MEDICAL ETHICS

Dr.Nirmal k meena
Dept. of psm
RNT medical college,udaipur

1
 Doctors world overall-
Respected,Regarded
and Trusted

Trust mayy wither away,

y
unless conscious attempt
preserve it .
is made to p

Trust, in fact, is shrinking,

for decline & deviation from
ethics 2
Pure medical Professionalism
To
Medical Industrialization
Lead to
deviation from ethics
&
loss of trust

3
 Profession
It is a vocation or calling and implies service to
Others;
It has a distinctive knowledge base which is
kept up to date;
It determines its own standards and sets its own
Examinations;
It has a special
p relationshipp with those whom it
serves – patients; and
It has pparticular ethical p
principles
p

4
 Professionalism
“Constituting those attitudes and behaviors that
serve to
t maintain
i t i patient
ti t interest
i t t above
b physician
h i i
Self-interest”
Altruism(interest of patients,
patients not self-interest,
self interest is the
rule.),
Accountability
Accountability,
Excellence,
Duty,
Honor and Integrity, and
Respect for others.

5
Human social behavior is g
governed by
y:
Custom etiquette Ethics Law Morality
Mores Professional Prof.
Prof values States,
States Spirituality
Statutes,
legislations
Tradition Courtesy Competence Enforceme Religious
nt
Fairness Compulsion Good v/s
bad
Truth Justice Right v/s
wrong
Integrity Judiciary
Goodwill Punishment
6
 Medical Ethics
Ethics: Greek word from "ETHIKOS"means Theory of living.
Ethics or moral philosophy is the systematic
endeavour to understand moral concepts
and justify moral principles and theories.
Medical etiquette
q
Refers to the courtesy with which a doctor
should treat his colleagues
g

7
Medical Ethics:
“Deals
Deals with the moral principle that doctors
should adhere to in their transaction with
patient, colleagues and the state”.
Concern not only doctors but also patients
and society.
The core of ME is doctor patient relationship.
Contemporary legal medical practices

Contract
C t t ( basis
b i off patient
ti t doctor
d t relationship
l ti hi )
9 Voluntary,
9 Quasi
Q i
Law at tort( please protect yourself, ) when
li bili off h
liability harm iis on D
Doctor
9 Negligence tort
9 Intentional tort
9
Negligence tort

Duty
Breach
Causation
Damage
g

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 Intentional Tort

Assault- Immediate apprehension of harm (

Assault
words with supporting gestures)
Battery Unauthorized touching
Battery-
False imprisonment
D f
Defamation-
ti H
Harming
i th the repute
t – verbally/
b ll /
written
Invasion of privacy ( giving information to
unauthorized )
Infliction of mental distress
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 Scope of Medical Ethics

Development of ethical codes and guidelines

Promotion of ethical practice
Prevention of ethical breaches
Recognition of ethical dilemmas Resolution
of ethical conflicts

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Components of Medical Ethics

Physician patients relationship

Physician: physician relationship
Physician : health system relationship
Physician: Society relationship

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 Importance of Medical Ethics

Increasing profile\Recent press headlines

Increase in technology-
technology use vs abuse
Better informed society-awareness
Doctors in Management
Public scrutiny-Audit, CPA

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 Why
y we need it

“Patients
Patients are entitled to,
to good standards of
practice and care from their doctors. Essential
elements of this are p
professional competence,
p ,
good relationships with patients and
colleagues and observance of professional
ethical
hi l obligations.”
bli i ”

From Good Medical Practice, GMC.

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The moral duties of the doctor
Help, cure
Promote and protect the patient’s health
Confidentiality
P t t the
Protect th patient’s
ti t’ life
lif
Respect the patient’s autonomy
Protect privacy
Respect the patient’s dignity

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The moral rights of the patient
High quality medical service
Autonomous choice
Decide
Be informed
Privacy
Health education
Dignity
g y

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Role of the doctor within the health
service
i
Understanding of the:

Health care system

Clinical responsibilities
As researcher, mentor or teacher, manager
Q li controll
Quality
Team work

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 Six principles of Medical Ethics
Beneficence To act in the best interest of the patient
Non - Do no harm
Malfeasance
Autonomy The patient right to refuse or choose{
consent)
Justice Who gets what treatment on the merit
of illness
Dignity Patient and doctor both have the right
to dignity
Truthfulness/ The p patient deserve to know the whole
Honesty truth about the illness and treatment
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Beneficence and Non – Malfeasance
Think good
You may not say any thing- others can still read you
Face
Accent
Body language/ Gestures
silence may still be saying something
Talk / Say good
good- the words
The art of communication is the foundation of
the p
patient doctor relationship
p
Do good – the acts

Write good
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Beneficence and Non-Malfeasance
Non Malfeasance
Questions:

Is the patient your only concern?

(possible conflict with utility)
Do we always know what is good for the
patient?
ti t?
(patient’s view may differ from ours)

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Constraints on Beneficence
Need to respect autonomy-patient and
doctor may differ re. Management

Need to ensure health is not bought at too

high
g apprice

Need to consider rights

g of others

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 Autonomy
Capacity to think, decide, take action

Mental incompetence= no autonomy

Autonomy –v-Paternalism

Wh
When patient
ti t nott autonomous
t –no clash.
l h
When patient autonomous-questionable
procedure

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 Truth Telling
g
Increase the Knowledge Increase the Sorrows”
If you override it you endanger doctor/patient
relationship(based on trust)
At times there are g good reasons for overridingg
the truth telling principle
The case for deception is founded on 3 fallacies
9Hippocratic obligations
9Not in a position to know the truth
9Patients do not want the truth if the news is
bad

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 Duties of a doctor

Compulsory duties:
9 Notification of births, deaths, infectious disease
and notifiable diseases and in some states
industrial diseases too.
9 Responsibilities to state
™Responding
R di tot emergency military
ilit services
i
™Attending accidents
™Reporting cases of poisoning
™Reporting unnatural death
™Reporting cases under privileged communication

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 Duties of a doctor
Voluntary duties
1. Answerability and responsibility to patients
2. Medical examination
3. Surgical operation
4. Medico-legal
g examination ((includingg ppost-
mortum examination)
5. Issuing various certificates and carrying out
tasks outlined under Geneva convention

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 Doctor p
patient relationship
p
Formal agreement with a serious commitment
and carries the possibility of legal action if
breached.
Implied by y action of parties ,rarelyy expressed
in formal contract terms.
The fact that patient does not pay far services
do not affect the existence of the contract or
lessen the physicians’ duties, obligations ,
responsibilities and liabilities.
liabilities
Doctor is not an employee of patient
Physical contact but even the telephonic
instruction can infer relationship in courts.
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 Doctor patient relationship
Doctor Patient relationship is not established :
9 In emergency situation where the doctor has
given some first aid.
9 Court of law has asked doctor to examine
the person.
Once the relationship is established doctor can
not stop treating the patient except in some
circumstances like patient does not comply,
comply
wants to change doctor etc.

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 Consent
Consent -a free and voluntary agreement/
approval or permission or compliance of some
act
Statutory legal obligation in accordance with
section 13 of Indian contract act.
ed ca , co
In medical, consent
se is s most
os important
po a in
followings:
9 Examination of patient
9 Examination of person for medico legal and statutory
purpose
9 Postmortem examination and removal of tissues and
organs for transplantation.
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 Consent
Implied consent:
This is provided by behavior of patient and far
th mostt common variety
the i t off consent,
t this
thi does
d
not apply to more complex procedure like rectal
or vaginal examination.
examination
Expressed consent :
9 Expressed either verbally or in writing
9 For all major diagnostics or therapeutics
procedure and general anesthesia written
consent should be obtained
9 Should be for specific
p procedure and not to be
p
a blanket consent to cover all subsequent
procedure. 30
 Statutory body to enforce
regulation: MCI
Created in year 1933 by virtue of Indian Medical
Council Act 1933
Replaced by IMC act 1956 and further amended
i 1964
in
Maintains and prescribes the standards of
undergraduate and post graduate medical
education
Recognize the various medical qualification
Maintains register of medical practitioners
Advice state councils on disciplinary matters.
matters
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Statutory
y body
y to enforce regulation
g

State medical council

Maintain register of medical practitioner in their
states
Obtaining a qualification alone does not mean a
doctor can start his/her practice
After registration a distinctive number is allotted
which must appear on all his professional
activities.
activities

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 Medical negligence
g g
“Defined as lack of exercising reasonable care
and skill by physicians for treatment of a patient
leading to endangering his health and life”
Legal wrong: when the standard of medical
care given to patient is considered to be of
inadequate.
q The negligence
g g could be civil and
criminal depending upon severity.
Ethical wrong: when the professional behavior
falls below which is expected from a doctor i.e.
professional misconduct of infamous conduct.

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Criteria to prove negligence

Duty of care

Dereliction of duty

Causation of damage

Direct causation

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Common criminal negligence
g g

In case of death doctor can be booked under

section 304 A (rash and negligent act)
Common example of criminal negligence.
9Amputation or removal of wrong limb or
organ
9Ligation
Li ti off ducts/
d t / vessels
l
9Retaining of objects in surgical site
9Tight
Ti ht plaster
l t castt leading
l di to t gangrene
9Transfusion or anesthetic mistakes.

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 Euthanasia
Active: an active intervention to end life
Passive : deliberately withholding treatment
that might help a patient live longer
Voluntary : euthanasia is performed following a
request from a patient
Doctor assisted suicide : a doctor prescribes
p
a lethal drug which is self administered by the
patient
Non-voluntary : ending the life of a patient who
is not capable of giving permission
Involuntary : ending life against a patients will
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Duties of Physician in Consultation
Avoid unnecessary consultation
9 Consultation for Patient’s Benefit

9 Punctuality in Consultation

Statement to Patient after consultation

Fee and other charges- Display

Name and designation on prescription

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Responsibility to fellow physician
Conduct in consultation:
9 No rivalry
y
Consultant not to take charge of the case
9 Not criticize the referring physician
Appointment of Substitute:
9 Requests another physician to attend his patients
d i hi
during his ttemporary absence
b ffrom hi
his practice.
ti
9 Consideration to the interests and reputation of
the absent physician

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Public and Community
C Health
9 Enlighten the public concerning quarantine
regulations
9 Measures for the p
prevention of epidemic
p and
communicable diseases
9 When an epidemic occurs a physician should not

abandon his duty for fear of contracting the disease

himself.

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 Unethical acts
Advertising, except
9 Change in address
9 Start of Practice & change in nature of practice
9 Declaration of charges
9 Proceeding on leave/ resuming
Patents and copy rights
Running own shop
Rebates and commissions
Secret Remedies
Violation of Human Rights
Euthanasia
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 Misconduct
Violation
oa o o of the
e Regulations
egu a o s

Adultery or Improper Conduct

Conviction by Court of Law

Se Determination Tests
Sex

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Punishment and disciplinary action

A complete list of the infamous acts which calls

for disciplinary action, and that by issuing this
notice the Medical Council of India and or
State Medical Councils are in no way
precluded from considering and dealing with
any other form of professional misconduct on
the part of a registered practitioner.

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Any complaint with regard to professional
misconduct can be brought before the appropriate
Medical Council for Disciplinary action. Upon
pt of any comp
receip plaint of professional
misconduct, the appropriate Medical Council
would hold an enquiry and give opportunity to the
registered medidcal practitioner to be heard
in person. If the medical practitioner is found
to be guilty of committing professional
misconduct, the appropriate Medical
Council may award such punishment as
deemed necessary or may direct the removal
altogether or for a specified period, from
the register of the name of the delinquent
registered practitioner.
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In case the punishment of removal from the
register is for a limited period,
period the appropriate
Council may also direct that the name so
removed shall be restored in the register
g after
the expiry of the period for which the name
was ordered to be removed.

Decision on complaint against delinquent

physician shall be taken within a time limit of 6
months.

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 An innate desire

People world over still wish to see the

doctors as trustworthy and honorable

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Thank you