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Medical ethics
Medical ethics
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Medical Ethics

  2. 2. WHO IS A MEDICAL PRACTITIONER? <ul><li>The Indian Medical Council Act defines a Medical Practitioner </li></ul><ul><li>A Medical Practitioner is supposed to be registered with the Indian Medical Council (“IMC”) and have the requisite qualifications </li></ul><ul><li>A Medical Practitioner is entitled to practice in the Country but he has to observe the code of ethics </li></ul>
  3. 3. <ul><li>A patient is anyone who consults a medical practitioner </li></ul><ul><li>The moment a person consults a medical practitioner he becomes that medical practitioners patient </li></ul>WHO IS A PATIENT?
  4. 4. RIGHTS OF MP … Contd <ul><li>The right to refuse treatment </li></ul><ul><li>Clause 10 of the Code of Medical Ethics </li></ul><ul><li>&quot;Though a physician is not bound to treat each and everyone for his services except in emergencies, for the sake of humanity and the noble traditions of the profession, he should not only be ever ready to respond to calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he incurs in the discharge of his professional duties. In his ministrations, he should never forget that the health and the lives of those entrusted to his care depend upon his skill and attention.&quot; </li></ul>
  5. 5. RIGHTS OF MP … Contd <ul><li>The right to be reimbursed </li></ul><ul><li>The Code does not prescribe any standard of charges nor does it say that charges must be reasonable. </li></ul><ul><li>Whether the physician should specify charges before he undertakes to treat a patient ? </li></ul><ul><li>Does the rule of caveat emptor (let the buyer beware) apply in the relationship between a patient and a physician since it the patient who seeks out a physician for obtaining relief ? </li></ul>
  6. 6. RIGHTS OF MP … Contd <ul><li>The right to withhold information </li></ul><ul><li>A physician-patient relationship is fiduciary and requires confidentiality </li></ul><ul><li>The physician is not expected to divulge information about his patient </li></ul><ul><li>This right to withhold information is not absolute </li></ul>
  7. 7. RIGHTS OF MP … Contd <ul><li>The right to retain medical documents </li></ul><ul><li>There is one view which holds that since information contained in a document is privileged the physician/ hospital has the right to retain such document </li></ul><ul><li>A contrary view holds that since the information, though privileged, may be needed by the patient for future reference it should be given when specifically sought. </li></ul>
  8. 8. RIGHTS OF MP … Contd <ul><li>The right to reputation </li></ul><ul><li>There is no other right as dear to a physician as the right to a good name </li></ul><ul><li>Defamation (the opposite of name or reputation) is broadly defined as &quot;the publication of a statement which tends to lower a person in the estimation of right thinking members of society generally&quot; </li></ul><ul><li>The usual form of publication is writing or printing </li></ul>
  9. 9. DUTIES AND OBLIGATIONS OF MP <ul><li>Duties and obligations of MP are enlisted under various laws of the land and Codes of Medical Ethics and Declarations - Indian and International, which are </li></ul><ul><li>Code of Medical Ethics of Medical Council of India; </li></ul><ul><li>Hippocratic Oath; </li></ul><ul><li>Declaration of Geneva; </li></ul><ul><li>Declaration of Helsinki; </li></ul><ul><li>International Code of Medical Ethics; </li></ul><ul><li>Government of India Guidelines for Sterilization </li></ul>
  10. 10. <ul><li>The duties can be summarized as under - </li></ul><ul><li>Duties to Patient </li></ul><ul><li>Duties to Public </li></ul><ul><li>Duties towards Law Enforcers </li></ul><ul><li>Duties not to violate Professional Ethics </li></ul><ul><li>Duties not to do anything illegal or hide illegal acts </li></ul><ul><li>Duties to each other. </li></ul>DUTIES AND OBLIGATIONS OF MP … CONTD
  11. 11. <ul><li>Standard Care, </li></ul><ul><li>Providing Information to the Patient /Attendant </li></ul><ul><li>Consent for Treatment </li></ul><ul><li>Emergency Care </li></ul>DUTIES TO PATIENT
  12. 12. <ul><li>Patient autonomy is an accepted principle </li></ul><ul><li>Informed consent flows from the doctrine of autonomy </li></ul><ul><li>In India, informed consent = Consumer Protection Act </li></ul>DUTIES TO PATIENT - Consent for treatment
  13. 13. <ul><li>Fully informed consent is probably never attainable </li></ul><ul><li>A sick person has lost some measure of autonomy </li></ul><ul><li>Complexities of medical and their many possible side effects can never be explained to the nonmedical person: many are not even known to the medical profession </li></ul>DUTIES TO PATIENT - Consent for treatment
  14. 14. <ul><li>There are no precise words to communicate the extent and quantum of pain </li></ul><ul><li>Pain remains beyond communication </li></ul><ul><li>Communication forms the soul of the concept on informed consent </li></ul>DUTIES TO PATIENT - Consent for treatment
  15. 15. DUTIES TO PUBLIC <ul><li>Health Education </li></ul><ul><li>Medical help when natural calamities like drought, flood, earthquakes, fire etc. </li></ul><ul><li>Medical help during train accidents, house collapse, road accidents </li></ul><ul><li>Compulsory notification of births, deaths, infectious diseases, food poisoning etc. </li></ul>
  16. 16. DUTIES TOWARDS LAW ENFORCERS <ul><li>To inform the police all cases of poisoning, burns, injury, illegal abortion, suicide, homicide, manslaughter, grievous hurt and its natural complications like tetanus, gas-gangrene , etc. </li></ul><ul><li>This includes vehicular accidents, fractures, etc. </li></ul><ul><li>To call a Magistrate for recording dying declaration </li></ul><ul><li>To inform about bride burning and battered child cases </li></ul>
  17. 17. <ul><li>Not to associate with unregistered medical practitioner </li></ul><ul><li>Not to indulge in self-advertisement Not to write secret formulations. </li></ul><ul><li>Not to refuse professional service on grounds of religion, nationality, race, party politics or social status. </li></ul>DUTY NOT TO VIOLATE ETHICS
  18. 18. DUTY NOT TO DO OR HIDE ANYTHING ILLEGAL <ul><li>Not calling Magistrate for recording dying declaration </li></ul><ul><li>Unauthorized, unnecessary, uninformed treatment and surgery or procedure </li></ul><ul><li>Sex determination </li></ul>
  19. 19. <ul><li>When a patient ( consumer ) hires or avails of services of a Medical Practitioner for treatment, he has the following duties :- </li></ul><ul><li>He must disclose all information </li></ul><ul><li>He must co-operate with the doctor for any relevant investigations required to diagnose and treat him. </li></ul>DUTIES OF A PATIENT / ATTENDANT
  20. 20. <ul><li>A Medical Practitioner cannot be forced to treat any person </li></ul><ul><li>He has certain possibilities for those whom he accepts as patients. </li></ul><ul><li>It is an implied contract. </li></ul>MEDICAL PRACTITIONER PATIENT CONTRACT
  21. 21. <ul><li>Responsibility towards a patient begins the moment a Medical Practitioner agrees to examine the case. </li></ul><ul><li>He must not, therefore, abandon his patient except under the following circumstances – </li></ul><ul><li>The patient has recovered from the illness, for which treatment was initiated. </li></ul><ul><li>The patient / attendant does not pay the Medical Practitioner ’s fees (in case of a private practitioner). </li></ul>CONTINUE TO TREAT
  22. 22. <ul><li>The patient / attendant consults another Medical Practitioner without the knowledge of the first attending Medical Practitioner . </li></ul><ul><li>The patient / attendants do not co-operate and follow the Medical Practitioner ’s instructions. </li></ul><ul><li>The patient is under some other responsible care, e.g., the patient, after admission in a hospital, comes under care of senior Medical Practitioner s / unit head. </li></ul><ul><li>The Medical Practitioner has given due notice (orally or written ) for discontinuing treatment. </li></ul><ul><li>The Medical Practitioner is convinced that the illness is a fictious one. </li></ul>CONTINUE TO TREAT … CONTD
  23. 23. <ul><li>Use clean and proper instruments </li></ul><ul><li>Provide proper and suitable medicines if he dispenses them himself </li></ul><ul><li>If not, he should write the prescriptions legibly, using standard abbreviations and mention instructions for the pharmacist in full </li></ul><ul><li>He should give full directions to his patients as regards administration of drugs and other measures </li></ul>REASONABLE CARE
  24. 24. <ul><li>The degree of skill a Medical Practitioner undertakes is the average degree of skill possessed by his professional brethren of the same standing as himself. </li></ul><ul><li>The best form of treatment may differ when different choices are available. </li></ul><ul><li>There is an implied contract between the Medical Practitioner and the patient when the patient is told in effect : &quot; Medicine is not an exact science. I shall use my experience and best judgment and you take the risk that I may be wrong. I guarantee nothing .&quot; </li></ul>REASONABLE SKILL
  25. 25. PROFESSIONAL SECRETS <ul><li>A professional secret is one which a Medical Practitioner comes to learn in confidence from his patients </li></ul><ul><li>A Medical Practitioner is under a moral and legal obligation not to divulge any such secret </li></ul><ul><li>This is known as privileged communication which is defined as a communication made by a Medical Practitioner to a proper authority who has corresponding legal, social and moral duties to protect the public. </li></ul>
  26. 26. PROFESSIONAL SECRETS… CONTD <ul><li>EXCEPTIONS: It must be bonafide and without malice, e.g., </li></ul><ul><li>as a witness in a court of law; </li></ul><ul><li>warning spouses of AIDS patients and those found infected with HIV; </li></ul><ul><li>informing public health authorities of food poisoning from a hotel etc; </li></ul><ul><li>assisting apprehension of a person who has committed a serious crime; </li></ul><ul><li>informing law enforcers about medico-legal cases, etc. </li></ul>
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  29. 29. CONTACT US <ul><li>UNIVERSAL LEGAL </li></ul><ul><li>5th Floor, Kimatrai Building </li></ul><ul><li>77/79 Maharshi Karve Road </li></ul><ul><li>Mumbai – 400 002 </li></ul><ul><li>Phone : 2203 4293 - 95 </li></ul><ul><li>Fax : 2203 9845 </li></ul><ul><li>E-mail: [email_address] </li></ul>