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Medical Ethics
Definition

❖ Medical ethics are the rules of professional etiquette and traditions in medicine,
which is considered the minimum requirements expected from any medical
practitioner in the professional conduct.
Physician-patient relationship

❖ The doctor should provide his patient with best care.

❖ A doctor cannot be forced to treat a patient but once he agrees to examine the
patient; he become responsible towards him completely until either the patient
become well or goes to another one.
❖ If the doctor knows that he cannot accomplish a cure, he must advise his patient to
go to another specialist.
❖ A physician is not enforced by law to accept any patient even if he is the only
available doctor unless it is an emergency case.
❖ A hopeless prognosis should not be told to the patient himself. It is better to inform
the relatives.
Physician- Physician relationship
Following cases are considered examples of offences against rules & must be avoided

❖ Trying to replace another colleague in the treatment of a patient or in any

professional job.
❖ Refusing to attend or treat a colleague or any of his relative. He should not accept
fees except for x-ray or laboratory analysis.
❖ Any fees for such treatment except in case of radiological work & laboratory techniques.
❖ Attending a patient whom he knows to be under the care of fellow practitioner
without calling him unless the patient or relatives refuse such partnership.
❖ Criticizing the treatment prescribed by a colleague.

Professional secrecy )‫ (السرية المهنية‬or Medical confidentiality )‫(الثقة الطبية‬

❖ The term "Medical confidentiality" is better to be used.
Aim

❖ The concept of "Medical confidentiality" is directed at the well-being of the patient

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That’s because

❖ If a patient is confident that what he tells doctor will stay secret, he will reveal
everything during the clinical history; so, best diagnosis and treatment can be offered
❖ If a patient cannot be confident that what he tells the doctor will stay secret, he will not
reveal everything and the clinical history may then be deficient or even misleading; so,
the best diagnosis and treatment cannot be offered.
The conditions for disclosure include
1) Permission of the patient himself.
2) To relatives
❖ Close relatives are naturally told the nature of the patient's illness to care for the
patient at home.
❖ This disclosure is not automatic, but if the patient wishes.
3) To other doctors and non-medical healthcare staff
❖ Such as nurses, physiotherapists: to discuss the medical facts of the case
4) Legal requirements
❖ Many national laws force the doctor to reveal medical secrets. e.g. births, deaths,
infectious diseases, drug addiction and occupational diseases.
5) In courts of law
❖ As a witness to disclose any medical facts relevant to the legal proceedings.
6) The police
❖ Have no power to demand the disclosure of medical secret by a doctor.
7) In the public good
❖ It must be left to the doctor's own conscience whether he reveals matters which
affect people other than the patients.
1. Diseases
❖ Laws force the doctor to reveal medical secrets in infectious diseases.
❖ However, there is dilemma about serious illness possessing a potential threats to
the safety or health of the patients or the public
❖ Serious hypertension, epilepsy or severe diabetes in a bus-driver may cause him to crash,
angina in air-pilot, tuberculosis or other infective disease in a teacher or food-handler
A. The proper course for the doctor
❖ Explain and advice the patient to change his job but the patient may refuse
❖ So the doctor fails that the public good outweighs the ethical duty of
confidentiality, so, try to pass the relevant information to another doctor.

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2. Injuries
❖ Treating wounds in victims or assailant in a serious crime to protect some
individuals or the public, child abuse for the safety of the child.
❖ In some countries, it is a criminal offence for a doctor not to report criminal injuries
especially in connection with terrorism.
8) Disclosure to lawyers
❖ They have no right to obtain medical information and records without the consent
of the patients. He must apply to the court for disclosure

Medical consent )‫(الموافقة الطبية‬

Definition

Permission for examination, diagnosis and treatment, as well as research in patients.

Responsibility

❖ The doctor may be guilty of assault if he touches an unwilling person.

❖ The most common is injuries effect of a surgical operation and invasive procedures.
Who give consent?

❖ The patient but in case of children and mental disease; responsible relatives or
guardian give it.
When consent is not necessary?

❖ In an emergency, such as accident where the victim is unconscious or shocked.

❖ In those urgent circumstances, no subsequent legal action based on lack of consent
succeeds.
Types of consent
1) Implied consent
❖ Most medical practice is conducted by implied consent which covers only basic clinical
methods of examination such as history taking, inspection, palpation and auscultation.
❖ A patient comes to a doctor's clinic or office or ask the doctor to visit him implies
that he is willing to be examined and treated.
2) Express consent
❖ Needed for complex medical procedures more than basic clinical examination such
as all surgical procedures under anesthesia, intimate manual internal examination as
vaginal or rectal and endoscopy.

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Forms of consent
1) Oral consent.
2) Written consent
❖ It is usually obtained for major surgical operation or complex diagnostic procedures
such as endoscopy or techniques such as vascular and anything requiring an anesthesia
❖ It should be witnessed by another person at the signing to prevent any allegation
that the consent was obtained under pressure.
❖ Witten consent is much easier to prove at a later time if any dispute over consent arises.
❖ Extent only to what was explained to the patient beforehand.
1. Dilemma
❖ If something unexpected is found at operation which necessitate a change of procedure.
❖ The patient should have given permission for the new operation but he is unconscious
and there is a risk of a second operation (e.g. tying uterine tubes during a caesarean
section or amputating a limb instead of less orthopedic operation.)
2. Dilemma for the doctor
❖ Occurs if the doctor fully explains everything, so many patients will be frightened of
a procedure which may cure them.
Validity of consent

❖ The consent procedure is legal.

❖ The patient should be told everything that the doctor knows: full explanation of
nature and risks of any surgical or diagnostic procedure.
❖ The patient should understand for what he is giving permission.
❖ The consent is taken from a person who has the right to give it.

Medical malpractice )‫(سوء التصرف الطبي‬

Definition

❖ All defects in the professional behavior of doctors.

Types
1) Medical incompetence )‫(عدم الكفاءة الطبية‬
❖ Lack of reasonable medical knowledge and skill.
❖ Medical responsibility: the doctor is guilty of incompetence action because all patients
have the legal rights to expect a satisfactory standard of medical care from their doctors.
❖ The dispute between the doctor and the patient is under the civil law.

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2) Medical Negligence )‫(اإلهمال الطبي‬

❖ The standard of medical care given to a patient is considered to be inadequate.
1. Medical responsibility
❖ The doctor is guilty of careless actions because all patients have the legal rights to
expect a satisfactory standard of medical care from their doctors.
❖ The dispute between the doctor and the patient is under the civil law.
2. Examples of medical negligence
A. Obstetrics and gynecology
❖ Brain damage in newborn due to hypoxia from prolonged labour and uterine
ligation.
B. Orthopedic
❖ Missed fractures, tissue damage from overtight plaster casts.
C. Accident surgery
❖ Missed wounds undiagnosed intracranial hemorrhage, discharge of head injuries.
D. General medical practice
❖ Incorrect dose of drugs with toxic results, giving incorrect drugs, failure to diagnose
the disease
E. General surgery
❖ Retention of instrument, operating on the wrong patient or wrong patient or wrong
limb.
F. Anesthesiology
❖ Allowing hypoxia to occur with resultant brain damage, incompatible blood
transfusion, allowing the surgeon to start operation early causing pain or even
death from reflex vagal inhibition.
3) Professional misconduct )‫(سوء السلوك المهني او سوء اإلدارة‬
❖ It is unexpected personal professional behavior.
❖ Examples of professional misconduct:
- Writing a medical certificate with incorrect data.
- Performing criminal abortion.
- Asking for percentage of fees from his colleague because of sending patients to him.
- Illegal use of narcotics.
- Sexual activity with a mentally ill patients, unconsciousness or anaesthetized

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