1. Ethics of Trust Vs ethics of Rights

2. objectives
• Autonomy
• Consent
• Rights of the patient
• Confidentiality
• Right to life
• Sex Pre selection and female foeticide
• Assisted Reproductive Technologies

3. 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

4. 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.

5. 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.

7. • 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

8. Types of consent
• Implied consent
• Expressed consent
a) Oral
b) Written
• Written Informed Consent
• Blanket Consent

9. • 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.

10. • 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.

11. • 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

12. • 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.

13. 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

14. 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

15. 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 .

16. 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.

17. Issues related to Right of life
• Abortion
• Infanticide /Foeticide/ Selective Abortion
• Euthnasia
• Suicide
• Capital Punishment
• Foetal tissue research

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. • 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.

25. 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.

26. Foeticide/ Infanticide

27. • 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

28. 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.