Diagnostic Radiology Notes

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Introduction CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Introduction using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Introduction Continuous Assessment 40% PRACTICE • Small Group Discussion Professional Responsibility Licensing Bodies Key Points BMJ.324:838–842. Buckingham: Open University Press. Medical Ethics and Professionalism – Extended Notes – Introduction MEDICAL ETHICS AND PROFESSIONALISM 1 INTRODUCTION Sub-Enabling Outcomes (1) Describe basic concepts of ethics and professionalism in medical practice Utilize theories and principles of medical ethics in delivering health care services Demonstrate professional values in providing quality health care services Describe the relationship between clinician and society in providing quality health care servicesSub-Enabling Outcomes (2) Describe rights of patients and health care providers in the provision of health care services Manage ethical dilemmas in medical practice in improving provision of health care services Apply knowledge of medical laws in disclosing health information Apply principles of medical ethics in obtaining clients’ consent Integrated Method of Assessment Continuous Assessment 40% Written 30% Assignments 10% End of Semester Examination 60% Written 60%BASIC CONCEPTS OF ETHICS AND PROFESSIONALISM IN MEDICAL PRACTICE 6 Learning Objectives By the end of this session, students are expected to be able to: Explain professionalism in clinical medicine practice Identify the characteristics of a profession Describe the code of ethics for medical profession Recognize the roles of professional associations and licensing bodies a)Explain professionalism in medical practice b) Explain the term ethics in medical practice c) Explain characteristics of a profession d) Describe medical code of ethics e) Explain the social role of a profession f) Explain the roles of professional associations and licensing bodies What does the term Profession mean? The words ‘profession’ and ‘professional’ come from the Latin word ‘ professio’ which means a public declaration with the force of a promise. Professions are groups which declare in a public way that their members promise to work, operate and live in certain ways and that the group and the society may discipline those who fail to do so The profession presents itself to society as a social benefit and society accepts the profession, expecting it to serve some important social goal. 10Select this paragraph to edit The profession usually issues a code of ethics stating the standards by which its members can be judged. It is a vocation in which knowledge of some department of science or learning, or the practice of an art founded on it, is used in the service of others. Its members profess a commitment to competence, integrity, morality, humanity, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession autonomy in practice and the privilege of self regulation. Professions and their members are accountable to those served and to society. Medical professionalism differs from other professions in both content and motivation. 12• It is a service profession dedicated to patients, centering on the doctor-patient relationship. Medicine seeks the prevention of disease and injury, the promotion and maintenance of health, the relief of pain and suffering, the care and cure of those with illness, the avoidance of premature death, and the pursuit of a peaceful death. The true professionalism in medicine will always put in first place the well-being of the patient and the community as principal objective. Medicine is a moral endeavor which demands integrity, competence, and high ethical standards among other key attributes Medical professionalism embodies the relationship between medicine and society as it forms the basis of patient-physician trust It attempts to make tangible certain attitudes, behaviors, and characteristics that are desirable among the medical profession. Professionalism embodies the competence, skills and behaviours expected of a practitioner Characteristics of a Profession Body of knowledge Usually the knowledge is not easily understood by the public, and consequently the professions are given substantial control over its use. They acquire responsibility for its integrity, for its proper application, and for its expansion, which for medicine, means the support of science Professions have an obligation to transmit their knowledge by teaching it to future practitioners, the general public, and their patients. Service The knowledge is used in the service of others. Clinicians use their knowledge primarily to benefit individual patient. Altruism There is agreement that the trust placed in the professions and their privileged status are only justified by the expectation that they will be altruistic (Disinterested and selfless concern for the well-being of others) For clinicians this means consistently placing the interests of individual patients and society above their own. Professions must be devoted to the public good. Autonomy This is another important characteristic of a profession. Individually, clinicians are granted sufficient autonomy to act in the best interests of their patients. In the early days, autonomy was expressed in a paternalistic fashion, but modern society, recognizing patient autonomy, now views the clinicianpatient relationship as a partnership. The profession is also granted collective autonomy through self-regulation. It has the privilege and obligation to set and maintain standards for education and training, entry into practice, and the standards of practice. It must guarantee the competence of its practitioners, and has an absolute obligation to discipline unprofessional, incompetent, or unethical conduct. This means that professionals have a particularly strict duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Code of ethics Professions have codes of ethics which specify the obligations arising from their duty Professionalism requires that the practitioner strive for excellence in the following areas which should be modelled by mentors and teachers and become part of the attitudes, behaviours, and skills integral to patient care: Altruism: Clinician is obligated to attend to the best interest of patients, rather than

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles Virtue Ethics Ethical Principle Ethical Theories Immanuel Kant. Case Study Honesty (Veracity) Other Ethical Principles Key Points University Press. Capetown: Heinemenn. Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles Ethical Theories and Principles in Medical Practice Learning Objectives Define common terms related to ethical theories and principles in medical practice Identify major ethical theories in medical practices Identify the importance of systematic study of ethics to medicine Identify the ethical principles in medical practice Analyze ethical principles in medical practice Apply ethical principles when managing patients/clients Definition of Terms Ethics Virtue Ethics: A systematic study of what a persons’ conduct and actions ought to be with regard to himself or herself, other human beings and the environment. The word ethics originated from the Greek word ‘ethos’ meaning customs or character. It is concerned with judgement about what is right or wrong conduct. Virtue: Moral excellence, goodness and rightness. It is also defined as conformity of one’s life and conduct to moral and ethical principles, uprightness, and rectitude Virtue Ethics Refers to a virtue of character as a health practitioner rather than rules governing conduct or consequences of any action by a health practitioner. Virtue ethics demands the practitioner to exercise loyalty, devotion and trustworthiness, good temperament, compassion and integrity. Virtue ethics is a philosophy developed by Aristotle and other ancient Greeks. It is the quest to understand and live a life of moral character. This character-based approach to morality assumes that we acquire virtue through practice. Bioethics: A system of standards arising from the professional agreement to determine, sanction, and justify the interaction of biomedical professional and patient. Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research. Bioethics is both a field of study and professional practice, interested in ethical issues related to health, including those emerging from advances in biology, medicine, and technologies. Ethical Principle Is a basic concept by which behaviour can be judged. Ethical Principles help people to make decisions, because they serve as a standard with which to measure actions. Governing rules of conduct, as code of conduct by which life and action can be directed, or as generalization that provide a basis for reasoning A principle is an established rule of action to be followed in implementing a set of activities Values Is something of worth or excellence or that which is esteemed, prized, or highly regarded. Values refer to one’s evaluative judgement about what one believes is good or what makes something desirable. Values are individual beliefs that motivate people to act one way or another. They serve as a guide for human behavior. Ethical Theories Consequentialism or Utilitarianism This is a moral theory that holds that an action is judged as good or as bad in relation to the consequence, outcome or end result that is derived from it. According to the utilitarianism school of thought, right action is that which has great utility or usefulness. Utilitarianism holds that the only factors that make actions good or bad are the outcomes, or end results, that are derived from them. Consequentialism is an ethical theory that judges whether or not something is right by what its consequences are. Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of consequentialism. Non-Consequentialism or Deontological Ethics Deontological theories of ethics are based upon rationalistic view that rightness or wrongness of an act depends upon nature of the act rather than its consequences. The term is taken from the Geek word for duty. For example, a man needs money to feed his family. He knows that he will not be able to repay it but sees that nothing will be lent to him if he does not promise to repay it at a certain time. Deontological ethics advocates against giving wrong promises disregarding the outcome of the wrong promise, hence this man should not give the wrong promise. The most famous version of non-consequentialism is deontology, which holds that one has an absolute duty to obey certain rules. “Never kill an innocent person” or “never lie” are examples of such rules. Deontology is an ethical theory that uses rules to distinguish right from wrong. Deontology is often associated with philosopher Immanuel Kant. Importance of Systematic Study of Ethics to Medicine Helps in understanding the origin and process of ethical and moral thinking. Enables health care workers to recognize situations with ethical and moral implications and make coherent and logical ethical decisions based upon recognized ethical principles and theories. Equips medical practitioners with knowledge necessary for making right decisions in issues and situations that have element of ethical or moral uncertainty and dilemma. Types of Ethical Principles There are five types of ethical principles: The value of life principle The principle of goodness or rightness The principle of justice or fairness The principle of truth telling or honesty The principle of individual freedom The Value of Life Principle This principle requires the medical practitioner to value human life and honour the patients’/clients’ wishes regarding quality of life. It demands to recognize life as basic and important, but also life should be recognized as having an end. Yet no life should be ended without strong justification such as in the situation whereby life of a pregnant woman is threatened by the presence of the fetus. In addition, when a medical practitioner becomes negligent, he threatens the life of the patient; when life of a patient is valued, a medical practitioner will not ignore any instruction on

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Professional Values CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Professional Values using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Professional Values 108: Key Point York: Thomson. Learning Objectives • Community Factors Own Actions Key Points Medical Ethics and Professionalism – Extended Notes – Professional Values Professional Values and Provision of Quality Health Services Learning Objectives By the end of this session, students are expected to be able to: Define the terms values and integrity Explain the link between values and a profession Describe values in the provision of quality health services Sub-Enabling Outcome: Utilize professional values in providing quality health care services a) Define the terms values and integrity b) Explain the link between values and a profession c) Describe values in the provision of quality health care services Definition of Values DISCUSS: “What is the difference between values and ethics?” Although there is a definite link between ethics and values, the two concepts are not identical. Values can be defined as relatively stable convictions about what is good or desirable. principles or standards of behaviour; one's judgement of what is important in life. " they internalize their parents' rules and values" The difference from ethics here is clearly that one can have values that are not ethical or that have nothing to do with ethics. Some values examples: Respect Transparency Fairness Justice Values and Profession The values of a profession will be reflected in their ethical code of practice. Values of a profession will be reflected through the behaviour of their professional members, who have to practice in a specific manner accepted by ethical code of practice, ethical principles and standards of the profession. Professional values include: Punctuality Commitment Respect Fairness and equality Quality of services Creativity and innovativeness For any profession to function optimally, good relations and interactions between stakeholders are required. In order to ensure such good relations and interactions occur, members of the profession need to commit themselves to specific ethical codes of practice and professional ethics. Integrity within the Profession Integrity is another concept that is closely aligned to ethics. Integrity is however a more restricted concept than ethics. It refers specifically to human character. A person is regarded as someone with integrity when she/he consistently adheres to a set of ethical standards. the quality of being honest and having strong moral principles. the state of being whole and undivided. Integrity, is often associated with concepts like Fairness Consistency Uprightness Wholeness These characteristics make a person of integrity, reliable and trustworthy. The person with integrity will always adhere to her or his values People with good moral characters can turn to unethical behaviour if they find themselves in organizations where unethical conduct is the norm. People can be restrained from unethical behaviour if they find themselves in organizations that do not tolerate unethical behaviour, but reward ethical behaviour. Ethical behaviour should not only be addressed on the individual level, but also on the system or organizational level. Characteristics of Quality Health Services Every person regardless of age or condition is afforded access to quality health care. The service is to be timely, reliable and adequate. Services to be provided to all in need guaranteeing equal access to medical services. Service that allow exercise of moral and religious freedom when receiving health care. Services where medical personal do not harm, do positive good, and respect the autonomy of persons, and adhere to principles of justice. Services that create a bond of trust between patients and health care providers which is built on shared decision-making. Services where patients or their relatives are provided with complete information in order to participate fully in their own care. Services that recognize the quality and availability of health care services for women affect the health and wellbeing of their children and families so that limitations to these services have a profound long-term effect on the public’s health. Services where medical professionals exercise their professional judgment in the best interests of their patients; and recognizing the professional obligation of medical providers to support access to medical care for all people in the interest of the public good. Services which respect and protect the dignity and autonomy of each person regardless of the person’s health issues, religious views or social status. Respecting every person’s dignity means that each person should enjoy the right to health, to health care, to direct access to health care, and to the continuation of that care, regardless of the ownership of the institution from which they seek care. Services where patient expects and has the right to expect the health care professional to employ the highest standard of care and best medical practices Services that respect transplantation of organs from living donors is permissible when such a donation will not sacrifice or seriously impair any essential bodily function of the donor Values and Provision of Quality Health Services In the provision of quality care, there are many values which result in the desired behaviour of a practitioner. These include: Good therapeutic relationship. The term ‘therapeutic relationship’ includes all professional interactions between care providers, individually or as a team, and recipients of care. Good therapeutic relationships are centered on the needs and informed choices of the person receiving care. Such relationships are based on respect and mutual giving and receiving. Good therapeutic relationships help to prevent conflicts about the goals and means of care. A good therapeutic relationship is founded on mutual trust and respect between providers and recipients of care. When care providers lose this sense of mutuality, they become mere experts and the human quality in the relationship is lost. xx When persons receiving care lose this sense of mutuality, they experience a perceived or real loss of control and increased

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights Related Tasks Key Points York: Thomson. Activity: Case Study Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights Patient Rights Learning Objectives Define the terms right, patient, culture and values Identify rights of the patient/client Identify the culture and values that influence comprehensive health care Demonstrate the application of the patient rights when providing medical service Sub-Enabling Outcome : Describe rights of patients and health care providers in the provision of health care services Related Tasks a) Define the term patient’s rights b) Identify patient rights c) Describe providers rights in the provision of health services d) Describe how to meet patients’ rights in the provision of health services e) Describe approaches to uphold human rights in health services Explanation of Patient Rights ‘What are patient rights?’ Patient rights encompass legal and ethical issues in the providerpatient relationship and include person's right to privacy; the right to quality medical care without prejudice; the right to make informed decisions about care and treatment options, and the right to refuse treatment. Many issues comprise the rights of patients in the medical system, including a person's ability to sue a health care provider; access to emergency and specialty care, diagnostic testing, and prescription of medication without prejudice; confidentiality and protection of patient’s medical information; and continuity of care.Select this paragraph to edit Besides basic rights of care and privacy, is the education of patients concerning what to expect of their health care facility and its providers. Recognition of Patient Rights The right of individuals to be treated with respect and dignity. The rights of the individual to life, liberty, and security. The right of individuals to have their religious and cultural identity respected. The right to a competent professional and quality care. The right to an appropriate standard of care to meet individual needs. The right to privacy and confidentiality, which includes access to medical records upon request. The right to personal safety self-determination. The right to be recognized as human beings who are social beings with social needs. The right to participate in the development and implementation of the plan of care. The right to be informed about condition, treatment options, and the possible results and side effects of treatment. The right to refuse treatment in accordance with the law, and receive information about the consequences of refusal. The right to quality health care without discrimination because of race, creed, gender, religion, national origin, or source of payment. The right to know the identity of the person treating the patient, as well as any relationship between professionals and agencies involved in the treatment. The right to informed consent for all procedures, including the medical records by the patient or by the patient's legally authorized representative and hospital charges. The right to consultation and communication freely without fear. The right to complain or compliment without the fear of compromising access to quality care. Together with these rights the patient has a responsibility to follow the plan of care agreed upon, and providing relevant, complete and accurate health information. The patient is further responsible for consequences of refusal of treatment, of not following the rules and regulations of a hospital, and of not being considerate of others‘ rights. Meeting Patient Rights in the Provision of Health Services ‘How can patient rights be met in the health facility during provision of health services?’ In accordance to patient rights health care providers have the obligation to adhere to these patients rights. Each provider has to adhere to ethical code of practice and has responsibilities for provision of quality of care as guided below. The Right of Individuals to be Treated with Respect and Dignity Health providers should promote an environment that engenders mutual respect including respect for the dignity and rights of all concerned. The Rights of the Individual to Life, Liberty and Security Promote emotional security, provide physical security, and enable religious and spiritual security for patients while in hospital care. Assure patients that their independence will be encouraged. Provide mechanisms that enable patients and staff to offer feedback or make complaints without fear of revenge to quality care. Provide and promote a safe working environment for patients and all staff. Respect and protect rights of staff to freedom of association, (including the right to choose whether or not to join an employee association). The Right of Individuals to Have Their Religious and Cultural Identity Respected Provide care in an environment that supports the cultural and language needs of residents and their families. Provide food and drink which meet the needs for reasonable personal, cultural and religious preferences. Provide ease of access to spiritual advisers and a place (not necessarily a dedicated place) for religious observances appropriate to the wishes of the patient. The Right of Competent Individuals to Self-determination Promote an environment that provides patients with opportunities for self-development and that maximise their potential for well-being, especially patients who stay for long time in the hospital. Respect the right of patients to their reasonable choices of care provision. Encourage patients to take responsibility for their actions and choices. Provide access to independent social, legal or other advice and help, which are relevant to patient care. Develop protocols, within the law, to assist patients with selfmedication for this type of care. The Right to an Appropriate Standard of Care to Meet Individual Needs Act in the best interests of patients in determining, particularly before admission, whether or not the hospital has the capability of providing them with care appropriate to their needs. Provide food, drink,

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice Ethical Dilemmas in Medical Practice Learning Objectives Define the term ethical dilemmas Explain the characteristic of ethical dilemmas Explain common ethical dilemmas Identify sources of ethical dilemmas Describe strategies used to solve ethical dilemmas Definition of Ethical Dilemmas and their Characteristics An ethical dilemma is a situation having two or more undesirable alternatives. It can also be defined as a confusing problem that offers a choice between equally unsatisfactory alternatives. An ethical dilemma is a situation that will often involve a conflict that brings questions on which to obey as they may have implications on each other Ethical dilemma addresses ethical questions of right vs. wrong. Characteristics of Ethical Dilemmas In order for a problem to be an ethical dilemma it must have three characteristics The problem cannot be solved using only empirical data (empirical data is information derived from observation/experiences) The problem must be so confusing that deciding what facts and data need to be used in making decision is difficult. The results of the problem must affect more than the immediate situation; and there should be far reaching effects. Common Ethical Dilemmas Common Ethical Dilemmas identify common ethical dilemmas in medical practice Dilemmas of Beneficence Involves deciding what is good as opposed to what is harmful. Often occurs when a clinician, patients, or family members disagree about what course of action is in the best interest of the patient. Dilemmas of Non-maleficence Involves the avoidance of harm. These issues often involve a clinician’s responsibility to ‘blow the whistle’ if the clinician sees others compromising the patient’s safety. In these situations, a clinician notifies higher authorities on weaknesses in the care they provide by not following established communication channels. Dilemmas of Autonomy Involves deciding what course of action maximizes the patient’s right of self determination. Autonomy issues are related to beneficence issues, especially when individuals other than the patient must determine what is best for the patient. Dilemmas of Justice Involves issues of fairness and equality, such as dilemmas that involve dividing limited health care resources fairly. Dilemmas of Fidelity Involves issues that involve honouring promises. These may include the extent and limits of a clinician’s role and duties to patient that might conflict with other duties such as duties of the laboratory technician. Dilemmas of Veracity This is an obligation to be truthful to patients and to cultivate their understanding of relevant consideration. This may involve even delivering bad news to patients and relatives. Sources of Ethical Dilemmas Problems arise when one or more ethical principles conflict with each other. Patients and clinicians- For example human rights are involved when a patient refuses to commit herself in signing consent while the clinician believes it is ethically appropriate to get his/ her permission. The value system, beliefs and culture- For example a patient who belongs to Jehovah’s Witnesses refuses blood transfusion at the time when blood will save the life of that individual. Sources of Ethical Dilemmas cntd Dilemma may arise from justice and conflicts between clinician and other health care professionals, health care organizations, administrators or patients and family members. Example one: Quick service provided to patients who can pay extra money and leaving patients with low economical status to wait. Example two: Family members may demand the HIV results of a patient and create a difficult situation. Example three: A woman may demand abortion for her school age girl who has been raped by a school teacher. Sources of Ethical Dilemmas cntd Technology advancement- Knowledge among people is growing and patients may come to the hospital with full information of their expectations including services like DNA, such as when the clinician is asked to conduct tests to confirm if the claimed father is a true father of the child or not. Technological advancement provides challenges when we are required to extend life support services for terminally sick patients and simplifies accessibility to information. Strategies Used to Solve Ethical Dilemmas There are no clear ways of solving the dilemmas. Different strategies and ways need to be applied in solving the dilemma as described below First the medical practitioner defines his/her obligations, to patients and fellow employees which helped her to analyze ethical conflicts. He/She notes that six steps proved useful to define those obligations:- To maximize a patient’s well being.To maximize a patient’s wellbeing. To balance the patient’s need for autonomy and, in the case of a minor, his/her parents’ responsibilities for his or her wellbeing. To support each family member and enhance the family support system. To carry out the hospital’s policies. To protect the other patients’ good. To protect his or her own standards of care. After examining one’s obligations, it is usually recommended that four additional steps should be taken: Collect as much information as possible about the patient and other significant persons in the situation. Describe probable consequences of each of the courses of action being considered, for the patient and the significant others in the situations. Consider who should make the final decision in the matter. Consult other health practitioners, especially those who are prepared by practice, ethical committee and education to contribute meaningfully to solving problems of an ethical nature. Even after taking the steps described above, solutions may not necessarily be forthcoming when ethical conflicts are present. Commitment to ethical standards of practice is an essential part of medical care, as is the commitment to respecting the rights and dignity of the person receiving care. Key Points An ethical dilemma is a situation having two or more undesirable alternatives. An ethical dilemma must have three characteristics: The problem cannot

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Ethics in Special Situations CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Ethics in Special Situations using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Ethics in Special Situations Medical Ethics Medical Research Health Management Organizations Case Study Key Points York: Thomson. Medical Ethics and Professionalism – Extended Notes – Ethics in Special Situations Ethical Issues in Special Situations Learning Objectives Describe several special situations with implications in medical ethics Explain approaches in addressing special situations based on medical ethics Special Situations with Implication in Medical Ethics list some special medical situations In medical practices there are various situations that can be encountered and found to be a dilemma to the performance of medical duties. Medical research Torture to human being Capital punishment Abortions Prisoners Disaster & emergency situations. HIV and AIDS and other infectious diseases Medical examination required by employer Publicity and advertisement Diagnosis of death (Brain dead) Health management organizations Practitioners appearance, presentation and attire Approaches to Special Situations Based on Medical Ethics Health care providers face different issues that require some ethical solutions. The kind of solution is normally determined by nature and situation of the task as follows: Medical Research Familiarity with research methods is essential for competent medical practice and the best way to gain this familiarity is to take part in research projects. The most common method of research for practicing clinicians is clinical trial. In conducting research, the ethical values of the medical practitioner compassion, competence, autonomy, dignity apply to medical researcher as well as long as the medical practitioner understand and follow the basic rules of research ethics There are several procedures required to make the research legal and this shall be dealt with in Research Module. Torture of Human Being It is the obligation of the practitioner in the service of humanity, to preserve and restore physical and mental health of the client. The practitioner shall: Not participate in any way in the practice of torture of human being or other forms of cruel, inhuman or any form of degrading procedures no matter whether such practice or procedure is ordered after due process of law. Not provide any premises, instrument, substance or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment, or to diminish the ability of the victim to resist such treatment. Abortion Medically induced abortion is not allowed by the laws of the country. Abortion is not legal in Tanzania; only in some medical conditions where mother’s health is compromised by the presence of the pregnancy. Prisoners The practitioner while attending a client held in prison or detention is urged to provide professional services to the best interest of the health of the prisoner or detainee and the general community of that prisoner. The practitioner shall: Draw to the attention of the responsible authority of an existing or impending unhealthy environment or condition. Take all necessary steps to preserve dignity of the prisoner or detainee. Disaster and Emergency Situation In disastrous and emergency situations like floods, road accidents, earth quakes, and fire outbreak, practitioner shall practice the profession with conscience and dignity, and the health of the clients shall be paramount. The practitioner shall have an obligation during life threatening emergencies to take immediate steps to ensure that necessary treatment is given to the victim without discrimination and undue delay. HIV& AIDS and other Infectious Diseases In the management of HIV and AIDS and other infectious diseases, the practitioner may encounter ethical problems embodied in the special nature of the disease, its fatality, and absence of cure, public stigma and imminent danger to the society. The practitioner shall: Balance the need to observe confidentiality and save human life against deliberate acts likely to infect potential victims. Acquire adequate knowledge and skills on counselling related to the special aspects of HIV&AIDS other infectious diseases including prevention and transmission. Ensure that individuals infected with HIV or suffering from AIDS and other infectious diseases are informed or supportive measures available. Ensure that individuals infected with HIV&AIDS or any other chronic disease are afforded opportunity to agree or decline from being research subjects and to the method applied for scientific research, teaching, and taking of photographs, video or film. Medical Examinations Requested by Employer Practitioners shall ensure that an employee is fully aware and consent to medical or dental examination requested Publicity and Advertisement Sound relationship between a practitioner and colleagues is essential for fostering the esteem and truthfulness of the medical profession. Practitioners shall be aware that matters of general interest are paramount and practitioner shall refrain from adopting methods aimed at advertising a particular person, institution, remedy or technique. Diagnosis of Death A situation may arise whereby the human body is controlled which is damaged to an uncertain degree and poses ethical dilemma for termination of life. In such a situation a patient shall be considered dead when there is irrevocable establishment of brain stem death. Death shall be clinically ascertained by not less than two physicians and one of them shall be the doctor in charge of the care and another one should be an experienced and clinically independent of the first. In any case the examination must be done over twenty four hours at eight hourly intervals. Health Management Organizations Health Management Organizations (HMOs) have their basis, profit making by ‘managing’ health funds. This, at times, leads to unreasonable exclusion from key investigations, drugs therapy, surgical procedures and others and interference in the confidentiality of the clients. Practitioners must have interest of their clients at heart and should not barge to HMO’s pressures. In every aspect of practice the patient’s welfare remains the practitioner’s responsibility irrespective of the influences of the health agents. Practitioner Appropriate Presentation and Attire

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Confidentiality in Medical Practice CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Confidentiality in Medical Practice using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Medical Ethics and Professionalism – Extended Notes – Confidentiality in Medical Practice Confidentiality in Medical Practice Learning Objectives Define confidentiality Explain the principles of confidentiality in medical practice Describe the importance of confidentiality in medical practice Identify limitations of confidentiality in medical practice Definition of Terms What is confidentiality? Confidentiality: The ethical principle that requires non-disclosure of private or secret information with which one is entrusted. In research, confidentiality refers to the researcher’s assurance to participants that information provided will not be made public or available to anyone other than those involved in the research process without participants consent. The obligation to respect confidentiality applies when a person has information in confidence. Principle of Confidentiality in Medical Practice The medical practitioner’s duty to keep patient information confidential has been a cornerstone of medical ethics since the time of Hippocrates. Hippocratic Oath states: ‘What I may see or hear in the course of treatment or even outside of the treatment in regard of life of men, which in no account one must spread abroad, I will keep to myself holding such things shamefully to be spoken about’. The World Medical Association International Code of Medical Ethics requires that: ‘A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died’. However, other codes reject this absolutist approach to confidentiality. The high value that is placed on confidentiality has three sources: autonomy, respect for others and trust. Autonomy relates to confidentiality in that personal information about an individual belongs to him or her and should not be known to others without his or her consent. When an individual reveals personal information to another, a medical practitioner or nurse for example, or when information comes to light through a medical test, those who have access to the information are bound to keep it confidential unless authorized to divulge it concerned. Confidentiality is also important because human beings deserve respect. One important way of showing them respect is by preserving their privacy. In addition, the basis of trust between the patient and healthcare professionals is the ethical and legal standard of confidentiality that healthcare professionals are expected to uphold. Without an understanding that their disclosures will be kept secret, the patient might withhold personal information. This will hinder medical providers in their efforts to provide effective interventions or to obtain public health goals. Case Study A medical practitioner was playing pool with his colleague, while in the process they were discussing about the seriousness of a tumour of one school teacher. This conversation was overheard of the patient and the patient was informed. Questions Was the practitioner right to discuss this issue at that location? Do you think the patient will prefer again being attended by this doctor? Why? The Importance of Confidentiality in Medical Practice A confidential relationship arises whenever one person entrusts confidential information of another person. Confidential information is known as secrets. Where the person to whom the information has been entrusted or conveyed is a medical practitioner, the patient has the right to believe that this confidential information will not be conveyed to others without the patient’s consent and that it will only be used for the purpose for which it has been given. The Importance of Confidentiality in Medical Practice cntd The trust which the patient places in the medical practitioner can be viewed as the basis of a healthy practitioner-patient relationship. Two important aspects of confidentiality are identified: To limit access to information To make provision for communication on intimate and other sensitive, personal matters Vulnerable patients, and in this instance particularly the dying patient, would be more willing to reveal personal information and secrets and personal information of the patient should not be shared unnecessarily. The Importance of Confidentiality in Medical Practice cntd Confidentiality should be viewed as the basis of a confidential relationship in which the practitioner is accountable for her/his practice. In the execution of this professional accountability she/he will not disclose any information which is obtained during the care of the patient, except with the consent of the patient or a person who may make decisions on behalf of the patient, or if the court requires such a disclosure. The Importance of Confidentiality in Medical Practice cntd Professional Pledge of Service for medical professional states in as follows; ‘I will hold in confidence all personal matters coming to my knowledge’. Dispute Relating to Confidentiality Health care personnel are obliged both legally and ethically to maintain strict confidentiality in respect of the patient. If this obligation is not met, it may be viewed as a serious ethical offence and disciplinary actions may be taken. Most institutions lay down strict policy measures in respect of the confidentiality of patient information It is the practitioner’s duty to acquaint him or herself with these measures to prevent being held accountable for the disclosure of confidential information. Anyone who feels that the disclosure of confidential information in certain instances is morally justifiable or even obligatory bears a burden of proof which cannot be denied. Limitations/Challenges to the Requirement to Maintain Confidentiality Routine breaches of confidentiality occur frequently in most healthcare institutions, for example: Many individuals, i.e. doctors, nurses, laboratory technicians, and students, require access to patient’s health in order to provide adequate care to that person and, for students to learn how to practice medicine. When patients speak a different language than their caregivers, there is a need for interpreters to facilitate communication. In cases of patients who are not competent to make their own medical decisions, other individuals have to be given information about them in order to make decisions on their behalf and

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Consent in Medical Practice CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Consent in Medical Practice using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Consent in Medical Practice Sub-Enabling Outcome • Implied Consent Medical Practice General Issues Case Study Key Points /PMC2840885/ IMPLIED VS. EXPRESSED CONSENT INFORMED CONSENT DISCLOSURE OF INFORMATION PRE-REQUISITES EXCEPTIONS TO DISCLOSURE BLANKET CONSENT DOCUMENTATION INFORMED REFUSAL CONCLUSION Medical Ethics and Professionalism – Extended Notes – Consent in Medical Practice Consent in Medical Practice Learning Tasks Define consent in medical practice Describe the forms of consent in medical practice Mention requirements for true consent in medical practice Mention legal implications from lack of consent in medical practice Sub-Enabling Outcome 2.3.4 Apply principles of medical ethics in obtaining clients’ consent a) Define the term informed consent b) Explain types of consent c) Describe clinically significant of consent d) Describe informed consent for minors and adolescents e) Describe exceptions to consent f) Obtain clients’ consent Definition of Terms Consent: The clinical principle that each person has a right to self determination and is entitled to have their autonomy respected finds its expression in law through the notion of consent. Any intentional touching of a person without lawful justification or without their consent amount to the tort of battery and may also constitute a criminal offence. The law relating to consent is one of the most important to medical law, serving as the means of protecting and preserving the right of the patient to decide what is to happen to him/her. Consent can be in the form of expressed or implied. Expressed consent: Is when the patient explicitly agrees to what is proposed by the doctor, it does not need to be set out in any specific form and it does not need to be in writing. The vast majority of time when a patient is touched, it is done in the examination rooms where none of apparatus of consent is present. Consent forms: Have been part of hospital procedure for a long time. The form usually covers statements like ‘I confirm that I have explained the operation, investigation or treatment, and such appropriate options as are available and the type of anaesthetic, if any proposed to the patient in terms which in my judgement are suited to the understanding of the patient and/or to one of the parents or guardians of the patient’. The form is signed by both the doctor and the patient. Most of forms have a statement saying ‘I understand that any procedure in addition to the investigation or treatment described on this form will only be carried out if it is necessary and in my best interests and can be justified for medical reasons.’ • Implied Consent Consent may just be implied meaning the client did not expressly authorize the doctor to conduct a procedure. Actions often speak louder than words. Holding up one bare arm to a doctor at a vaccination point is as clear as agree as if it were expressed in words. Even silence and inaction may, in some circumstances, be interpreted as expression of willingness. Failure to resist or protest indicates consent if a reasonable person who is aware of the consequences and capable of protest or resistance would voice his objection. A girl who is silent to an amorous proposal, cannot, afterwards complain of assault. Requirements for a True Consent in Medical Practice • There are three relevant issues which have to be determined: Did the patient have capacity in law? (Was the patient competent to give consent?) Was the person giving consent appropriately informed before hand? Was the consent voluntarily given? Each of these issues may be analyzed by reference to the nature and extent of the doctor’s duty, that is, to inform or to ensure voluntariness and competence. The need for consent derives from the law’s respect for patient’s right to decide. Consent, therefore, has a positive and a negative property. This means it is an exercise to make one’s own decisions to say ‘yes’ (consent) or to say ‘no’ (refuse). It is also a right to change one’s mind. Hence the patient may withdraw their consent to treatment. Obviously, this could be done before the procedure but it may also be done during the procedure. General Issues In court issues, responsibility of proving absence of consent rests on the patient. Liability in trespass results in responsibility for all the consequence of the trespass and may be concurrent with criminal liability for assault. Consent must be to the actual physical ‘invasion’ in issue. It is a battery if the patient consents to removal of his left leg and the surgeon removes the right leg. Surgery may be authorized either by a provision in a standard consent form or by defence of necessity. Further treatment must be shown to be necessary at the time of the original operation. Doing surgery for removing woman’s ovaries without express consent, or any nonconsensual treatment may constitute serious professional misconduct. It is not sufficient that the doctor believes that what she/he does is in patient’s best interests or that 99% of patients would have consented. Advance directive of the patient must be respected. Failure to provide adequate information is actionable. It is the doctor’s duty to provide not just competent treatment, but competent advice as well. Consent for detained mental patients must be obtained for nonmental problems. Which medical procedures require informed consent? Treatment with high-risk medications, such as opioids. Tests and medical interventions that go inside your body, such asendoscopy. Childbirth interventions, such as forceps delivery or episiotomy. Surgery. Biopsy. Medical implants. Use of anesthesia. Use of radiation. Chemotherapy. Blood transfusions. Genetic testing. Clinical trials involving human research subjects (including psychology research). Procedures involving medical students. Certain