Ethics and Professional Conduct in Medical Practice

ETHICS AND PROFESSIONALISM IN MEDICAL PRACTICE

Outline

• Code of ethics for medical profession

Principles of Ethics and Code of Professional Conduct for medical practitioners

At the end one should be able to:-

• Describe the code of ethics for medical profession

Describe principles of ethics and Code of Professional Conduct for medical practitioners

Code Of Ethics For Medical Profession

Definition of code of ethics

A statement encompassing the set of rules based on values and the standards of conduct to which practitioners of a profession are expected to conform.

• A standard of conduct deep-rooted in commitment, confidentiality, and relationships.

With regards to medical profession it is meant for medical practitioners

Ethics and Professional Conduct in Medical Practice

Committed to performance improvement and maintaining integrity, personal accountability and moral obligation to all customers served—clients, employees, employers, physicians, organizations, and the public.

Professionals promote the dignity of the profession and are committed to practicing the profession with honesty, integrity, and accountability, respecting all laws and refusing to participate in or conceal any unethical, false, fraudulent, or deceptive activity

Code Of Ethics For Medical Profession Cont.’

NOTE

The true professionalism in medicine will al ways put in first place the well-being of the patient and the community as principal objective.

Code Of Ethics For Medical Profession Cont.’

Code Of Ethics For Medical Profession Cont.’

Altruism: Clinician is obligated to attend to the best interest of patients, rather than self-interest.

ƒ Accountability: Clinicians are accountable to their patients, to society on issues of public health, and to their profession.

ƒ Excellence: Clinicians are obligated to make a commitment to life-long learning.

ƒDuty: Clinicians should be available and responsive when ‘on call,’ accepting a commitment to service within the profession and the community.

Code Of Ethics For Medical Profession Cont.’

Honour and integrity: Clinicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession.

ƒRespect for others: A Clinician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.

ƒThese values should provide guidance for promoting professional behaviour and for making difficult ethical decisions.

History in brief

The Principles of Ethics and Code of Professional Conduct, have their roots In Greece', way back in 500 B.C and traceable to the emergence of Hippocrates (460B.C.) and his philosophy in scientific approaches in medicine and principles on moral and ethical requirement of an ideal physician.

Code Of Ethics For Medical Profession Cont.’

History in brief

The principles, which were then summarized in the form of "Hippocratic oath", were the fundamental governance of the medical and dental professions.

Existed throughout history until when they were officially modified by the Geneva Convention in 1948, which then formed the basis for diverse ethical approaches

Code Of Ethics For Medical Profession Cont.’

The principles of ethics are inspirational goals and attributes of the professions.

• They provide guidance and other justification for the professional conduct.

Code Of Ethics For Medical Profession Cont.’

Ethics and Professional Conduct in Medical Practice

The Principles can overlap each other as well as compete with each other for priority as one principle can justify a given element of the code of professional conduct and may at times, need to be balanced against each other.

• Otherwise the principles are the profession‘s firm guideposts.

Code Of Ethics For Medical Profession Cont..'’

Ethics and Professional Conduct in Medical Practice

Notably, ethics attained in the principles closely relate to the law but are not the same I', and often do exceed legal duties.

For that matter, in resolving any ethical problem not explicitly covered by the code, both practitioners and clients shall consider the ethical principles, client's need and interests with respect to the applicable law.

Code Of Ethics For Medical Profession Cont..’

Principles Of Ethics And Code Of Professional Conduct For Medical Practitioners

The Principles of Ethics and Code of Professional Conduct for medical and dental practitioners in Tanzania are therefore epitomized and presented into five cardinal principles Beneficence

• Non maleficence
• Autonomy
• Justice and

Veracity and Fidelity

1. Beneficence (Do Good)

Beneficence is one of the moral principles of medical practice.

The principle of beneficence refers to positive acts that lead to the welfare of others and a client in particular.

It implores that a practitioner has to do all he can to promote good, kindness or generosity, and it implies acts of humanity, mercy or charity. It is a moral obligation required from the practitioner to act for the benefit of others.

Ethics and Professional Conduct in Medical Practice

It holds that one should help others further their important and legitimate interests as those persons understand them, or as one conceives them to be.

One is obliged to act to benefit others when one can do so with minimal risks, inconvenience, or expense.

• It is the basis for doing good for, and being kind to patients.

1. Beneficence (Do Good) Cont.’

It requires that:-

• One should not inflict harm;
• One should prevent harm;
• One should remove what is bad;
• One should promote good.

1. Beneficence (Do Good) Cont.’

One should not worsen any human being’s situation;

One should improve such a human being’s situation It is not enough simply not to inflict harm to others, rather one has also to take positive steps to help others, and to provide benefits to others Promoting the welfare of patients, and not merely avoiding to harm them, is the goal of health care.

1. Beneficence (Do Good) cont.’

The practitioner shall:­

• Devote times and life to the service of humanity;
• Maintain by all means the honor and noble traditions of the profession;
• Practice the profession with conscience and dignity, and the health of the client
• shall be his first consideration;

1. Beneficence (Do Good) cont.’

The practitioner shall:­

Maintain the utmost respect and preservation for human life even when subjected under threat Act only in the client’s interest when providing care, which might have the effect of weakening the physical and mental condition of the 1. Beneficence (Do Good) cont.’

Have the duty to give emergency care until he is sure that others are willing to give such care;

Give advice and treatment as shall be necessary to reduce the suffering of the client Represent, recommended or perform treatment or diagnostic techniques that are evidence based best practice.

1. Beneficence (Do Good) Cont.’

2. Non-maleficence (Do No Harm)

This principle is based on the concept that a practitioner is under moral obligation to refrain from any act or omission that may result into undesirable or uncomfortable consequences inflicted upon a client.

The practitioner shall:-

Refrain from taking part-in any activity or experiment which does not conform to ethical requirements and which is likely to cause harm or endanger the health and well-being of a client including but not limited to taking part in strikes in circumstances which endangers or causes harm to a patient, or compromises the Hippocratic Oath;

2. Non-maleficence (Do No Harm) Cont.’

Strive to have adequate standard equipment and necessary supplies for practice;

Be obliged, whenever an examination or treatment is beyond his/her skills, capacity, knowledge and experience, to seek an advice or refer a client to a practitioner who has the necessary special skills, knowledge, ability and experience;

Upon completion of the care, where dealing with a referral case, return the patient back to a referring practitioner, unless a client expressly indicates different preference;

2. Non-maleficence (Do No Harm) Cont.’

Not permit oneself or herself to be exploited in a manner which is undesirable to the public or professional interest;

Be obliged at all times to protect health of a client by assigning to qualified auxiliaries only those duties which can be professionally delegated Be obliged to supervise the client care provided by auxiliary personnel working under his direction;

2. Non-maleficence (Do No Harm) Cont.’

Ethics and Professional Conduct in Medical Practice

Once instituted a course of treatment to a client he should not discontinue that treatment without giving the client adequate notice and the opportunity to obtain services of another practitioner;

• Not select a health facility on the basis of financial gains when referring his or
• her client.

2. Non-maleficence (Do No Harm) Cont.’

3. Autonomy (Self Determination)

This principle is based on the concept that a client has inherent right to make decisions in accordance with his values, as opposed to the values of others who do not suffer the consequences of the decisions.

The principle mandates the client to make informed decisions unrestricted by values of the practitioner

The provider shall:-

Offer treatment and other forms of health intervention to client only after getting informed consent from the client.

Always give the client sufficient information to enable him to decide whether or not to accept treatment, including the relevant risks, expected benefits and available alternatives.

Ensure that consent is given free from undue influence such as force, pretense, promise and deception. Any decision to withdraw the consent must be respected 3. Autonomy (Self Determination) Cont.’

Note that:

Consent can be implied or express, oral or written.

But, consent for major surgery and test for sensitive diseases such as HIV/AIDS must be express 3. Autonomy (Self Determination) Cont.’

Note that:

Consent from a client who lacks capacity such as a child or unconscious person, shall be obtained from the next of kin or any other person or authority for the best interest of the client and only for the necessary intervention When seeking client's consent as to the disclosure of confidential information, the practitioner shall ensure that the client clearly understands the reasons for such disclosure and its possible consequences 3. Autonomy (Self Determination) Cont.’

The client has the right to choose a practitioner, who will attend the

client

The client's last wishes while still in sound mind and his right to die in dignity must be respected The client's right to receive or decline spiritual and moral comfort must be respected

3. Autonomy (Self Determination) Cont.’

4. Justice (Fairness)

Refers to just conduct or fair dealing.

It is the principle that requires that each person be assured of the things that belong to him/her.

• It means giving every person what they deserve:

Just treatment implies giving a person the reward or punishment that she or he deserves.

Ethics and Professional Conduct in Medical Practice

This principle is based on the concept of fairness, equitable and appropriate treatment in light of what is due or owed to a person.

• Health needs are limited, and every health care system faces some form of scarcity.
• Given the circumstances, the practitioner is
• expected to use wisdom to ensure that the limited resources are distributed fairly

4. Justice (Fairness) cont.’

Ethics and Professional Conduct in Medical Practice

Treat all clients fairly and equitably by providing services to clients based on their needs regardless of factors such as economic status, faith, race, gender, tribe, age or physical attributes 4. Justice (Fairness) cont.’

Justice is commonly conceptualized as Distributive or Commutative.

• Both are relevant in medical and nursing practice.

4. Justice (Fairness) cont.’

Distributive Justice

• Regulates relationships between public officials and members of the public;
• Demands a fair distribution of public benefits and burdens among members of the public;

Is violated by favoritism and impartiality.

Commutative Justice

• Regulates relationships among professional colleagues;

Demands restitution or compensation to re-establish balance.

Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty)

Veracity is the principle that imposes a duty upon the practitioner to be honest and truthful in the course of interaction with clients.

The practitioner is obliged to respect the inherent trust that exists in the practitioner – client relationship.

It requires a practitioner to communicate with a client truthfully and without deception, and thus maintain professional integrity

Ethics and Professional Conduct in Medical Practice

On the other hand fidelity is the principle based on the concept that a practitioner shall keep promises made to the client, and requires the practitioner not to represent in a false or misleading manner any care or service rendered by him to the client Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty) Cont..’

The practitioner shall:

• Not charge fees for providing care in a false or misleading manner;
• Not increase fee to a client on reason that a client is covered under insurance scheme;
• Not recommend or perform unnecessary procedures for purposes of financial gain;

Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty) Cont..’

Ethics and Professional Conduct in Medical Practice

While presenting educational or scientific information in an article, seminar or other programmes, disclose to the reader or participants stakeholders as the case may be, any monetary or other special interest he may have with a company whose products are being promoted or endorsed in the presentation;

Disclose any monetary or other special interests he may have with the company whose products are being promoted or endorsed in educational, scientific information in an article, seminar or other programmes.

• Disclosure shall be made in any promotional material and in the presentation itself

Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty) Cont..’

Ethics and Professional Conduct in Medical Practice

In the event of adverse reaction to a drug or device, the practitioner shall communicate that information to members of the profession and relevant authorities;

Not misrepresent his training or competence in any way which is false or misleading in any material respect.

Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty) Cont..’

Do you remember the Principles of Ethics and Code of Professional Conduct for medical practitioners