The physician-patient is based on brotherhood. The physician must maintain the highest standards of justice. He should also follow the following guidelines : good intentions, avoiding doubtful things, leaving alone matters that do not concern him, loving for others, causing no harm, giving sincere advice, avoiding the prohibited, doing the enjoined acts, renouncing greed, avoiding sterile arguments, respect for life, basing decisions and actions on evidence, following the dictates of conscience, righteous acts,

guarding the tongue. humane limits.quality work. performing good acts to wipe out bad ones. seeking help from God. avoiding anger and rage. He must work for the benefit of the patients and the community. treating people with the best of manners. The physician should be professionally competent . balanced . consciousness of God in all circumstances. have responsibility and accountability . and avoiding oppression or transgression against others. . maintaining objectivity. restraint and modesty.

Informed consent requires disclosure by the physician. . decision by the patient. and authorization by the patient to carry out the procedures. The patient has the purest intentions in decisions in the best interests of his or her life.MEDICAL DECISIONS No medical procedures can be carried out without informed consent of the patient except in cases of legal incompetence. voluntariness of the decision. recommendation of the physician on the best course of action. The patient must be free and capable of giving informed consent. legal competence of the patient. understanding by the patient. Others may have bias their decision-making.

. Consent can be by proxy in the form of the patient delegating decision making or by means of a living will.The patient is free to male decisions regarding choice of physicians and choice of treatments.

Consent is limited to what was explained to the patient except in an emergency. and offering the patient a choice. It involves explaining the procedure contemplated. informed. making sure the patient understands.Valid consent must be voluntary. and by a person with capacity to consent. Refusal to consent must be an informed refusal (patient understands what he is doing). Refusal to consent by a competent adult even if irrational is conclusive and treatment can only be given by permission of the court. .

Physician assisted suicide. A spouse cannot overrule the patient’s choice. Spouses and family members do not have an automatic right to consent. and voluntary euthanasia are illegal. proxy informed consent by the family are made for the unconscious terminal patient on withholding or withdrawal of treatment. active euthanasia. Advance directives. .Doubts about consent are resolved in favor of preserving life. A do not resuscitate order (DNR) by a physician could create legal complications.

.The living will has the following advantages: (a) reassuring the patient that terminal care will be carried out as he or she desires (b) providing guidance and legal protection and thus relieving the physicians of the burden of decision making and legal liabilities (c) relieving the family of the mental stress involved in making decisions about terminal care. The disadvantage of a living will is that it may not anticipate all developments of the future thus limiting the options available to the physicians and the family.

The device of the power of attorney can be used instead of the living will or advance directive. doctors in armed forces. prison doctor. Decision by a proxy can work in two ways: (a) decide what the patient would have decided if able (b) decide in the best interests of the patient. . Informed consent is still required for physicians in special practices such as a ship’s doctor. Police surgeons may have to carry out examinations on suspects without informed consent.

. The consent of one parent is sufficient if the 2 disagree. Mental patients cannot consent to treatment. Parental choice is final in therapeutic or non-therapeutic research on children. Parental choice takes precedence over the child’s choice. Life-saving treatment of minors is given even if parents refuse. or sterilization because of their intellectual incompetence. Courts can overrule parents.CONSENT OF THE INCOMPETENT Competent children can consent to treatment but cannot refuse treatment. research.

Suicidal patients tend to refuse treatment because they want to die. if they are a danger to themselves. and treatment can be withdrawn in a persistent vegetative state since the chance of recovery is low.They are admitted. or on a court order. hydration. detained. for purposes of assessment. There is no moral difference between withholding and withdrawing futile treatment. and treated voluntarily or involuntarily for their own benefit. . in emergencies. Nutrition.

Forced medical intervention and cesarean section may be ordered in the fetal interest.Labor and delivery are emergencies that require immediate decisions but the woman may not be competent and proxies are used. Birth plans can be treated as an advance directive. .

Deception violates fidelity. . If disclosure will cause harm it is not obligatory. the physician must tell the whole truth. Partial disclosure and white or technical lies are permissible under necessity. Patients have the right to know the risks and benefits of medical procedure in order for them to make an autonomous informed consent. Disclosure to the family and other professionals is allowed if it is necessary for treatment purposes. Physicians must use their judgment in disclosure of bad news to the patient.DISCLOSURE AND TRUTHFULNESS As part of the professional contract between the physician and the patient.

. Privacy is the right to make decisions about personal or private matters and blocking access to private information. This confidentiality must be maintained within the confines of the Law even after death of the patient.PRIVACY AND CONFIDENTIALITY Privacy and confidentiality are often confused. The patient voluntarily allows the physician access to private information in the trust that it will not be disclosed to others. In routine hospital practice many persons have access to confidential information but all are enjoined to keep such information confidential.

Confidentiality includes medical records of any form. Release is not justified without patient consent for the following purposes: education. The patient should not make unnecessary revelation of negative things about himself or herself. and in the public interest. for criminal investigations. . The physician can not disclose confidential information to a third party without the consent of the patient. Information can be released without the consent of the patient for purposes of medical care. research. medical audit. employment or insurance.

It includes: acting in faith. fulfilling agreements. and fiduciary responsibilities (trust and confidence). The fidelity obligation may conflict with the obligation to protect third parties by disclosing contagious disease or dangerous behavior of the patient. It is not based on a written contract.FIDELITY The principle of fidelity requires that physicians be faithful to their patients. . maintaining relations. Abandoning the patient at any stage of treatment without alternative arrangements is a violation of fidelity.

The conflict may be between two patients of the physician such as when maternal and fetal interests conflict.The physician may find himself in a situation of divided loyalty between the interests of the patient and the interests of the institution. . Physicians involved in clinical trials have conflicting dual roles of physicians and investigators.


EXAMINATION AND INVESTIGATION Patient consent is necessary for history taking otherwise it is considered trespassing on privacy and spying. The physician is not obliged to report criminal information to the authorities unless there is demonstrable immediate public interest and necessity. . History taking provides an opportunity to discuss diseases of the heart that underlie physical disease.

A patient can only be examined against his or her consent only if there is a necessity relating to the life of the patient or to public interest such as criminal investigation. Mental patients can are not legally competent to give consent.Physical clinical examination also requires informed consent. the necessary consent could be obtained .

. A physician of the opposite gender can be used only if a situation of necessity arises.Examination by a caregiver of the opposite gender requires special consideration. Examination limited to what is necessary. A chaperone must be present. It is always preferable that physicians of the same gender carry out the examination.

their benefits should be carefully weighed against the benefits. The results of radiological investigations are confidential. These investigations should be carried out only if there is a clear necessity. Invasive investigations carry a higher risk to the patient. .The results of laboratory investigations have the same requirements for confidentiality as history and clinical examination.

antimetabolites. electrolytes). biological modification & modulation. and detoxification). antagonists. analgesia etc). cytotoxics. and supportive treatment (diet. . rest.MEDICAL TREATMENT Medical treatment may involve destruction (antibiotics. fluids. replacement (hormones. antitoxins. psychoactive therapy.

and critical care. restorative/reconstructive surgery. Transfusion of whole blood or blood components is widely accepted and raises few legal or ethical issues. transplantation. anesthesia.SURGICAL TREATMENT Permitted surgical procedures include resection. blood transfusion. Blood donation is analogous to organ donation by a living donor. .

Attempts must be made to minimize inappropriate mixing of male and female health care personnel in a small confined space of the operating theater. .

financial considerations complicate the picture when destitute patients who cannot pay present at the emergency room.In emergency treatment/critical care. .

alternative.OTHER TREATMENTS Prayers are spiritual treatments. Immunization and other preventive measures are treatment before disease. immunotherapy. . and genetic therapy. and complementary therapies are permitted if they are of benefit. Various traditional. Other permitted treatment modalities are irradiation.