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Medical Ethics

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Medical Ethics Basic Concepts of Medical ethics All medico legal examinations where persons are produced from custody require expressed written witnessed consent ... – PowerPoint PPT presentation

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Title: Medical Ethics


1
Medical Ethics
  • Basic Concepts of Medical ethics

2
  • Confidentiality

3
Confidentiality
  • The doctor patient relation ship is an extremely
    confidential one
  • All information that the doctor has acquired
    professionally should be kept strictly
    confidential
  • (Professional secrecy)

4
Confidentiality
  • Breach of this duty can lead to a civil law suit
    or criminal defamation if done intentionally
  • Divulging such information to a third party (eg.,
    insurance company or employer) should be done
    with consent only

5
Hippocratic Oath
  • Whatever, in connection with my professional
    practice, or not in connection with it, I see or
    hear, in the life of men, which ought not to be
    spoken of abroad, I will not divulge, as
    reckoning that all such should be kept secret

6
The declaration of Geneva of 1948
  • I will respect secrets confided in me, even
    after the patient has died

7
The international code of Medical Ethics amended
in Venice in 1983
  • A physician shall respect the rights of
    patients, colleagues and of other health
    professionals and shall safeguard patient
    confidences
  • A physician shall preserve absolute
    confidentiality on all he knows about his patient
    even after the patient is dead

8
WHO guide lines on Medical Confidentiality
  • All information must be kept confidential
  • Information can only be disclosed if the patient
    gives explicit consent, or if the law
    specifically provides
  • Consent may be presumed where disclosure is to
    other health care providers involved in that
    patients treatment
  • All identifiable patient data must be protected

9
  • Medical interventions may only be carried out
    when there is a proper respect shown to the
    privacy of the patient. This means that the only
    persons who may be present when an intervention
    is carried out are persons who are necessary for
    the interventions, unless the patient consents or
    require otherwise
  • Patients admitted to health care institutions
    have the right to expect physical facilities
    which ensure privacy

10
  • In some instances the rule of professional
    secrecy does not apply and a doctor will not be
    liable for divulging information to a relevant
    third party (Privileged communications)
  • Such communication should be made with caution
    and least embarrassment to the patient

11
Privileged communication
12
  • (1) In the interest of the patient ( conveyed to
    other medical colleagues or parents/guardian)
    - Referral to health personnel who assists in
    the clinical management - Parents/guardian,
    when
  • patient refuses to carry out treatment
    patient has suicidal tendencies
  • psychopath with violent anti- social
    tendencies
  • minors/insane persons

13
  • (2) In the interest of the patients family
    - Communicable diseases
  • - AIDS/HIV - to warn the sexual partner

14
  • (3) As a Statutory duty laid down by Law
    - notification of infectious diseases
    - registration of births, still births and
    deaths - industrial diseases - public health
    laws (poisons-factories ordinance)
  • - PTA Act and other regulations - therapeutic
    abortions
  • - drug addicts

15
  • (4) Notification to police When a crime is
    committed against the patient or by the patient.
    - Assaults, RTA, sexual offences etc
    - Abortion
  • - Poisoning - Child abuse

16
  • (5) In the interest of public good A doctor is
    not only a health care personnel but also a
    citizen of the country with duties to the society
  • - food handlers with chronic infections
  • - unfit for public service - vehicle drivers
    with epilepsy

17
  • (6) Courts of Law
  • doctor may ask court to respect his silence
  • may ask permission to write the answer without
    making it public
  • court can insist that the doctor answers verbally
    for all in the Court to hear
  • Doctors refusal to answer may result in
    imprisonment for contempt of court

18
  • - All matters voiced in Court are absolutely
    privileged and carry no risk of a subsequent
    action for defamation or breach of confidence
  • Reports sent to Court on Court orders are also
    absolutely privileged
  • - Statements made to state prosecutors and crime
    investigators is also absolutely privileged
  • - A report given to the rival party or a third
    party without the consent of the patient amounts
    to breach of confidence

19
  • (8) Disclosure in self interest- when a doctors
    own integrity is threatened
  • In civil or criminal actions against the doctor
    by the patient, a doctor can defend himself, by
    giving evidence about the patients illness. Eg.,
    patient alleges that the doctor did not treat
    the patient with antibiotics (patient had viral
    infection)
  • information may also be disclosed at the
    discretion of the disciplinary proceeding
    committee of the SLMC in an inquiry against a
    doctor

20
  • Medical teaching, research and audit A doctor
    can report a case without revealing the patients
    identity

21
  • Medical records
  • belong to the hospital authority and not to the
    doctor unless in the case of private patients.
    If records are called for by Court the hospital
    authority must submit them confidentially
  • - should not be given to lawyers without prior
    consultation with the legal representatives of
    the hospital when legal action concerning
    negligence of medical or nursing staff in
    concerned
  • - records should not be given to
    employers/insurance companies without the consent
    of the patient or if dead/incapacitated without
    consent of next of kin

22
  • Insurance companies
  • - The medical examination for taking out a
    insurance policy is a voluntary act therefore
    consent is implied
  • - Should not give information to an Insurance
    Company about a patients past medical history,
    if the patient has consulted him before

23
  • Consent

24
  • In medical practice it refers to the willingness
    of a person to subject himself for examination,
    investigation and treatment

25
  • Consent is valid when
  • free, voluntary, without undue influence
  • given by a competent person
  • is informed
  • - information necessary to make therapeutic
    decision
  • - relevant information about research
  • - relevant medicolegal information

26
  • Should be taken from the spouse especially when
    it affects the reproductive and sexual functions
    permanently
  • Maybe given by a guardian ( proxy consent) in the
    case of the mentally retarded, minors

27
Consent
  • Implied Expressed

Verbal Written Gesture Written/witnessed
28
Implied consent
  • The behavior of person indicated that the person
    is willing for examination and treatment
  • Consent is implied when
  • - a person voluntarily comes to the OPD/clinic
    and sits by the doctor
  • - when he gets admitted to a ward
  • - a person who comes voluntarily with a MLEF
    for examination
  • However this consent is limited to ordinary forms
    of examination, investigation and treatment

29
Expressed consent
  • When consent is not implied, the doctor has to
    get consent from a competent patient after
    explaining what he is going to do and the
    implications of what is to be done. In other
    words the patient must express his willingness
    for the examination, investigation and treatment
  • It must be obtained in the presence of a third
    party

30
  • Gestures
  • - patient may say yes by nodding the head or
    say no by moving the head to and fro sideways
    or moving the hand to and fro sideways or by
    simply running away
  • - this type of consent is dangerous as the
    doctor really does not know what the patient
    actually means by the gesture
  • - a doctor must not be satisfied with consent
    in the form of a gesture

31
  • Oral
  • - patient will express his willingness by word
    of mouth
  • Written
  • - the patient will express his willingness in
    writing by putting his signature on the BHT/a
    printed form provided by the institution

32
Expressed written consent should be taken.
  • Before invasive examination/treatment
  • - Per vaginal examination
  • - Rectal examination
  • - Taking blood for investigations
  • - Intra venous therapy
  • - Chemotherapy , Radiotherapy
  • - Surgery
  • - Any procedure needing anaesthesia
  • Experimental medicines / clinical trials

33
  • Written and Witnessed
  • - the patient will express his willingness in
    writing and the fact such signature was free
    and voluntary and obtained after explaining
    the procedure and the consequences and is
    witnessed by a third party

34
  • All medicolegal examinations where persons are
    produced from custody require expressed written
    witnessed consent
  • - examination for drunkenness - victims of
    sexual offences - assailants of sexual offences
    - suspects/accused produced by police
  • - examinations for insanity - any other person
    produced from custody

35
  • Such consent is also required from next of kin
    for pathological autopsies and removal of organs
  • However if such person refuses to subject himself
    for examination, the doctor cannot proceed to
    examine him against his expressed wishes

36
  • Consent by Others - in the case of minors and
    others who are incapable of giving valid
    consent, the consent of the parent or guardian
    is required - where there in no such parent or
    guardian, a court order may be obtained
  • - no examination can be carried out at the
    request of a police officer or an employer
    without consent

37
  • in the case of school children in state schools,
    even though the consent of the parents is not
    required, the objections of the parent is upheld
    on condition that they arrange their own GP to
    conduct an examination.

38
  • - Consent for procedures involving marital
    rights such as sterilizations, termination of
    pregnancy the consent of the spouse is obtained
    to preserve family harmony even though it is
    not legally required - If the procedures are
    carried out to save the life or preserve health
    of spouse, there is absolute no need for
    consent of other spouse

39
Instances when consent is not necessary
  • Emergency
  • Mandatory vaccination requirements
  • Statutes requiring quarantine in cases of
    contagious diseases
  • Examination under court order
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