For public

2. DR: NAJEEB MEMON
Asst: Professor
COMMUNITY MEDICINE & P.H.S
LUMHS, JAMSHORO
Sind, PAKISTAN
e mail mnajeeb80@gmail.com

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

6. 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.

7. OR
The application of moral principles and
analysis to medical situations

8. 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.

9. “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

10. –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.”

11. 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

12. 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

13. The Principle of Autonomy
The Principle of Beneficence
The Principle of Non-Maleficence
The Principle of Truth
The Principle of Confidentiality(or Fidelity)
The Principle of Social Responsibility and Justice
http://mdmedicine.wordpress.com/2011/04/05/what-is-medical-ethics/
PRINCIPLES IN MEDICAL ETHICS

14. 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.

15. In particular as a doctor you must
1. Make the care
of your patient
your first concern.

16. 2 Treat every patient
politely and considerately.

17. 3. Respect patients’
dignity and privacy.

18. 4. Listen to patients and
respect their view.

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

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

21. 7. Keep your professional
knowledge and skills up to date.

22. 8. Recognize the limits of your
professional competence.

23. 9. be honest and trustworthy

24. 10. Respect and protect
confidential information.

25. 11.make sure that your personal beliefs
do not prejudice your patients’ care.

26. 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.

27. 13. Avoid abusing your position as a
doctor.

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

29. 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 .

30. Finally
Always opt for the cheapest
effective treatment

31. Always opt for the best treatment

32. Keep this confidence

33. What is my purpose?
What is my priority?

34. Treat this patient rather than
the patient

35. Respect patients wishes
Maximize Autonomy
Always strive to do the very best
for one’s individual patient

36. Confidentiality

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

38. Principles of confidentiality

39. 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

40. 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.

41. 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;

42. 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,

43. 5. You must respect requests by
patients that information should
not be disclosed to third parties,
save in exceptional circumstances

44. 6. If you disclose confidential
information
you should release only as much
information as is necessary for
the purpose

45. 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.

46. 8. If you decide to disclose
confidential information,
you must be prepared to
explain and justify your
decision.

47. THANKYOU

50. 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)