Subject: Medical Ethics and Professionalism

Term Date Topic Lecturer

First Bimonthly Aug.26, 27 & Introduction to Medical Ethics and Dr. Aparece
28 Professionalism
Sept 2, 3, & 4 The Core Principles Dr.Aparece
Sept 9, 10 & 11
Sept 16, Informed Consent Dr. Aparece
17,&18
Sept 23, 24 & Medical Confidentiality(Principles) Dr. Aparece
25
Sept 30,Oct 1 & Medical Confidentiality( Cases) Dr. Aparece
2
Oct 6 First Bimonthly Exam Dr. Aparece
Oct 7, 8 & 9 Exam Rationalization Dr. Aparece
2nd Bimonthly Oct 14, 15 & 16 Patient- Doctor Relationship Dr. Aparece
Oct 21, 22 &23

Oct 27, 28 & 29 End of Life Decisions Dr. Aparece

Nov 4, 5 & 6 Medical Practice (Principles) Dr. Aparece
Nov.11, 12 &13
Nov. 18, 19 & Medical Practice (Cases) Dr. Aparece
20
Nov 25, 26 &
27
Dec 1 2nd Bimonthly Exam Dr. Aparece
Dec 2, 3& 4 Exam Rationalization Dr. Aparece
 Objectives
• By the end of this module a student should be able to:
1. Define the basic terminology related to medical ethics
2. Describe the development of medical ethics
3. Appreciate the importance of medical ethics
 Ethics

Can be defined as the system of moral principles

that govern the conduct of an individual or group
of individuals and according to which human
actions are judged as right or wrong, good or bad.
 Ethics

 Ethics is an understanding of the nature of conflicts

arising from moral imperatives and how best we
may deal with them.
 Also known as Moral philosophy
 Morals
 Those principles and values that actually guide,
for better or for worse, an individual’s personal
conduct.( Guy, 2001)
 Values
 Guiding principles of behavior and conduct
 The core motivator for behaviors
 Medical Ethics
 Branch of moral philosophy.
 The discipline of evaluating merits, risks, and
social concerns of activities in the field of
medicine.
 Practical Ethics
 Works out on the implications of general
theories for specific forms of conduct and moral
judgment
 Formerly called applied ethics
 Professionalism
 Term which embodies numerous qualities of
physicians as public servants
 Professionalism
• A belief system in which group members declare to
each other and the public the shared competency
standards and ethical values they promise to uphold in
their work and what the public and individual patients
can and should expect from medical professionals
(American Board of Medical Specialties)
 Primary strands of thought:
• 1. Utilitarian -considers the balance of benefits and
harms were outcome may justify the action (ends
justify means)
 Primary strands of thought:
2. Deontological – considers duties and obligations
and how best they may be met. Outcome may not be
sufficient to justify action (ends alone may not justify
means).
 Importance of Medical Ethics

• Health care decisions are based not only on

clinical and technical grounds, but also on ethical
grounds.
 Importance of Medical Ethics

• It may not always be the case that what the clinician

believes is in the best interest of the patient is what
the patient wishes or will consent to.
• It may not always be the case that what the
clinician believes is in the best interest of the
patient is what the patient wishes or will
consent to.
 Development of Medical Ethics
• Medical ethics has developed over centuries.
Such development commenced from the time of
ancient civilization and over time has several
codes.
4 Important Events in the Development of Medical Ethics.
 Hippocratic Oath
• An oath historically taken by doctors swearing to
practice medicine ethically.
• It is one of the most widely known of Greek
medical texts.
 Development of Medical Ethics

Hippocratic Oath
 The Declaration of Helsinki

•the World Medical Association’s (WMA) best-known

policy statement.
•The first version was adopted in 1964 and has been
amended seven times since, most recently at the
General Assembly have been replaced and should
not be used or cited except for historical purposes.
 The Medical Coding

• It is the transformation of healthcare diagnosis,

procedures, medical services, and equipment into
universal medical alphanumeric codes.
• The diagnoses and procedure codes are taken
from medical record documentation, such as transcription
of physician's notes, laboratory and radiologic results, etc.
 The Belmont Report

• The principles of biomedical ethics emerged from the

work of the National Commission for the Protection
of Human Subjects of Biomedical and Behavioral
Research
• Created by an act of Congress in 1974
 A. Respect for Persons
• Incorporates 2 ethical convictions:
• That individuals should be treated as autonomous agents
• Persons with diminished autonomy are entitled to protection
• Divides into 2 separate moral requirements:
• To acknowledge autonomy
• To protect those with diminished autonomy
 Respect for Persons

• Autonomous person
• An individual capable of deliberation about personal
goals and of acting under the direction of such
 Respect for Persons

• To respect autonomy-to give weight to autonomous

persons’ considered opinion and choices while
refraining from obstructing their actions unless
clearly detrimental to others
 Respect for Persons

• To show lack of respect

– to repudiate that person’s considered judgments,
– to deny an individual the freedom to act on those
considered judgments or
– to withhold information necessary to make a considered
judgment when there are no compelling reasons to do so.
 Respect for Persons

• Not every human being is capable of self -determination

• The capacity for self determination matures during an
individual’s life and some individuals lose this capacity wholly
or in part because of illness, disability or circumstances that
severely restrict liberty
• Respect for the immature and incapacitated
 Respect for Persons

• Some persons are in need of extensive protection even to the point of

excluding them from activities which may harm them
• Other persons require little protection beyond making sure they
undertake activities freely with awareness of possible adverse
consequence
• The extent of protection afforded should depend upon the risk of harm
and the likelihood of benefit.
 B. Beneficence
• Persons are treated in an ethical manner not only by
respecting their decisions and protecting them from
harm, but also by making efforts to secure their well-
being
• covers acts of kindness or charity that go beyond strict
obligation.
 Beneficence

• understood in a stronger sense, as an obligation.

• Two general rules have been formulated as complementary
expressions of beneficent actions in this sense:
– (1) do not harm and
– (2) maximize possible benefits and minimize possible
harms.
 Beneficence

• The Hippocratic maxim “do no harm” has long been a

fundamental principle of medical ethics.
• Claude Bernard extended it to the realm of research,
saying that one should not injure one person regardless
of the benefits that might come to others.
• However, even avoiding harm requires learning what is
harmful; and, in the process of obtaining this
information, persons may be exposed to risk of harm.
 Beneficence

• Hippocratic Oath requires physicians to benefit their patients

“according to their best judgment.”
• Learning what will in fact benefit may require exposing persons
to risk.
• The problem posed by these imperatives is to decide when it is
justifiable to seek certain benefits despite the risks involved, and
when the benefits should be foregone because of the risks . . . .
 C. Justice

• An injustice occurs when some benefit to which a

person is entitled is denied without good reason or
when some burden is imposed unduly.
• Another way of conceiving the principle of justice is
that equals ought to be treated equally.
Thank you for listening.