MEDICAL ETHICS

What do you mean

by the term medical
ethics?
MEDICAL ETHICS IS
A system of values common to the
medical profession.

THERE SHOULD BE
Systematic application of values
concerning the practice of medicine.
 What
are the
components of
medical ethics?
COMPONENTS OF MEDICAL ETHICS

The Physician -- Patient Relationship

(Duties towards the Patient)

The Physician -- Physician

Relationship
(Duties towards the Colleagues)
 The relationship of the
Physician to the System of
Healthcare

The Relationship of the

Physician to Society
(Duties towards the
Society)
 Whatare the
principles of medical
ethics?
 The Principle of Non-Maleficence

First do no harm

Respect the life of the patient

Calculated risk or risk benefit

 The Principle of Beneficence

Do only that which benefits the patient

Patients welfare as the first

consideration
THE PRINCIPLE OF AUTONOMY

Respect the right to information and self

determination

Obtain free and informed consent

Intentional participation in treatment

Respect and dignity maintained during

the treatment
THE PRINCIPLE OF
TRUTHFULNESS
Truth telling

Obligation to full and honest

disclosure
CONFIDENTIALITY

Maintain the confidentiality of all

personal, medical and treatment
information
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 the Law

WHY IS CONSENT
IMPORTANT IN
MEDICAL PRACTICE?
COMMON LAW
Every person has the right to
have his bodily integrity
protected against invasion by
others /Trespess.
Touching without consent by
another can amount to assault
Damages can be awarded.
 Consent
should be
given freely
and
 Whatare the types
of consent use in
medical practise?
 IMPLIED CONSENT
The fact that the patient
presents him self at the
OPD or ward or before a
medical practitioner is
held to imply that he is
agreeable to medical
examination in the general
sense.
EXPRESSED CONSENT

1. Oral
2. Written
 What do you mean by
the term Informed
Written Consent.?
INFORMED CONSENT

Introduce your self.

Explain the procedure
Explain the need.
Explain the consequences (That are
needed)
(Good and Bad)
Clarify any doubts
Take specific consent in writing.
 common instances where
you need informed written
consent?
INFORMED WRITTEN
CONSENT.
Written consent is obtained for all major
surgical procedures/ anaesthesia/ major
diagnostic procedures.
Intimate examinations
Separate written consent is needed for
each procedure
Examination of persons produced by law
enforcing authorities.
 How would you obtain
consent from a child,
unconscious patient,
mentally subnormal or
abnormal patient?
Obtaining a valid consent is
an issue in :
A Child

An unconscious patient

A mentally subnormal or
abnormal

Due to religious considerations in

 Can you treat a patient
without the consent?
In good faith to save the
patients life.
Legal principle of necessity
legitimates an otherwise
wrongful act
 Whatis
Confidentiality ?
CONFIDENTIALITY

Based on loyalty and trust

Maintain the confidentiality of all

personal, medical and treatment
information
Respect the secrets which are
confided in me, even after the
patient has died.
 When can you breach the
confidentiality?
 What is privileged
communication?
PRIVILAGED COMMUNICATION

When the doctor breach the confidatiality

Protection from civil action is given by the
law in two degrees.
.ABSOLUTE PRIVILAGE

Any statement made in the court of law.

Any statement made in the parliament
Any statement made to the barristers or
solicitors in the course of preparation for a court
case.
Nothing said in above circumstances can be used
as ground for legal action against the doctor.
 QUALIFIED PRIVILAGES

Only to parties that have a duty to receive it.

e.g. Notifiable diseases/ deaths.
Colour-blind driver.
Child abuse.
Injuries of violence
Industrial and transportation accidents
SERIOUS PROFESSIONAL MISCONDUCT
OR

INFAMOUS CONDUCT

Can lead to erasure of the registration

after disciplinary inquiry by the
Medical Council
 What constitute to
serious professional
misconduct?
Common instances-
case examples
ABORTION

Illegal in our law.

Only provision is to save the mothers life if
the life is in real danger due to pregnancy or
its complications.
Can lead to erasure of registration
 ALCOHOL.

Abuse of alcohol.
May warn several times.
If the offence is repeated suspension or
erasure.
Drunken driving.
Drunk and treating (Also may constitute to
criminal negligence)
Drunk and misbehaviour
ADULTORY.

When the doctor uses his professional

privileges to do such acts.
The woman need not be a patient.
She may have come with another.
In divorce cases the doctor may
become an accused or respondent.
Sometime the court may inform
the medical council
 ADDICTION

Doctors have the powers to prescribe dangerous

drugs.
Therefore they may get addicted.
Pethidine/ Morphine/ Heroin/ Barbiturates/
Amphetamines/ Halothane/ Nitrous oxide.
Suspension is to protect the doctor as well as to
protect the patients.
Irregularities in prescribing drugs of abuse can
lead to erasure
ADVERTISING

Cannot advertise.
Name boards must be in the prescribed size.
No leaflets banners.
Things change some countries have allowed GPs
to advertise to certain extent.
But not to the specialists.
They only can give information to the GPs.
 ASSOCIATION.

Association with unqualified assistants in

professional practice
e.g.: employing unqualified persons
FALSE CERTIFICATES
Death certificates
Medical certificates
Insurance claims
Certificates for various grants.
FEE-SPLITTING

Consultation fee may be split between two

doctors.
Prescribing certain drugs and obtaining
money
Engaging touts
FAILURE TO ATTEND TO A
PATIENT
FRAUD

Medical fees
Extra duty payments
Travelling
Other expenses
FORCE

Abusive and violent to patients

Usually it is the other way.
INDECENT BEHAVIOUR BY THE DOCTOR.

Allegations by the females/abuse of

children
Examination without chaperones
 What is medical
negligence?
 DEFINITION.

Failure to exercise a
reasonable degree of skill and
care in the management of a
patient by an act of omission or
by an act of commission
 The liability of medical negligence
is mainly under the civil law.
The plaintiff will ask for
compensation.
It is considered criminal when the
doctor has been grossly negligent
as to have no regards to the life
of
the patient.
 What is criminal
negligence?
Prosecution is done by the state.

To protect the community by

furtherer acts.

The treatment should be grossly

negligent, reckless and wicked.

There is gross ignorance of the

principles and practise of medicine
There is severe disregard to the
life of the patient.

The charge is culpable homicide

not amounting to murder.

e.g giving anaesthesia under

influence of alcohol or drugs.

Performing a child delivery under

influence of alcohol.
 Whatare the criteria
that should be there
to establish medical
negligence?
In a case of medical
negligence the
plaintiff should
establish the
following in the court
 A duty of care (By the doctor
to the
patient.)
Breach of duty (By an act of
omission or commission)
Causation (Damages suffered
by the
patient)
The relationship between the
No doctor is expected to aware
of all current medical
knowledge.

No doctor is capable to apply

all known diagnostic and
therapeutic methods to a single
patient.
The standard of care
depends on
Experience

Knowledge

Facilities available

Circumstances .
 What is Doctor Patient
Relationship.?
 Extremely easy to start. (E.g. in
OPD
when enters the room.)
No need to formally accept the
patient. (E.g. Emergency, Good
samatarion)
No need to treat the patient.
(E. g.
Advice)
No need the patient to be
aware.
When a doctor examines a
patient for any reason other
than providing advice and
treatment there is no Doctor
Patient Relationship.
e. g. medico legal
examination/examination for
insurance / disability/
drunkenness.
But if any harm done during
WHAT IS BOLAM
TEST?
Bolam Test after a case in
1957.
A doctor is not guilty of
negligence if he has acted in
accordance with a practise
accepted as proper by a
responsible body of medical
men skilled in that particular
art
WHAT ARE THE
DAMAGES THAT CAN BE
SUFFERED BY THE
PATIENT IN A CASE OF
MEDICAL NEGLIGENCE?
1.Loss of earnings

Absence from work

Impairment of his ability to carry

on his previous work.

Shortening of the earning period.

1.Expenses due the
damages caused by the
negligence.
Hospital expenses

Special treatment

Food/schooling
3. Reduction in expectation
of life.

4. Reduced
Loss enjoyment of
of a limb/eye/ear
life.
5. Reduced physical ability
Sexual ability/marriage
Child bearing
6. Pain and suffering

7. Death.
How can a doctor
Breach the Doctor
Patient Relationship ?
1.Failure to make an accurate
diagnosis.

If has not exercise proper skill and

care.

Appendicitis/ MI/Fracture

Not negligent by reason of

2. Not informing the patient
regarding the risks of treatment.
Any treatment has a risk.
The patient must be educated
regarding accepted risks.

3. Failure to communicate with

other doctors.
4. Failure to attend to a patient.

Patient has the right to summon the

doctor.
Birth of a baby.

5. Failure to refer to a specialist

concerned.

6.Retention of swabs, packs/

instruments inside the body.
7. Surgery on the wrong patient or
wrong part of the patient.

8. Administration of the wrong

drug or wrong strength,

9. Failure to obtain a valid consent.

 10. Therapeutic hazards

Diathermy
Hot water bottles
Catheters
Injections.

What are the defences

against an allegation of
negligence.?
 Delegation of duties.

Treatments are complex.

More than one party gets involved.
(Nurses/Technicians/Radiographers)

The doctor has this defence if he has

A properly trained staff.
Devised a safe system of working.
If he has made the staff fully aware of
the system by written orders.
Injections ----the doctor has to check.
Contributory

Negligence
The patient is also responsible.

Patients acts may have worsened the

condition.
e.g. patient tampering a
dressing/damaging a POP/ Not taking
an antibiotic.
Novos actus
interveniens

A new act intervening.

e.g. A surgical registrar doing a
tendon repair defectively and
while correcting that a surgeon
cutting the radial artery.
Assumption of the
risk by the patient.

By giving the consent.

Explained the risks.

 Inevitable accidents

Denial of negligence

Accepted method of treatment.