1. SUBMITTED TO: DR. AMANJOT
COMPILED BY: HARMAN KAUR

2.  Introduction
 Importance of Medical Ethics
 Principles of Medical Ethics
 Ethical Codes
 Medical Negligence
 Liabilty
 Acts Contribute to Negligence
 Ingredients of Medical Negligence
 Misconduct
 Duties & Responsiblities of Physicians in general
 Duties of Physicians to their patient
 Duties of Physicians in consultation
 Responsibilities to each other
 Punishment & Disciplinary Action

3.  Ethics is concerned with moral principles,values
and standards of conduct.(WHO)
 Ethics is the study of morality “careful and
systematic reflection on and analysis of moral
decisions and behavior”.
In simple words, Ethics is a set of philosophical
beliefs and practices concerned with the
distinction between right and wrong.
 Medical Ethics is the branch of ethics that deals
with moral issues in medical practices.
 Medical ethics is closely related to, but not
identical to, bioethics.

4.  Whereas medical ethics focuses primarily on
issues arising out of the practice of
medicine,bioethics is a very broad subject
that is concerned with the moral issues by
developments in the biological sciences more
generally.
 In recent times, medical ethics has been
greatly influenced by developments in human
rights.

5.  Ethical principles such as respect for person,
informed consent and confidentiality are
basic to the physician-patient relationship.
 The study of ethics prepares medical
professionals to recognize difficult situations
and to deal with them in a rational and
principled manner.
 Ethics is also important in physicians
interactions with society and their colleagues
and for the conduct of medical research.

6.  AUTONOMY
 BENEFICENCE
 CONFIDENTIALITY
 DO NO HARM/NON-MALEFICENCE
 EQUITY OR JUSTICE

7.  Patient has freedom of thought,intention and
action when making decisions regarding
health care procedures.
 For a patient to make a fully informed
decision,she/he must understand all risks
and benefits of the procedure and the
likelihood of success.

8.  The practitioner should act in “the best
interest” of the patient – the procedure be
provided with the intent of doing good to the
patient.
 Patient’s welfare is the first consideration.

9.  Based on loyality and trust.
 Maintain the confidentiality of all
personal,medical and treatment information.
 Introduction to be revealed for the benefit of
the patient and when ethically and legally
required.

10.  “Above all,do not harm”.
 Make sure that the procedure doesnot harm
the patient or others in society.
 When interventions undertaken by physicians
create a positive outcome while also
potentially doing harm it is known as
“DOUBLE EFFECT”
 Eg.. The use of morphine in the dying
patient, eases pain and suffering while
hastening the demise through suppression of
the respiratory drive.

11.  Fair and equal distribution of scarce health
resources and the decision of who gets what
treatment.
 The burdens and benefits of new or
experimental treatments must be distributed
equally among all groups in society.

12.  Hippocratic Oath – 5th century BC
 Nuremberg Code – 1948
 Declaration of Geneva – 1948
 Universal Declaration of Human Rights – 1948
 Helsinki Declaratiom – 1964
 International Code of Medical ethics
 Indian Medical Council Regulations,2002

13.  One of the earliest document in medical
ethics – 5th century BC.
 Traditionally all doctors recite this oath at
swearing in.It is considered sacred for its
religious foundation and sancity.

15.  Voluntary informed consent
 Likelihood of some good resulting
 Based on prior research
 Avoidance of physical or psychological injury
or harm
 Benefits should outweigh risks
 Right to withdraw consent
 Research must stop if harm is resulting

16.  The Nuremberg Code is set of research ethics
principles for human experimentation set as
a result of the Subsequent Nuremberg Trial
at the end of the Second World War

17.  Adopted at World Medical Association
General Assembly in 1948.
 Amended in 1968,1984,1994,2005 and 2006.
 Declaration of physician’s dedication to the
humanitarian goals of medicine.

18.  Set of ethical principles regarding human
experimentation developed by the World
Medical Association in 1964.
 Undergone 6 revisions since then.Last
revision in 2008.
 More specifically addressed clinical
research,reflecting changes in medical
practice from the term “HUMAN
EXPERIMENTATION” used in the Nuremberg
Code.

20.  “The well-being of the human subject should
take precedence over the interests of
science and society”.
 Consent should be in writing.
 Use caution if participant is in dependent
relationship with researcher.
 Limit use of placebo.
 Participants benefits from research.

21.  Given by World Medical Association
 The code applies both in peace and war
 It codifies the duties of physician in
general,duties to patients and colleagues

22.  The Medical Council of India notified the
“Indian Medical Council Regulations,2002” on
11 March 2002.
 Last amended in 2010.

23. DEFINITION:
 It is the failure to execute
 Reasonable degree of skill and care
 Or wilful negligence of a medical practitioner
which causes some harm or bodily injury or
death to the patient
 It is the act or omission in treatment of a
patient by a medical professional,which
deviates from the accepted medical

24.  “No doctors knows everything.There’s reason
why it’s called “practising
medicine”.(ANONYMOUS)
 “In my opinion,our health care system has
failed when a doctor fails to treat an illness
that is possible.”(KEVIN ALAN LEE)
 “The important question isn’t how to keep
bad physicians from harming patient;it’s how
to keep good physicians from harming
patients.(ATUL GAWANDE)

25. The liabilty of the person committing the wrong can be
of three types depending on the harm or the injury
suffered by the injured person they are:
 CIVIL LIABILITY: Civil liabilty usually includes the
claim for damages suffered in the form of
compensation. If there is any breach of duty of care
while operating or while the patient is under the
supervision of the hospital or the medical
professional they are held to be vicariously liable
for such wrong committed.
 CRIMINAL LIABILTY: There may be an occasion when
the patient has died after the treatment and
criminal case is filed under Section 304A of the
Indian Penal Code for allegedly causing death by
rash or negligent act.

26.  Further,In Dr. Suresh Gupta’s Case – Supreme
Court of India,2004 – the court held that the
legal position was quite clear and well settled
that whenever a patient died due to medical
negligence,the doctor was liable in civil law for
paying the compensation.Only when the
negligence was so gross and his act was as
reckless as to endanger the life of the
patient,criminal law for offence under section
304A of Indian Penal Code,1860 will apply.
Indian Penal Code 1860 sections
52,80,81,83,88,90,91,92 304A,337 and 338
contain the law of medical malpractice in
India.

27.  The conduct of medical malpractice was brought
under the Consumer Protection Act,1986,due to
the landmark case of the Indian Medical
Association vs. V.P. Shantha & others.The
judgement in this case defined medical care as a
“service” that was covered under the Act,and
also clarified that a person seeking medical
attention may be considered a consumer if
certain criteria were met.
 The service provided was not free of charge or
for a nominal registration fee;
 If free,charges were waived because of the
patient’s inability to pay;

28.  It is not stated that doctors are negligent or
irresponsible but while performing the duty
which requires a lot of patience and care, often
many practitioners fail or breaches their
responsibility towards the patient.
 Medicine which is one of the noblest professions
requires setting a realm which can benefit the
victims of various diseases.
 Many doctors even the specialist sometimes
neglects small things to be taken care of while
practicing which may result in damages to the
patients that could have been avoided or
sometimes even the death of the patient.

29.  This type of professional negligence needs more
focus than to include it in other laws or statutes.
An independent and unique legislature shall be
set up to govern the malpractice.In our country
recently in a case Krishna Iyer v.State of
Tamilnadu and Others the Apex Court awarded a
compensation of 1.8 crores on july 1,2015 as she
lost her eyes in 1996. This is highest amount of
compensation awarded in the country.Many
activists and the victims of medical negligence
have been alleging to get redressal against
malafied acts of medical practitioners and
doctors.

30.  Operation on a wrong patient on a wrong
part
 Loss of hand due to prolonged splinting
 Forgotten instruments
 Mismatch transfusion
 Improper administration of medicines
 Performing the wrong or inappropriate type
of surgery
 Not giving proper medical advice
 Leaving any object in the body of the patient
such as sponge or bandage,etc.after surgery

31.  ACT OF COMMISSION(doing something wrong)
 ACT OF OMISSION(failing to do the right
thing)

32.  4D’s
• Duty of care
• Dereliction of duty of care
• Direct causation
• Damage

33.  Violation of regulations
 Adultery or improper conduct
 Conviction in court of law
 Sex determination test
 Signing false professional certificates,reports
and other documents

34.  CHARACTER OF PHYSICIAN:
 Uphold dignity and honour of his profession.
 Render service to humanity.
 Person with recognized qualification can only
practice modern system of medicine.
 MAINTAINING GOOD MEDICAL PRACTICE:
 Render service to humanity with full respect
for the dignity of profession and man.
 Display of registration numbers.
 Use of Generic names of drugs.

35.  MAINTENANCE OF MEDICAL RECORDS:
 Maintain the medical records pertaining to
his/her indoor patients for a period of 3
years.
 Records to be given within 72 hours.
 Maintain a register of medical certificates
giving full details of certificates issued.
 Highest Quality Assurance in patient care.
 Explosure of Unethical Conduct.

36.  OBLIGATIONS TO THE SICK:
• Always respond to the cells of the sick.
• Ailment not within range of experience he can
refuse treatment & refer.
 PATIENCE,DELICACY & SECRECY:
• Patience and delicacy should characterize the
physician.
• Secrecy of patients to be maintained except
when required by laws of the state and no
protect healthy individuals.
 PROGNOSIS:
• Neither exaggerate or minimize gravity of
patient’s condition.

37.  DO NOT NEGLECT THE PATIENT:
• Physician free to choose.
• Once undertaken should not neglect the
case.
• Respond to request in emergency.

38.  AVOID UN-NECESSARY CONSULTATION:
• Consulting pathologist,radiologist or asking
for lab investigation should be done
judiciously.
 Consultation for patient benefit
 Statement to patient after consultation
 Treatment after consultation
 Punctuality in consultation
 Patient reffered to specialist
 Fees and other charges

39.  Consultant not to take the charge of the case
 APPOINTMENT OF THE SUBSTITUTE:
• Only when he has the capacity to discharge
the additional responsibility along with
his/her other duties.
 VISITING ANOTHER PHYSICIAN’S CASE:
• Avoid remarks upon the diagnosis or the
treatment that has been adopted.

40.  Complaint is first heard by appropriate
medical council.
 During the enquiry the full opportunity is
given to registered medical practitioner to
be heard in person or by pleader.
 The decision has to be taken within 6
months.
 Appropriate medical council gives decision
according to the case.
 Complaints heard by Medical Council of
India(MCI)-as an apex body.

41.  The punishment given by the appropriate
medical council or MCI includes:
• Warning
• Reprimand – official action
• Cancellation of registration
 Temporary- for specific period of time
 Permanent