Ethics and Medico-legal aspects

What is Medical Ethics?

 Systematic application of values concerning

the practice of medicine
 Standards of behavior by which the
physician may evaluate his/her
relationships with patients, colleagues and
society
Components of Medical Ethics
 The Physician -- Patient Relationship
 The Physician -- Physician Relationship
 The relationship of the Physician to the
System of Healthcare
 The Relationship of the Physician to Society
Principles in Medical ethics

 AUTONOMY
◦ The patient has the right to refuse or choose their
treatment
 BENEFICENCE
◦ A practitioner should act in the best interest of the
patient
 NON-MALEFICENCE
◦ "first, do no harm”
 JUSTICE
◦ Requires that people be treated fairly
◦ Treat all patients equally –not to discriminate on
age, sex, religion, race, position or rank
 RESPECT FOR PERSONS
◦ The patient (and the person treating the patient)
have the right to be treated with dignity
 TRUTHFULNESS AND HONESTY
 A patient’s 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 compulsion to accept a treatment
◦ Agreement: verbal or written (preferred) to discussed intervention
 CONFIDENTIALITY

◦ The conversations between doctors and patients will

be confidential
◦ The termination of a pregnancy in an underage
patient, without the knowledge of the patient's
parents
◦ The diagnosis of a sexually transmitted disease in a
patient who refuses to reveal the diagnosis to a
spouse
 IMPORTANCE OF COMMUNICATION
 REFERRAL
◦ Fee splitting and the payments of commissions to
attract referrals of patients is considered unethical
and unacceptable in most parts of the world
 VENDOR RELATIONSHIPS
◦ Doctors can be influenced by drug company
inducements, including gifts and food
 TREATMENT OF FAMILY MEMBERS
◦ Many doctors treat their family members, don’t
ignore them
 SEXUAL RELATIONSHIPS
◦ Sexual relationships between doctors and patients
can create ethical conflicts
◦ Doctors who enter into sexual relationships with
patients face the threats of deregistration and
prosecution
 FUTILITY
◦ "Expressed wishes" of the patient are documented
and this provides a framework to guide family
members and health care professionals in the
decision making process
Standards for Physiotherapists

 Physiotherapist must have registration in

Indian Association of Physiotherapists for
clinical practice
 Competency

 The physiotherapist practices only in those

areas in which she/he is competent
 Where a patient’s needs are beyond the scope
of the physiotherapist’s expertise, the patient
shall be informed and assisted in identifying a
qualified person to provide the necessary
service
 Rights of patients

 Patients have the right:

◦ To be treated without discrimination on the basis of
nationality, religion, age, gender, race, creed,
politics, social status, sexual orientation, or health
status or disability
◦ To know the name and qualifications of the person
giving treatment
◦ To select or change their physiotherapist
 Cultural Competence
 Physiotherapy clinical practice is planned and
delivered in a way that respects cultural
values, requirements and variations
 The physiotherapist’s own cultural values are
acknowledged and respected
 Communication with patients
 Physiotherapists communicate openly and
honestly with patients and use active
listening skills, providing opportunities for
the patient to communicate effectively
 Confidentiality
 The physiotherapist treats all information provided by
the patient as confidential
 The physiotherapist provides an appropriate level of
personal privacy for patients
 Patient records must be securely stored
 It should be retained for 10 years from the date of the
last treatment of that individual
 Clinical records are destroyed in a secure manner
after the lapse of the required time-scale
 Informed Choice and Consent
 The physiotherapist must provide sufficient
information, including significant benefits, risks
and side effects of proposed treatments, in a
manner they can understand, to enable them to
make an informed decision, before starting any
examination/treatment/procedure
 Written consent forms should be used for any
invasive or high risk physiotherapy
interventions
 The patient is informed that they may be
treated by a student or physiotherapy
assistant, and given the right to decline this
option
 Patients have the right:

 To discuss treatment during its course

 To voice any concerns about the state and
quality of the service
 To withdraw from or refuse treatment at any
stage, without this prejudicing their future
care
 Environment
 The physiotherapist provides an environment
which is clean and safe for patients, has
equipment appropriate for the interventions
being provided and ensures patient, carer and
physiotherapist safety
 All Physiotherapy Electrical equipment must be
checked regularly
 Patients are made aware during receiving the
treatment, ask to call assistance; this may be
by the provision of a bell or alarm they can
activate
 Infection Control
 All physiotherapists and institutions in which
they practice will have an infection control
policy in place and adhered to
 Infection control procedures are followed e.g.
hand washing, correct disposal of sharps,
clinical waste and sterilization
 Emergency Procedures
 Physiotherapy practitioner should able to
identifies the risk for potential emergencies
which may occur within that practice or service
and establishes appropriate risk management
systems to deal with such emergencies as
effectively as possible
Continuing Professional Development
 The physiotherapist maintains at all times the highest
standard of professional practice and continues to
update and extend their professional knowledge and
skills
 The physiotherapist is aware of research and evidence
based practice relevant to physiotherapy practice, and
recognizes the need for ongoing evaluation and
research
 Standards of Clinical Practice
 The physiotherapist completes a
comprehensive assessment of the patient
 The physiotherapist formulates functional,
measurable treatment goals and outcomes in
conjunction with the active participation of
the patient
 The physiotherapist keeps the patient’s
referring to health professional e.g.
General Practitioner, informed of the
patient’s progress and any concerns the
physiotherapist may have
 The physiotherapist ceases intervention if the
physiotherapy clinical practice does not achieve
identified goals within a time frame appropriate
to the condition or injury, or does not enable the
patient to maintain health or lifestyle
 The physiotherapist ceases intervention when the
physiotherapy clinical practice has achieved and
sustained agreed defined functional goals