Ethical theories and HPCSA Flashcards
What is medical ethics?
The six principles of Medical Ethics
- Beneficence - To act in the best interest of the patient.
- Non-malfeasance - Do no harm
- Autonomy - The patient right to refuse or choose (consent)
- Justice - Who gets what treatment on the merit of illness
- Dignity - Patient and doctor both have the right to dignity
- Truthfulness/honesty - The patient deserves to know the whole truth about the illness and treatment
The case of the forced rectal exam
Since 2011, in at least eight countries, medical personnel have participated in forced anal examinations of men and transgender women who are charged with consensual same-sex conduct.
The UN Special Rapporteur on Torture and other Forms of Cruel, Inhuman and Degrading Treatment has described forced anal examinations as a form of torture or cruel, inhuman, and degrading treatment that is “medically worthless”
Furthermore, the Independent Forensic Experts Group, composed of forensic medicine specialists from around the world, has determined that “the examination has no value in detecting abnormalities in anal sphincter tone that can be reliably attributed to consensual anal intercourse”.
The WMA is deeply disturbed by the complicity of medical personnel in these non-voluntary and unscientific examinations, including the preparation of medical reports that are used in trials to convict men and transgender women of consensual same-sex conduct.
Although some medical personnel argues that accused persons provide “consent” for such exams, the ability of persons in custody to provide free and informed consent is limited. Even when consent is given freely, medical personnel should refrain from undertaking procedures that are medically worthless, discriminatory, and potentially incriminating
The South African Medical Association has proposed a resolution that calls on doctors to stop conducting these forced anal exams.
with the support of Human Rights Watch, this resolution has been through a year-long review and feedback process, allowing all members to comment in advance
the World Medical Association then added their voice and called on national medical associations to issue written communications prohibiting their members from participating in them, and to educate doctors and health workers about “the unscientific and futile nature of forced anal exams and the fact that they are a form of torture or cruel, inhuman and degrading treatment.” It also calls on the World Health Organization to make an official statement opposing forced anal exams as unscientific and in violation of medical ethics, which would build on an existing reference that condemns the practice.
WHO published existing reference that condemns this practice in their Gender Equity and Human Rights. FAQ on Health and Sexual Diversity. An introduction to key concepts report.
WMA published physicians pledge calling on doctors to refrain from discrimination on a number of grounds, including sexual orientation –> which reads as follows:
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
WMA Resolution on Prohibition of Forced Anal Examinations to Substantiate Same-Sex Sexual Activity.
- Adopted by the 68th General Assembly, Chicago, United States, October 2017
- The World Medical Association’s 1975 Declaration of Tokyo strictly forbids medical personnel from engaging in acts of torture or other forms of cruel, inhuman, or degrading treatment and requires them to respect the confidentiality of medical information.
- In addition, the United Nations’ “Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment” prohibits health personnel from “participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment.”
Jacobson v. Massachusetts, 197 U.S. 11 (1905) (vaccination)
The defendant claimed that the state’s compulsory smallpox vaccination law was unreasonable, arbitrary and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as he or she seems best; and that the execution of such a law against one who objects to vaccination, no matter for what reason, is nothing short of an assault upon his person
This argument was denied by the court
the liberty/freedom secured by the Constitution (of the USA in this case) does not import an absolute right in each person to be, at all times and in all circumstances, wholly free from restraint
“The possession and enjoyment of all rights are subject to such reasonable conditions as may be deemed by the governing authority of the country essential to safety, health, peace, good order, and morals of the community. Even liberty itself, the greatest of all rights, is not unrestricted license to act according to one’s will …”
Buck v. Bell, 274 U.S. 200 (1927) (sterilization)
the issue, in this case, was the constitutionality of a statute that authorized selective sterilization of mental incompetents
The Plaintiff, Carrie Buck, was the daughter of a “feeble-minded mother . . . and the mother of an illegitimate feeble-minded child.“’
The court that originally issued the sterilization order found that she was:
“ ‘the probable potential parent of socially inadequate offspring, likewise afflicted, that she [could be] sexually sterilized without detriment to her general health and that her welfare and that of society [would be] promoted by her sterilization.’
Carrie Buck urged the Court that the statute was unconstitutional because it violated her “right of bodily integrity and denied her equal protection of the laws
Judge Holmes was unpersuaded and stated that:
“We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned… The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes…
The four principles of ethics
- Non-Malefence
- Beneficence
- Autonomy
- Justice
Non-malefecence
Non-maleficence is the main basis for medical decisions it means not harming.
It’s basically on the notion that it is more important not to harm than to do good
now this may seem odd at first because you think it will be better to do good than No Harm. Well, yes ideally but in the real world this doesn’t happen so the principle is applied to limit the chances of a doctor using their enthusiasm and or opinion of treatments without adequate research possibly harming the patient
Beneficence
Beneficence is where a doctor should act in the best interest of the patient.
It means benefiting or doing good.
it involves balancing the benefits of treatment against the risks and costs of the treatment
how? in short both beneficence( doing good) and nonmaleficence (not harming) work together to achieve this balance.
Autonomy
Autonomy is where the patient has the right to refuse medical treatment or choose a medical treatment.
The choice can be based on one’s own personal interest which may not be based on the benefits of the medical treatment itself.
Autonomy perfectly complements non-maleficence and beneficence:
How and why?
= before the Ethical principle of autonomy non-maleficence and beneficence allowed only a paternalistic approach in other words these two principles non-maleficence and beneficence alone are physician based
= physcian based is where the doctor alone makes the Decisions of what are in the best interest of their patients and basically the patient have no say but this autonomy means that the patient does have a right to choose to or not to be treated.
Justice
Justice is where patients are treated impartially without bias on account of gender race sexuality wealth and etc
in the medical field it usually refers to distributive justice in other words Justice usually Focuses on who gets medical treatment with specific scarce medical resources.
E.g dialysis
Three perspectives to ethics as shown by the Ethical decision making model summary
- Bowens model for Strategic decision-making
- Tares ethical Persuasion
- Potter’s box for decision making
Bowens model for Strategic decision-making
- Ensure professional is autonomous
- Consider key duties to client and public when making a decision
- Consider ethical questions when communicating the choice
TARES Ethical Persuasion
T - truthfulness of the message A - authenticity of the persuader R - respect for the persuader E - equity of the persuasive appeal S - social responsibility for the common good
