ETHICS RELATING TO DOCTOR AND THE SOCIETY - PowerPoint Presentation

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ETHICS RELATING TO DOCTOR AND THE SOCIETY

BY ADENIKE ADENIRAN

LEARNING OBJECTIVE

Upon completion, participants should be able to:

Have increased knowledge and competence in discussing medical ethics.

Handle challenges they may come across in the course of practicing medicine

OUTLINE

Definition of terms

What medical ethics

involve.

History of medical ethics

Key values for

deciding ethical issues

Examples of ethical problems doctors may be involved in handling

Professional standards that guide the doctor on handling ethical problems.

Practical implications of medical ethics.

Ethics, morality and religion.

Who decides medical ethics?

DEFINITION OF TERMS

T

he word ‘ethics’ means a system or code of morals of a particular profession

The word ‘moral’ means to be capable of making the distinction between right and wrong

Moral reasoning/ethical reasoning in social work practice means being able to make the distinction between right and wrong in how one conducts the practice.

There are ethical and nonethical aspects of work. The nonethical aspect include various aspects of clinical practice e.g. particular intervention techniques, process notes, where to conduct one’s practice, whether or not to collect fees or methods of assessment.

These are tasks of clinical practice or business decisions which require the development of certain skills or techniques or the acquisition of

certain knowledge but do not necessarily involve the ability to judge between what is right and wrong.

Medical ethics involves examining a specific problem, usually a clinical case scenario, and using values, facts and logic to decide what the best course of action should be.

It is a system of moral principles that apply values and judgments to the principles of medicine

As a discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy and sociology.

HISTORY OF MEDICAL ETHICS

The Western Medical Ethics can be traced back to the guidelines on the duty of physicians in antiquity like the Hippocratic oath and early Christian teachings.

The first code of Medical ethics was published in the 5

th

century (Formula

Comitis

Archiatrorum

)

Conduct of a physician was the first book dedicated to medical ethics. It was written by an Islamic scholar

Ishaq

ibn

Ali al-

Ruhawi

In the medieval and early modern period

Other intellectual traditions that contributed to the field of medical ethics include:

Jewish thinkers (Maimonides)

Roman catholic scholastic thinkers like Thomas Aquinas

Thomas Percival, an English Physician and author, wrote the first modern code of medical ethics. First drafted a pamphlet in 1794 and by 1803, wrote an expanded version coined the ‘Medical Ethics’ and ‘Medical Jurisprudence’.

Some critics like Jeffrey

Berlant

considered

Percival’s

codes of physician consultations too protective of the physician’s reputation

That the physician community was anti-competitive and ‘guild-like’ in nature.

The British Parliament passed an Apothecaries Act in 1815.

T

his introduced compulsory apprenticeship and formal qualification for the apothecaries under the license of the Society of Apothecaries.

This was the beginning of regulation of the medical profession in the UK.

American Medical Association adopted its first code of ethics in 1847, based

largelyb

on

Percival’s

work.

The secularized field was based largely on the Catholic medical ethics but by the 20

th

century, liberal protestant approach surfaced articulated by thinkers such as Joseph Fletcher

The idea of Bioethics emerged in the 1960s/1970s when liberal theory and procedural justice became the order of the day.

With increased influence of ethics in contemporary medicine, there has been more use of institutional review boards in the evaluation of experiments on human subjects, establishment of hospital ethics committees, expansion of the role of clinicians, ethicists and integration of ethics into many medical school curricular.

KEY VALUES FOR DECIDING ETHICAL ISSUES

There are four (4) basic values or moral principles recommended by professional ethicists to be judged and weighed against each other with keen attention given to the scope of their application before making decision on ethical issues. These four principles are:

Respect for autonomy:- patient’s right to refuse or choose their treatment (

Voluntas

Aegroti

Suprema

Lex

)

b) Beneficence: practitioner should act in the best interest of the patient (

Salus

Aegroti

Suprema

Lex

)

c) Non-

Maleficence

: first do no harm (

Primum

non

nocere

)

d) Justice: fairness and equity. This concerns the distribution of scarce health resources and the decision of who gets what treatment.

OTHER IMPORTANT VALUES

Respect for persons: the patient and the person treating the patient have right to be treated with dignity.

Truthfulness and honesty: the concept of informed consent has gained importance since the historical events of the Doctors’ Trial of the Nuremberg trials and the Tuskegee Syphilis Experiment.

Note: these values do not give answers to how to handle any particular situation but they provide useful framework for understanding conflict.

EXAMPLE OF ETHICAL PROBLEMS DOCTORS MAY BE INVOLVED IN

Some are pretty straight forward like determining right from wrong.

Others can be more perplexing e.g. deciding between two rights when the two values are in conflict with each other or deciding between two different value systems such as patient’s versus the doctor’s

As a doctor, you may have to deal with a variety of ethical problems where some physicians hold different opinions e.g. withholding treatment to meet an organization’s budget or because of insurance policies

Accepting money from pharmaceutical or device manufacturers

Up coding to get treatment covered

Getting romantically involved with patient or patient’s family member

Covering up a mistake.

Reporting an impaired colleague

Prescribing a placebo

Practicing defensive medicine to avoid lawsuits.

Breaching patient’s confidentiality owing to a health risk

Professional standards are ways to provide guidance on ethical problems but they cannot address every issue especially troubling nuances like reconciling two conflicting values.