PHYSICAL DIAGNOSIS Do all persons without exception have dignity?
BIOETHICS Where does the human person derive or get his
Dr. Dax O. Librado, MD
INTRODUCTION
- Ethics in PD is not necessarily an ethical type that gives
moral judgment on action
- More on the attitude of the physician towards the
patient and profession
- Concerns the intimate and humane but professional
relationship
- Requires knowledge at the ethical principles and
guidelines and the capability to apply them in cases
- Bioethics comes before a diagnosis has come up
- As soon as the patient enters the clinic, bioethical
principles are already applied
- The moment the patient answers the question of the
physician, the physician is bound to keep in
confidentiality (BIOETHICAL PRINCIPLE)
- The concern and focus is not only with and on the
scenario of the physical diagnosis but also when a
physical examination is being done in order to come up
with a diagnosis
PRINCIPLE OF HUMAN DIGNITY
- Lies on the roots of Bioethics
- A fundamental principle which should not be
presumed
- Hippocrates considered ethical behavior the foremost
characteristic of a physician
- Human person’s dignity as a core of ethics
- In the sense that moral life is basically living out the
meaning of the person in relation to oneself, other
human persons and other sentient beings
- A human action is morally right or wrong depending
on how the person has expressed his humanness
towards the other person
• It is wrong for a physician to terminate a
pregnancy for whatever reason because the
meaning of being a person to the other is to
respect the life of the other because that life
does not belong to him nor does it belong to
the pregnant woman
- This response therefore is that one gives to human
dignity is respect so that respect for the dignity of all
persons and each person is the necessary condition for
all morally good attitudes and acts
• Wrong is committed if and when in given
situations, there is no respect towards other
human persons
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dignity from?
- All persons without exception have dignity from the
newly conceived to the dying
- ELEMENTS: A person has dignity because of his nature
that is, a thinking and a will
- Every person is endowed of intelligence and a will
{ INTELLIGENCE }
-` Faculty that enables the person to think, deliberate,
reflect, understand, realize and make conclusions
{ WILL }
- Faculty that enables the human person to decide and
choose freely
- As long as the human intelligence and will are present
the dignity is there
- It is the intelligence and will that make all human
persons equal to each other
• The physician who looks down on the patient
because he does not have the medical expertise
as he has is an ethically wrong attitude
What makes the human person really so
dignified? His freedom.
- Human dignity would entail respecting the human
person in all 3 dimensions of his personhood, in his:
{ BODY }
- Human person must be respected on his body
- Biological bodies are the basis for their human
consciousness and their personhood
- Each human person- absolute unique singularity: body
and spirit
- To respect the dignity of man amounts to safeguarding
this identity of the man who is one in body and soul
- Should be mindful of the language, what he may think
as endearing maybe offensive to the patient
- Relationship has not been established with the patient
- Scenes that may be misunderstood by the patient
during physical examination results to unexpected
problem
- The physician should be extra careful when doing a
physical examination especially when the sensitive parts
of the body are exposed
- Extra careful means actions does not convey any tint
of malice
- If private parts are to be examined like genitals and
breasts, the physician should use gloves and avoid any
inappropriate action or manner of examination can be
construed as fondling
- The physical examination procedure can be abused
- It can be said that is not only unethical but immoral
- The doctor knows deep in his heart when he is abusing
the physical procedure
- The necessary attitude is to be truthful to oneself and
to the medical profession
- EXAMPLES:
• Physician does a breast or pelvic examination
when this is not indicated
• Physician does an appropriate examination of
the breast or genitals in an erotized manner
• Patients are raped or fondled while awake or
under anesthesia in the operating room or clinic
{ SOCIAL NATURE }
- Human person must be respected in his social nature
- Humans are by nature social beings
- “No man is an island”
- Within the context of a society, his rights and
responsibilities are recognized and not only is it upheld
by natural and civil laws but also those intrinsic in
customs and traditions
- The physician must respect whatever custom or
tradition the patient may have on health and medicine
including religious beliefs
- Should not discount superstition or practices or
judgment that offends personal beliefs
- Treat equally no matter its social or financial status
{ REASON AND LIBERTY }
- Human person must be respected in his reason and
liberty
- Each has his own perception and understanding of
things
- When expressed, either written or spoken, it is the
manifestation of his uniqueness and individuality so
that there can be as many points of view as there are
persons with differences and similarities
- All opinions, thoughts, and ideas of others even if
one's own mind is wrong
- One does not force another to accept one’s own
thinking or perception nor does a person manipulate
another to decide or choose something that he is willing
to take or make
- When the patient enters a physician’s clinic, the doctor
looks at the patient as a peso or dollar sign or another
prescription of a particular drug, even not as a sexual
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object but as a human person in need of medical
expertise
- - The patient even if he is sick and no matter how
deforming, is still a human being with intelligence and
free will
- Respecting the reason of the patient is respecting his
opinions, judgments, reflections and deliberations
including fear and anxiety
- Physician must not manipulate the ideas and thoughts
- As a physician you owe the patient explanations, so he
must make decisions
- It is also the duty of the physician to make the
necessary correction when there is misconception
- Use of emergency privilege
- Respecting the liberty of the patient is respecting its
decision and choices, although not absolute.
- Limited by other’s rights
- Patient’s freedom must be respected if its exercise
does not violate or injure the rights of other human
persons
- Physician has the right to withdraw from care if the
decisions made by the patient are contrary to his
personal beliefs and values or those of the institutions
where he practices
HIPPOCRATES
Father of Rational Medicine
- “The ideal physician is primarily concerned with the
patient and not only the disease”
PRINCIPLE OF FREE AND INFORMED CONSENT
- Most significant and expressive way of showing
respect to the dignity of the patient as a human being is
by respecting his autonomy
- Through this autonomy is giving free and informed
consent
- Consent is necessary to be able to do something on
him
- No presumption even patient is in the clinic for consult
- ELEMENTS:
{ THRESHOLD }
- Patient's competence (ability to understand the
diagnosis, treatment or procedure, risks and benefits)
{ INFORMATION }
- Disclosure and understanding of the information given
(the patient is informed of the diagnosis because he has
the right to know his sickness that afflicts him)
- The nature and purpose of the treatment and
prognosis
- Costs of treatment
- All information should be truly communicated
- Use of medical terms should be avoided and should
not be used
{ CONSENT }
- Voluntariness and authorization
- Patient is not coerced or forced to agree to the
treatment
- Patient is not manipulated nor under the influence of
drugs or alcohol
- Voluntariness presumes that all necessary information
that have to be known have been given to the patient
Application of the principle of informed consent to
physical examination and diagnosis
- If a case is important for a conference discussion, care
should be taken to keep the identity of the patient
anonymous
- Confidentiality is not absolute; it may have to be
dispensed with for the sake of another person’s welfare
• 6 month old baby diagnosed with HIV. It should
not only be the mother who should be informed
but also the babysitter if there is one. This is
established so the carer (babysitter) can protect
herself. It is not right that the mother withhold
information to the carer in fear that once
disclosed, might leave her job.
- Confidentiality is one of the principles most violated
- Anyone who is known in the community gets to have
his privacy violated
- Physicians and medical students should be aware not
to violate privacy
- Upholding dignity and respect to the patient

- Before taking the history, the patient should be told CONCLUSION

that important information relevant of his sickness is to - Not hard rules that curtail freedom of the physician
be asked - These are guidelines that would help physicians in
- Explain to the patient the importance of physical dealing and relating with their patient in the highest
examination and the reason for it possible ethical standards
- Before proceeding to the examination ask for concrete
and actual consent of the patient
- Patient can see honesty, modesty and professionalism
- The presence of a chaperone during physical
examination is reassuring to the patient
- Situations having a chaperone are recommended:
• Patient with history of sexual abuse
• Patient with extreme anxiety and psychiatric
disorder
• Litigious patient
• Patient undergoing pelvic examination
• With a patient who for any reason raises
concerns in the physician

PRINCIPLE OF CONFIDENTIALITY
- Based on the principle of human dignity
- As a creature with a dignity that has its source from
the very nature of the human being, he has rights that
are based on their nature as humans
- The most fundamental of this rights is the right to life
- Since he is a rational being, he also has the right to
privacy, since the human person, even if he is a social
being is not owned by society
- This principle protects any information from being
disclosed for whatever reason
- Whatever information extracted from the medical
history is strictly confidential

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