1. Ethics and Professionalism Prof MAM Ibnouf

2. Aims : الأهداف 1- To define medical ethics 2- To provide examples of ethical clinical practice 1- تعريف الأخلاق الطبية 2- تقديم امثلة للمارسة الأخلاقية الطبية

3. Four Bioethical Principles 1- Autonomy: respect for the individual and their ability to make decisions with regard to their own health and future. 2- Beneficence: actions intended to benefit the patient or others

4. Four Bioethical Principles 3- Non-maleficence: actions intended not to harm or bring harm to the patient and others 4- Justice: being fair or just to the wider community in terms of the consequences of an action

5. Confidentiality Confidentiality is not a single ethical principle in itself, rather it is linked in to several bioethical principles.

6. Confidentiality Respect for an individual's autonomy and their right to control the information relating to their own health. Keeping secret the doctor is acting beneficently. Disclosing information without the patient's consent can damage the patient this would be the very reverse of beneficent i.e. malificent. Maintaining confidentiality can therefore also be seen as non-maleficent.

7. Breaking confidentiality For instance if there is a risk to a third party this may overrule the necessity to maintain confidentiality.

8. Examples Psychiatry: A patient disclose to his doctor that he believes his sister is an evil witch. His delusion is also linked to a plan to kill her.

9. Answer The doctor must weigh his duty to maintain confidentiality against a duty to protect the sister. Conflict between the principles of autonomy and non-maleficence.

10. Breaking confidentiality 1- The vulnerable patient: a- Where serious harm may occur to a third party, b- Where a doctor believes a patient to be the victim of abuse and the patient is unable to give or withhold consent to disclose c- Where, without disclosure a doctor would not be acting in the overall best interests of a child who is incapable of consenting to disclosure

11. Breaking confidentiality 2- The General Right and Responsibility: a- When, without disclosure the prevention of a crime by the police would be delayed b- when, without disclosure the prosecution of a crime would be delayed (e.g. a patient tells you that he killed someone several years ago)

12. Breaking confidentiality 3- The General Public Interest: a- Where a doctor has concerns over an epileptic patient’s fitness to drive.

13. Breaking confidentiality 4- Health professional: a- Where a doctor has a know a health professional and has concerns over his fitness to practice posing a serious danger to patients

14. Ethics should never be viewed as being interchangeable with the law. The is often informed by ethics. The law may face ethical principles, such as a law requiring a doctor to send incurable patients to a the prison. The law should never be a substitute for ethical reasoning.

15. the court can require a doctor to break confidentiality

16. Summary Points Confidentiality involves a respect for autonomy and also beneficence towards the patient and a desire to act non-maleficently Confidentiality is not an ethical principle in itself. It can be characterized as a duty by some health professionals. The concept of confidentiality is elastic and may be interpreted rigidly or less strictly with information 'sharing' by a team

17. Summary Points Most countries have laws to enable the breaking of confidentiality Breaking confidentiality to protect the safety of a third party is seen as reasonable The law is not necessarily interchangeable with a system of ethics The ethos of a group can change over time

18. The 'serious misconduct' The professional has in a privileged position and there is a profound power differential between the patient and the doctor. A sexual relationship could be viewed as abusive, in which there is ill-informed consent lack of autonomy. In avoiding such relationships the professional is acting non-maleficently.

19. The Uncertainty! How does this fit into ethics? 1- For how long should we give NSAID to patients with osteoarthritis? 2- If a patient has a elevated PSA ll how likely is he to have cancer? If FNA is not conclusive? 3- A boy at 15 he may attract a diagnosis of conduct disorder, but if he is 16 he might be diagnosed as a personality disorder. Why does the diagnosis change is the age?

20. At a personal level how certain are we ourselves know a set of facts or how certain are that we can perform a standard procedure. e.g. Open chole my  CBD injury Child birth may end with hystrectomy Iserting i.v. canula may be a failure

21. Is it true in our current set up Only where the certainty of competence is high could the doctor, then an expert, act in confidence in the best interests of the patient. Is this true in our current set up?

22. Does the level of competence interact with Ethics? Where is the responsibility towards patients’ safety is it at the level of individual heath care providers? Or at the level of the group?