Introduction
to
in
Medicine
Prof. GMC Isiguzo.
From inability to let well alone, from too much zeal
for the new and contempt for what is old, from
putting knowledge before wisdom, science before
art and cleverness before common sense, from
treating patients as cases and from making the cure
of the disease more grievous than the endurance of
the same, good Lord deliver us. Sir Robert
Hutchison (1871-1960)
Outline
• Introduction
• Definition
• Is ethics same as morality or Law
• Why is ethics important
• Principles of Ethics
• Ethical codes
• Responsibilities of a Physician
• Ethical dilemmas
• Conclusion
Introduction
The Greek word ethike means Habit, action, character
The Latin word mos (morals) means habit or custom
Ethics is a set of philosophical beliefs and practices concerned with the distinction
between right and wrong,
It is the science or study of morals and its activity in the academic context.
Why is ethics important?
Ethical principles such as respect for persons, informed consent and
confidentiality are basic to the physician-patient relationship
Application of these principles in specific situations is often problematic, since
disagreement about what is the right way to act in a situation can arise between
physicians, patients, family members and other healthcare personals.
Why is ethics important?
The study of ethics prepares the medical professional to recognize difficult
situations and to deal with them in a rational and principled manner
Ethics is also important in physician’s interaction with the society , colleagues
and in conduct of research
What makes an action Moral or
not?
• The act itself “what”
• The motive ”why”
• The circumstances: when, where, how, to whom and how often
• What it right= What a culture believes is right??
• Where does ethics come from?
• tradition,
• Religion/authority,
• Reasons
Autonomy
Patients have the freedom of thoughts, intentions and actions
For a patient to make fully informed decision, she/he must understand
all the risk and benefits of the procedure and likelihood of success
This includes the need to tell the truth (veracity) and to be faithful to
one’s commitments (fidelity)
The practitioner should act in the
best interest of the patient- the
procedure to be provided with the
Beneficen intent of doing good to the patient
ce
Patient’s welfare is the first
consideration
Based on loyalty and trust
Confidentia Maintain the confidentiality of all
personal, medical and treatment
lity information
Information to be revealed for the
benefit of the patient and when
ethically and legally required
Above all, do no harm
Do no Make sure that the procedure does
not harm the patient or others in
harm society
When the intervention creates a
positive result while potentially
doing harm, it is known as double
effect
Equity or Justice
Fair and equal distribution of scarce health resources and decision
of who gets what treatment
The burden and benefits of new or experimental treatments must
be distributed equally among all groups in society
Informed Consent
• DEFINITION: A patient’s willing acceptance of a medical intervention after adequate
disclosure from their MD of the nature of the intervention, risks, benefits and
alternative treatment options
• What constitutes informed consent ?
• Disclosure : information to allow reasonable person to make a decision
• Understanding: comprehension of information given
• Voluntary; no coercion or incentive to accept or deny a treatment
• Agreement: Verbal or written (preferred) to discuss intervention
• Many are screening patients for HIV without informed consent!!
Hippocratic Oaths- 5th century BC
Nuremberg Code- 1948
Declaration of Geneva – 1948
Ethical
Codes Universal Declaration of Human Rights-1948
Helsinki Declaration- 1964
International Code of Medical Ethics
Ethical Dilemmas
Situations
necessitating a choice A conflict between two In an ethical dilemma,
between two equal or more ethical there is no correct
(usually undesirable) principles decision
alternatives
Major types of Ethical Dilemmas
Refusal of Scarcity of
Euthanasia
Treatment Resources
Euthanasia
• Intentional action or lack of action that causes the merciful death of
someone suffering from a terminal illness or incurable condition
• Active
• Passive
• Voluntary
• Doctor assisted suicide
• Non-voluntary
• Involuntary
Refusal of Treatment
A patient’s rights to
refuse treatment and
Based on the principle
to die often challenges
of autonomy
the values of most
health care providers
Scarcity of • The allocation od scarce resources (e.g.,
organs, specialist) is emerging as a major
resources medical dilemma
Conclusio To go far in your learning and
Practice,
n Before you reach that important
decision,
Your thoughts should be on ….
……whatever is noble,
whatever is right,
whatever is
pure………..excellent and
praiseworthy.
BUT!
