Forensic Medicine

lecture 4

Dr. Abdirahman Moalim Hassan

GREEN HOPE UNIVERSITY

(BSc in MBBS, BSc in GN, Master of Health service Mgt , Candidate PhD of Nursing Science )

CHAPTER 2 : THE ETHICS OF MEDICAL PRACTICE

LECTURE 4
 Introduction
The principles of medical ethics have developed over several thousand years and
continue to evolve and change, influenced by society, the legal profession and
the medical profession itself.

The laws governing the practice of medicine vary from country to country, but
the broad principles of medical ethics are universal and are formulated not only
by national medical associations, but organizations such as the World Medical
Association (WMA).
 Duties of a physician as defined by the
World Medical Association:
1. Respect a competent patient’s right to accept or refuse treatment.

2. Deal honestly with patients and colleagues.

3. Not receive any financial benefits or other incentives only for referring patients or
prescribing specific products.

4. Behave towards colleagues as he/she would have them behave towards him/her.

5. Provide a high standard of practice and care at all times.

NB The key to a doctor–patient relationship is trust.

• As a professional, you are personally accountable for actions and omissions
in your practice, and must always be able to justify your decisions.
 Medical ethics in practice:

1. Patient autonomy and their right to refuse or choose treatment.

2. Non-maleficence – do no harm.

3. Beneficence – acting in the patient’s best interests.

4. Dignity.

5. Honesty – providing informed consent.

6. Justice – how healthcare is apportioned when.

7. Health and financial resources may be limited

 When confidentiality may not apply?

1. If required by law.

2. Reporting serious communicable diseases.

3. Reporting concerns about driving capabilities.

 Five C's.” The Five C's are:

• Consent—A clinician may release confidential information with the consent of

the patient or a legally authorized surrogate decision maker, such as a parent,

guardian, or other surrogate designated by an advance medical directive.

• Court Order—A clinician may release confidential information upon the receipt

of an order by a court of competent authority.

• Continued Treatment—A clinician may release confidential information
necessary for the continued treatment of a patient.

• Comply with the Law—A clinician may reveal confidential information in order
to comply with mandatory reporting statutes (e.g., child abuse), law enforcement
or administrative agency investigations, and other such legal purposes.

• Communicate a Threat—This is the well known Tarasoff exception to

confidentiality that involves the clinician's duty to protect others from violence
by a patient. The Tarasoff exception exists in a variety of forms in many
jurisdictions.
What is Tarasoff warning?

The Tarasoff case imposed a liability on all mental health professionals to

protect a victim from violent acts. ... Duty to warn means that the social worker
must verbally tell the intended victim that there is a predictable danger of
violence.
 Consent:

1. Consent is a key concept of healthcare and it is expected that all decisions

about treatment and healthcare come about as a result of collaboration

between doctors and patients.

Consent should be based on trust, openness and good communication.

2. Age is not a rigid factor in ability to consent, although it is generally
accepted that those aged 16 years and older have the capacity to make
decisions about treatment or care.

3. If patients are unable to make decisions for them selves, the doctor
must engage with those who are close to the patient and with colleagues
involved in the healthcare.
 ETHICS REGARDING CONSENT

Minors, that is, persons who are younger than the statutory age of consent viz.

below the age of 12 years, can not give valid consent to suffer any harm from an
act done in good faith and for the benefit of the patient.

A person above 18 years can give valid consent to suffer any harm from an act,
not intended or known to cause death, and done in good faith and for his
benefit.
• A physician may treat a minor without parental consent if the minor is
emancipated. -----Young person who live independently

• The emancipated minor is a young person who lives independently of parents

or guardians, physically, financially or otherwise.
In life threatening emergencies, patients may be unable to express their
preferences or give their consent because they are unconscious or in shock.

In such situations, it has become customary for physicians to presume that the
patient would give consent if able to do so, since the alternative would be death
or severe disability.

This is a reasonable presumption.

• General anesthesia should not be given to child without consent of his legal
guardian; if given, it should be given by a qualified anesthetist talking all
possible precautions before hand.

• In case of anesthetic deaths, the case must be reported to police by

anesthetist or surgeon for necessary enquiry as to cause of death.

• Doctor should not start any surgery or experiment unless informed consent is
obtained in writing.
 ETHICS REGARDING
DETERMINATION OF DEATH
Declaring death is one of the legal duties of physicians. The common definition
of death in medicine and in the law was irreversible cessation of circulation and
respiration.

In the 1960s it became possible to maintain respiratory function by use of

mechanical ventilator.

The concept of “brain criteria” for death would compliment or replace “cardio
respiratory criteria” emerged in the 1960s.
• Nowadays, brain death describes certain clinical characteristics of a
nonfunctioning brain.

• unreceptive and unresponsive to external stimuli, no movements or

breathing, no reflexes, fixed and dilated pupils, no reaction to auditory
irrigation and absent doll’s eyes response.
 ETHICAL PROBLEMS IN PEDIATRICS

• This proceeds in the same fashion as in adult medicine. In general, the

responsibilities of pediatricians are the same as those of other physicians viz. to
benefit the patient and to abstain from harm.

• The goals are restoration of health, relief of symptoms, and restoration of

impaired function, saving life and preventing premature death.

• In pediatric medicine, the exercise of those responsibilities has some special

features:
1. Infants have no preferences.

2. Children are immature to formulate preferences.

3. Parents or guardians have the moral and legal responsibilities to act in the
child’s best interest.

4. The interest of the patient may be affected by

A. The Economic Factors

B. Religious Beliefs

C. Interest Of The Siblings.

5. As children mature, their preferences become important in reaching
decisions about appropriate treatment.

6. These features may modify the basic responsibilities of a pediatrician.

 ETHICS REGARDING EUTHANASIA
• The Netherlands is the only country to legalize euthanasia in 2002.

• Strict rules govern mercy killing.

• There should be evident that patient will have a future of unbearable

suffering and the patient must make a voluntary request to die.

• Another physician should be consulted before ending patient’s life in a

medically appropriate way
 INTERNATIONAL CODE OF MEDICAL
ETHICS
The duties laid down in the international code of Medical Ethics are as follows;
1. Doctor’s duty to the sick

A. A doctor must always keep in mind the importance of preserving human life
the day of conception until death.

B. A doctor owes to his patient complete loyalty and all the resources of his
science. When some examinations and treatments are beyond his capacity,
he should call another doctor who has the necessary ability.
C. A doctor owes to his patient absolute confidentiality regarding that which has
been confided to him or what he knows by virtue of the patient’s confidence on
him.

D. A doctor must give necessary treatment in emergency circumstances unless

he is certain that it can and will be given by others.
 2. Doctor’s duty to another doctor.

1. A doctor should behave towards his colleagues in a way which he will like to

have from them.

2. A doctor must not entice patient from his colleagues

 3. Duties of a doctor in general.

1. A doctor must always maintain the highest standards of professional

conduct.

2. A doctor must not allow himself to be influenced merely by motives of

profit.

3. A doctor should consider the following practices unethical-

Any self advertisement.

• Participation in any health care system in which the doctor will not have
professional independence.

• Receiving money for the service to his patient other than acceptance of proper
professional fee or payment of money in such circumstances, without the
knowledge of the patient.
D. A doctor is not permitted to do anything which can weaken the

physical or mental resistance of a human being, without strict

therapeutic or prophylactic indication, in the interest of the patient.

E. A doctor should be very careful in publishing his observations or discoveries,
particularly in respect of a method of treatment which is not recognized by the
professional men.

F. In case of issuance of a certificate and when required to give evidence he

should only mention of what he can verify or prove.
The end
Thank you