Medical Ethics why we need it by Dr.T.V.Rao MD

1. MEDICAL ETHICS
Why we Learn and Practice
Dr T.V.Rao MD
7/23/2018 Dr.T.V.Rao MD @Medical Ethics 1

2. WHAT ARE MEDICAL ETHICS -
Medical ethics refers
•
Chiefly to the rules of etiquette adopted by
the medical profession to regulate
professional conduct with each other, but
also towards their individual patients and
towards society, and includes
considerations of the motives behind that
conduct.
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3. •Why Should doctors have to
swear an oath when they qualify?
The Hippocratic Oath.doc
Modern Hippocratic Oath.doc
To save self and Others too
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4. WE ARE BOUND BY
HIPPOCRATIC OATH
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5. WHAT IS THE NEED FOR MEDICAL ETHICS?
• The practice of medicine and the practice of ethics are
inseparable.
• Every clinical decision invokes an ethical decision as
well.
• In many instances, the ethical issue may not be
readily apparent.
• In others conflicts arise between ethical
principles and medical decisions, which require
the clinician to be well versed with the former
in order to guide the latter.
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6. Who said what on Medical Ethics
Abhijit Naskar
•A doctor should
be a clown at
heart,
a scientist at
brain and a
mother at
conscience.
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7. Ethics
•Ethics –moral principles of right and wrong –not
absolute;
may vary by person, by time, by place –and may be in
competition with each other
Research ethics –incorporating ethical principles into
research practice –may involve a balance between and
within principles and practices –all stages,
all those involved, from inception of research through to
completion and publication of results and beyond
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8. ETHICAL PRINCIPLES
• Justice: This refers to the need to treat all people equally and fairly
• Society uses a variety of factors as a criteria for distributive justice,
including the following:
• to each person an equal share
• to each person according to need
• to each person according to effort
• to each person according to contribution
• to each person according to merit
• to each person according to free-market exchanges
• We should strive to provide some decent minimum level of health
care for all citizens, regardless of ability to pay DR
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9. Voluntary Participation
•Subjects must agree to reveal information about
themselves.
• Subjects must be able to provide informed
consent.
• Behavior observed in public settings is assumed to
imply agreement to being observed.
• Subjects contacted after being observed in a public
setting must be informed they were observed in a
public setting
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10. PATENTS ARE DEMANDING
UNLIKE PAST- FOLLOW ETHICS
•Patients are entitled to
good standards of
practice and care from
their doctors .Essential
elements of this are
professional
competence, good
relationships with
patients and colleagues
and observance of
professional ethical
obligations7/23/2018 Dr.T.V.Rao MD @Medical Ethics 10

11. Right to privacy
•The right to privacy
refers to the right to
limit “access of
others to one’s body
or mind… through
physical contact or
disclosure of thought
or feelings”.
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12. Protecting Privacy
• In India, the importance of
protecting privacy is enshrined
in law and ethical guidelines.
Interpretation of Article 21 of
the Constitution of India—
Right to Life and Personal
Liberty— has established a
penumbral right of privacy or
the right to be free from
encroachment on private life
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13. Can medical
students observe
the patient?
• Yes, they can.
Particularly if you are
receiving care at a
teaching hospital,
notice that students
are learning under
supervision to improve
their skills is included
in the Notice of Privacy
Practices given to all
patients.
Dr.T.V.Rao MD @Medical Ethics 7/23/2018 13

14. No Harm… The great Choice
•Subjects must be free
from reasonably
anticipated physical or
emotional harm.
• Subjects must be
informed of the
manifest content of the
information they will be
asked to reveal about
themselves.
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15. Can We Deceive the Subjects ?
• Is it permissible to
deceive subjects,?
as long as the
deception cannot be
anticipated to
create physical or
emotional harm
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16. INFORMED CONSENT
•Definition: A patient’s willing acceptance of a
medical intervention after adequate disclosure of the
nature of the intervention, risks, benefits and
alternative treatment options
• What constitutes informed consent?
• Disclosure: information to allow reasonable person
to make a decision
• Understanding: comprehension of the information
given •
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17. INFORMED CONSENT
•• Voluntary: no coercion or incentive to accept
or deny a treatment
• Agreement: verbal or written (preferred) to
discussed intervention
• Many are screening patients for HIV without
informed consent ? •
Many are doing sex determination in fetus even
it is prohibited ???
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18. Informed Consent means
• Purpose of study.
• How respondent was selected.
• Results will be used for research and [other].
• Voluntary participation in the study or any part of it.
• Respondent can keep any incentives if they
withdraw from the study.
Confidentiality of responses.
• Contact information of the researcher
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19. Areas of Academic misconduct
•1. Plagiarism
2. Fabrication and
falsification
3. Non-
publication of
data
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20. Areas of Academic misconduct
•4. Faulty data-
gathering procedures
5. Poor data storage
and retention
6. Misleading
authorship
7. Sneaky publication
practices
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21. LEARNING ABOUT ETHICAL
ISSUES REQUIRES
• An understanding of
the issue-the science
and knowledge base
• An understanding of
ethical frameworks
and principles-not just
case studies and
anecdotes •
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22. LEARNING ABOUT ETHICAL ISSUES
REQUIRES
•• An understanding of
one’s own values
• Ability to think
through the issue-logic
and argument
• Recognition of
uncertainty-limits to
knowledge
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23. KNOWLEDGE CREATES CONFLICT SO
THE DOCTORS FIGHT
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24. WHAT IS YOUR CHOICE MAKES DIFFERENCE
???
•Medicine is about :
“Can we?”
•Ethics is about:
“Should we?”7/23/2018 Dr.T.V.Rao MD @Medical Ethics 24

25. Changing Ethics for Today
• Being a doctor, is not simply
about having an
understanding of anatomy
and sickness, rather it is
about having an
understanding of true
wellness and more
importantly, it is about
understanding the intensity
of the concern of the
patient’s next of kin.
• Abhijit Naskar
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26. SOLUTIONS TO ETHICAL
PROBLEMS?
•Not simple
• Ethics not like
science
• Is ethics arbitrary?
Or
• Can we discover an
ethic for medicine?
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27. ONE DAY WE TOO ARE PATIENTS SO
WE TOO NEED ETHICS ONE DAY ???
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