Ethical, Medico legal And Administrative issues in Managing Emergencies by Prof. Adnan Albar

1. Ethical, Medico legal And Administrative issues in Managing EmergenciesbyProf. Adnan Albar

2. Conflict of interest in dealing and Emergency cases Paid Vs. Free Gov. Vs. Private

3. Issues related to justice • Rationing • Duty • Moral Issues in Disaster Medicine • Research

4. Teaching • Clinical teaching • Burden • Privacy • Teaching by simulation • Proceedures on the newly dead

5. Relationship with Biomedical Industry

6. Thank You

7. بسم الله الرحمن الرحيم“ On the name of Allah most graceores most merciful “

8. Confidentiality : Justified disclosure • Reporting related to public health • Vital statistics • Contagious diseases • Child / Women / elder abuse • Criminally inflicted injuries • Poisoning • Loss of consciousness (the independent)

9. Confidentiality : Justified disclosure • Legal / justice proceedings • Quality assurance review • Protection of a third party from mortal harm

10. Truth telling and communication • Communicating bad news • Protection of human subjects in biomedical and behavioural research • Considering the therapeutic privilege is morally licit when there is a significant probability of causing harm by truth telling ( e.g stressful news)

11. Compassion and empathy: • Empathy is the ability to feel the anguish of illness and struggle and treating the anguish if not the illness . it’s the feeling of “I am you” or “I could be you“

12. The emergency rule to informed consent • Unconscious pt. or otherwise incapable of cons. • Harm from a failure to treat is imminent compared to the and proposed treatment. • Lack for a substituted consent

13. A valid informed refusal of care requires • The patient must have a decision making capacity . • Comprehension. • Volantarness

14. The determination of decision making capacity requires that: • The pt. appreciates that he or she has the power to wake decision on his or her behalf • The pt. understands the medical situation and prognosis, the nature of the recommended evaluation or care the a alternatives, the risks and benefits of each and the likely consequences • The patients decision is stable over time and is consistent with his or her life values or goals

15. Compassion and empathy improve patient and physician satisfaction by • Promoting communication • Minimizing conflict • Maximizing patient confidence in the Dx and Rx plan

16. Distributive justice seeks a morally correct distribution of benefits and burdens in society .It requires equitable but not necessarily equal allocation of resources

17. Distributive justice affects allocation of health care resources at 3 levels • At the societal interest level ( competes with education interest social services .etc ) • At allocating health care resources rationally • At institutional level of care departmental and bedside level

18. Gatekeepers / Limiters (third Party) • Laws / eligibility • Insurance • Managed care

19. Moral issues in disaster medicine • Triage is based on the ethical principle of providing the greatest benefit to the greatest number • Priority to the personnel who might be able to return to the rescue effort and to those injuries most amenable to treatment

20. The 4 Principle of health care ethics • Autonomy i-e self rule • Beneficence • Non maleficence • Justice is Treating equals equally and Treating non equals non equally.

21. Physicians must not act is away which in detrimental to patients.

22. Beneficence requires physicians to act to the best interests of their patients. They must balance goods and potential harms.

23. Ethical decisions can be made by considering four factors Medical indicators Equity of life Patients preference Features

24. 3 rules for ethical decision • Impartiality • Universability • Impersonal justifiability

25. Informed consents involve two duties • Disclose information to patients • Obtain patients consent

26. It is the health care provider's responsibility to assure that the patient can meaningfully participate in the decisions

27. Shared decision making requires that the patient possess correct and complete information and that the decision promote the patients goal and life values

28. There are 3 elements in the consent process • Information • Comprehension • Volantariness

29. The concept of Legal Competence Advanced directive A written document which explains the future wishes of a patient when he/she becomes unable to participate in the decision directly e.g -The terminally ill - The Suicide attemptlor

30. End of life decisions • Limiting resuscitation • Don’t resuscitate order “DNR” • Futility

31. The physician – patient - relationship • Confidentiality • Truth telling and communication • Compassion and empathy

32. Ensuring availability of Essential structural (Design ,Space ,Manpower ,ambulance , equipment ,supplies,…ete ) and process ( policies , procedures , job description , job distribution , referral …… ete ) requirement for the provision of effective emergency care services

33. Dealing with emergencies in the private medical facilities • Availability • Suitability • Problems of coverage • Problems and Insurance

34. Sources of profusion ethic in Islam ) ما فرطنا في الكتاب من شيء ) ( اليوم أكملت لكم دينكم وأتممت عليكم نعمتي ورضيت لكم الإسلام ديناً ) ( إنما بعث لأتمم مكارم الأخلاق )

35. Characteristic of the professional ethics in Islam • Define sources • Worship intent • Constant • Based on clear fundamental rule • Self accountability

36. Issues in dealing with Psychiatric emergencies • Ethical • Administrative / legislative • Medic legal • Security and safety

37. Ethical Issues in dealing with police emergency cases

38. Financial Issues in dealing with emergency cases • Payment • Extent of coverage • Approval and third party

39. Human rights in managing emergencies and disasters