Ethical, Medico legal And Administrative issue in Managing

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Transcript Ethical, Medico legal And Administrative issue in Managing

Ethical, Medico legal And
Administrative issues in Managing
Emergencies
by
Prof. Adnan Albar
Conflict of interest in dealing and
Emergency cases
Paid Vs. Free
Gov. Vs. Private
Issues related to justice

Rationing

Duty

Moral Issues in Disaster Medicine

Research
Teaching

Clinical teaching
Burden
 Privacy


Teaching by simulation
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Proceedures on the newly dead
Relationship with Biomedical
Industry
Thank You
‫بسم هللا الرحمن الرحيم‬
“ On the name of Allah most
graceores most merciful “
Confidentiality : Justified
disclosure

Reporting related to public health
Vital statistics
 Contagious diseases
 Child / Women / elder abuse
 Criminally inflicted injuries
 Poisoning
 Loss of consciousness (the independent)
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Confidentiality : Justified
disclosure

Legal / justice proceedings

Quality assurance review

Protection of a third party from mortal
harm
Truth telling and communication
Communicating bad news
 Protection of human subjects in
biomedical and behavioural research
 Considering the therapeutic privilege is
morally licit when there is a significant
probability of causing harm by truth
telling ( e.g stressful news)

Compassion and empathy:

Empathy is the ability to feel the
anguish of illness and struggle and
treating the anguish if not the illness .
it’s the feeling of “I am you” or “I could
be you“
The emergency rule to
informed consent

Unconscious pt. or otherwise incapable
of cons.

Harm from a failure to treat is imminent
compared to the and proposed
treatment.

Lack for a substituted consent
A valid informed refusal of
care requires

The patient must have a decision
making capacity .

Comprehension.

Volantarness
The determination of decision
making capacity requires that:
1.
2.
3.
The pt. appreciates that he or she has the
power to wake decision on his or her behalf
The pt. understands the medical situation
and prognosis, the nature of the
recommended evaluation or care the a
alternatives, the risks and benefits of each
and the likely consequences
The patients decision is stable over time
and is consistent with his or her life values
or goals
Compassion and empathy improve
patient and physician satisfaction by

Promoting communication

Minimizing conflict

Maximizing patient confidence in the
Dx and Rx plan
Distributive justice seeks a
morally correct distribution of
benefits and burdens in society .
It requires equitable but not
necessarily equal allocation of
resources
Distributive justice affects
allocation of health care resources
at 3 levels
1.
2.
3.
At the societal interest level (
competes with education interest
social services .etc )
At allocating health care resources
rationally
At institutional level of care
departmental and bedside level
Gatekeepers / Limiters (third Party)

Laws / eligibility

Insurance

Managed care
Moral issues in disaster medicine

Triage is based on the ethical principle
of providing the greatest benefit to the
greatest number

Priority to the personnel who might be
able to return to the rescue effort and
to those injuries most amenable to
treatment
The 4 Principle of health care ethics

Autonomy i-e self rule
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Beneficence

Non maleficence
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Justice is Treating equals equally and
Treating non equals non equally.
Physicians must not act is away
which in detrimental to patients.
Beneficence requires physicians to act
to the best interests of their patients.
They must balance goods and potential
harms.
Ethical decisions can be made by
considering four factors



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Medical indicators
Equity of life
Patients preference
Features
3 rules for ethical decision

Impartiality
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Universability

Impersonal justifiability
Informed consents involve two
duties

Disclose information to patients

Obtain patients consent
It is the health care provider's
responsibility to assure that the patient
can meaningfully participate in the
decisions
Shared decision making requires that
the patient possess correct and
complete information and that the
decision promote the patients goal
and life values
There are 3 elements in the
consent process

Information

Comprehension

Volantariness
The concept of Legal Competence
Advanced directive
A written document which explains the
future wishes of a patient when he/she
becomes unable to participate in the
decision directly
e.g -The terminally ill
- The Suicide attemptlor
End of life decisions

Limiting resuscitation

Don’t resuscitate order “DNR”

Futility
The physician – patient relationship
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Confidentiality
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Truth telling and communication
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Compassion and empathy
Ensuring availability of Essential
structural
(Design ,Space ,Manpower ,ambulance ,
equipment ,supplies,…ete ) and process
( policies , procedures , job description ,
job distribution , referral …… ete )
requirement for the provision of
effective emergency care services
Dealing with emergencies in the
private medical facilities

Availability

Suitability

Problems of coverage

Problems and Insurance
‫‪Sources of profusion ethic in‬‬
‫‪Islam‬‬
‫) ما فرطنا في الكتاب من شيء )‬
‫( اليوم أكملت لكم دينكم وأتممت عليكم نعمتي ورضيت لكم اإلسالم دينا ً )‬
‫( إنما بعث ألتمم مكارم األخالق )‬
Characteristic of the professional
ethics in Islam

Define sources

Worship intent
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Constant
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Based on clear fundamental rule

Self accountability
Issues in dealing with Psychiatric
emergencies

Ethical

Administrative / legislative

Medic legal

Security and safety
Ethical Issues in dealing with
police emergency cases
Financial Issues in dealing with
emergency cases
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Payment

Extent of coverage

Approval and third party
Human rights in managing
emergencies and disasters