Ethical Issues in Special Situations

Ethical Issues in Special Situations

Learning Objectives

• By the end of this session, students are expected to be able to:
• Describe several special situations with implications in medical ethics

Explain approaches in addressing special situations based on medical ethics

Ethical Issues in Special Situations

In medical practices there are various situations that can be encountered and found to be a dilemma to the performance of medical duties.

• These working situations include:
• 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.

Ethical Issues in Special Situations

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.

Ethical Issues in Special Situations

• 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 and other infectious diseases including prevention and transmission.

Ethical Issues in Special Situations

• Ensure that individuals infected with HIV or suffering from AIDS and other infectious diseases are informed on 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 by the employer

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 by a brain 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.

Ethical Issues in Special Situations

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 Organisations

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.

Activity: Case Study

Scenario

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.

Ethical Issues in Special Situations

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?

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.