Transcript Medical Ethics

MAINTENANCE OF ETHICAL STANDARD
Ethical standard is maintained by overseeing
professional conduct of registered medical
practitioner by the council critically. His name
can be suspended or removed altogether if
the disciplinary committee of the council finds
him guilty of professional misconduct.
DEVELOPMENT OF MEDICAL
PRACTITIONER
Human Being
Medical Practitioner
•
MP (Medical practitioner) is given
extensive instructions / training to
equip him with knowledge and skills
peculiar to practice of medicine
•
Before granting registration (legal
practitioner) he has to sit for qualifying
examination
•
Once registered, he is like any other
practitioner, free to practice the art of
healing
•
MP must understand his duty (sphere of
professional activity) in pursuit of his
noble profession
State/Employer
Family/Himself
Doctor
Patient
Teacher/Colleague
A careful analysis of the work of MP will indicate that he owe a duty towards
his patients, teachers, state, himself and family (ethical and legal)
•
To perform these duties, he must have a
peculiar
skill and Knowledge
(commensurating with his
claim) backed
by
authority i.e. Registration
•
The granted authority will not allow him to
become careless or his attitude become
unkind towards his patients
Ethics
The word “Ethics” is noun and according to
Oxford dictionary, it has been equated with the
word moral or relating to morals i.e. moral duty,
moral principles, moral problems, treating moral
questions and moral judgment; evolving the
meaning of morality:
What is right?
What is wrong?
What is virtuous?
What is evil?
In Human Conduct
Definition
Ethics is the study of the general nature of
morals and specific moral choices to be
made by an individual in his relationship with
others
In other words it implies the principles or the
standards governing the conduct of the
members of society
Medical ethics
Medical ethics, may be defined as a code
of behavior (moral) voluntarily accepted
with in the medical profession as opposed
to statutes and regulations imposed by
official legislation
Position of medical practitioner /
patient in society
Medical practitioner enjoys privileged position
in society as he has both skill and authority.
The patient is at his mercy, helpless,
dependent and vulnerable, is in a state of
complete surrender.
Medical practitioner’s work
analysis
Medical practitioner, throughout his life, come
across situations, where he has to face ethical
issues and these issues become more
important because of the special relationship
between him and his patient.
Besides, there are some aspects of medical
practice where he has to choose between two
alternatives
• The patient is insisting on abortion, but the
medical practitioner
medically unjustified
thinks
that
it
is
• The medical practitioner prescribes morphine
in case of severe angina, but the
patient
objects to it that use of narcotic is
prohibited in religion
• In case of an insurance compensation, the
sufferer demands damages that medical
practitioner considers unjust
These are the few examples of numerous
situations, where the interest of one party
comes into conflict with the scruples of the
other.
Resolving such dilemma involves ethical
consideration
Ethical behavior
Civilized behavior and Good manners.
Taking the example of medical profession,
important issues are history taking and
physical examination of the patient’s body,
as these are pre-requisite to prescription of
appropriate treatment
History taking means, on many occasions,
taking the secrets of the patient, even the most
guarded ones
Physical examination of the body means
manipulation of any part of the body and / or
introduction of finger / instrument in any
opening (even private) of the body
Prescription of appropriate treatment includes
administration of drugs (even poisons, drugs
of addictions etc.) and administration of
treatment such as laprotomy, D&C, IUD or
ligation
Those aspects of medical practitioner’s
behavior which fall out side formal legislation
or cannot be brought under legislation are left
largely to the conscience of the individual
medical practitioner but the limits are set by
the profession
In case of violation, the wrongdoer may be
declared unfit for the profession being guilty
of infamous / professional misconduct.
Professional misconduct or
Infamous conduct
“ If a medical man, during the pursuit of his
profession, has done something, which is
regarded disgraceful or dishonorable by his
professional brethren of good repute and
competency, than it is open to the Medical
Council, to say that he is guilty of professional
misconduct or infamous conduct”
Medical practitioner must avoid being involved or to fall prey to
professional misconduct which are remembered as 5As
5As
1. Abuse of privilege:
• Issuing false medical certificate
• Prescription of dangerous drugs for abuse
• Disclosure of patient’s secrets
2. Abuse of professional knowledge:
• Criminal abortion
3. Abuse of doctor patient relationship:
• Indecent assault and adultery with patient
4. Association with
running business
unqualified
person
in
5. Advertising / convincing with a view to have
unreasonable gains
Disciplinary Proceedings Against
Medical Practitioner
Court Conviction
Patient Complaint
Hospital Administration
President PMDC
Complaint Rejected
being frivolous
Asked Doctor to Explain
Warning Issued
Complaint Dismissed
Disciplinary Committee
Registration Suspend
Complaint Dismissed
Registration Canceled
Ethics in relation to colleagues
Much of the ethics of medical practice
represents purely intra professional code
of conduct
•Criticism
•Unfair competition
•Privileges of colleagues and their families
Ethics in relation to patients
Ethics in relation to patients has a special
significance having primary consideration not
to take advantage of his privilege in view of his
special training or position as a professional
man i.e. law relating to medical practice
•Consent
•Negligence
•Infamous conduct
Ethics in relation to employer
Medical ethics is also necessary to express the
independence of individual practitioner to offer his
service as he sees fit in accordance with the ethical
standards, even in defiance of the request or demands
of the patient or even employer i.e.
•
Attend the court and give guidance
•
Inform
police
suspected death
•
Inform public health authorities of any
notify able disease or food poisoning
about
unexplained
Scope of medical ethics
Not fixed in to rigid boundaries because it continues
to widen with modern developments and new
inventions, examples being practice of organ
transplantation, artificial insemination and cloning
Each invention creates new problems requiring laying
of ethical principles suited to the new situation
It would be useful to keep the following golden troika
in mind
1. Adherence to scientific basis
2. Impartial presentation of scientific findings
3. Dedication to serving justice
Code of medical ethics
The oldest known to the medical profession is the
one that used to be sworn by Greek physicians, the
Hippocratic Oath.
Formerly, this Oath used to be pledged by fresh
entrants to the medical profession at their graduation
ceremonies.
Unfortunately, the practice of taking such ethical
Oath has been discontinued, resulting in gross
transgression of ethical behavior of medical
practitioner and has given disrepute to the medical
profession
The World Medical Association, after the Second
World War, took cognizance of the deteriorating
ethical standards in Geneva and restated the
Hippocratic Oath in simple language and modern
style known as Declaration of Geneva, upon which
the International Code of medical Ethics is based.
The P M D C with slight modifications has adopted
this Oath as Code of Medical Ethics in Pakistan for
administration to medical graduates at the time of
their graduation:
Code of medical ethics in
Pakistan
“In the name of Allah, Most Gracious and Merciful.
• I solemnly pledge that I shall abide by the principles
laid down in the Code of Medical Ethics of PM&DC.
• I further make solemn declaration that:
• I consecrate my life to the service of humanity
• I will give my teachers the respect and gratitude which
is their due
• I will practice my profession with conscience dignity
and fear of God
• The health of my patient will be my first consideration
• I will respect the secretes, which are confided in me
• I will maintain by all the means in my power, the honor
and the noble traditions of the medical profession
• My colleagues will be my brothers and sisters
• I will not permit consideration of religion, nationality,
race, party politics, social standings to intervene
between my duty and my patient
• I will maintain the utmost respect, for human life, from
the time of conception; even under threat, and will not
use my medical knowledge contrary to the laws of
humanity
• I make these promises solemnly, free and upon my
honor.”
Doctor vs community
Emerge as a friend
Conscience and ethics
Morality
Professionalism
Fear of God