Professionalism & Medical Ethics

What is professionalism? What are medical ethics? Professionalism and Medical Ethics

What does professionalism means to you?

It has been described by The American Board of Internal Medicine as : “Constituting those attitudes and behaviors that serve to maintain patient interest above physician Self-interest”

The concept of professionalism includes the following values as: Honesty Altruism Service Commitment Communication Commitment to excellence accountability Life-long learning

Medical ethics Is based on philosophical ethics It isn’t any special ethics but rather ethics of special cases. Medical ethics does not concern only doctors but also patients and society. The central question of medical ethics is the doctor-patient relationship.

Confidentiality Obligation of physician to maintain information in strict confidence Breaching patient confidentiality may be merited only: –When ordered by court of law – a court case –Where statutory requirement – public health laws –Where required in health professional’s defense –malpractice suit –Where necessary for appropriate patient care- speaking to another provider in the medical care system

Hippocratic Oath excerpt: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.” -not legally binding

The moral duties of the doctor The duty to help, cure The duty to promote and protect the patient’s health The duty to confidentiality The duty to protect the patient’s life The duty to respect the patient’s autonomy The duty to protect privacy The duty to respect the patient’s dignity

The moral rights of the patient The right to high quality medical service The right to autonomous choice The right to decide The right to be informed The right to privacy The right to health education The right to dignity

Is it ethically permissible to accept gifts from pharmaceutical representatives? Ethical Scenario

Gifts to Physicians from Industry Any gift accepted by a physician should primarily entail a benefit to patients and should not be of substantial value. Individual gifts of minimal value are permissible as long as they relate to the physician’s work.

Ethical Scenario A medical error has occurred in the course of caring for a patient. Should the treating physician disclose this information to the patient?

Patient Information When a patient suffers significant medical complications that may have resulted from a physician’s error, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred.

Ethical Scenario A resident has concerns that an attending physician’s order is reflective of poor clinical judgment. How should this situation be handled?

Disputes Between Medical Supervisors and Trainees Trainees should refuse to participate in patient care ordered by their supervisors in those rare cases in which they believe the orders reflect serious errors in clinical or ethical judgment, or physician impairment, that could result in a threat of imminent harm to the patient or to others.

DNR  DNR orders affect CPR only  Other therapies should not be influenced by DNR order  Should be reviewed frequently  Rationale should be in medical record

Persistent Vegetative State  Unconsciousness/ loss of self awareness lasting more than weeks  Supreme court draws no distinction between artificial feeding, hydration vs. mechanical ventilation

Death  Irreversible cessation of circulatory and respiratory function  Irreversible cessation of all brain function (including brainstem)

Ethical Dilemmas  Euthanasia –Legally prohibited in the US except in Oregon which permits MD assisted suicide  Destroying Frozen Embryos

Case Studies  Lake, your 36-year-old patient, has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet.

Case Studies  22 year-old woman, is admitted to the hospital with a headache, stiff neck and photophobia but an intact mental status. Lab tests reveal contagious meningitis. She refuses treatment for it.

#1 You and your partner have been trying to have a girl for 15 years. Instead, you have had five boys. At a very early stage of pregnancy, you discover another boy is on the way. If there was a genetic treatment to change the gender of your fetus, would you use it?

Go To the Weebly – Lung Transplant You are a group of 4 determining who will receive a lung transplant. As a Group look read all 4 of the patient cases and decide which patient is most worthy and which is least worthy. Rank the patients 1-4 with 1 being “most worthy” Give 5 reasons the underlie the basis of your decision.