Ethics of Trust Vs ethics of Rights

objectives

• Autonomy

• Consent

• Rights of the patient

• Confidentiality

• Right to life

• Sex Pre selection and female foeticide

• Assisted Reproductive Technologies

Autonomy

• The word “Autonomy” is derived from the Greek word “autos”(self) and “nomos” (rule , governance or law).

• Principle of Autonomy

a) Right to information and self determination

b) Free and informed consent

c) free will and accord – Intentional participation in treatment

d) Respect and dignity maintained

Consent

“Permission to do something”.

or

“A written agreement to carry out an activity after being fully informed in one’s native

language of all information relevant to the activity.”

or

A legal term stating when one party has given authority to another party for particular purpose.

CONSENT

• Consent refers to the provision of approval or agreement, particularly and especially after thoughtful consideration and understanding

• As per jurisprudence prior provision of consent signifies a possible defense (justification) against civil or criminal liability by the doctor.

• Practitioners who use this defense claim that they should not be held liable for a tort or a crime ,as the consequence in question occurred with the prior consent and permission of the patient without realizing whether it is a commission or an omission and the extent of negligence.

• Informed Consent - It is the process by which a fully informed patient can participate in choices about her health care.

• It is necessary in physician –patient relationship

Types of consent

• Implied consent

• Expressed consent

a) Oral

b) Written

• Written Informed Consent

• Blanket Consent

• Implied consent is consent which is not expressly granted by a person, but rather inferred from a person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's silence or inaction). Example – Physical Examination like ,BP, Weight or Height.

• Expressed Consent – Any examination beyond routine physical examination requires a specific consent given i.e. expressed by the patient. Example- giving injections, examination of private parts giving anesthesia, radiological anesthesia etc.

• It can be oral or written – but with the presence of two or more witness in sufficient.

• Written Informed Consent – It refers to the written consent given by the patient after being informed of nature of illness, nature of operation or procedures to be done, its alternatives consequences and publications

• Blanket consent - It refers to the consent which is taken usually on a printed form at the time of admission of the patient authorizing to do any surgery under anesthesia.

Confidentiality

• “All that comes to my knowledge in the exercise of my profession or outside of my profession pr in dairy commerce with me which ought not to spread abroad. I will keep secret and will never reveal.” – Hippocratic Oath

• “I will respect the secrets which are confined in me even after the patient has died”. – Geneva

Breach of Confidentiality might occur under a variety of situations

• Gossiping between doctors or the doctor and others.

• Leaving note on desk, where it is accessible to others

• Press and employers representatives may pose as close relatives and ask for information.

• Talk over phone

There is a need for safeguards

• when it is approached by lawyers , employers and insurance companies

• Computers held records

• When collecting health statistics.

Information may be given to the third party in certain situations :

• Notifiable infectious disease

• Infectious disease risk to the community

• Risk to public safety .

Right to life

• Life is a valuable gift of god . Life exsist in all living organisms.

• “Every one has the right to life, liberty and security of person” - Article 3 of universal declaration of human rights.

• “Every human being has the inherent right to life”. Article 6 of the International convenant on civil and political right.

• Every all religions emphasize that god gives life and no human being has a right to take away one or his/her own life , if so it is considered as a sin. So in general all the declarations , laws , religions etc. saying that right to life is in herent in a person , a human being.

Issues related to Right of life

• Abortion

• Infanticide /Foeticide/ Selective Abortion

• Euthnasia

• Suicide

• Capital Punishment

• Foetal tissue research

Abortion

• It is an issue in Right of life.

• An operation or other procedure to terminate pregnancy before the fetus is viable or it is premature termination of pregnancy by spontaneous or induced expulsion of nonviable fetus from the uterus.

Abortion is permitted by Law on:

1.Physical Health Grounds :

• Laws that authorize abortion to protect the pregnant woman‘s life and physical health.

2.Mental Health Grounds:

• Laws expressly permit abortion to protect the woman’s mental health as well as her life and physical health.

3. Socioeconomic Health:

• Laws , which allow abortion on socioeconomic grounds, permit consideration of factors as a woman’s economic resources , her age, her marital status, and the number of her children. Such laws are generally interpreted liberally.

4.Without Restriction as to Reason:

• Finally, the least restrictive abortion laws are those abortion without restriction as to reason. Most countries with such laws , however , impose a limit on the period during which women can readily access the procedure.

MTP(Medical Termination of Pregnancy )Act

• It was passed in 1971. • The act was intended to grant women freedom

from unwanted pregnancies. Especially where there was social censure or medical risk involved .

• The aim of the act is to allow for the termination of certain pregnancies by registered medical practioners.

• If someone who is not a registered practitioner terminates a pregnancy , it would constitute an offence punishable under the Act.

When MTP is permitted

• where the length of the pregnancy does not; exceed 12 weeks or Where the length of the pregnancy exceeds 12 weeks but does not exceed twenty weeks, if not less than 2 registered medical practioners are, of opinion, formed in good faith, that –

The continued pregnancy would cause a risk of injury to the woman’s physical or mental health.

• There exists a substantial risk that the fetus would suffer from a severe physical or mental abnormality.

• The pregnancy resulted from rape or incest.

• The continued pregnancy would significally affect the social or economic circumstances.

Consent to perfom MTP

• A pregnancy can be terminated only with the informed consent of the pregnant woman; no other person’s consent needs to be obtained.

• Less than 18 years – parents Consent to be taken.

• For Unconscious or Severely mentally disabled woman the pregnancy can be terminated.

Foeticide/ Infanticide

• Foeticide - The destruction of a fetus in the uterus.

or

Selective Sex Abortion.

Female Foeticide - Female foeticide is the act of aborting a fetus because it is female. The frequency of female foeticide is indirectly estimated from the observed high birth sex ratio, that is the ratio of boys to girls at birth

Infanticide

• There are some people who advocate the doing away of life of the newborn, if the newborn is defective. The defects are compatible with life but may be a burden on the individual, the family and even the society.