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Dr.T.V.Rao MD 1A History of Ethics Principles: A History of Ethics Principles 460-377 B.C Hippocrates of Cos 1792 Percival: Manchester Infirmary Committee 1803 Percival: Medical Ethics: A Code of Ethics and Institutes Adopted to the Professions of Physic and Surgery 1808 Boston Medical Society (self-regulation) 1847 AMA: “Code of Ethics” 1903 AMA: “Principles of Medical Ethics” 1912 AMA: revised “Principles” 1957 AMA: concise “Principles”, “Opinions” 1980 AMA: FTC-imposed Principles revision 1981 AAPS: “Principles of Medical Ethics” 1980s-1990s ACP Code, and many others 2001 AMA: revised “Principles” Dr.T.V.Rao MD 2What are medical ethics: What are medical ethics Medical ethics refers C hiefly to the rules of etiquette adopted by the medical profession to regulate professional conduct with each other, but also towards their individual patients and towards society, and includes considerations of the motives behind that conduct. Dr.T.V.Rao MD 3PowerPoint Presentation: Why Should doctors have to swear an oath when they qualify ? The Hippocratic Oath.doc Modern Hippocratic Oath.doc To save self and Others too Dr.T.V.Rao MD 4Patents are demanding unlike past- follow ethics : Patients are entitled to good standards of practice and care from their doctors . Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligations Patents are demanding unlike past- follow ethics Dr.T.V.Rao MD 5Definition of medical ethics : The practice of medicine is rooted in a covenant of trust among patients, healthcare professionals, and society. The ethics of medicine must seek to balance the healthcare professional’s responsibility to each patient and the professional, collective obligation to all who need medical care. Definition of medical ethics Dr.T.V.Rao MD 6Basic Rights and Ethical Duties: 7 Basic Rights and Ethical Duties Human Rights Access to health care Right to non-discrimination Right to privacy and confidentiality Right to environment that is not harmful to health or well being Human Dignity Dr.T.V.Rao MDPrinciples of Medical Ethics: Principles of Medical Ethics The good of the patient is paramount TRUST must be nurtured before all else Avoid conflicts of interest (COI) Avoid perception of COI Respect rights of patient safeguard confidentiality respect self-determination communicate honestly with all maintain competenceTypes of Ethics: Types of Ethics Medical Ethics: Clinical obligations fidelity first to patients’ interests telling the truth (cancer, errors) Professional Ethics: Obligations of the profession self-regulation education of self and others Bioethics: Guides for public policy gene technology, stem cell research health system reformWhat is the need for medical ethics?: What is the need for medical ethics? The practice of medicine and the practice of ethics are inseparable. Every clinical decision invokes an ethical decision as well. In many instances, the ethical issue may not be readily apparent. In others conflicts arise between ethical principles and medical decisions, which require the clinician to be well versed with the former in order to guide the latter. Dr.T.V.Rao MD 10ETHICAL PRINCIPLES: ETHICAL PRINCIPLES Autonomy: Respect for an individual’s autonomy or ability to make decisions for him/herself includes respect for their privacy and confidentiality need to provide sufficient information for them to make informed choices truth telling protection of persons with diminished or impaired autonomy. Dr.T.V.Rao MD 11ETHICAL PRINCIPLES: ETHICAL PRINCIPLES Justice: This refers to the need to treat all people equally and fairly Society uses a variety of factors as a criteria for distributive justice, including the following: to each person an equal share to each person according to need to each person according to effort to each person according to contribution to each person according to merit to each person according to free-market exchanges We should strive to provide some decent minimum level of health care for all citizens, regardless of ability to pay Dr.T.V.Rao MD 12ETHICAL PRINCIPLES: ETHICAL PRINCIPLES Beneficence: This refers to the tradition of acting always in the patients’ best interest to maximise benefits and minimise harm. Non-malfeasance: This principle ensures that treatment or research ought not to produce harm Negligence Misconduct Dr.T.V.Rao MD 13Ethical vs. Legal Obligations: Medical ethics and the law are not the same, but often help define each other Breach of ethical obligation may not necessarily mean breach of law Breach of ethical obligation may be used to prove medical malpractice or medical negligence Ethical vs. Legal Obligations 14 Dr.T.V.Rao MDMicro Level Ethical Principles : 15 Micro Level Ethical Principles I. Respect for Autonomy (or Person) Respect the decisions of autonomous persons and protect persons who lack decision-making capacity (e.g., confused patients, mentally ill). Recognize the capacity of mentally and legally competent patients : To think and make decisions independently To act on the basis of their decisions To communicate their wishes to health workers Uphold patient confidentiality Dr.T.V.Rao MDEthical Principles : 16 Ethical Principles II. Non-Maleficence (Not inflicting harm) Health professionals should not inflict harm on patients III. Beneficence Act in the best interests of patients or research participants. Contribute to patient welfare – help patients further health interests Dr.T.V.Rao MDHealthcare Professional Role: 17 Healthcare Professional Role Paternalistic model Emphasizes health and well-being (beneficence) over respect for autonomy and patient choice Patient is selectively given information Evolution of newer decision-making models Independent choice vs. enhanced autonomy Paternalistic vs. informative vs. interpretive vs. deliberative Dr.T.V.Rao MDLEARNING ABOUT ETHICAL ISSUES REQUIRES….: LEARNING ABOUT ETHICAL ISSUES REQUIRES…. An understanding of the issue-the science and knowledge base An understanding of ethical frameworks and principles-not just case studies and anecdotes An understanding of one’s own values Ability to think through the issue-logic and argument Recognition of uncertainty-limits to knowledge Dr.T.V.Rao MD 18We are confused many times about truth ???: We are confused many times about truth ??? Should doctors always tell patients their diagnosis? What about uncertainty in diagnosis? Is it right to make patients share this? Is it ever right to suppress diagnoses – what about stigmatising diagnoses, e.g. MS, dementia, HIV, psychiatric diagnoses? What if relatives ask doctors not to disclose diagnoses to patients? Dr.T.V.Rao MD 19Informed Consent: 20 Informed Consent Definition : 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 coercion or incentive to accept or deny a treatment Agreement: verbal or written (preferred) to discussed intervention Many are screening patients for HIV without informed consent ? Many are doing sex determination in fetus even it is prohibited ??? Dr.T.V.Rao MDTHE RELATION BETWEEN LAW AND ETHICS : THE RELATION BETWEEN LAW AND ETHICS Ethical values have often been influenced by and influenced legal doctrine and legal principles are closely related to ethical principles. Ethical obligations exceed legal duties Law serves to demarcate the limits of individual autonomy in the interests of society. It also protects the rights of individuals Dr.T.V.Rao MD 21Knowledge creates conflict so the doctors fight : In much wisdom is much grief :and he that increaseth knowledge increaseth sorrows” (Ecclesiastics 1,18) Knowledge creates conflict so the doctors fight Dr.T.V.Rao MD 22Medical ethics create better physicians: Medical Ethics Good of the patient Virtues biological-medical good self-understood good Excellent physician Medical ethics create better physiciansPractice good practices you will flourish : Values Virtues Flourishing life Ethics Basic template for professions: identify distinguishing characteristic rank virtues for particular profession define professional excellence Practice good practices you will flourishWhat is your choice makes difference ???: What is your choice makes difference ??? Medicine is about : “ Can we?” Ethics is about : “ Should we ?” Dr.T.V.Rao MD 25Practicing ethics is expensive ?????: Practicing ethics is expensive ????? Dr.T.V.Rao MD 26Solutions to Ethical Problems: Not simple Ethics not like science Is ethics arbitrary? Or Can we discover an ethic for medicine? Solutions to Ethical Problems Dr.T.V.Rao MD 27PowerPoint Presentation: Dr.T.V.Rao MD 28 Programme created by Dr.T.V.Rao MD for Medial Professionals with Major resources from American Medical association who constantly thrive to improve the standards in Medical Profession to benefit the patients Email email@example.com You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.