臨臨臨臨臨臨 臨臨臨臨臨臨 Ethics in Clinical P Ethics in Clinical P ractice ractice Ming-Been Lee, M.D. Ming-Been Lee, M.D. Departments of Psychiatry and Social Departments of Psychiatry and Social Medicine Medicine College of Medicine College of Medicine National Taiwan University National Taiwan University
臨床醫療倫理 Ethics in Clinical Practice. Ming-Been Lee, M.D. Departments of Psychiatry and Social Medicine College of Medicine National Taiwan University . 醫學的真諦. 醫學是 關係 的科學. ◎ 病 人 為中心 ◎ 家庭為單位 ◎ 社區為基礎 . 醫學以 人文 為基礎. 傳統 : 人的 尊嚴 、 利益 與 價值 現代 : 人與萬物 和諧共生. 專業技術 專業倫理 - PowerPoint PPT Presentation
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臨床醫療倫理臨床醫療倫理Ethics in Clinical PracticeEthics in Clinical Practice
Ming-Been Lee, M.D.Ming-Been Lee, M.D.Departments of Psychiatry and Social MedicineDepartments of Psychiatry and Social Medicine
College of Medicine College of Medicine National Taiwan University National Taiwan University
ObjectivesObjectives of Medical Ethics Education: To Teachof Medical Ethics Education: To Teach
1. 1. HumanisticHumanistic and ethical aspects of medical career; and ethical aspects of medical career;
2. Personal moral and 2. Personal moral and professional professional moral moral commitments;commitments;3. Foundation of philosophical, social, and 3. Foundation of philosophical, social, and legal knowledge; legal knowledge; 4. Medical4. Medical reasoning reasoning;;
5. 5. Interactional skillsInteractional skills to apply insight, knowledge and to apply insight, knowledge and reasoning to clinical care.reasoning to clinical care.
Parties Involved in Clinical EthicsParties Involved in Clinical Ethics
Staff-patientsStaff-patients Staff-Staff-familyfamily Staff-Staff-staffstaff Staff-societyStaff-society Third partiesThird parties
Health Care EthicsHealth Care Ethics Model of Staff-Patient relationship: a Model of Staff-Patient relationship: a TeamTeam.. Good mannersGood manners Keep secret: third parties, legal, using Keep secret: third parties, legal, using
computerscomputersInformed decision makingInformed decision making Patient’s right and responsibilityPatient’s right and responsibility Justice: Resource allocation, Minimal justice Justice: Resource allocation, Minimal justice High-tech medicineHigh-tech medicine Special issues: AIDS/ICU/organ transplantationSpecial issues: AIDS/ICU/organ transplantation
Clinical EthicsClinical Ethics: Three : Three Obligations to PatientsObligations to Patients
Give the best care that we Give the best care that we cancan
Be honestBe honestBe trustworthyBe trustworthy
Principle of AutonomyPrinciple of AutonomyRationalRational individuals should be permitted to be individuals should be permitted to be
self-determinedself-determined..
Patient’s autonomy VS rights and needs of Patient’s autonomy VS rights and needs of othersothers . .
Respect for AutonomyRespect for AutonomyPatient’s Patient’s body integritybody integrity..Patient’s control over Patient’s control over touching, manipulatitouching, manipulation, invasion, medication, or other intervenon, invasion, medication, or other intervention.tion.Patient’s right to Patient’s right to authorizeauthorize beneficient act. beneficient act.
Informed ConsentInformed ConsentShow Show respectrespect for self-determination.for self-determination.Function as a Function as a correctivecorrective process to process to
paternalism.paternalism.Provide opportunity and encouragement Provide opportunity and encouragement
to become more active in to become more active in decision decision makingmaking..
A A PROCESSPROCESS rather than a rather than a DocumentDocument..
Consent ProcessConsent ProcessProvision of Provision of informationinformationComprehensionComprehensionVoluntarinessVoluntarinessConsentConsent ActiveActive authorization rather than passive authorization rather than passive consentconsent
Required DiscussionRequired Discussion 1. Define problems1. Define problems 2. Exact 2. Exact nature nature of proposed treatmentof proposed treatment 3. 3. AlternativesAlternatives 4. 4. PrognosisPrognosis with and without treatment with and without treatment 5. 5. RisksRisks and benefits of treatment and and benefits of treatment and alternativesalternatives 6. Serious risks even if unlikely 6. Serious risks even if unlikely 7. Any question7. Any question patient patient may havemay have
General Process of Case AnalysisGeneral Process of Case Analysis 1. The Case: Review of fact.1. The Case: Review of fact. 2. Identification of 2. Identification of ethicalethical problems. problems. 3. Determine reasonable 3. Determine reasonable alternativesalternatives.. 4. Consider the option in relation to 4. Consider the option in relation to
ethical ethical PrinciplesPrinciples and and ContextContext.. 5. Propose a resolution.5. Propose a resolution. 6. Consider your position 6. Consider your position criticallycritically.. 7. Action required: Do the 7. Action required: Do the RIGHT RIGHT thing. thing.