Post on 17-Jan-2016
transcript
SYSTEMS GOVERNING
HUMAN SOCIAL BEHAVIOUR
CUSTOM ETIQUETTE ETHICS LAW MORALITYMores Professional Professional State, Statutes Spirituality
Etiquette Values Legislature
Tradition Courtesy Competence Enforcement ReligiousIntegrity Compulsion Good vs EvilFairness Judiciary Right vs WrongGoodwill Punishment Truth Justice
THE MEDICAL ECOSYSTEM
- Enlarging Circle of Influence
DOCTOR PATIENT
Disease DiagnosisHealth Promotion
Disease Prevention Therapy
Medical Insurance Managed Care
Hospital
Laboratories
Pharmaceutical Industry
Patients’ Family, Culture, Religion
Patients’ Work, Employer
Other Doctors
Paramedics
Clinic Management
Public Health
Medical Research
Medical Students
CME, CPD
Doctor’s Employer
Doctor’s Family
Doctor’s Employee
Practice Management
MDO
Medical Council
The LAWGovernment Bodies
Medical Charities
Patient Organisation
Alternative Medicine
Press, Media
National Community
International Community
Natural Disasters
Political Upheaval, War
Historical values, private values, corporate values, legal statues
MEDICAL ETHICS - definition and scope
System of values common to the medical profession.
Systematic application of values concerning the practice of
medicine.
Standards of behaviour by which the physician may evaluate his/her
relationships with patients, colleagues and society.
Scope of medical ethics includes:development of ethical codes and guidelinespromotion of ethical practice prevention of ethical breachesrecognition of ethical dilemmasresolution of ethical conflicts
Components of Medical Ethics
• The Physician -- Patient Relationship• The Physician -- Physician Relationship• The relationship of the Physician to the
System of Healthcare• The Relationship of the Physician to
Society
The Principle of Non-Maleficence
• first do no harm• sanctity of life• calculated risk or risk benefit
The Principle of Beneficence
• do only that which benefits the patient• patient’s welfare as the first consideration• care consideration competence
The Principle of Veracity
• Truth telling• Obligation to full and honest disclosure
When do you tell the truth?
The Principle of Confidentiality
• Based on loyalty and trust• Maintain the confidentiality of all personal,
medical and treatment information• Information to be revealed with consent and
for the benefit of the patient• Except when ethically and legally required• Disclosure should not be beyond what is
required
The Principle of Justice and Social Responsibility
• Actions are consistent, accountable and transparent
• not to discriminate on age, sex, religion, race, position or rank
• greater good of society• respect of the Law• equity and distribution of burden & benefits
THE PRINCIPLES IN MEDICAL ETHICS
• The Principle of Non-Maleficence• The Principle of Beneficence• The Principle of Autonomy• The Principle of Veracity• The Principle of Confidentiality(or
Fidelity)• The Principle of Social Responsibility and
Justice
PRIMUM NON NOCERE
Conflicts of Ethical Principles
autonomy
veracity
confidentiality
paternalism
nonmaleficence
justice
beneficence
research
dual obligations
family interest
payer's interest
Resolution of Ethical Dilemmas
• Principles• Ethical codes• Clinical judgement• Reasoned analysis• Ethical committees• Ethical tests
• Declarations• Oaths & Pledges• Commonsense• Debate• Ethical Consults• The Law
obligation to keep information about your patient private
• WAIT A SEC
Shared decision making entitles patients to participate actively in health care decisions
The Principle of Autonomy
• right to information and self determination• free and informed consent• free will and accord - intentional
participation in treatment• respect and dignity maintained
R
Types of mistakes are omission, commission, and iatrogenic
Preventive Medicine: using specificity and sensitivity a well as EBM articles
Advanced Directives
• Distributive cost • Pain management
Consider patients competent. Continue treatments but observe DNR
A Patient wishes to die!
Can Physicians do anything they want?
• Euthanasia is legal in Belgium, the Netherlands , Canada, and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont.
Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%
Canada accepts the concept of Euthenasia
SLIPPERY SLOPE…namely the disable
• The argument is known as the “Slippery Slope”: apprehension that PAS for terminally ill will progress to other vulnerable communities, such as disabled, or those less worthy on their demographic or social economic and even to those who do not consent
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