MDPCZ PRESENTATION FOR ZIMA CONGRESS VICTORIA FALLS

20-23/08/15 – ON ETHICAL MEDICAL PRACTICE

TITLE÷ETHICAL MEDICAL PRACTICE – MEDICAL COUNCIL’S PERSPECTIVES

PRESENTERS – DR F.M CHIWORA/MRS J. MWAKUTUYA

Presentation - Lay out1) Definition and brief general overview of

Medical ETHICS.2) Common ETHICAL VIOLATIONS.3) Disciplinary cases and complaints cases over

5years4) Conclusion.

1)DEFINITIONS AND OVERVIEW OF MEDICAL ETHICS

a)- ETHICS ÷ The moral principle that governs a person’s behaviour or way in which an activity is conducted.

÷A branch of knowledge concerned with moral principles.

÷Science of morals in human behaviour ÷Rules of conduct÷Moral principles.

Cont’d

÷Study of morality – a careful and systematic reflection and analysis of moral decisions and behaviour.

b) HEALTH CARE ETHICS AND THE LAW

- Medical ethics and the law are closely related but are NOT THE SAME

- ETHICS prescribes higher standards of behaviour than the law.

- ETHICS often demands that practitioners disobey laws that require unethical behaviour.

- Regulatory bodies and professional bodies will punish practitioners for violations of both medical ethics and the law.

Cont’d

- Medical ethics are closely related to human rights.

- The right to human dignity, humane treatment, autonomous decision – making, privacy and right to healthcare are all part of medical ethics.

c) PROFESSIONALISM AND HEALTHCARE PRACTICE

-Central to healthcare practice is a moral contract between the public and the health profession.

-This sets standards of what patients expect from healthcare practitioners.

-Underpins public trust in practitioners.-Advances in social, economic, scientific and

political fields constantly reshape public expectations.

Cont’d

- Professional failure- Professional Autonomy vs Accountability.- Litigation and social justice.

d) CORE VALUES OF PROFESSIONALISM

- Compassion- Competence- Communication- Autonomy ÷ Patient ÷ Practitioner.

e) AUTONOMY;BENEFICENCE;MALFICENCE AND JUSTICE

AUTONOMY ÷ Definition ÷ The right to self government or freedom of the will.

- Absolute right over one’s body is fundamental in medical practice.

- “An adult person who is corpus mentis has the absolute right over what happens to their body”

Cont’d

-Patient autonomy similar to Property rights.-Autonomy withdrawn vis-a-vis Third party

protection.BENEFICENCE – Doing good. Being sincere – the

sincerity of our actions. Patient having benefits

MALFICENCE – Hurtful or criminal acts. Doing or causing harm.

Cont’d

JUSTICE – Refers to social justiceALTERNATIVE TREATMENT- Fundamental patients right to know

alternative treatment or investigation.

- Expected outcomes- Possible complications that may arise.- Financial implications.

2) COMMON ETHICAL VIOLATIONS Handled By MDPCZ

2.1 CONSENTING PROCESS AND COMMUNICATION WITH PATIENTS

- MR A. 28yrs chronic cough from childhood. Pulmonary abscess.

- THORACOTOMY, for pneumomectomy 4 weeks before wife gives birth to his first child. Patient demised.

- Brother-why did doctor not tell us that this operation was so dangerous. He could have waited and seen his child before the operation!

2.2 Alternative treatment/second opinion

Patient with orthopaedic problem consulted specialist surgeon. Advised on surgical treatment. Was not kin on this line of treatment. Requested results and referral to another doctor. Specialist refused with the results and any documents.

2.3 DOCTOR – DOCTOR RELATIONSHIP

Doctor A working in mining area A. which is 70km from mining area B where doctor B is stationed. Patient from mining area A involved in mine accident near area B. Patient admitted to Mine hospitals under Dr B who instructed the nurses to initiate emergency medical care intending to see patient in the morning.

Cont’d

• DR A was not happy about this and send his ambulance to evacuate patient from the hospital B to his mine hospital in area A. Patient demised on the way.

2.4 Expected outcomes and possible complications.

- Large bowel perforation at laparoscopy.- Possible complications not explained.

2.5 MEDICAL RECORDS- Patient with large pharyngeal tumour coming

for excision for the third time – No clinical records or clerking documents to indicate the nature of the lesion and history.

2.6 Medical Negligence/ Incompetence

a) Same patient in 2.5 was anaesthetised using muscle relaxant and subsequent failed intubation.

- Surgeon failed to do a tracheostomy.- Patient demised.b) Patient with sleep apnoea was intubated for

ENT operation.

Cont’d

-At end of procedure patient wheeled to the recovery room still intubate to be extubated by SCN who was not theatre –trained.

-Patient had apnoea and demised.

2.7 DOCTOR- PATIENT ROMANTIC RELATIONSHIP

Gynaecologist had a love affair with a married patient. Husband discovered the E-mail communication between the two.

2.8 Inappropriate Examination of female patient

Gynaecologist fondling a married patient’s breasts and bums while the husband was in the reception area.

2.9. Patient Sterilisation without consent.- Gynaecologist performs Tubal Ligation on a

Government patient at fourth caesarean section without consent.

2.10 DOCTORS AND CRIMINAL ACTIVITIES

a) Doctor involved in fist fight - opponent fell down and sustained head injury.

Transferred to neuro surgeons – later died.b) Doctor involved in hit and run accident.

2.11 DOCTORS AND FRAUD

a) – Junior doctor charged patients to be treated at government hospital.

b) -Registrar charge a father a cow in order to take the child for insertion of V.P SHUNT

c) Surgeon charged US$21 000-00 for appendicectomy on a child.

2.12DRUNKEN DOCTOR ON DUTY

Doctor performed caesarean section under alcohol and divided the ureter.

2.13 TAKING OVER PATIENT UNDER THE CARE OF ANOTHER DOCTOR

Patient admitted into Hospital under Doctor E., Prepared for emergency surgery. Dr F took over patient unknown to DR E under the instructions of a Medical Aid Society and operates on the patient.

2.14 INAPPROPRIATE OPERATION

Patient with advanced cervical cancer. Hysterectomy by a Family Practitioner- Table death from haemorrhage.

Surgeon – Knows when to operate Good surgeon – Knows when NOT to operate

3)HIGHLIGHTS OF STATISTICS AND TRENDS OVER THE YEARS

COMPLAINTS BY NATURE OF COMPLAINTS 2010-2015Complaints Report By Nature 2010 2011 2012 2013 2014 2015 Total

Ethical Practice 15 25 31 41 41 20 182

Anaesthetic Deaths 7 3 10 10 15 10 55

Associating With An Intern 2 5 8 6 4 0 25

Death Within 24 Hours with unprofessional practice

0 3 4 9 17 5 38

Mal Practice 5 5 21 23 18 13 85

Maternal Deaths with unprofessional practice

0 0 7 9 22 3 41

Table Death 2 2 12 22 34 3 75

Total 31 43 93 120 151 73 511

Cont’Ethical Practice 182Advertising 27 Neglect of duty 5 Anaesthetic Deaths

55Assault 5 Practising without supervision 7 Associating with an interns

25Poor Communication 72 Fraudulent activities 14 Death within 24 hours

38Unethical Practice 43 Sexual abuse 1 Unprofessional practice

85Sick leave 8 Maternal Deaths

41 Table Deaths 75

4) CONCLUSION