SYSTEMS GOVERNING HUMAN SOCIAL BEHAVIOUR. THE MEDICAL ECOSYSTEM - Enlarging Circle of Influence DOCTOR PATIENT Disease DiagnosisHealth Promotion Disease.

SYSTEMS GOVERNING

HUMAN SOCIAL BEHAVIOUR

CUSTOM ETIQUETTE ETHICS LAW MORALITYMores Professional Professional State, Statutes Spirituality

Etiquette Values Legislature

Tradition Courtesy Competence Enforcement ReligiousIntegrity Compulsion Good vs EvilFairness Judiciary Right vs WrongGoodwill Punishment Truth Justice

THE MEDICAL ECOSYSTEM

- Enlarging Circle of Influence

DOCTOR PATIENT

Disease DiagnosisHealth Promotion

Disease Prevention Therapy

Medical Insurance Managed Care

Hospital

Laboratories

Pharmaceutical Industry

Patients’ Family, Culture, Religion

Patients’ Work, Employer

Other Doctors

Paramedics

Clinic Management

Public Health

Medical Research

Medical Students

CME, CPD

Doctor’s Employer

Doctor’s Family

Doctor’s Employee

Practice Management

MDO

Medical Council

The LAWGovernment Bodies

Medical Charities

Patient Organisation

Alternative Medicine

Press, Media

National Community

International Community

Natural Disasters

Political Upheaval, War

Historical values, private values, corporate values, legal statues

MEDICAL ETHICS - definition and scope

System of values common to the medical profession.

Systematic application of values concerning the practice of

medicine.

Standards of behaviour by which the physician may evaluate his/her

relationships with patients, colleagues and society.

Scope of medical ethics includes:development of ethical codes and guidelinespromotion of ethical practice prevention of ethical breachesrecognition of ethical dilemmasresolution of ethical conflicts

Components of Medical Ethics

• The Physician -- Patient Relationship• The Physician -- Physician Relationship• The relationship of the Physician to the

System of Healthcare• The Relationship of the Physician to

Society

The Principle of Non-Maleficence

• first do no harm• sanctity of life• calculated risk or risk benefit

The Principle of Beneficence

• do only that which benefits the patient• patient’s welfare as the first consideration• care consideration competence

The Principle of Veracity

• Truth telling• Obligation to full and honest disclosure

When do you tell the truth?

The Principle of Confidentiality

• Based on loyalty and trust• Maintain the confidentiality of all personal,

medical and treatment information• Information to be revealed with consent and

for the benefit of the patient• Except when ethically and legally required• Disclosure should not be beyond what is

required

The Principle of Justice and Social Responsibility

• Actions are consistent, accountable and transparent

• not to discriminate on age, sex, religion, race, position or rank

• greater good of society• respect of the Law• equity and distribution of burden & benefits

THE PRINCIPLES IN MEDICAL ETHICS

• The Principle of Non-Maleficence• The Principle of Beneficence• The Principle of Autonomy• The Principle of Veracity• The Principle of Confidentiality(or

Fidelity)• The Principle of Social Responsibility and

Justice

PRIMUM NON NOCERE

Conflicts of Ethical Principles

autonomy

veracity

confidentiality

paternalism

nonmaleficence

justice

beneficence

research

dual obligations

family interest

payer's interest

Resolution of Ethical Dilemmas

• Principles• Ethical codes• Clinical judgement• Reasoned analysis• Ethical committees• Ethical tests

• Declarations• Oaths & Pledges• Commonsense• Debate• Ethical Consults• The Law

obligation to keep information about your patient private

• WAIT A SEC

Shared decision making entitles patients to participate actively in health care decisions

The Principle of Autonomy

• right to information and self determination• free and informed consent• free will and accord - intentional

participation in treatment• respect and dignity maintained

R

Types of mistakes are omission, commission, and iatrogenic

Preventive Medicine: using specificity and sensitivity a well as EBM articles

Advanced Directives

• Distributive cost • Pain management

Consider patients competent. Continue treatments but observe DNR

A Patient wishes to die!

Can Physicians do anything they want?

• Euthanasia is legal in Belgium, the Netherlands , Canada, and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont.

Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey[12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%

Canada accepts the concept of Euthenasia

SLIPPERY SLOPE…namely the disable

• The argument is known as the “Slippery Slope”: apprehension that PAS for terminally ill will progress to other vulnerable communities, such as disabled, or those less worthy on their demographic or social economic and even to those who do not consent

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