Ethics in medicine

I.T. Gangaidzo MA, BM BCh(Oxon); DTM&H(Lond); FRCP(Lond)

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Disclaimer

Ethics?

Introduction

To demonstrate that ethics are an essential component to good medical practice

Explain the crisis that currently faces the health services delivery in the country

Emphasize the role that doctors play in shaping the future of health services in Zimbabwe

Part of this solution is to prioritise ethics in medical practice

Learning objectives

Ethics deals with right and wrong conduct, with what we ought to do and what we should refrain from doing. 

Medical ethics concerns how to handle moral problems arising out of the care of patients; often clinical decisions must consider more than just the patient's medical condition.

Why ethics are important?◦ 1. Essential component of good medical practice; reputation◦ 2. Clinical importance of trust: without trust patients will not

cooperate in diagnosis and treatment◦ 3. Rational self interest: care of doctor and those close to him

guaranteed by ensuring widespread practice◦ 4. The law: ethical considerations enshrined in statute and common

law. Doctors may be sued in criminal and civil law◦ 5. Professional regulation: inescapable throughout the world

Do ethics matter?

Harsh economic environment◦ Poorly performing economy◦ Inability to afford services

Medical referral systems◦ Exporting resources to India, South Africa etc.◦ Delayed specialist referral; primary care by specialists◦ Faith-based health services

Increasing numbers of practitioners◦ Larger numbers from local and foreign medical schools

Health funders playing the role of health service providers◦ Conflict arising from managed health care models

Diminishing public opinion regarding doctors◦ Rude, unprofessional and unethical behaviour towards patients

Medicine in crisis

Realisation that the community of doctors has to be the primary source of ideas and activity to resolve problems◦ Principle of social justice

Adequate mobilisation of resources◦ Principle of social justice

Develop a coherent strategy to medical issues in the country

Demand high levels of professionalism◦ All components of medical ethics

How do we address this crisis

Technical knowledge alone is insufficient in the practice of good medical care

Understand (as opposed to remember) the knowledge◦ Chauffer knowledge

Corresponding skills in applying knowledge are essential Knowledge and skills are complemented by correct attitude

◦ Practice incorporating all three leads to good practice◦ Attitude is largely determined by cultural and ethical factors

Proficiency alone is not enough

knowledge

attitudeskills

The components of good clinical practice

The 3 principles at the core of medical ethics◦ 1. The principle of protecting life and health

Serving the patient’s interest, not causing harm or unnecessary suffering. Only give treatment the patient needs (beneficence & non-maleficence)

◦ 2. The principle of patient autonomy physician is one of many advisors to an autonomous

patient observe patient’s right to make choices & to dignity related rights to informed consent and confidentiality

◦ 3. The principle of social justice access to care should be based on need, not favour or

prejudice calls upon the profession to promote a fair distribution

of health care resources

Core principles of medical ethics

Confidentiality◦ forms a cornerstone of the doctor-patient relationship◦ implies respecting the patient's privacy, encouraging them to seek

care◦ protects the trust between doctor and patient, the physician should

not release personal medical information without the patient's consent◦ like other ethical duties, confidentiality is not absolute. Can be

necessary to override privacy in the interests of public health Informed consent

◦ follows from principle of patient autonomy; consent required before providing care

◦ required for any purpose: diagnostic, investigational, cosmetic, palliative, or therapeutic

◦ serves as a significant protection to you against possible litigation.◦ consent may be expressed or implied

Related principles

Describe the case simply but with the pertinent facts Specify the ethical dilemma What alternatives do you have? List the key considerations: Autonomy; Beneficence (what

are the medical alternatives?); Justice (rights of patient vs. family, etc); Context (situational factors such as your own feelings, your peers, the law)

Propose a resolution Review this choice critically: formulate it as a general

maxim and review its plausibility Do the right thing!

Hébert PC. Doing right: a practical guide to ethics for medical trainees and physicians. Oxford University Press, 1995

Proposed framework for resolving ethical dilemma

In practice of medicine; knowledge and skill alone are not enough

To practice good medicine ATTITUDE is an important component

A good attitude depends on the right cultural and ethical framework

If the profession is to adequately address the crisis that faces it, there is need to walk the talk: “ETHICS IS AS IMPORTANT AS KNOWLEDGE AND SKILL”

In conclusion

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