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Medical ethics we too need one day l.jpg

Medical ethicswe too need one day ???

Dr.T.V.Rao MD

Dr.T.V.Rao MD

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What are medical ethics

  • Medical ethics refers

    • Chiefly to the rules of etiquette adopted by the medical profession to regulate professional conduct with each other, but also towards their individual patients and towards society, and includes considerations of the motives behind that conduct.

Dr.T.V.Rao MD

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Why Should doctors have to swear an oath when they qualify?

The Hippocratic Oath.doc

Modern Hippocratic Oath.doc

To save self and Others too

Dr.T.V.Rao MD

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Patients are demandingunlike past- follow ethics

  • Patients are entitled to good standards of practice and care from their doctors .Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligations

Dr.T.V.Rao MD

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Definition of medical ethics

  • The practice of medicine is rooted in a covenant of trust among patients, healthcare professionals, and society.

  • The ethics of medicine must seek to balance the healthcare professional’s responsibility to each patient and the professional, collective obligation to all who need medical care.

Dr.T.V.Rao MD

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Human Rights

Access to health care

Right to non-discrimination

Right to privacy and confidentiality

Right to environment that is not harmful to health or well being

Basic Rights and Ethical Duties



Dr.T.V.Rao MD

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The good of the patient is paramount

TRUST must be nurtured before all else

Avoid conflicts of interest (COI)

Avoid perception of COI

Respect rights of patient

safeguard confidentiality

respect self-determination

communicate honestly with all

maintain competence

Principles of Medical Ethics

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Medical Ethics: Clinical obligations

fidelity first to patients’ interests

telling the truth (cancer, errors)

Professional Ethics: Obligations of the profession


education of self and others

Bioethics: Guides for public policy

gene technology, stem cell research

health system reform

Types of Ethics

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What is the need for medical ethics?

  • The practice of medicine and the practice of ethics are inseparable.

  • Every clinical decision invokes an ethical decision as well.

  • In many instances, the ethical issue may not be readily apparent.

  • In others conflicts arise between ethical principles and medical decisions, which require the clinician to be well versed with the former in order to guide the latter.

Dr.T.V.Rao MD

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  • Autonomy: Respect for an individual’s autonomy or ability to make decisions for him/herself

    • includes respect for their privacy and confidentiality

    • need to provide sufficient information for them to make informed choices

    • truth telling

    • protection of persons with diminished or impaired autonomy.

Dr.T.V.Rao MD

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  • Justice: This refers to the need to treat all people equally and fairly

  • Society uses a variety of factors as a criteria for distributive justice, including the following:

    • to each person an equal share

    • to each person according to need

    • to each person according to effort

    • to each person according to contribution

    • to each person according to merit

    • to each person according to free-market exchanges

  • We should strive to provide some decent minimum level of health care for all citizens, regardless of ability to pay

Dr.T.V.Rao MD

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  • Beneficence:This refers to the tradition of acting always in the patients’ best interest to maximise benefits and minimise harm.

  • Non-malfeasance:This principle ensures that treatment or research ought not to produce harm

    • Negligence

    • Misconduct

Dr.T.V.Rao MD

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Ethical vs. Legal Obligations

  • Medical ethics and the law are not the same, but often help define each other

  • Breach of ethical obligation may not necessarily mean breach of law

  • Breach of ethical obligation may be used to prove medical malpractice or medical negligence

Dr.T.V.Rao MD

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I. Respect for Autonomy (or Person)

Respect the decisions of autonomous persons and protect persons who lack decision-making capacity (e.g., confused patients, mentally ill).

Recognize the capacity of mentally and legally competent patients :

To think and make decisions independently

To act on the basis of their decisions

To communicate their wishes to health workers

Uphold patient confidentiality

Micro Level Ethical Principles

Dr.T.V.Rao MD

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II. Non-Maleficence (Not inflicting harm)

Health professionals should not inflict harm on patients

III. Beneficence

Act in the best interests of patients or research participants.

Contribute to patient welfare – help patients further health interests

Ethical Principles

Dr.T.V.Rao MD

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Paternalistic model

Emphasizes health and well-being (beneficence) over respect for autonomy and patient choice

Patient is selectively given information

Evolution of newer decision-making models

Independent choice vs. enhanced autonomy

Paternalistic vs. informative vs. interpretive vs. deliberative

Healthcare Professional Role

Dr.T.V.Rao MD

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An understanding of the issue-the science and knowledge base

An understanding of ethical frameworks and principles-not just case studies and anecdotes

An understanding of one’s own values

Ability to think through the issue-logic and argument

Recognition of uncertainty-limits to knowledge


Dr.T.V.Rao MD

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We are confused many times about truth ???

  • Should doctors always tell patients their diagnosis?

    • What about uncertainty in diagnosis? Is it right to make patients share this?

    • Is it ever right to suppress diagnoses – what about stigmatising diagnoses, e.g. MS, dementia, HIV, psychiatric diagnoses?

    • What if relatives ask doctors not to disclose diagnoses to patients?

Dr.T.V.Rao MD

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Definition: A patient’s willing acceptance of a medical intervention after adequate disclosure from their MD of the nature of the intervention, risks, benefits and alternative treatment options

What constitutes informed consent?

Disclosure: information to allow reasonable person to make a decision

Understanding: comprehension of the information given

Voluntary: no coercion or incentive to accept or deny a treatment

Agreement: verbal or written (preferred) to discussed intervention

Many are screening patients for HIV without informed consent ?

Many are doing sex determination in fetus even it is prohibited ???

Informed Consent

Dr.T.V.Rao MD

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  • Ethical values have often been influenced by and influenced legal doctrine and legal principles are closely related to ethical principles.

  • Ethical obligations exceed legal duties

  • Law serves to demarcate the limits of individual autonomy in the interests of society. It also protects the rights of individuals

Dr.T.V.Rao MD

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Knowledge creates conflictso the doctors fight

  • In much wisdom is much grief :and he that increaseth knowledge increaseth sorrows”(Ecclesiastics 1,18)

Dr.T.V.Rao MD

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Medical ethics create better physicians

Medical Ethics


Good of the patient

Excellent physician

biological-medical good

self-understood good

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Practice good practices you will flourish




Flourishing life

Basic template for professions:

  • identify distinguishing characteristic

  • rank virtues for particular profession

  • define professional excellence

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What is your choice makes difference ???

  • Medicine is about : “Can we?”

  • Ethics is about: “Should we?”

Dr.T.V.Rao MD

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Solutions to Ethical Problems

  • Not simple

  • Ethics not like science

  • Is ethics arbitrary? Or

  • Can we discover an ethic for medicine?

Dr.T.V.Rao MD

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Dr.T.V.Rao MD