Medical Ethics and Professionalism – Extended Notes – Ethics in Special Situations

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
• A practitioner shall, at all times in and outside the place of work,
• appear in smart, proper and decent dress and behave in a manner
• becoming of the profession.
• At a place of work, a practitioner shall present himself and appear in
• official attire that shall include proper uniform and identification

name tag.

Case Study

• Chakubanga was admitted in the ward 3 weeks ago with complaints
• of difficulty in breathing, cough and fever. Laboratory test results
• revealed that he is HIV positive. During routine medical rounds, it was
• observed that some doctors on duty have been skipping
• Chakubanga’s bed. Usually it is said that ‘this is a known case let him
• continue with prescribed treatment’. But Chakubanga was having a
• new problem which was not reported when he was admitted; this
• situation caused difficulties to him as he did not have a place to voice
• his concern for management.
• What medical ethics do you think these doctors/clinicians have
• violated?
• What rights does Chakubanga deserve?
• How should Chakubanga be treated if one is observing medical ethics
• ?
• Break up into groups discuss, write your responses for presention to
• the class
• Answers: The ethical issues surrounding, respect, dignity were
• violated but deserved by Chakubanga. He should be treated with

rights to quality care and the right to complain

Key Points

• There are several working situations which any medical practitioner
• must make sure that are handled properly so that the rights of the
• patient are preserved.
• Often the rights of infectious and chronically ill patients are
• neglected; therefore care should be taken to ensure this does not
• happen.
• Evaluation
• What are the special situations which have implications to medical
• ethics?
• What approaches used to address these special situations basing on
• medical ethics?

References

• Beauchamp, T.L. and Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). New York: Oxford University

Press.

• Burkhardt, Margareth A. & Nathaniel, A.K. (2007) Ethics and Issues in Contemporary Nursing. (3rd ed.) New

York: Thomson.

• Devettere, R.J. (1995). Practical Decision Making in Health care Ethics: Cases and Concepts. Washington DC:
• Georgetown.
• Furrow, D. (2005). Ethics: Key Concepts in Philosophy. New York, Continuum
• International Ethics Guidelines for Biomedical Research Involving Human Subject, CIOMS, Geneva, 1993.
• Mason, J.K., McCall Smith R.A. & Laurie, G.T. (1999). Law and Medical Ethics. London: Butterworths
• Mellish, J.M. & Paton, F. (1999). An Introduction to the Ethics of Nursing. Capetown: Heinemenn.
• Tanzania National Health Research Forum (2001). Guidelines on Ethics for Health Research in Tanzania.
• World Medical Association (2009). Medical Ethics Manual (2nd ed.). France: World Medical Association.