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Medicine and Ethics. Chapter 6. Introduction. Ethics concerns itself with the philosophies underlying ideal relationships between human beings, as well as the promotion of the highest good for humanity as a whole.

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Ethics concerns itself with the philosophies underlying ideal relationships between human beings, as well as the promotion of the highest good for humanity as a whole.

Decisions that people make based on ethical beliefs can quite possibly alter the course of human existence.

this chapter will examine
This chapter will examine:

Rights and duties as related to ethics

Four types of ethical problems

Making ethical decisions

The impact that CEJA has had on ethical decisions made by healthcare professionals

The reasons that confidentiality is an ethical issue

CEJA opinions

history of ethics in medicine
History of Ethics in Medicine

Ethics explores the moral right or wrong of an issue.

Ethics should not be confused with etiquette.

Etiquette refers to courtesy, customs, and manners.

code of hammurabi
Code of Hammurabi

Earliest written code of ethics

Written in approximately 2250 B.C.

Elaborated on the conduct expected of a physician

Set the fees a physician could charge

oath of hippocrates
Oath of Hippocrates

Written in approximately 400 B.C. by Hippocrates

Greek physician

Known as the Father of Medicine

Administered to medical school graduates even today

percival s code of medical ethics
Percival’s Code of Medical Ethics

Thomas Percival

Physician, philosopher, and writer from Manchester, England

Published his Code of Medical Ethics in 1803

ama code of ethics
AMA Code of Ethics

Formulated in 1847 at the first annual AMA meeting

Specifically acknowledged Percival’s Code of Ethics as its foundation

american medical association
American Medical Association

AMA was established in 1846

Provides information and support to physicians

council on ethical and judicial affairs
Council on Ethical and Judicial Affairs

CEJA consists of nine active members of the AMA

Includes one resident physician

Includes one student member

CEJA is responsible for interpreting the AMA Principles of Medical Ethics as adopted by the House of Delegates

components of the ama code of ethics
Components of theAMA Code of Ethics

Four components:

Principles of medical ethics

Fundamental elements of the patient-physician relationship

Current opinions of the CEJA with annotations

Reports of the CEJA


Code of Medical Ethics: Current Opinions with Annotations

Contains the first three components Contains discussion of more than 135 ethical issues encountered in medicine

Reports of the Council on Ethical and Judicial Affairs

Discusses the rationale of the Council’s opinions

making ethical decisions
Making Ethical Decisions

We must first understand…

the elements of ethics.

types of ethical problems.

the decision-making process.

elements of ethics
Elements of Ethics

Three general elements of ethics

Duties: Obligations that a person has or perceives himself or herself to have

Rights: Claims that a person or group makes on society, a group, or an individual

Character traits: A disposition to act in a certain way

types of duties
Types of Duties


Refraining from harming oneself or another person


Bringing about good


Concept of promise-keeping


Telling the truth

types of duties1
Types of Duties


Fair distribution of benefits and burdens among individuals and groups in society having legitimate claims on those benefits


Righting a wrong


* Feeling grateful after being the beneficiary of someone’s goodness

rights versus privileges
Rights Versus Privileges

The Bill of Rights guarantees certain liberties that we enjoy as U.S. citizens.

Americans do not have the RIGHT to healthcare services; it is a privilege.

Rights apply to all people within a group without prejudice.

Consider the phrase “the RIGHT to life.”

character traits
Character Traits

Not always an indication as to how a person will act in every situation.

No human being is perfect.

Humans are often unpredictable.

types of ethical problems
Types of Ethical Problems

Ethical Distress

A situation in which certain course of action is indicated, but some type of hindrance or barrier prevents that action

ethical distress
Ethical Distress

From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.

types of ethical problems1
Types of Ethical Problems

Ethical Dilemma

A situation in which an individual is faced with two or more choices that are acceptable and correct, but doing one precludes doing another

ethical dilemma
Ethical Dilemma

From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.

types of ethical problems2
Types of Ethical Problems

Dilemmas of Justice

Focuses on the fair distribution of benefits to those who are entitled to them

dilemmas of justice
Dilemmas of Justice

From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.

types of ethical problems3
Types of Ethical Problems

Locus of Authority

Two or more authority figures have their own ideas about how a situation should be handled, but only one of those authorities will prevail

locus of authority
Locus of Authority

From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.

recognizing ethical problems
Recognizing Ethical Problems

It is not always easy to recognize the type of ethical problem present.

Sometimes, a mixture of problems exists.

the ethical decision making process
The Ethical Decision-Making Process

Purtillo presents a five-step method for making ethical decisions:

Gather relevant information

Identify the type of ethical problem

Determine the ethical approach to use

Explore practical alternatives

Complete the action

current opinions of ceja
Current Opinions of CEJA


Should a woman who has been raped and become pregnant have an abortion?

current opinions of ceja1
Current Opinions of CEJA


What harm can come to a patient’s family if medical professionals are incorrect about their assessment of abuse?

current opinions of ceja2
Current Opinions of CEJA

Allocation of Health Resources

If the CEO of American Airlines, the winner of last year’s Best Actor Oscar, and a drug-abusing mother of three were all equally ill and needed a liver transplant, who should receive it?

current opinions of ceja3
Current Opinions of CEJA

Artificial Insemination

A man fertilized eggs that were frozen for later use, but he died without having made provision for the use of those eggs after his death. Should the man’s wife be able to use the eggs?

current opinions of ceja4
Current Opinions of CEJA

Stem Cell Research

A medical student is recruited to work with a physician who is researching paralysis. Once the project is underway, the student discovers that the physician is using embryos that have been questionably obtained. What should the student do?

current opinions of ceja5
Current Opinions of CEJA

Surrogate Motherhood

What is a fair length of time to give a surrogate mother to petition to void a surrogacy contract?

current opinions of ceja6
Current Opinions of CEJA

Human Cloning

If a couple loses their child through death but it were possible to clone the child, what concerns would be present for the family?

current opinions of ceja7
Current Opinions of CEJA

Genetic Counseling

What could happen if parents were to “design” a baby, but it arrived flawed in some way or did not meet their expectations?

current opinions of ceja8
Current Opinions of CEJA

Physician-Assisted Suicide

If a patient mentioned in passing that he or she would want the right to commit suicide in the event of a terminal illness, would you support that decision if the situation did arise?

current opinions of ceja9
Current Opinions of CEJA

Surrogate Decision Making

A physician recommends that a patient be taken off life support. The patient lives with his homosexual partner and has not seen his parents in 10 years. The partner does not wish to remove life support, stating that the patient would want every opportunity to live. If the parents disagree, whose decisions should prevail?

current opinions of ceja10
Current Opinions of CEJA

Withholding or Withdrawing Life-Prolonging Treatment

How would a medical assistant handle the family of a patient who asks for advice about withdrawing life-prolonging treatment? To whom should the medical assistant defer the question?

current opinions of ceja11
Current Opinions of CEJA

Quality of Life

A mentally ill single woman who is institutionalized becomes pregnant and refuses to give up her maternal rights so that the child can be adopted. Even if she were to reconsider, what complications would result if the child were born deaf and with a severe liver disorder? Should the child be fed and cared for by the hospital staff?

current opinions of ceja12
Current Opinions of CEJA

Clinical Trial and Investigation

If your brother were homosexual and wanted to participate in clinical trials for a vaccination against HIV, would you support his decision?

current opinions of ceja13
Current Opinions of CEJA

Cost of Healthcare Services

Should an 87-year-old patient with cardiovascular disease and stomach cancer undergo expensive breast reconstructive surgery?

current opinions of ceja14
Current Opinions of CEJA

Organ Donation

A woman dies with a living will that states that she wishes her organs to be donated. Her mother, still living, disagrees and does not want her daughter’s organs donated. What should the health professional do in this situation?

current opinions of ceja15
Current Opinions of CEJA

Capital Punishment

A very emotional patient, the parent of a child who was raped and killed, has been given the opportunity to attend the execution of the murderer. During a visit to her family physician, she expresses concerns about being able to cope with the memory of her daughter during the execution and asks you if you would attend in the same situation. How to you handle this?

ethical issues surrounding hiv
Ethical Issues Surrounding HIV

HIV-positive individuals deserve privacy, as do all patients.

Unique identifiers help maintain confidentiality.

ethics and the human genome
Ethics and the Human Genome

Human Genome Mapping Project was completed in 2003.

Data will be studied for years to come.

Access to genetic information presents privacy concerns as to who owns the genetic information and who controls it.

As genetic technology advances, the application of ethics to that technology must also be considered.

other ethical issues
Other Ethical Issues

Interprofessional Relationships

Medical professionals should speak up when errors by other professionals are suspected.

Referrals to other professionals should be made only when one is confident in his or her ability.

Physicians in private practices are free to decide whom they will treat.

Sports medicine physicians must consider the patient first and not make medical decisions based on potential game outcomes.

other ethical issues1
Other Ethical Issues

Confidentiality and Patient Privacy

It is unethical and unacceptable to divulge any information about a patient to any person not directly involved in the patient’s care.

All information in the record must be kept in strict confidence.

Confidentiality restrictions apply to all patient medical records, including separately filed x-rays, etc.
other ethical issues2
Other Ethical Issues


Only deceptive trade practice regulations govern advertising by medical facilities and practitioners.

other ethical issues3
Other Ethical Issues

Communications with the Media

Medical professionals cannot discuss any patient with any member of the media without his or her written permission.

other ethical issues4
Other Ethical Issues

Physician Obligations in Disaster Preparedness and Response

Physicians are ethically obligated to provide emergency care during disasters.

Examples include natural disasters, such as a severe hurricane, epidemics, and terrorist attacks.

other ethical issues5
Other Ethical Issues

Malevolent Use of Biomedical Research

Physicians must assess the possible ramifications of participation in research before engaging in projects.

other ethical issues6
Other Ethical Issues

Racial and Ethnic Healthcare Disparities

Patients are entitled to the same quality of care regardless of their race or ethnic background

other ethical issues7
Other Ethical Issues

Diagnostic Imaging on Request

Physicians should perform diagnostic imaging only when they believe that the benefits of the imaging service outweigh the risks involved.

other ethical issues8
Other Ethical Issues


All authorized personnel must comply with HIPAA regulations with regard to computer use.

other ethical issues9
Other Ethical Issues

Charging or collecting an illegal or excessive fee is prohibited

Fee Splitting and Contingent Fees

The practices of fee splitting and accepting contingent fees are unethical

Fee Splitting

Accepting a payment from another physician solely for the referral of a patient

Contingent Fees

Accepting a patient and collecting fees based on the outcome of treatment

other ethical issues10
Other Ethical Issues

Insurance Forms

Facilities are allowed to charge for completing multiple insurance forms.

other ethical issues11
Other Ethical Issues

Waiver of Insurance Copayments

Routine waiver of insurance copayments may violate the contracts with the insurance company or managed care organization.

other ethical issues12
Other Ethical Issues

Professional Courtesy

Physicians may offer professional courtesy discounts, but this practice has become less common in recent years.

The office policy manual should provide strict details and guidelines about the issue of professional courtesy.

other ethical issues13
Other Ethical Issues

Appointment Charges

It is completely ethical to charge a reasonable fee for missed appointments that are not cancelled or rescheduled in accordance with the office policy manual.

Patients must be informed as to the policy regarding missed appointments.

other ethical issues14
Other Ethical Issues

Prescribing Drugs and Devices

Physicians should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in the supplier.

other ethical issues15
Other Ethical Issues

Professional and Contractual Relationships

Physicians should negotiate the wording of contracts such that there is no question of financial incentives for the physician that would in any way compromise professional judgment or integrity.

other ethical issues16
Other Ethical Issues

Health Facility Ownership by a Physician

Physicians may own a health facility or have a financial interest in such a facility but must disclose this connection to the patients before referring them to the facility.

other ethical issues17
Other Ethical Issues

Ghost Surgery

It is unethical to substitute surgeons without patient knowledge and consent.

other ethical issues18
Other Ethical Issues

Discipline within Medicine

Physicians should expose incompetent, corrupt, dishonest, or unethical conduct by members of the profession.

other ethical issues19
Other Ethical Issues

Physician Health and Wellness

A physician who knows that he or she has an infectious disease should not engage in any activity that would cause a significant risk to patients.

other ethical issues20
Other Ethical Issues

Substance Abuse

It is unethical for physicians to practice medicine when under the influence of a controlled substance.

Healthcare providers who are aware of colleagues who engage in such activities must be reported to the appropriate authorities.

other ethical issues21
Other Ethical Issues

Unethical Conduct

Be absolutely sure of all information.

Decide whether the information should be reported, and to whom it should be reported.

Determine if working for the professional who engages in unethical behavior is in the best interest of the medical assistant.

summary of scenario
Summary of Scenario

There are always at least two sides to each ethical situation.

Be nonjudgmental toward patients and coworkers.

Never inflict personal opinions onto patients.

Periodically perform a self-evaluation regarding ethical views.

closing comments
Closing Comments

Keep abreast of current issues that have ethical implications.

Study of ethics requires serious thought and introspection.

Determine personal views about each of the opinions in the text.

Belief systems should be personally created, not adhered to simply because parents held certain beliefs.