Bioethics Flashcards
ethics focused on moral issues in the field of health care
Bioethics
ETHICAL SYSTEMS
Deontological ethics
Teleological ethics
Virtue ethics
focused on adherence to independent moral rules or duties
Deontological ethics
when you follow your duty, you are behaving morally; when you fail to follow your duty, you are behaving immorally.
Deontological ethics
focused on the consequences which any action might have;
Teleological ethics
ends justifying the means
Teleological ethics
focus on helping people develop good character traits,
such as kindness and generosity, which allow a person to make the correct decisions later in life.
Virtue ethics
“___________is defined as practice that reflects the commitment to caring relationships with patients and families and strong ethical values; utilization of specialized knowledge, critical inquiry, and evidence-informed decision making; continuous development of self and others; accountability and responsibility for insightful competent practice; demonstration of a spirit of collaboration and flexibility to optimize service.”
Professional practice
“Professional practice is defined as practice that_____ the_____ to____ relationships with patients and families and strong______;
utilization of_____,_______, and______ decision making;
continuous development of_______;
____ and _____for insightful competent practice;
demonstration of a spirit of_____ and _____ to optimize service.”
reflects; commitment; caring; ethical values
specialized knowledge; critical inquiry; evidence-informed
self and others
accountability and responsibility
collaboration and flexibility
concerned with the obligations of the doctors and the hospital to the patient along with other health professionals and society.
Medical ethics
Ethics in medicine/medical practice
Medical ethics
FOUR MAJOR ETHICAL PRINCIPLES
Autonomy
Beneficence
Non-maleficence
Justice
The act of respecting the decisions of others
AUTONOMY
The basis of informed consent: patient must Understand the procedure and its likelihood of success
Autonomy
Free from coercion
Autonomy
doing an action that benefits others
Beneficence
Intention of doing good for the patient
Beneficence
chief objective of health professionals: to help
Beneficence
Kung di ka magpakuha dugo mapatay ka
No autonomy
Blood extraction for lab test and help in the diagnosis
Beneficence
Non- maleficence
avoidance of doing harm to others through commission or omission
NON-MALEFICENCE
The ‘do no harm’ principle
Non-maleficence
Imbes na vein kuhaan kau artery
Non maleficence
Treat all patients equally.
JUSTICE
‘Give to each that which is his due’
Justice
Gi sigwan kay gi correct ang mali
Maleficence
Beneficence
PROBLEMS IN MEDICAL ETHICS
IGNORANCE
NEGLIGENCE
•Medical Negligence/Medical Malpracticel
NEGLIGENCE
Brachial artery ka nagkuha dugo
Wala justice
DNR pero wala kabalo si patient
Most justifiable thing to do?
I ingon kay patient
lack of technical or theoretical knowledge in the act of doing work
IGNORANCE
examples:
incompetent
no experience
no knowledge of consequence
failure of job execution
IGNORANCE
Ignorance examples
examples:
incompetent
no experience
no knowledge of consequence
failure of job execution
Dentist mag suture/ diagnose tas nagka problem
Ignorance
the failure to observe, for the protection of the interests of another person, that degree of care, precaution, and vigilance which the circumstances justly demand, whereby such other person suffers injury
NEGLIGENCE
Negligence
the failure to____, for the protection of the interests of another person, that degree of____,____, and_____ which the circumstances justly demand, whereby such other person suffers injury
observe
care, precaution, vigilance
failed to take an action that a reasonable person would do
Negligence
did something that a reasonable person would not do
Negligence
Doctor na kabalo sa mga bulihaton pero naiwan ang gloves sa loob ng patient
Negligence
Failed to double check
Negligence
Medical malpractice is under
Negligence
‘a particular form of negligence which consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances’
Medical malpractice
ELEMENTS OF NEGLIGENCE
a duty was owed
the duty was not met: breach
Injury or harm was done
failure to meet the duty owed resulted to the injury: proximate cause
may be implied from the physician’s affirmative action to diagnose and/or treat a patient, or in his participation in such diagnosis and/or treatment
DUTY
created when the patient engages the services of the doctor and the doctor agrees to provide care to the patient
Duty
There must be a professional relationship between the patient and the physician
DUTY
Nagtalk si sir niel kay doc chessa abt sa iya sakit yas bigla nagsulpot si doc isma
Naa nau duty
Why? Cuz maki engage si doc isma
Doctors’ arguments: they were just passing by the ER for lunch
These doctors ordered and x-ray, gave medication and recommended care to the patient is already and implied physician-patient relationship.
Hindi kailangan na siya talag ang attending physician.
Neglect of Duty
breach of the standard of care/improper performance expected of other similarly trained medical professionals acting under the same circumstances
BREACH
BORROMEO V. FAMILY CARE HOSPITAL
Borromeo’s wife was sent to the hospital for acute appendicitis
Post-op, patient had low blood pressure and was unresponsive to blood transfusion and IV infusion
Patient became restless and pale and then died (hemorrhage due to disseminated intravascular coagulation is the COD)
Issue: Is there negligence?
SC verdict: NO MEDICAL MALPRACTICE (the death was due to a medical disorder)
no proof that the doctor fell short of the expected standard required under the circumstances
Direcy result of doctors breach
Injury
testimony of an expert witness
Doctrine of res ipsa loquitur
Injury
Doctrine of
(‘the thing speaks for itself”):
res ipsa loquitur
Doctrine of res ipsa loquitur (‘the thing speaks for itself”): if availed, the need for expert witnesses is dispensed with
Obvious na may injury.
It REQUIRES a testimony form expert witness.
Injury
special knowledge experience and practical training that qualify him/her to explain highly technical medical matters to the Court.
EXPERT WITNESS TESTIMONY
Ramos v. CA: the expert witness, who is a pulmonologist, not qualified to testify on the field of anesthesiology
EXPERT WITNESS TESTIMONY
Dapat anesthesiologist
Cereno v. CA: The Court excluded the testimony of an expert witness whose specialty was anesthesiology, and concluded that an anesthesiologist cannot be considered an expert in the field of surgery or even in surgical practices and diagnosis.
Expert witness testimony
Dapat surgeon
allows the mere existence of an injury to justify a presumption of negligence on the part of the person who controls the instrument causing the injury
RES IPSA LOQUITUR
RES IPSA LOQUITUR elements
- The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence;
- It is caused by an instrumentality within the exclusive control of the defendant or defendants;
- The possibility of contributing conduct would make the plaintiff responsible is eliminated.
CANTRE V. GO
Injury in left arm of a woman after giving birth
Wound was caused by constant taking of blood pressure: forgot to deflate the BP cuff after use
Wound is not an ordinary occurrence after childbirth Sphygmomanometer is under the supervision of the physician
Wound was outside the control of the mother
Res ipsa loquitor
Gloves naiwan and nah cause injury
Res ipsa loquitur
BATIQUIN V. CA
A piece of a rubber glove was left on the patient’s uterus after giving birth
Patient became feverish, pale, and breathing fast plus with an infection in the abdominal cavity
After another surgery, the ovaries were infected and had to be removed
Res ipsa loquitur
• Objects left in the patient’s body at the time of surgery
• Sponge left in abdomen (Armstrong v. Wallace)
• Broken needle left in the abdomen during cholecystectomy (Hohenthal v.
Smith)
• Rubber drain left in the breast (Evan v. Munro)
RES IPSA LOQUITUR IN AMERICAN
JURISPRUDENCE
Injury to a healthy part of the body
• Fracture of the maxilla and knocked-out tooth during tonsillectomy (Brown v. Shortilledge)
• Child’s uvula removed during tonsillectomy (Thomsen v. Burgeson)
RES IPSA LOQUITUR IN AMERICAN
JURISPRUDENCE
• Infection from unsterilized instruments
• Gonorrhea (Helland v. Brindestine)
• Fatal abscess following dental extraction (Barham v. Biding)
RES IPSA LOOUITUR IN AMERICAN
JURISPRUDENCE
Removal of the wrong part of the body when another part was intended: removal of the wrong tooth (Griffin v. Norman)
RES IPSA LOOUITUR IN AMERICAN
JURISPRUDENCE
(TAHBSO).
Total
Abdominal
Hysterectomy and
Bilateral
Salpingo-
Oophorectomy
‘the cause which produces the injury and without which the result would not have occurred’
PROXIMATE CAUSE
The breach committed by the physician is the direct cause of your injury.
Proximate cause
Issue: Whether the proximate cause of the deaths was the overturning of the bus or the fire that burned the bus
The proximate cause is the overturning
Dili man mangadto ang mga rescuers carrying a light torch kung wala nag overturn ang bus in the first place.
the operating surgeon is the person in complete charge of the surgery room and all personnel connected with the
oneration
CAPTAIN OF THE SHIP DOCTRINE
Kung kinsa ang captain of the ship, masali gid sila if may kaso
CAPTAIN OF THE SHIP DOCTRINE
PROFESSIONAL SERVICES INC. V. AGANA
patient was rushed to the hospital wherein a doctor diagnosed her to be suffering from cancer of the sigmoid and the cancer has spread to the ovary
Surgeon performed anterior resection and hysterectomy
decided to close the incision despite the fact that the attending nurses informed him that there were missing gauzes
Patient complained of pain in the anal region and 2 pieces of
gauze were extracted from her vagina
The surgeon was held liable
Captain of the ship doctrine
Maski wala sala si surgeon, kay kasali gyapon siya kay siya naga lead
An act of voluntary agreement between two parties
CONSENT
CONSENT (2)
IMPLIED CONSENT
EXPRESSED CONSENT
Written or oral
Expressed consent
‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without the patient’s consent commits an assault, for which he is liable in damages.
THE DOCTRINE OF INFORMED CONSENT
This is true, except in cases of medical emergency, where the patient is unconscious, and where it is necessarv to operate before consent can be obtained!
(Schloendorff vs. Society of New York Hospitals)
THE DOCTRINE OF INFORMED CONSENT
“the patient’s right of self-decision can only be effectively exercised if the patient possesses adequate information to enable him in making an intelligent choice” (Li v. Spouses Soliman)
THE DOCTRINE OF INFORMED CONSENT
“the scope of disclosure is premised on the fact that patients ordinarilv are persons unlearned in the medical sciences”
(Li v. Spouses Soliman)
THE DOCTRINE OF INFORMED CONSENT
Always inform the procedure to the patients
THE DOCTRINE OF INFORMED CONSENT
COMPONENTS OF INFORMED CONSENT
Disclosure
Capacity
Voluntariness
refers to the communication of relevant information by the
clinician and its comprehension by the patient.
Disclosure
refers to the patient’s ability to understand the information
and to appreciate those consequences of his or her decision that might reasonably be foreseen.
Capacity
refers to the patient’s right to come to a decision freely, without force, coercion, or manipulation.
Voluntariness
WHAT SHOULD BE EXPLAINED TO PATIENTS?
Nature of the procedure
Risk/s of the procedure
Alternative/s to the procedure
Expected benefits of the procedure
Potential consequences of not doing anything
IN CASE THE PATIENT IS INCAPABLE OF GIVING CONSENT…
Spouse
Son or daughter of legal age
Either parent
Brother or sister of legal age
Guardian
INSTANCES WHEN CONSENT MAY NOT BE NECESSARY
In cases of emergency
When the law made it compulsory for everyone to submit to the procedure
• “If the patient is unconscious or incapable of giving consent and there is no one who can give consent in his behalf, the physician can perform any medical procedure…without consent.” (Pratt V. Davis)
• “There was valid consent because there had been no time to discuss in full the various risks in such an acute emergency.” (Crouch v. Most)
No consent needed
Note: If the patient is in full possession of his mental faculties or someone who could act in his behalf is present,_____ must be obtained in spite of the existence of an emergency.
consent
• People v. Abad Lopez: a father was found guilty of a crime after not presenting his twin children to vaccination
When the law made it compulsory for everyone to submit to the procedure
Intentionally not disclosing information to a patient or surrogate is legal in situations of emergency or when patients waive their right to be informed
INTENTIONAL NONDISCLOSURE
if physicians believe “divulging the information would potentially harm a depressed, emotionally drained, or unstable patient”
use of placebos when used properly during experimental research
if the research is relatively risk-free to the participants and when the nature of the research is behavioral or psychological and disclosure might seriously skew the outcomes of the research
INTENTIONAL NONDISCLOSURE
Autonomy vs. beneficence
HOME AGAINST MEDICAL ADVICE (HAMA)
A prudent and reasonable physician will not leave the patient at the mercy of a layman’s decision (provide medication plans and follow-up visits)
HOME AGAINST MEDICAL ADVICE (HAMA)
‘There is no expectation from doctors that they track down each patient who apparently missed their appointments or force them to comply with their directives. After all, a person is still the master of his own body.’
HAMA
only allowed in cases if ang patient is prisoner.
Detained or convicted prisoner; with a very contagious disease; mentally-ill
PATIENT DETENTION
….if the patient cannot pay the hospital or physicians bill, the law provides a remedy for them to pursue, that is, by filing the necessary suit in court for the recovery of such fee or bill’
PATIENT DETENTION
„.if the patient is prevented from leaving the hospital for
his inability to pay the bill, any person who can act on his behalf can apply in court for the issuance of the writ of habeas corpus’ (MDH vs. Chua)
Patient detention
Prohibits patient detention on the grounds of non-payment of hospital bills
Requires execution of a promissory note covering the unpaid obligation
HOWEVER.patients in private rooms are NOT covered by this act
RA 9439
The patient has the right to privacy and protection from unwarranted publicity.
Disclosure of confidential information
PATIENT CONFIDENTIALITY
Patient condition is in controversy in a court litigation
When public health or safety demands
With patient consent
Patient’s condition is discussed in a scientific forum
PATIENT CONFIDENTIALITY
Result of the evaluation of the nature and extent of the disease, administration of treatment and
procedures
Itemized bill of the hospital and medical services
Continuing health care requirements following discharge
Medical record
RIGHT TO INFORMATION
Express complaints and grievances without fear of discrimination
RIGHT TO EXPRESS GRIEVANCES
Right to refuse medical treatment or procedures which may be contrary to religious beliefs
RIGHT TO RELIGIOUS BELIEF
No discrimination
Good quality of service
RIGHT TO QUALITY CARE AND HUMANE TREATMENT
