also known as moral philosophy, branch of philosophy addresses questions about morality that is, concepts such as

ETHICS

Good and evil, Right and wrong, Virtue and vice Justice & Crime. etc

also known as moral philosophy, branch of philosophy addresses questions about morality that is, concepts such as:

Medical Ethics system of moral principles that apply values and judgments to the practice of medicine.

Medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, & sociology.

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OR

The application of moral principles and analysis to medical situations

Medical Ethics (WHO)• Medical Ethics Ethics is the understanding of moral values. Medical ethics means the

moral principles, which should guide the members of the medical profession in the course of their practice of medicine and in relationship with their patients and other members of the profession.1 Medical ethics is a code of conduct for the member of the medical profession in order to render the best possible service to the humanity and to maintain the honour and dignity of the profession. It is the code containing the main principles for the information & guidance of registered medical practitioners in course of their medical practice, which defines the duties of the doctors in general, their duties towards the sick & their duties towards one another. Central areas of health ethics : In the context of fairness and equity the physician should consider the economic situation of patient & family, choosing patients for treatment under resource constraints. WHO has given special emphasizes to work on some specific health issues like treating HIV/ AIDS patients, patients with mental illness, making end-of-life decision (Euthanasia), organ donation and transplantation and medical termination of pregnancy. Physicians of government and non-governmental organizations, lawmakers and member of the civil society should jointly come up with a policy to deal with these specific health issues mentioned by WHO.

“I solemnly pledge to:– dedicate my life to the service of humanity;

– give due respect and gratitude to my teachers;

– practise my profession with conscience and dignity;

– make the health of my patient my first consideration;

– respect the secrets which are confided in me;

– uphold the honor and noble traditions of the medical profession; –

SMC’S PHYSICIAN’S PLEDGE

–respect my colleagues as my professional brothers & sisters;

– not allow the considerations of race, religion, nationality or social standing to intervene between my duty and my patient;

– maintain due respect for human life;

– use my medical knowledge in accordance with the laws of humanity;

– comply with the provisions of the Ethical Code;

– and constantly strive to add to my knowledge and skill;

– I make these promises solemnly, freely and upon my honor.”

Hippocratic Oath “Do no harm” 460 --- 377 BC. Ishaq bin Ali Rahawi 10th Century. ( Conduct of a Physician, the first book dedicated to medical ethics) Thomas Percival. “Code of medical ethics” 1803. American Medical Association. Adopted its first “code of ethics” based on Percival work 1847.World Medical Association. Adopted “International Code of Medical Ethics” 1949.Adopted “Declaration of Helsinki”( research ethics) 1964.

HISTORICAL BACKGROUND

Principles of medical ethics have evolved over centuries

•Greek------4th centaury BC

•Chinese code of conduct--dating from the 2nd century BC.• India----2000 years ago• Roman• Islamic code of medical ethics• Contemporary medical ethics & concept of legal practice Country wise [ regulating bodies PMDC,NHS, AMA] Who/Geneva WMA

The Principle of AutonomyThe Principle of BeneficenceThe Principle of Non-MaleficenceThe Principle of TruthThe Principle of Confidentiality(or Fidelity)The Principle of Social Responsibility and Justice

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PRINCIPLES IN MEDICAL ETHICS

Patients must be able to trust doctors with their lives and wellbeing. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life.

In particular as a doctor you must

1. Make the care of your patient your first concern.

2 Treat every patient

politely and considerately.

3. Respect patients’

dignity and privacy.

4. Listen to patients and respect their view.

5. Give patients information in a way they can understand.

6. Respect the rights of patients to be fully involved in decision about their care.

7. Keep your professional

knowledge and skills up to date.

8. Recognize the limits of your

professional competence.

9. be honest and trustworthy

10. Respect and protect

confidential information.

11.make sure that your personal beliefs

do not prejudice your patients’ care.

12. Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice.

13. Avoid abusing your position as a doctor.

14. Work with colleagues in the ways that best serve patients’

interests.

In all these matters: you must never discriminate unfairly against your patients or colleagues.

And you must always be prepared to justify your actions to them .

Finally

Always opt for the cheapest effective treatment

Always opt for the best treatment

Keep this confidence

What is my purpose?

What is my priority?

Treat this patient rather than the patient

Respect patients wishes

Maximize Autonomy

Always strive to do the very best for one’s individual patient

Confidentiality

Confidentiality is at the centre of maintaining trust between patients and doctors

Principles of confidentiality

1. Patients have a right to expect that you will not disclose any personal information which you learn during the course of your professional duties, unless they give permission

2. When you are responsible for confidential information

you must make sure that the information is effectively protected against improper disclosure when it is

disposed of , stored, transmitted or received.

3. When patients give consent to disclosure of information about them,

you must make sure they understand what will be disclose, the reasons for disclosure and the likely consequences;

4. You must make sure that patients are informed whenever information about them is likely to be disclosed to others involved in their health care , and that they have the opportunity to withhold permission,

5. You must respect requests by patients that information should

not be disclosed to third parties,

save in exceptional circumstances

6. If you disclose confidential information

you should release only as much information as is necessary for the purpose

7. You must make sure that health workers to whom you disclose information understand that it is given to them in confidence which they must respect.

8. If you decide to disclose confidential information,

you must be prepared to explain and justify your decision.

THANKYOU

How to Analyze an Ethics Case• What is being proposed?

– What are the medical issues?– Risks, benefits, alternatives– Case and statutory law

• Who are the stakeholders?• Patient, family, medical staff, hospital, state• Cultural and religious concerns• Are possible consultants to medical, legal, and ethical issues

• When does this need to be done?– Emergency exceptions to informed consent

• Why is an ethical dilemma being created?– Conflicts between decision makers, law and ethics

• How can this be resolved?– Meeting(s), buying time, consultation(s)