CHAPTER 2 MEDICAL ETHICS
1. Beneficence- To act in the best interest of the patient
LEARNING OBJECTIVES
 Define Medical Ethics
 Know the Principles of Medical Ethics
 Differentiate the types of ethical problems
 Understand Ethical Codes
 Define and classify Medical Negligence
 Explain the importance of Medical Ethics
ETHICS can be defined as,
 the thoughts, judgments, and actions on issues that have
implications of moral right and wrong.
 comes from the Greek word "Ethike" which means habit,
action, character.
MEDICAL ETHICS
 branch of ethics that deals with moral issues in medical
practice.
 focuses primarily on issues arising out of the practice of
medicine
MEDICAL ETIQUETTES
The conventional laws, customs of courtesy, and the code of
conduct governing the relationship of the physician with his
professional colleagues.
SIX PRINCIPLES OF MEDICAL ETHICS
 The practitioner should act in "the best interest" of the
patient - the procedure be provided with the intent of
doing good to the patient.
 Patient's welfare is the first consideration.
2. Non-maleficence- Do no harm
 "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"
3. Autonomy- The patient right to refuse or choose
(consent)
 Patient has freedom of thought, intention, and action
when making decisions.
 Includes the need to tell the truth (veracity) and to be
faithful to one's commitments (fidelity).
 For a patient to make a fully informed decision, they must
understand all risks and benefits of the procedure and
the likelihood of success.
4. Justice- Who gets what treatment on the merit of illness
 Fair and equal distribution of scarce health resources,
and the decision of who gets what treatment.
 The burdens and benefits of new or experimental
treatments must be distributed equally among all groups
in society.
5. Dignity- Patient and doctor both have the right to dignity
6. Truthfulness/ Honesty- The patient deserve to know the
whole truth about the illness and treatment
TYPES OF ETHICAL PROBLEMS
 Ethical Dilemmas
 Locus of Authority
 Ethical Distress
 Dilemmas of justice
ETHICAL DECISION-MAKING PROCESS
 Gather relevant information
 Identifying the type of ethical problems
 Determining the ethics approach to use
 Exploring the practical alternatives
 Completing the action
ETHICAL CODES
 Hippocratic Code- 5th Century BC. One of the earliest
document in medical ethics. Traditionally all doctors
recite this oath at swearing in. It is considered sacred for
its religious foundation and sanctity.
 Nuremberg Code- 1948
- voluntary informed consent
- likelihood of some good resulting
- based on prior research (animal models)
- avoidance of physical or psychological injury or
harm
-benefits should outweight risks
-proper experience of researcher
- right to withdraw consent
-research must stop if harm is resulting
(no specific mention of children, unconscious people, or
others who may not be competent to give consent)
 Declaration of Geneva
- adopted at Medical World Association General
assembly on 1948
- amended in 1968, 1984, 1944, 2005, and 2006
- Declaration of Physicians’ declaration to the
humanitarian goals of medicine
- Universal Declaration of Human Rights
  It can be either Legal or Ethical.
 Helsinki Declaration- 1964
- set of ethical principles regarding human LEGALLY WRONG
experimentation developed by the World Medical  when the standard standard of medical medical care
Association. given to patient is considered to be of inadequate. The
- Undergone 6 revisions since then. Last was 2008. negligence could
- More specifically addressed clinical research, be civil and criminal depending upon severity.
reflecting changes in medical practice from the
term “Human experimentation” used in the ETHICALLY WRONG
Nuremberg code.  when the professional behavior falls below which is
- the well being of a human subject should take expected from a doctor i.e. professional misconduct of
precedence over the interest of science and society infamous conduct.
-consent should be in writing
- use caution if the participant is in dependent CRITERIA TO PROVE NEGLIGENCE
relationship with the researcher  Direct Causation
-limit use of placebo  Duty of Care
-participants benefits from research  Dereliction of Duty
 Causation of Damage
 International code of medical ethics- 2006
- given by World Medical Association IMPORTANCE OF MEDICAL ETHICS
-the code applies both in peace and war
- it codifies the duties of physician in general, duties The study of ethics prepares medical professionals to
to patients and colleagues. recognize difficult situations and to deal with them in a
rational and principled manner.
MEDICAL NEGLIGENCE
 “Defined as lack of exercising reasonable care and skill by Ethics is also important in physicians' interactions with
physicians physicians for treatment treatment of a society and their colleagues and for the conduct of medical
patient patient leading to endangering his health and life” research.
Ethical principles such as respect fo persons,
informed consent and confidentiality are basic
to the physician-patient relationship.
PATIENT RIGHTS AND HEALTHCARE COMPLIANCE
The Rights of the Patients
1. Right to Appropriate Medical Care and Humane
Treatment
Every person has a right to health and medical care corresponding to
their state of health, without discrimination and within the limits of the
resources, workforce, and competence available for health and medical care
at the appropriate time. The patient has the right to appropriate health and
medical care of good quality. In the course of such, his human dignity,
convictions, integrity, individual needs, and culture shall be respected. If any
person cannot immediately be given medically necessary treatment, he
shall, depending on his state of health, either be directed to wait for care or
be referred or sent for treatment elsewhere, where the appropriate care
can be provided. If the patient has to wait for care, he shall be informed of
the reason for the delay. Patients in an emergency shall be extended
immediate medical care and treatment without any deposit, pledge,
mortgage, or any form of advance payment for treatment.
2. Right to Informed Consent
The patient has a right to a clear, truthful, and substantial
explanation, in a manner and language understandable to the patient, of all
proposed procedures, whether diagnostic, preventive, curative,
rehabilitative, or therapeutic, wherein the person who will perform the said
procedure shall provide his name and credentials to the patient, possibilities
of any risk of mortality or severe side effects, problems related to
recuperation, and probability of success and reasonable risks involved:
Provided, That the patient will not be subjected to any procedure without
his written informed consent, except in the following cases:
a) in emergency cases when the patient is at imminent risk of physical injury
or decline of death if treatment is withheld or postponed. In such cases, the
physician can perform any diagnostic or treatment procedure as good
practice of medicine dictates without such consent;
b) when the health of the population is dependent on the adoption of a
mass health program to control epidemic;
c) when the law makes it compulsory for everyone to submit procedure;
d) when the patient is either a minor or legally incompetent, in which case.
Third-party consent is required;
e) when disclosure of material information to the patient will jeopardize the
success of treatment, in which case, third-party disclosure and consent shall
be in order;
f) When the patient waives his right in writing.
Informed consent shall be obtained from a patient concerned if he is
of legal age and sound mind. If the patient is incapable of giving consent,
third-party consent is required. The following persons, in the order of
priority stated hereunder, may provide support:
i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. Guardian
If a patient is a minor, consent shall be obtained from his parents or
legal guardian. If next of kin, parents, or legal guardians refuse to give
support to a medical or surgical procedure necessary to save the life or limb
of a minor or a patient incapable of providing consent, courts, upon the
petition of the physician or any person interested in the welfare of the
patient, in a summary proceeding, may issue an order giving consent.
3. Right to Privacy and Confidentiality
The patient’s privacy must be assured at all stages of his treatment.
The patient has the right to be free from unnecessary public exposure,
except in the following cases:
a) when his mental or physical condition is in controversy and the
appropriate court, in its discretion, orders him to submit to a physical or
psychological examination by a physician;
b) when public health and safety so demand; and
c) when the patient waives this right in writing.
The patient has the right to demand that all information,
communication, and records about his care be treated as confidential. Any
health care provider or practitioner involved in the treatment of a patient
and all those who have legitimate access to the patient's record is not
authorized to divulge any information to a third party who has no concern
with the care and welfare of the
patient without consent, except:
a) when such disclosure will benefit public health and safety;
b) when it is in the interest of justice and on the order of a competent court;
and
c) when the patients waive, or the confidential nature of such information is
needed for continued medical treatment or advancement of medical science
subject to de-identification of the patient and shared medical confidentiality
for those who have access to the information.
Informing the spouse or the family to the first degree of the patient's
medical condition may be allowed, Provided that the patient of legal age
shall have the right to choose whom to inform. If the patient is not of legal
age or mentally incapacitated, such information shall be given to the
parents, legal guardian, or his next of kin.
4. Right to Information
In the course of their treatment and hospital care, the patient or
their legal guardian has a right to be informed of the result of the evaluation
of the nature and extent of their disease, any other additional or further
contemplated medical treatment on surgical procedure or procedures,
including any other different medicines to be administered and their generic
counterpart including the possible complications and other pertinent facts,
statistics or studies, regarding their illness, any change in the plan of care
before the change is made, the person's participation in the program of care
and necessary changes before its implementation, the extent to which
payment may be expected from Philhealth or any payor and any charges for
which the patient may be liable, the disciplines of health care practitioners
who will furnish the care and the frequency of services that are proposed to
be provided.
The patient or his legal guardian has the right to examine and be
given an itemized hospital bill and medical services rendered in the facility
or by their physician and other health care providers, regardless of the
manner and source of payment. He is entitled to a thorough explanation of
the such bill. The patient or their legal guardian has the right to be informed
by the physician or their
delegate of their continuing health care requirements following discharge,
including instructions about home medications, diet, physical activity, and all
other pertinent information to promote health and well-being.
At the end of their confinement, the patient is entitled to a brief,
written summary of the course of their illness, which shall include at least
the history, physical examination, diagnosis, medications, surgical
procedure, ancillary and laboratory procedures, and the plan of further
treatment, and which shall be provided by the attending physician. They are
likewise entitled to the explanation of, and to view, the contents of the
medical record of their confinement confinement but with the presence of
their attending physician or in the absence of the attending physician, the
hospital's representative. Notwithstanding that they may not be able to
settle his accounts because of financial incapacity, they are entitled to
reproduction, at their expense, the pertinent part or parts of the medical
record, the purpose or purposes of which he shall indicate in their written
request for reproduction. The patient shall likewise be entitled to a medical
certificate, free of charge, concerning their previous confinement.
5. The Right to Choose Health Care Provider and Facility
The patient is free to choose the health care provider to serve him as
well as the facility except when he is under the care of a service facility or
when public health and safety so demands or when the patient expressly
waives this right in writing.
The patient has the right to discuss his condition with a consultant
specialist at the patient's request and expense. If appropriate, he also has
the right to seek a second opinion and subsequent opinions from another
health care provider/practitioner.
6. Right to Self-Determination
The patient has the right to avail themself of any recommended
diagnostic and treatment procedures. Any person of legal age and sound
mind may make an advance written directive for physicians to administer
terminal care when they suffer from the terminal phase of a terminal illness:
Provided that.
a) he is informed of the medical consequences of his choice;
b) he releases those involved in his care from any obligation relative to the
consequences of his decision;
c) his decision will not prejudice public health and safety.
7. Right to Religious Belief
The patient has the right to refuse medical treatment or procedures
which may be contrary to his religious beliefs, subject to the limitations
described in the preceding subsection: Provided that parents shall not
impose such a right upon their children who have not reached the legal age
in a life-threatening situation as determined by the attending physician or
the medical director of the facility.
8. Right to Medical Records
The patient is entitled to a summary of his medical history and
condition. He has the right to view the contents of his medical records,
except psychiatric notes and other incriminatory information obtained from
third parties, with the attending physician explaining the contents. At his
expense and upon discharge of the patient, he may get a reproduction of
the same record from the health care institution whether or not he has fully
settled his financial obligation with the physician or institution concerned.
The health care institution shall safeguard the confidentiality of the
medical records and ensure the integrity and authenticity of the medical
records. It shall keep the same within a reasonable time, as determined by
the Department of Health. The health care institution shall issue a medical
certificate to the patient upon request. Any other document the patient may
require for insurance claims shall be available within forty-five (45) days
from the request.
9. Right to Leave
The patient has the right to leave the hospital or any other health
care institution regardless of his physical condition: Provided that,
a) they are informed of the medical consequences of their decision
b) they release those involved in their care from any obligation relative to
the consequences of his decision;
c) their decision will not prejudice public health and safety.
No patient shall be detained against their will in any health care
institution solely because he fails to settle his financial obligations fully.
However, they shall only be allowed to leave the hospital provided
appropriate arrangements have been made to pay the unpaid bills. Further,
the patients’ unpaid bills shall be considered a loss of income by the hospital
and health care provider/practitioner. They shall be deducted from gross
income as income loss only in that particular year.
10. Right to Refuse Participation in Medical Research
The patient has the right to be advised if the health care provider
plans to involve him in medical research, including but not limited to human
experimentation which may be performed only with the written informed
consent of the patient: Provided, That an institutional review board or
ethical review board by the guidelines set in the Declaration of Helsinki be
established for research involving human experimentation: Provided,
further, that the Department of Health shall safeguard the continuing
training and education of future health care provider/practitioner to ensure
the development of the health care delivery in the country: Provided,
furthermore, That the patient involved in the human experimentation shall
be made aware of the provisions of the Declaration of Helsinki and its
respective guidelines.
11. Right to Correspondence and to Receive Visitors
The patient has the right to communicate with relatives and other
persons and to receive visitors subject to reasonable limits prescribed by the
rules and regulations of the health care institution.
12. Right to Express Grievances
The patient has the right to express complaints and grievances about
the care and services received without fear of discrimination or reprisal and
to know about the disposition of such complaints. Such a system shall allow
all parties concerned to settle all grievances amicably.
13. Right to be Informed of His Rights and Obligations as a
Patient
Every person has the right to be informed of his rights and
obligations as a patient. The Department of Health, in coordination with
health care providers, professional and civic groups, the media, health
insurance corporations, people's organizations, and local government
organizations, shall launch and sustain a nationwide information and
education campaign to make known to people their rights as patients, as
declared in this Act. Such rights and obligations of patients
shall be posted on a bulletin board in a health care institution.
It shall be the duty of health care institutions to inform of their rights
and the institution's rules and regulations that apply to the patient’s conduct
while in the care of a such institution.
HEALTHCARE COMPLIANCE: TRAINING, REGULATION, AND
RESOURCES
What is the purpose of healthcare compliance?
Compliance programs promote organizational adherence to applicable
federal and state law and private payer healthcare requirements. An
effective compliance program can help protect practices against fraud,
abuse, waste, and other potential liability areas. The importance of
compliance in healthcare. A compliance program in healthcare is essential
for many reasons. For starters, the stakes are high. Healthcare compliance is
meant to help prevent fraud or abuse of patients. Healthcare compliance
and regulations also protect patient privacy and safety and encourage
healthcare professionals to provide high-quality care to all patients. It
also dictates how to bill patients properly. Not only do compliance program
regulations protect people, but they also protect valuable information.
Compliance with health information technology laws and regulations can
help protect against potential data breaches or cybersecurity threats.
Adhering to the federally instated laws and regulations allows a healthcare
organization to protect its patients and become a credible organization.
WHO IS RESPONSIBLE FOR HEALTHCARE COMPLIANCE?
Everyone in a healthcare organization must adhere to the healthcare
regulations established by the government. It’s the responsibility of every
professional to make sure they are acting ethically and per all laws. Many
healthcare organizations have a compliance officer, or a similar role, to help
ensure the facility is compliant.
Having someone in a designated role can help make it easier for a facility to
coordinate or communicate with government agencies or third-party
organizations that maintain healthcare compliance standards.
Department of Health (DOH):
A government agency focused on improving every Filipino's health, safety,
and well-being. It is responsible for ensuring access to essential public health
services for Filipinos through providing quality health care and regulating
health goods and service providers.
The Department of Health (DOH) is mandated to be the overall technical
authority on health. The primary mandate of DOH is to provide national
policy direction and develop national plans, technical standards, and
guidelines on health.
Food and Drug Administration (FDA):
An entity that regulates the information that must be included and disclosed
on prescription drugs. The FDA also approves or disapproves of prescription
drugs used in healthcare.
These entities can provide resources and guidance on any healthcare
compliance issues you might encounter.
THE CONSEQUENCES OF NON-COMPLIANCE
In healthcare, the consequences of non-compliance are severe and may
result in legal actions. The products are so major because of noncompliance
risks to patient safety and privacy.
If a healthcare organization is non-compliant, it will face fines and legal
charges, not to mention a damaged reputation. Patients seek a high quality
of care; if they are in the market for a new healthcare provider, they are
more likely to choose one who hasn’t been involved in a lawsuit or
complaint.
HOW TO ENSURE COMPLIANCE IN HEALTHCARE SETTINGS
To adhere to healthcare compliance requirements, you should have a
compliance plan in place — a plan that includes clear directives and policies,
a designated compliance person, and training and audits. Anyone pursuing a
job or completing an education in healthcare should be exposed to relevant
standards, regulations, and compliance guidelines. However, the exact role
(for instance, clinical versus clerical) may dictate additional or more
specialized training in compliance.
• Develop clear policies
Healthcare organizations need clear policies for every component of
compliance and a fully developed organizational compliance plan. Create
policies that adhere to each law and regulation. This will promote
consistency in production and high-quality service among your providers
and healthcare staff. Ensure all policies and requirements are incorporated
in onboarding and accessible by every employee.
• Designate a compliance officer
A compliance officer helps standardize and enforce all healthcare
regulation requirements and laws at an organization. Compliance officers
should also know how to identify risks and find remedies. Additionally, they
ensure that all healthcare systems are sufficiently updated to protect patient
records and private information. Compliance officers should be fully
educated in healthcare compliance and understand how each law impacts
day-to-day tasks. This education generally involves, at minimum, a
bachelor’s degree in healthcare administration. However, some positions
may benefit from a more profound education by completing a master's
degree in healthcare administration.
• Train employees
All healthcare employees undergo compliance training when onboarded
and then regularly after that. While your compliance officer is responsible
for standardizing compliance policies and identifying risks for the
organization, all healthcare employees should be trained in compliance.
Employees who have undergone training are better able to understand
compliance risks. When employees have a clear understanding of the
regulations, they can work with compliance officers or other organizational
leaders to ensure the safety of patients and sensitive information.

• Conduct compliance audits

Your compliance officer conducts regular healthcare compliance audits.
Compliance audits can help you identify potential hazards or risks before
they become a bigger problem. An audit evaluates the strengths and
weaknesses of your compliance policies and procedures. The evaluation
helps identify areas for improvement and where noncompliance might pose
a risk. A compliance officer then makes changes accordingly.

• Deal with noncompliance immediately

An organization must have policies in place to mitigate noncompliance
issues. A compliance officer makes sure the policies tell employees how to
report issues so that when one comes up, it’s addressed immediately. Issues
of noncompliance can be an opportunity to educate employees. A
compliance officer can show them that proactively responding to
noncompliance will help the organization prevent future incidents and
improve overall compliance.