10/19/2015 1 Basic Principles of Medical Ethics DR. ROBERT KETCHUM ASSOCIATE DEAN FOR ACADEMIC AFFAIRS AND PRE-CLINICAL EDUCATION AT THE BURRELL COLLEGE OF OSTEOPATHIC MEDICINE AT NEW MEXICO STATE UNIVERSITY What is ethical behavior? Or better yet, Why?
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Basic Principles of Medical EthicsDR. ROBERT KETCHUM
ASSOCIATE DEAN FOR ACADEMIC AFFAIRS AND PRE-CLINICAL EDUCATION AT THE BURRELL COLLEGE OF OSTEOPATHIC MEDICINE AT NEW MEXICO STATE UNIVERSITY
What is ethical behavior?Or better yet, Why?
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Basic principles of medical ethics
Respect for Autonomy Justice Beneficence Non-maleficence
Autonomy Respect for Autonomy
A patient has the right to choose or refuse treatment
Informed consent Free from coercion or coaxing “Plan general anesthesia as
discussed. Procedures, alternatives and risks explained, including but not limited to:…. All questions addressed, patient understands, wishes to proceed and agrees to any necessary intervention”.
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A 56 year-old man comes to the operating room for a re-operation to repair a heart valve following a previous heart surgery 15 years ago. The patient states he is a Jehovah’s Witness and refuses blood or blood product transfusion for any reason, even in the event of life-threatening blood loss.
During surgery, the surgeon inadvertently tears open the patient’s right ventricle, causing massive blood loss. The surgeon orders the anesthesiologist to transfuse 6 units of blood and 6 units of plasma.
Dr. Michael DeBakey
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Cancer in Asia
The first heart transplant
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Justice
Burdens and benefits of new or experimental treatments must be distributed equally among all groups insociety.Fair distribution of scarce resourcesCompeting needsRights and obligationsPotential conflicts with established legislation
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The Anytown regional medical center treats all patients who come to the emergency room for urgent care. Patients with private insurance are seen by the “Anytown Express Care” service, with an average wait time of 11 minutes.
Patients with Medicaid are seen in about 4 hours.
Patients without insurance are not seen except in emergencies, as mandated by EMTALA federal legislaton.
The developing world
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Renal dialysis
Beneficence
The procedure be provided with the intent of doing good for the patient involved.Providers develop and maintain skills and
knowledgeConsider individual circumstances of all
patientsStrive for net benefit
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A large Ivy-League university medical center has an anesthesiology residency training program. As part of the program, residents learn to place breathing tubes into patients by use of a fiberoptic telescope when other methods may be difficult or impossible. In order for residents to be able to perform this procedure in difficult situations, they initially practice on patients who do not need this technique. The technique is uncomfortable, requires extra injections and medications and prolongs surgical time.
Medical simulation
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Non-maleficence
The procedure does not harm the patient or others in society.The “do no harm” principleDoes not require intentionHarm should not be disproportionate to the
benefit of a treatment
The Michael Jackson Case
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Pediatric anesthesia
BCOM Essay Questions You are the State Medical Officer in a very conservative Southern state
and serve at the pleasure of the Governor. The physician at the State Prison has recommended cardiac bypass surgery for an inmate with critical coronary artery disease. The inmate is on death row and was arrested in the act of dismembering a 3 year old child, following his rape, torture and murder. All appeals have been exhausted and the inmate is expected to be executed within 12 months. The Governor has asked for your advice.
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Defend the position that, in states where it is allowed, execution by lethal injection should be performed by physicians.
You are on an medical ethics board and are reviewing recent cases: A pharmacist refusing to fill a HIV patient’s prescription, an EMT refused to perform lifesaving procedures on a gay patient, and a physician declined to advise a teenage pregnant girl how to get proper abortion care. All parties base their decision on a new bill that was passed through a State House of Representatives, called the Religious Freedom Restoration Act (RFRA). This new Bill prohibits the government from intervening if health care workers refuse service on the grounds of protecting personal religious beliefs. Comment.
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• A prominent surgeon with a great deal of knowledge and experience is performing a long surgery, after a long stressful week with little sleep, and suddenly recognizes she has made an error. She realizes this mistake will probably not cause any harm to the patient, the patient will recover well and there will be no consequences. She then decides to avoid revealing this mistake since it will not cause any harm to the patient, has learned from it and no one will ever know. In your opinion, are there times when it can be considered acceptable to avoid revealing a medical mistake if that mistake does not cause harm to the patient?
Your colleague is sharing with you that he is considering "firing" some of his non-compliant patients. He explains that they are contributing to lowering his pay-for-performance score. This consequence could impact his reimbursement in the future. How would you advise him?
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Of the following individuals, who do you consider is the worst criminal and why: Adolf Hitler, Joseph Stalin, Mao Zedong or Joel Steinberg.
Questions?
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