powers and Functions of the PRC and the PRB’s
● Quasi-legislative
- The power to make rules/policies / resolutions, including the power to interpret /
construe or to give an opinion on matters pertaining to the profession
- Final approval by the Commission Proper
● Quasi-judicial
- Hear and investigate violations of professional regulatory laws, rules and
regulations, Code of Ethics, etc.
- Render judgment and impose penalty in the form of reprimand, suspension,
revocation of certificate of registration

The Professional Regulatory Board of Medicine

● Formulated proposed revisions to the pending Physician Act regarding medical
education, licensure examinations, medical practice, classification of physicians,
specialization requirements
● Submitted to both Houses of Congress

Regulation of Medical Practice

● Main Goal: ensure high quality of care for the protection of the public; maintain high
professional standards
● Methods:
● Before entry: licensure exams
● In practice: requiring credentials
● requiring CPE
● continuing assessment
● enforcing regulatory laws

Guidelines Classification Requirement General Practitioner and Specialist

1. Graduation from recognized medical school
2. 1 year Internship
3. Passing Licensure exam – General Practitioner
4. For Specialist
5. Graduation from accredited residency training
6. Passing Certifying exam
7. For Subspecialist
8. Graduation from accredited subspecialty training
Clear Application of Guidelines
● At end of medical school and internship, a graduate may have acquired an academic MD
degree, but if he fails the licensure exams, he cannot be a licensed MD (GP)
● A physician may have finished residency training, but if he fails the certifying exams, he
cannot qualify as a specialist
● Physicians should have the proper education, training, and certification
● They can only perform procedures in areas of practice where they have been trained
and certified
● There are regulatory bodies governing the practice of medicine
● There are sanctions and penalties for violating the regulatory laws

Weaknesses of our systems:

At the level of medical schools
● Weak regulation by CHED
● Giving permits to open/operate
● Computer school with college of medicine
● Poorly performing med schools difficult to close down

At level of students
● NMAT: cut-off score decided by medical schools themselves
● Inappropriate use of a national screening test
● Allows entry of students who may not deserve to be admitted

At level of practice of medicine (PRC, PRBOM, PMA)

● Physicians declaring and marketing themselves as specialists
● Physicians forming unrecognized organizations
● Physicians misinterpreting the provisions of the Medical Act that they can do anything
once they are licensed
● Physicians engaging in questionable practices

At the level of continuing professional development

● CME activities heavily subsidized by drug companies

Admission to the Practice of Medicine

Prerequisites to the Practice of Medicine:
● Age requirement (21 years old)
● Educational background
● Examination requirements
● Passing the board examination
● Oath Taking
● Hippocratic Oath
● Administrative Oath
● Issuance of Certificate of Registration
Medical Ethics

Ethics are
● Moral Principles
● What is good and bad
● What is right and wrong
● Based on value system
● Ethical norms are not universal – depends on the sub culture of the society

Ethics
- refers to standards of behavior that tell us how human beings ought to act in the many
situations in which they find themselves as friends, parents, children, citizens,
businesspeople, teachers, and professionals.
- Medical ethics may be traced to guidelines on the duty of physicians such as the
Hippocratic Oath
- A physician must recognize a responsibility to patients first and foremost, as
well as to society, to other health professionals, and to self.
- These are not laws, but standards of conduct that define the essentials of
honorable behavior for the physician.

Four Basic Principles of Medical Ethics (4 Pillars of Medical Ethics)

Autonomy
- respect for the patient's right to self-determination
- 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.
- Always respect the autonomy of the patient - then the particular patient is free to
choose
- Such respect is not simply a matter of attitude, but a way of acting so as to recognize
and even promote the autonomous actions of the patient.
- The autonomous person may freely choose loyalties or systems of religious belief that
may adversely affect him.
- The patient must be informed clearly of the consequences of his action that may affect
him adversely.
- Desiring to "benefit" the patient, the physician may strongly want to intervene believing
it to be a clear "medical benefit." The physician has a duty to respect the autonomous
choice of the patient, as well as a duty to avoid harm and to provide a medical benefit.
- But the physician should give greater priority to the respect for patient autonomy than
to the other duties.
- However, at times this can be difficult because it can conflict with the paternalistic
attitude (making decisions for other people rather than letting them take responsibility
for their own lives) of many health care professionals.
- In the case of a child, the principle of avoiding the harm of death, and the principle of
providing a medical benefit that can restore the child to health and life, would be given
precedence over the autonomy of the child's parents as surrogate decision makers.
Beneficence
- the duty to 'do good'
- The practitioner should act in “the best interest” of the patient - the procedure be
provided with the intent of doing good to the patient.
- This needs health care providers to:
- develop and maintain skills and knowledge by continually updating training
- consider individual circumstances of all patients

Non-Maleficence
- the duty to 'not do bad'
- “Above all, do no harm,“ – Make sure that the procedure does not harm the patient or
others in society
- 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
- Physicians are obligated not prescribe medications they know to be harmful.
- Some interpret this value to exclude the practice of euthanasia
- Violation of non-maleficence is the subject of medical malpractice litigation

Medical Malpractice
- An act or omission by a health care provider that deviates from accepted standards of
practice in the medical community which causes injury to the patient.

Justice
- to treat all people equally and equitably
- 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.

The four main areas that health care providers must consider when evaluating justice
1. Fair distribution of scarce resources
2. Competing needs
3. Rights and obligations
4. Potential conflicts with established legislations