لخّصلي

Introduction •Life is complicated—as well as in medicine. •Health care providers -highly educated and the decisions make--life and death •A higher standard of behavior and conduct---the conduct of providers must be of the highest moral quality. •Healthcare professionals are upright and moral. •But doctors---have the potential to be unethical. •Codes of ethics--developed to guide physicians.

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Ethics Morality and Law Basically, ethics is all about asking the question, “What is the right thing to do?” What is morality? define it as choosing the right beliefs or behavior in a difficult situation. Ethics is then reflecting on those moral standards and acting upon them. Ethics sets moral standards for behavior in many professions. •Based on the four principles of medical ethics, providers--must weigh and balance one against another. •When these principles seem to contradict, deciding which one has more moral weight, based on moral arguments, is the task of medical ethics.

Many laws are derived from ethical or moral precepts, ethics and morality are not the same as the law. For instance: Law uphold ethics: (support): E.g Illegal for physician to have relationship with patient… and unethical. Ethics stricter than law: E.g Physician stating political point of view is legal. But unethical. Ethics in conflict with law: E.g Physician oppose abortion, but its legal in some countries. Ethics oppose law: E.g Lethal injection is legal in USA, but unethical (AMA-USA).

Ethics is not Law….How Ethics is not religion or philosophy, but ethics became part of the practice of medicine through interdisciplinary studies. Loading…

Ethics and Law Ethics are … NOT Enforceable by law But approved guidelines for healthcare providers Good ethics take over where legal sanctions end

Ethics and Law Ethics are not … Each country has its code of ethics Patient autonomy, nonmaleficence, beneficence, and justice are usually embraced (accepted) in most societies, but there are some exceptions. In some cultures, doctors don’t tell the truth to terminally ill patients because tradition states that doing so will undermine the patient’s will to live.

There have been times when ethical standards in medicine have been disregarded thus: Nuremberg code, Geneva code, Declaration of Helsinki, Belmont report Institutional review boards and government agencies that oversee research are founded on these codes and declarations

Hippocratic Oath Hippocratic Oath is a list of statutes---400 BCE in Ancient Greece.

The oath address: Physician behavior Doctor-patient relationship Ishaq bin Ali al-Rohawi: First text in medical ethics ‘The conduct of physician’. 900 A.D Thomas Aquinas: Catholic priest, Doctor of the church-1200 A.D

Taking a new oath at graduation •The Hippocratic Oath has been rewritten in modern language: •I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. •I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. •I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug •I will not be ashamed to say, “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery •I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Loading…

•قسم المهنة •أقسم بالله العظيم أن أكون مخلصا في عملي، مطيعا لرؤسائي، رحيما بمرضاي، مراعيا لمشاعرهم مدافعا عن حقوقهم، أمينا على أسرارهم، محترما لمعتقداتهم، محافظا على خصوصياتهم، كما وأعاهد الله ألا أعطي أو أتعاطى أي نوع من الأدوية إلا عن معرفة بما لا يتعارض مع ديني، وآداب مهنتي وأخلاقها وأن أحافظ على صحة وسلامة الإنسان وأن أكون متعاونا مع زملائي من أجل خدمة مصلحة المرضى والمجتمع ما استطعت إلى ذلك سبيلا.

•Revised version of Hippocratic oath after WWII atrocities. •The basic message is to “not use medical knowledge contrary to the laws of humanity

The Declaration of Geneva At the time of being admitted as a member of the medical profession: •I solemnly pledge to consecrate my life to the service of humanity •I will give to my teachers the respect and gratitude that is their due; •I will practice my profession with conscience and dignity; •The health of my patient will be my first consideration; •I will respect the secrets that are confided in me, even after the patient has died; •I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; •My colleagues will be my sisters and brothers; •I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; •I will maintain the utmost respect for human life; •I will not use my medical knowledge to violate human rights and civil liberties, even under threat; •I make these promises solemnly, freely and upon my honor.

Today's Codes of Ethics: American Medical Association •When you are in an ethically tricky situation-ask yourself some questions. These questions might include: •Is there a published standard of behavior about this issue? ✓ Would I want a member of my family to be treated this way? ✓ How will this action or treatment affect the patient? ✓ How will my conscience feel after I take this action?

American Medical Association Code of Ethics

1. Not enforceable: by law but serves as the standard of behavior for medical professionals with moral integrity

2. Eight principles Ethical codes and standards are, of course, much more complicated than these simple questions

The Eight principles of AMA

1. Provide competent medical care

2. Maintain highest professional standards

3. Respect law

4. Keep confidence of Patients and colleagues

The Eight principles of AMA 5. Advance scientific and medical education

6. Do not discriminate among peers and patients

7. Improve public health

8. Regard responsibilities to patients as paramount and support access to health care

Ethical Force Program (EForce) •The AMA has established this Program to promote and measure high ethical standards and expectations for healthcare providers. •It creates, tests, and publicizes ethical issues and standards. •The Eforce panel will create questions that doctors and patients can ask themselves and develop criteria for performance and policies.

Dealing with violations •Complaints can be referred to local medical societies •The Council holds hearings, and can then: •Acquit the doctor •Admonish or censure the doctor •Place the doctor on probation •Expel or suspend the doctor membership

American Nurses Association: Code of Ethics 1950 and revised regularly 1995. Nine provisions Respect for human dignity as expressed through autonomy Commitment to the patient by setting boundaries and collaborating with other professionals Protection of the health, safety, and rights of the patient, especially through respect for privacy and confidentiality

Accountability and responsibility of the profession Self-respect and integrity, using the same standards of respect and dignity they assign to their patients Maintenance and improvement in the healthcare environment Advancement of the profession through education and practice, to meet professional obligations American Nurses Association: Code of Ethics

American Nurses Association: Code of Ethics 1950 and revised regularly. Nine provisions Collaboration with others to meet society’s health needs, focusing on issues such as hunger and violations of justice Assertion of values: Support professional integrity and social policy

Ethics inside hospital: Ethics panel Hospital ethics panel: Physicians, Nurses, Lawyers, Social workers, Administrative staff, Normal people Religious people

Ethics inside hospital: Ethics panel Mission of ethics panel: Discuss ethics situation, Advise medical staff and patients to make choices, Review hospital policies, Educate staff about ethical issue,

•Ethics panel convene 1.At the request of a provider or patient or a patient’s family 2.Upon disagreement about the course of treatment 3.At the request of other hospital staff ➢The best of patient is at the center of every discussion, and the patient’s family values play a big role

Topics addressed by hospital ethics panel

1. Disagreements between providers and patients, within families, or within hospital staff about the best course of treatment for a patient

2. Clarification of ethical issues in a particular situation for providers and families

3. Review of criteria for waiting lists for treatments or transplants

4. Course of action when medical errors are committed

Topics addressed by hospital ethics panel 6. Need for informed consent and how this is best communicated with patient

7. Proxies and decision-making, such as living wills and advance directives

8. Equity of care: minorities, the poor, or those with different religious beliefs

9. Review hospital policies: abortion, end-of-life care

10. Whether or not to continue life-sustaining treatment

When discussing and deciding on these dilemmas, the ethics panel will consider ✓ What the patient really wants for the best outcome ✓ What the proxy, or designated representative, thinks the patient would want ✓ What doctors and other providers believe is the best course of treatment ✓ What to do when care is futile ✓ When lifesaving treatments should be withdrawn ✓ Whether to approve or deny cutting-edge medical treatments ✓ How cultural or religious beliefs factors into healthcare

✓ Ethics committees may or may not make a recommendation •The role of the provider and patient or patient’s family to make the final decisions

Hospital ethics panels do not ✓ Sanction or discipline doctors or other providers ✓ Publicize their decisions ✓ Issue binding legal judgments

Patients Bill of Rights ✓ To choose a physician freely ✓ To agree on terms with their provider ✓ To be treated with respect and consideration ✓ To have an advance directive on their chart ✓ To expect confidentiality and privacy ✓ To be fully informed about their condition and any treatments or drugs ✓ To receive responses to questions or requests in a reasonable time frame ✓ To be informed about business relationships among providers, the hospital, payers, and other entities ✓ To make choices about their care ✓ To refuse medical treatment ✓ To full disclosure of their condition, insurance plans, and treatment plans ✓ To expect continuity of care Loading…

Emergency Room Ethics: selected situations Triage Prioritizing cases for medical care in ER Quick Actions Taking prompt action within seconds Implied Informed Consent In ER patient can not give informed consent, yet we have to act Staff team work ER staff help each other

Introduction
•Life is complicated—as well as in medicine.
•Health care providers -highly educated and the decisions make--life and death
•A higher standard of behavior and conduct---the conduct of providers must be of the highest moral quality.
•Healthcare professionals are upright and moral.
•But doctors---have the potential to be unethical.
•Codes of ethics--developed to guide physicians.

Loading…

Ethics Morality and Law
☺Basically, ethics is all about asking the question, “What is the right thing to do?”
☺What is morality? define it as choosing the right beliefs or behavior in a difficult situation.
☺Ethics is then reflecting on those moral standards and acting upon them.
☺Ethics sets moral standards for behavior in many professions.
•Based on the four principles of medical ethics, providers--must weigh and balance one against another.
•When these principles seem to contradict, deciding which one has more moral weight, based on moral arguments, is the task of medical ethics.

☺Many laws are derived from ethical or moral precepts, ethics and morality are not the same as the law. For instance:
☺Law uphold ethics: (support): E.g Illegal for physician to have relationship with patient… and unethical.
☺Ethics stricter than law: E.g Physician stating political point of view is legal. But unethical.
☺Ethics in conflict with law: E.g Physician oppose abortion, but its legal in some countries.
☺Ethics oppose law: E.g Lethal injection is legal in USA, but unethical (AMA-USA).

Ethics is not Law….How
☺Ethics is not religion or philosophy, but ethics became part of the practice of medicine through interdisciplinary studies.
Loading…

Ethics and Law
Ethics are …
☺NOT Enforceable by law
☺But approved guidelines for healthcare providers
Good ethics take over where legal sanctions end

Ethics and Law
Ethics are not …
☺Each country has its code of ethics
☺Patient autonomy, nonmaleficence, beneficence, and justice are usually embraced (accepted) in most societies, but there are some exceptions.
☺In some cultures, doctors don’t tell the truth to terminally ill patients because tradition states that doing so will undermine the patient’s will to live.

☺There have been times when ethical standards in medicine have been disregarded thus:
☺Nuremberg code, Geneva code, Declaration of Helsinki, Belmont report
☺Institutional review boards and government agencies that oversee research are founded on these codes and declarations

Hippocratic Oath
☺Hippocratic Oath is a list of statutes---400 BCE in Ancient Greece.

The oath address:
☺Physician behavior
☺Doctor-patient relationship
☺Ishaq bin Ali al-Rohawi: First text in medical ethics ‘The conduct of physician’. 900 A.D
☺Thomas Aquinas: Catholic priest, Doctor of the church-1200 A.D

Taking a new oath at graduation
•The Hippocratic Oath has been rewritten in modern language:
•I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
•I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
•I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug
•I will not be ashamed to say, “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery
•I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.
Loading…

•قسم المهنة
•أقسم بالله العظيم أن أكون مخلصا في عملي، مطيعا لرؤسائي، رحيما بمرضاي، مراعيا لمشاعرهم مدافعا عن حقوقهم، أمينا على أسرارهم، محترما لمعتقداتهم، محافظا على خصوصياتهم، كما وأعاهد الله ألا أعطي أو أتعاطى أي نوع من الأدوية إلا عن معرفة بما لا يتعارض مع ديني، وآداب مهنتي وأخلاقها وأن أحافظ على صحة وسلامة الإنسان وأن أكون متعاونا مع زملائي من أجل خدمة مصلحة المرضى والمجتمع ما استطعت إلى ذلك سبيلا.

•Revised version of Hippocratic oath after WWII atrocities.
•The basic message is to “not use medical knowledge contrary to the laws of humanity

The Declaration of Geneva
At the time of being admitted as a member of the medical profession:
•I solemnly pledge to consecrate my life to the service of humanity
•I will give to my teachers the respect and gratitude that is their due;
•I will practice my profession with conscience and dignity;
•The health of my patient will be my first consideration;
•I will respect the secrets that are confided in me, even after the patient has died;
•I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;
•My colleagues will be my sisters and brothers;
•I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
•I will maintain the utmost respect for human life;
•I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
•I make these promises solemnly, freely and upon my honor.

Today's Codes of Ethics: American Medical Association
•When you are in an ethically tricky situation-ask yourself some questions. These questions might include:
•Is there a published standard of behavior about this issue?
✓ Would I want a member of my family to be treated this way?
✓ How will this action or treatment affect the patient?
✓ How will my conscience feel after I take this action?

American Medical Association Code of Ethics

1. 
   

   Not enforceable: by law but serves as the standard of behavior for medical professionals with moral integrity

   
   


2. 
   

   Eight principles
   Ethical codes and standards are, of course, much more complicated than these simple questions

   
   

The Eight principles of AMA

1. 
   

   Provide competent medical care

   
   


2. 
   

   Maintain highest professional standards

   
   


3. 
   

   Respect law

   
   


4. 
   

   Keep confidence of Patients and colleagues

   
   

The Eight principles of AMA
5. Advance scientific and medical education

6. 
   

   Do not discriminate among peers and patients

   
   


7. 
   

   Improve public health

   
   


8. 
   

   Regard responsibilities to patients as paramount and support access to health care

   
   

Ethical Force Program (EForce)
•The AMA has established this Program to promote and measure high ethical standards and expectations for healthcare providers.
•It creates, tests, and publicizes ethical issues and standards.
•The Eforce panel will create questions that doctors and patients can ask themselves and develop criteria for performance and policies.

Dealing with violations
•Complaints can be referred to local medical societies
•The Council holds hearings, and can then:
•Acquit the doctor
•Admonish or censure the doctor
•Place the doctor on probation
•Expel or suspend the doctor membership

American Nurses Association: Code of Ethics
1950 and revised regularly 1995. Nine provisions
☺Respect for human dignity as expressed through autonomy
☺Commitment to the patient by setting boundaries and collaborating with other professionals
☺Protection of the health, safety, and rights of the patient, especially through respect for privacy and confidentiality

☺Accountability and responsibility of the profession
☺Self-respect and integrity, using the same standards of respect and dignity they assign to their patients
☺Maintenance and improvement in the healthcare environment
☺Advancement of the profession through education and practice, to meet professional obligations
American Nurses Association: Code of Ethics

American Nurses Association: Code of Ethics
1950 and revised regularly. Nine provisions
☺Collaboration with others to meet society’s health needs, focusing on issues such as hunger and violations of justice
☺Assertion of values: Support professional integrity and social policy

Ethics inside hospital: Ethics panel
Hospital ethics panel:
♦Physicians,
♦Nurses,
♦Lawyers,
♦Social workers,
♦Administrative staff,
♦Normal people
♦Religious people

Ethics inside hospital: Ethics panel
Mission of ethics panel:
♦Discuss ethics situation,
♦Advise medical staff and patients to make choices,
♦Review hospital policies,
♦Educate staff about ethical issue,

•Ethics panel convene
1.At the request of a provider or patient or a patient’s family
2.Upon disagreement about the course of treatment
3.At the request of other hospital staff
➢The best of patient is at the center of every discussion, and the patient’s family values play a big role

Topics addressed by hospital ethics panel

1. 
   

   Disagreements between providers and patients, within families, or
   within hospital staff about the best course of treatment for a patient

   
   


2. 
   

   Clarification of ethical issues in a particular situation for providers
   and families

   
   


3. 
   

   Review of criteria for waiting lists for treatments or transplants

   
   


4. 
   

   Course of action when medical errors are committed

   
   

Topics addressed by hospital ethics panel
6. Need for informed consent and how this is best communicated with patient

7. 
   

   Proxies and decision-making, such as living wills and advance directives

   
   


8. 
   

   Equity of care: minorities, the poor, or those with different
   religious beliefs

   
   


9. 
   

   Review hospital policies: abortion, end-of-life care

   
   


10. 
    

    Whether or not to continue life-sustaining treatment

    
    

When discussing and deciding on these dilemmas, the ethics panel
will consider
✓ What the patient really wants for the best outcome
✓ What the proxy, or designated representative, thinks the patient would want
✓ What doctors and other providers believe is the best course of treatment
✓ What to do when care is futile
✓ When lifesaving treatments should be withdrawn
✓ Whether to approve or deny cutting-edge medical treatments
✓ How cultural or religious beliefs factors into healthcare

✓ Ethics committees may or may not make a recommendation
•The role of the provider and patient or patient’s family to make the final decisions

Hospital ethics panels do not
✓ Sanction or discipline doctors or other providers
✓ Publicize their decisions
✓ Issue binding legal judgments

Patients Bill of Rights
✓ To choose a physician freely
✓ To agree on terms with their provider
✓ To be treated with respect and consideration
✓ To have an advance directive on their chart
✓ To expect confidentiality and privacy
✓ To be fully informed about their condition and any treatments or drugs
✓ To receive responses to questions or requests in a reasonable time frame
✓ To be informed about business relationships among providers, the hospital, payers, and other entities
✓ To make choices about their care
✓ To refuse medical treatment
✓ To full disclosure of their condition, insurance plans, and treatment plans
✓ To expect continuity of care
Loading…

Emergency Room Ethics: selected situations
☺Triage
Prioritizing cases for medical care in ER
☺Quick Actions
Taking prompt action within seconds
☺Implied Informed Consent
In ER patient can not give informed consent, yet we have to act
☺Staff team work
ER staff help each other