MEDICAL ETHICS

Dr Muhammad Zahid Latif

4th Year MBBS, 25-03- 2015

DIFFERENT SCENARIOS

Visiting a Medical Conference

A pediatrician attended a medical conference
with his family and enjoyed a luxury
accommodation. He invited some of his ex class
fellows for evening tea in the same hotel. One of
the colleagues asked about the expenses. He
replied, it is sponsored by a Pharmaceutical but I
have not made any commitment with them. After
few months the same pediatrician called his class
fellow and informed that the representative of
same pharmaceutical is forcing to prescribe their
medicines as they have invested on him.

How will you comment on this issue?

Reporting a Wrong Result

A 25 year old patient came for the screening
of Hepatitis B & C. On investigation B was
negative where as Anti HCV was positive
and it was confirmed by PCR Test as well.
The patient asked the doctor that he
belongs to a very poor family. He is selected
for a job but with this result he will not be
allowed to join job. He requested again and
again to change the result as it is a matter
of his carrier and family.

What will you do in this case ?

Reporting a Wrong Result

The doctor changed the result as he was thinking
that this act will help him for job. After few
months the results of all candidates were cross
checked and situation became clear. The boy was
dropped

from

the

job

where

as

recruiting

company served legal notice to doctor.

What should be the action of doctor now?
Discuss this situation.

A Colleague in Trouble
You are a physician who works in both urban
and rural settings. Over the past six months,
the behavior of a colleague you have known
for 10 years has changed. The physician has:
become somewhat unreliable, late for meetings
and/or procedures undergone personality changes
lacked attention to detail
lacked judgment in some situations
responded negatively to colleagues who have
attempted to intervene

What would you do in this situation?

Accepting Gifts of Patients

You are a family physician with hospital
privileges working in a large urban clinic.
Following hospitalization for accident injury,
one of your long-term patients gives you a
gift as a thank you for the care you provided.
The cost of gift is around Rs 50000.00.
What would you do in this situation?

A Deal with Pharmacy Officer

At your last staff meeting, the rising cost of
rent and overhead was discussed. One of
your partners mentioned that he had been
approached by a large pharmacy chain with
an offer of space adjacent to their new
pharmacy. There was a suggestion that the
rent could be lowered if the volume of
prescriptions
from
your
office
were
substantial.
What will you do?

Prescribing Unnecessary
Medicine
A 40-year-old woman requested a prescription
that was, in your opinion, contraindicated
because of her co-morbid medical conditions.
She was aware of the risks and insisted that if
she wanted to proceed with the treatment,
she should be allowed to do so.
You have always tried to act in accordance to
do no harm and have felt that you must
make an independent decision. One of your
colleagues feels that if the patient is aware of
the risks then you should provide her with the
treatment if she requests.

Rights of Patient
Patients are entitled to good standards of practice
and care from their doctors.
Essential elements are
1. Professional competence
2. Good relationships with patients and colleagues
3. Observance of professional ethical obligations.
(From Good Medical Practice, GMC.)

Ethics
The branch of knowledge that deals
with moral principles.
Moral principles that govern a person's
behavior to conduct an activity.
(https://www.google.com.pk/webhp?sourceid=chrome-instant&ion=
1&espv=2&ie=UTF-8#q=ethics%20definition)

Ethics
The branch of philosophy dealing with

Values relating to human conduct with

respect to the Rightness and Wrongness
of certain actions and to Goodness and
Badness of the motives and ends of such
actions.
(http://dictionary.reference.com/browse/ethics)

Medical Ethics
Medical

Ethics

is

code

of

conduct for practicing doctors /

professionals

evolved

over

centuries and is based on the

most admirable human values
and principles.

Medical Ethics
Medical

ethicsis

system

of

moral

principles that apply values and judgments

to the practice ofmedicine. As a scholarly
discipline, medical ethics encompasses its
practical application in clinical settings as
well as work on its history, philosophy,
theology, and sociology.
(http://en.wikipedia.org/wiki/Medical_ethics)

Medical Ethics
It is the subject concerned with
moral principles for the members of
the

medical

dealings

with

profession
each

in

their

other,

their

patients & the state.

The aim is to honor & maintain the

History
Hippocratic Oath
Father
western
medicine

of

The oldest oath

of
medical
ethics
4th Century BC

Hippocratic Oath
Several parts of the oath have been revised over the years,
To consider dear to me, as my parents, him who

taught me this art; to live in common with him and, if

necessary, to share my goods with him
Nor will I give a woman a pessary to procure abortion;
I will not cut for stone, even for patients in whom the disease is
manifest;

I will leave this operation to be

performed by practitioners, specialists in his

art.

Muslim Physicians
Contribution in Medical Ethics

Ishaq Bin Ali Rahawi Wrote the

conduct of a Physician, the first book
dedicated to medical ethics
Muhammad bin Zakariya Al Razi
The doctors aim is to do good, even to
our enemies, so much more to our
friends, and my profession forbids us
to harm, as it is instituted for the
benefit and welfare of the human
race.

Muslim Physicians
Contribution in Medical Ethics

Razi

advised

practitioners

to

keep

updated with advanced knowledge by

continuously studying medical books
and

exposing

information

themselves

to

new

Code of Professional Conduct

(Hong
Medical
Council)
Medicine
as a Kong
profession
is distinguished
from other
professions by a special moral duty of care to save lives and
to relieve suffering.
Medical Registration Ordinance (Cap. 161) confers upon the
medical profession considerable freedom of self regulation,
the profession is obliged to abide by a strict code of
conduct which embodies high ethical values, protects
patients interests, and upholds professional integrity.
Trust is essential to the practice of medicine. There can be
no medicine in the absence of trust. The patients trust
imposes upon the doctor a corresponding duty to be
trustworthy and accountable.
(http://www.mchk.org.hk/code.htm)

Principles of Medical Ethics

1.Autonomy
2.Beneficence
3.Non-maleficence
4.Justice
5.Respect for persons
6.Truthfulness andHonesty

Autonomy
The Patient has the
right to refuse /
choose
their
treatment

Autonomy
Rights of individuals to make choices &
decisions.
Exceptions
Restriction of individual freedom e.g.
(yellow- fever
Quarantine)
Restriction on prostitutes (II world war to
control STDs)
With holding information from a patient
who is unable to handle it.

Beneficence
A practitioner should act in the best
interest of the patient.
Principle of doing good.
To respond to every call for help.
To Console patients and their relatives.
To encourage all to take greater
responsibility
for their own health. (Health
Education).

Non Maleficence

First do no
Harm

Non maleficence
First, do no harm.
The principle states that we should act in ways
that do not cause harm to others. In particular, we
should not cause avoidable or intentional harm.
This includes avoiding even the risk of harm.
A positive and determined attitude not to harm the
patient psychologically, physically, socially.
( e.g. avoid undue body exposure).
Organ donation should never be the out come of
compulsion. (Discontinuation of life support
system to a terminally ill patient is a difficult
decision)

Justice

Giving to every one his right

Two levels
Individualistic
Collective
Social, legal, economic, political

Respect for Persons

The patient (and the person treating
the patient) have the right to be
treated with dignity

Truthfulness andHonesty
The concept ofinformed consenthas
increased in importance.
It is the permission granted in full
knowledge of the possible consequences,
typically that which is given by a patient
to a doctor for treatment with knowledge
of the possible risks and benefits
All information should be translated into
language and concepts understandable
by the community.

Informed Consent
Informed consent is the process by which
the treating health care provider discloses
appropriate information to a competent
patient so that the patient may make a
voluntary choice to accept or refuse
treatment.
It originates from the legal and ethical right
the patient has to direct what happens to
his / her body and from the ethical duty of
the physician to involve the patient in his /
her health care.

Elements of Informed Consent

The goal is that the patient is an informed
participant in health care decisions. It
includes a discussion of the following
elements:
The nature of the decision / procedure
Alternatives to the proposed intervention
The
relevant
risks,
benefits,
and
uncertainties related to each alternative
Assessment of patient understanding
The acceptance of the intervention by the
patient

Confidentiality

Confidentiality
Conversations between doctors and patients.
This concept is commonly known as patientphysician privilege.
Confidentiality
is
commonly
applied
to
conversations between doctors and patients.
Legal protections prevent physicians from
revealing certain discussions with patients,
even under oath in court.
Thisphysician-patient privilegeonly applies to
secrets shared between physician and patient
during the course of providing medical care.
(Dr. Coburn's Peculiar Privilege, Oct 2, 2009 )

Euthanasia

Euthanasia ()
Euthanasiarefers
to
the
practice
of
intentionally ending a life in order to relievepain
andsuffering.
Different laws in each country.
Euthanasia is categorized in different ways,
which include voluntary, non-voluntary, or
involuntary.Voluntary euthanasiais legal in
some countries and U.S. states. Non-voluntary
euthanasiais illegal in all countries.Involuntary
euthanasiais usually considered murder.
As of 2006, euthanasia is the most active area of
research in contemporarybioethics.

Classification
Voluntary euthanasia
Conducted with the consent of the
patient . Active voluntary euthanasia is
legal in Belgium
Non-voluntary euthanasia
Conducted where the consent of the
patient is unavailable. (Examples
includechild euthanasia)
Involuntary euthanasia
Conducted against the will of the patient.

Types
Voluntary, non-voluntary and involuntary
euthanasia can be further divided into
passive or active .
Passive Euthanasia (withholding of
common treatments, such as antibiotics,
necessary for the continuance of life)
Active Euthanasia entails the use of
lethal substances or forces, such as
administering a lethal injection, to kill and
is the most controversial means.

Ethics Committee
These bodies are composed primarily
of health care professionals, but may
also includephilosophers, lay people,
andclergy- indeed, in many parts of
the world their presence is considered
mandatory in order to provide balance.

The believers whose faith is most

perfect are those who have the best
character.
(Akmalu
al-momineen
imanan
ahsanuhum khuluqan)
Hadith of the Prophet (SAW)
(from Imam Ibn Hanbal)

Al- Quran
"And if anyone saved a life, it
would be as if he saved the
whole mankind".

(Al- Quran 5:

32)
"No soul can die except by the
permission Allah"

(Al Quran 3 :

Consultation

The Oath of a Muslim Doctor

In the name of Allah, Most Gracious, Most
Merciful. Praise be to Allah, the Sustainer of
His Creation, the All-Knowing. Glory be to
Him, the Eternal, the All-Pervading. O Allah,
Thou art the only Healer, I serve none but
Thee, and, as the instrument of Thy Will, I
commit myself to Thee.I render this Oath
in Thy Holy name and I undertake:
(http://www.iium.edu.my/medicine/about-us/oath-muslim-

physician)

The Oath of a Muslim Doctor

To be the instrument of Thy Will and Mercy,
and, in all humbleness, to exercise justice,
love and compassion for all Thy Creation;
To extend my hand of service to one and all,
to the rich and to the poor, to friend and foe
alike, regardless of race, religion or color;
To hold human life as precious and sacred,
and to protect and honor it at all times and
under all circumstances in accordance with
Thy Law;
(http://www.iium.edu.my/medicine/about-us/oath-muslim-physician)

The Oath of a Muslim Doctor

To do my utmost to alleviate pain and misery,
and to comfort and counsel human beings in
sickness and in anxiety;
To respect the confidence and guard the secrets
of all my patients;
To maintain the dignity of health care, and to
honor the teachers, students, and members of
my profession;
To strive in the pursuit of knowledge in Thy
name for the benefit of mankind, and to uphold
human honor and dignity;
(http://www.iium.edu.my/medicine/about-us/oath-muslim-physician)

The Oath of a Muslim Doctor

To acquire the courage to admit my
mistakes, mend my ways and to forgive
the wrongs of others;
To be ever-conscious of my duty to Allah
and His Messenger (s.a.w) and to follow the
precepts of Islam in private and in public.
O Allah grant me the strength, patience
and dedication to adhere to this Oath at all
times.
(http://www.iium.edu.my/medicine/about-us/oath-muslim-physician)

Oath
of a
Musli
m
Docto
r
www.pima.org.pk

Code
of
Ethic
s
PMD
C

 Adapted

PMDC
Oath
Of
Medic
al And
Dental
Practition
ers

from the 2nd General

Assembly of the World Medical
Association,
Geneva,
Switzerland,
September 1948; and amended by the
22nd World Medical Assembly, Sydney,
Australia, August 1968; and the 35th
World Medical Assembly, Venice, Italy,
October 1983; and the 46th World
Medical Association General Assembly,
Stockholm, Sweden, September 1994.
and the Islamic Medical Association
Oath
for
Muslim
Doctors.

At the time of being admitted as a member of the

medical profession: I solemnly pledge myself to
consecrate my life to the service of humanity; I will
give to my teachers the respect and gratitude which
is their due; I will practice my profession with
conscience and dignity; The health of my patient
will be my first consideration; I will respect the
secrets which are confided in me, even after the
patient has died;I will maintain by all the means in
my power, the honor and the noble traditions of the
medical profession; My colleagues will be my sisters
and brothers; and I will pay due respect and honor to
them. I will not permit considerations of age,
disease or disability, creed, ethic origin, gender,
nationality,
political
affiliation,
race,
sexual
Practitione
orientation, or social standing to intervene between
rs
my duty and my patient; I will protect human life in
all stages and under all circumstances, doing my
utmost to rescue it from death, malady, pain and
anxiety. To be, all the way, an instrument of Allahs
mercy, extending medical care to near and far,
virtuous and sinner and friend and enemy. I make

PMDC
Oath
Of
Medica
l&
Dental

Questions