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

 Thank you  Disclaimer  Ethics?

 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

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

 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

 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

 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

knowledge attitudeskills

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

 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

 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

 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”

THANK YOU