Medical Ethics

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Medical Ethics
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Ethics
Ethics is the study of morality careful and
systematic reflection on and analysis of
moral decisions and behaviour.
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Medical ethics definition
is a system of moral principles that apply values
and judgments to the practice of medicine.
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As a scholarly discipline, medical ethics
encompasses its practical application in clinical
settings as well as work on its history,
philosophy, theology, and sociology.
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The study of medical ethics
The study of medical ethics prepares medical
students to recognize difficult situations and to
deal with them in rational and principled manner.
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Values in medical ethics
A common framework used in the analysis of
medical ethics is the "four principles"
approach There are four basic moral principles,
which are to be judged and weighed against
each other, with attention given to the scope
of their application. The four principles of
medical ethics are-
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1-Respect for autonomy(self-determination)  the
patient has the right to refuse or choose his
treatment. 2-Beneficence a practitioner should
act in the best interest of the patient.  
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3-Non- maleficence "first, do no
harm 4-Justice concerns the distribution of
scarce health resources, and the decision of who
gets what treatment (fairness and equality).
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Other values which are sometimes discussed
include 1- Respect for persons the patient (and
the person treating the patient) have the right
to be treated with dignity. 2-Truthfulness and
honesty the concept of informed consent .  
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Conflicts between autonomy and beneficence
Autonomy can come into conflict with beneficence
when patients disagree with recommendations that
health care professionals believe are in the
patient's best interest. When the patient's
interests conflict with the patient's welfare,
different societies settle the conflict in a wide
range of manners.
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Western medicine generally defers to the wishes
of a mentally competent patient to make his own
decisions, even in cases where the medical team
believes that he is not acting in his own best
interests. However, many other societies
prioritize beneficence over autonomy.
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On the other hand, autonomy and
beneficence/non-maleficence may also overlap. For
example, a breach of patients' autonomy may cause
decreased confidence for medical services in the
population and subsequently less willingness to
seek help, which in turn may cause inability to
perform beneficence.
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Beneficence is a task worthy of many to complete
due to its difficulty to perform under extreme
circumstances that are not correlated directly
with individuals seeking euthanasia.
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The principles of autonomy and
beneficence/non- maleficence may also be expanded
to include effects on the
relatives of patients or even the medical
practitioners, the overall population
and economic issues when making medical decisions.
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Medical ethics professionalism
From Hippocrates the founder of medical ethics
came the concept of medicine as a profession ,
whereby physicians make a public promise that
they will place the interests of their patient
above their own interests
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Medical ethics and human rights
In recent times , medical ethics has been greatly
influenced by human rights . In a pluralistic
and multicultural world with many different
moral traditions , the major international human
rights agreements can provide a foundation
for medical ethics that is acceptable across
national and cultural boundaries.
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Medical ethics and low
Medical ethics is closely related to law. In
most countries there are laws that specify how
physicians and nurses are required to deal with
ethical issues in patient care and research .
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Medical ethics and low
In addition , the medical licensing and
regulatory officials in each country can punish
physicians and nurses for ethical violations.
But ethics and low are not identical.
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Medical ethics and low
Ethics often prescribes higher standards of
behaviour than the law , and occasionally ethics
requires that physicians and nurses disobey
laws that demand unethical behaviour.
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In making decisions , it is helpful to know what
others physicians and nurses would do in similar
situations.
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Compassion ,competence, and autonomy are not
exclusive to medicine , however ,physicians
are expected to exemplify them to a higher
degree than other people , including
members of many other professions.
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compassion
Compassion , defined as understanding and concern
for another persons distress . It is essential
for the practice of medicine. In order to deal
with the patients problems , the must identify
the symptoms that the patient is
experiencing and their underlying causes
and must want to help the patient achieve relief.
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competence
A very higher degree of competence is both
expected and required of physicians. A lack of
competence can result in death and serious
morbidity for patients. Physician undergo long
training period to ensure competence ,but
considering the rapid advance of medical
knowledge . It is a continual challenge for them
to maintain their competence.
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Autonomy
Or self-determination , is the core value of
medicine that has changed the most over the
years. Individual physicians have traditionally
enjoyed a high degree of clinical autonomy in
deciding how to treat their patients.
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Autonomy
At the same time , there has been wide spread
acceptance by physicians worldwide of
patient autonomy ,which means that patients
should be the ultimate decision makers in
matters that affect themselves.
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Confidentiality
The physicians duty to keep patient
information confidential has been a
cornerstone of medical ethics since the time of
Hippocrates. Hippocrates Oath states what I
may see or hear in the course of treatment or
even out side of the treatment in regard to the
life of man ,which on no account must spread
abroad, I will keep to myself holding such
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Confidentiality
things shameful to be spoken about. The Oath ,
and some more recent versions , allow no
exception to this duty of
confidentiality . However , other codes
rejects this absolutist approach to
confidentiality.
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Confidentiality
The WMA International Code of Medical Ethics
states It is ethical to disclose confidential
information when the patient consents to it , or
when there is a real and imminent threat or harm
to the patient or to others and this threat can
be only removed by a breach of confidentiality
that breaches of confidentiality are sometimes
justified calls for clarification the very idea
of confidentiality.
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Confidentiality
In certain circumstances it is not unethical to
disclose confidential information.
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Beginning -of- Life Issues
Many of the most prominent issues in medical
ethics relate to the beginning of human life.
Each of them has been the subject of extensive
analysis by medical associations , ethicists ,
and government advisory bodies and in many
countries there are laws, regulations , and
policies dealing with them.
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Contraception
Although there is increasing international
recognition of a womans right to control her
fertility , including the prevention of
unwanted pregnancies , physicians still have to
deal with different issues such as requests for
contraceptives from minors and explaining the
risk of different methods of contraception.
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Assisted reproduction
For couples and individuals we cannot conceive
naturally there are various techniques of
assisted reproduction , such as artificial
insemination , and in-vitro fertilization , and
embryo transfer , widely available in major
medical centers . Surrogate or substitute
gestation is another alternative. None of those
technique is unproblematic , either in individual
cases or for public policies.
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Prenatal Genetic Screening
Genetic tests are now available for
determining whether an embryo or fetus is
affected by Certain genetic abnormalities and
whether It is male or female. Depending on
the finding ,a decision can be made whether
or not to proceed with pregnancy.
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Prenatal Genetic Screening
Physicians need to determine when to offer such
tests and how to explain the results to the
patient.
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Abortion
This has long been one of the most divisive
issues in medical ethics ,both for physicians and
for public authorities. The WMA Statement on
Therapeutic Abortion acknowledges this diversity
of opinion and belief and concludes that This is
a matter of individual conviction and conscience
that must be respected
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Severely compromised neonates
Because of extreme pre-maturity or congenital
abnormalities , some neonates have a very poor
prognosis for survival. Difficult decisions often
have to be made to attempt to prolong their lives
or allow them to die.
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Research Issues
These include the production of new embryos or
the use of spare embryos (those not wanted
for reproductive purposes ) to obtain stem
cells for potential therapeutic application
,testing of new techniques for assisted
reproduction, and experimentation of foetuses.
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End- of -life issues
End of life issues range from attempts to
prolong the lives of dying patients through
highly experimental technologies, such as the
implantation of animal organs , to efforts to
terminate life prematurely through euthanasia and
medically assisted suicide.
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End -of- life issues
In between these extremes lay numerous issues
regarding the initiation or withdrawing of
potentially life-extending treatments , the care
of terminally ill patients and the advisability
and use of advance directives.
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Two issues deserve particular attention
- Euthanasia and Assistance in suicide.
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Euthanasia
Euthanasia means knowingly and intentionally
performing an act that is clearly intended to
end another person' life that includes the
following elements
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Euthanasia
the subject is a competent ,informed person with
an incurable illness who has voluntarily asked
for his or her life to be ended the agent knows
about the persons condition
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Euthanasia
and desire to die ,and commits the act with
primary intention of ending the life of that
person and the act is undertaken with
compassion and without personal gain.
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Assistance in Suicide
Assistance in suicide means knowingly and
intentionally providing a person with the
knowledge or means or both required to
commit suicide , including counseling about
lethal doses of drugs , prescribing such lethal
doses or supplying the drugs.
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Euthanasia and assisted suicide are
regarded as morally equivalent, although there is
a clear practical distinction , and in some
jurisdiction a legal distinction between them
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Physicians are understandably unwilling to
implement requests for euthanasia or assistance
in suicide because these acts are illegal in most
countries and are prohibited in most medical
codes of ethics.
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This prohibition was part of Hippocratic Oath and
has been emphatically restated by WMA in
its Declaration on Euthanasia.
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Physicians , their colleagues and relationship
with other health professionals

• Physicians belong to a profession that has
  traditionally functioned in an extremely
  hierarchical fashion.
• A cooperative model of decision making
• has replaced the authoritarian model that was
  characteristic of traditional medical
  paternalism.
• Teachers have an obligation to treat their
  students respectfully and to serve as
  good role models in dealing with patients.

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Physicians , their colleagues and relationship
with other health professionals
Students concerned about ethical aspects of
their education should have access to such
mechanisms where they can raise
concerns. Reporting colleagues to disciplinary
authority should normally be a last
resort after other alternatives have been
tried and found wanting. Cooperation among
physicians and other health team members is
essential.
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Physicians , their colleagues and relationship
with other health professionals
The weakening of medical paternalism has
been accompanied by the disappearance of
the belief that physicians own their patients.
Uncertainty and diverse viewpoints can rise
to disagreement about the goals of care or
the means of achieving those goals.
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Physicians , their colleagues and relationship
with other health professionals
Conflicts should be resolved as informally as
possible , for example , through direct
negotiation between the persons who
disagree , moving to more formal
procedures only when informal
measures have been unsuccessful. The opinions
of all those directly involved should be
elicited and given respectful
consideration.
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Ethics and Medical Research
Importance of medical research in
medicine. Every proposal for medical research
on human subjects must be reviewed and
approved by independent ethics
committee before it can proceed. Medical
research involving human subjects must be
justifiable on scientific grounds.
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Ethics and Medical Research
Social value has emerged as an important
criterion for judging whether a project
should be funded. If the risk is entirely
unknown , then the researcher
should not proceed with the project until some
reliable data are available. The voluntary
informed consent of the human
research subjects is absolutely
essential.
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Ethics and Medical Research
Research subjects have a right to privacy
with regard to their personal health
information. Honest reporting of research
results.
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Conclusion
Like all human beings , physicians , nurses
have rights as well as responsibilities.
Physicians sometimes need also to be
reminded of the privileges they enjoy.
Physicians often forget that they have
responsibilities to themselves and their
families as well.