Transcript Ethics and Professionalism

Ethics and Professionalism
Prof MAM Ibnouf
Aims
1- To define
medical ethics
2- To provide
examples of
ethical clinical
practice
: ‫األهداف‬
‫ تعريف األخالق‬-1
‫الطبية‬
‫ تقديم امثلة‬-2
‫للمارسة األخالقية‬
‫الطبية‬
Four Bioethical Principles
1- Autonomy: respect for
the individual and their
ability to make
decisions with regard
to their own health and
future.
2- Beneficence: actions
intended to benefit the
patient or others
Four Bioethical Principles
3- Non-maleficence:
actions intended not to
harm or bring harm to
the patient and others
4- Justice: being fair or
just to the wider
community in terms of
the consequences of an
action
Confidentiality
Confidentiality is
not a single
ethical principle
in itself, rather it
is linked in to
several bioethical
principles.
Confidentiality
Respect for an individual's autonomy and their
right to control the information relating to
their own health.
Keeping secret the doctor is acting beneficently.
Disclosing information without the patient's
consent can damage the patient this would be
the very reverse of beneficent i.e. malificent.
Maintaining confidentiality can therefore also
be seen as non-maleficent.
Breaking confidentiality
For instance if there is a risk
to a third party this may
overrule the necessity to
maintain confidentiality.
Examples
Psychiatry: A patient disclose
to his doctor that he believes
his sister is an evil witch. His
delusion is also linked to a
plan to kill her.
Answer
The doctor must weigh his duty to
maintain confidentiality against a
duty to protect the sister.
Conflict between the
principles of autonomy and
non-maleficence.
Breaking confidentiality
1- The vulnerable patient:
a- Where serious harm may occur to a third party,
b- Where a doctor believes a patient to be the
victim of abuse and the patient is unable to give
or withhold consent to disclose
c- Where, without disclosure a doctor would not
be acting in the overall best interests of a child
who is incapable of consenting to disclosure
Breaking confidentiality
2- The General Right and Responsibility:
a- When, without disclosure the prevention
of a crime by the police would be delayed
b- when, without disclosure the prosecution
of a crime would be delayed (e.g. a patient
tells you that he killed someone several
years ago)
Breaking confidentiality
3- The General Public Interest:
a- Where a doctor has
concerns over an epileptic
patient’s fitness to drive.
Breaking confidentiality
4- Health professional:
a- Where a doctor has a know a health
professional and has concerns over his
fitness to practice posing a serious
danger to patients
Ethics should never be viewed as being
interchangeable with the law. The is often
informed by ethics. The law may face ethical
principles, such as a law requiring a doctor to
send incurable patients to a the prison.
The law should never be a
substitute for ethical
reasoning.
the court can require a
doctor to break
confidentiality
Summary Points
• Confidentiality involves a respect for
autonomy and also beneficence towards the
patient and a desire to act non-maleficently
• Confidentiality is not an ethical principle in
itself. It can be characterized as a duty by
some health professionals.
• The concept of confidentiality is elastic and
may be interpreted rigidly or less strictly with
information 'sharing' by a team
Summary Points
• Most countries have laws to enable the
breaking of confidentiality
• Breaking confidentiality to protect the safety
of a third party is seen as reasonable
• The law is not necessarily interchangeable
with a system of ethics
• The ethos of a group can change over time
The 'serious misconduct'
The professional has in a privileged position
and there is a profound power differential
between the patient and the doctor.
• A sexual relationship could be viewed as
abusive, in which there is ill-informed
consent lack of autonomy.
• In avoiding such relationships the
professional is acting non-maleficently.
The Uncertainty!
How does this fit into ethics?
1- For how long should we give NSAID to
patients with osteoarthritis?
2- If a patient has a elevated PSA ll how likely
is he to have cancer? If FNA is not
conclusive?
3- A boy at 15 he may attract a diagnosis of
conduct disorder, but if he is 16 he might
be diagnosed as a personality disorder.
Why does the diagnosis change is the age?
At a personal level how certain are we
ourselves know a set of facts or how
certain are that we can perform a
standard procedure.
e.g. Open chole my  CBD injury
Child birth may end with hystrectomy
Iserting i.v. canula may be a failure
Is it true in our current set up
Only where the certainty of
competence is high could the
doctor, then an expert, act in
confidence in the best interests
of the patient.
Is this true in our current set up?
Does the level of competence
interact with Ethics?
Where is the responsibility
towards patients’ safety is it at
the level of individual heath care
providers? Or at the level of the
group?