1. SYSTEMS GOVERNING HUMAN SOCIAL BEHAVIOUR

4. THE MEDICAL ECOSYSTEM - Enlarging Circle of Influence DOCTOR PATIENT Disease DiagnosisHealth Promotion Disease PreventionTherapy Medical Insurance Managed Care Hospital Laboratories Pharmaceutical Industry Patients’ Family, Culture, Religion Patients’ Work, Employer Other Doctors Paramedics Clinic Management Public Health Medical Research Medical Students CME, CPD Doctor’s Employer Doctor’s Family Doctor’s Employee Practice Management MDO Medical Council The LAW Government Bodies Medical Charities Patient Organisation Alternative Medicine Press, Media National Community International Community Natural Disasters Political Upheaval, War

5. Historical values, private values, corporate values, legal statues

6. MEDICAL ETHICS - definition and scope ] System of values common to the medical profession. ^ Systematic application of values concerning the practice of medicine. _ Standards of behaviour by which the physician may evaluate his/her relationships with patients, colleagues and society. ` Scope of medical ethics includes: Adevelopment of ethical codes and guidelines Apromotion of ethical practice Aprevention of ethical breaches Arecognition of ethical dilemmas Aresolution of ethical conflicts

7. Components of Medical Ethics The Physician -- Patient Relationship The Physician -- Physician Relationship The relationship of the Physician to the System of Healthcare The Relationship of the Physician to Society

8. The Principle of Non- Maleficence first do no harm sanctity of life calculated risk or risk benefit

9. The Principle of Beneficence do only that which benefits the patient patient’s welfare as the first consideration care consideration competence

10. The Principle of Veracity Truth telling Obligation to full and honest disclosure

12. When do you tell the truth?

13. The Principle of Confidentiality Based on loyalty and trust Maintain the confidentiality of all personal, medical and treatment information Information to be revealed with consent and for the benefit of the patient Except when ethically and legally required Disclosure should not be beyond what is required

14. The Principle of Justice and Social Responsibility Actions are consistent, accountable and transparent not to discriminate on age, sex, religion, race, position or rank greater good of society respect of the Law equity and distribution of burden & benefits

15. THE PRINCIPLES IN MEDICAL ETHICS The Principle of Non-Maleficence The Principle of Beneficence The Principle of Autonomy The Principle of Veracity The Principle of Confidentiality(or Fidelity) The Principle of Social Responsibility and Justice

16. PRIMUM NON NOCERE

17. Conflicts of Ethical Principles autonomy veracity confidentiality paternalism nonmaleficence justice beneficence research dual obligations family interest payer's interest

18. Resolution of Ethical Dilemmas Principles Ethical codes Clinical judgement Reasoned analysis Ethical committees Ethical tests Declarations Oaths & Pledges Commonsense Debate Ethical Consults The Law

19. obligation to keep information about your patient private WAIT A SEC

22. Shared decision making entitles patients to participate actively in health care decisions

23. The Principle of Autonomy right to information and self determination free and informed consent free will and accord - intentional participation in treatment respect and dignity maintained

27. R

28. Types of mistakes are omission, commission, and iatrogenic

29. Preventive Medicine: using specificity and sensitivity a well as EBM articles

30. Advanced Directives Distributive cost Pain management

31. Consider patients competent. Continue treatments but observe DNR

32. A Patient wishes to die!

34. Can Physicians do anything they want?

35. Euthanasia is legal in Belgium, the Netherlands, Canada, and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey [12] and Vermont.Belgium NetherlandsLuxembourgNetherlands LuxembourgSwitzerlandOregon MontanaWashingtonNew Jersey [12]Vermont Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey [12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%BelgiumNetherlandsLuxembourgNetherlandsLuxembourgSwitzerlandOregonMontanaWashingtonNew Jersey [12]VermontOregon Euthanasia is legal in Belgium, the Netherlands and Luxembourg. Assisted suicide, where the patient has to take the final action themselves (unlike euthanasia), is legal in the Netherlands, Luxembourg and Switzerland. In the United States there are assisted dying laws restricted to terminally ill and mentally competent adults in Oregon, Montana, Washington, New Jersey [12] and Vermont. Oregon was the first US State to legalize assisted suicide, which was achieved through popular vote. The Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51% to 49%. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Act. Voters chose to retain the Act by a margin of 60% to 40%BelgiumNetherlandsLuxembourgNetherlandsLuxembourgSwitzerlandOregonMontanaWashingtonNew Jersey [12]VermontOregon

36. Canada accepts the concept of Euthenasia

37. SLIPPERY SLOPE…namely the disable The argument is known as the “Slippery Slope”: apprehension that PAS for terminally ill will progress to other vulnerable communities, such as disabled, or those less worthy on their demographic or social economic and even to those who do not consent "..