Ethics And Law Flashcards
Dr. Gyedu is an oncologist treating Mr. Obeng, a 70-year-old patient with advanced, terminal cancer. Mr. Obeng’s prognosis is poor, with an estimated three months to live despite aggressive treatment. He is in significant pain and has expressed a desire to end his suffering. Mr. Obeng asks Dr. Gyedu to help him die peacefully by prescribing a lethal dose of medication.
What will you do as a Doctor?
Case 1- you’ll do it cause the patient has autonomy and mental capacity for it
If he isn’t mentally stable or doesn’t have the mental capacity to make such a decision, From an ethical standpoint, the best course of action for Dr. Gyedu, given that Mr. Obeng is not mentally stable to make an informed decision about ending his life, involves several key principles of medical ethics:
1. Beneficence: Focus on actions that promote the well-being of the patient. Providing effective palliative care to alleviate pain and suffering is paramount. 2. Non-maleficence: Avoid causing harm to the patient. This means not taking any actions that could intentionally end Mr. Obeng’s life, as he cannot give informed consent. 3. Respect for Autonomy: While respecting autonomy is critical, this principle is limited when a patient lacks the capacity to make informed decisions. In such cases, advance directives or previously expressed wishes should be considered, if available. 4. Justice: Ensure fair and equitable treatment. This includes providing Mr. Obeng with the same quality of care and consideration as any other patient in similar circumstances. 5. Professional Integrity: Maintain the integrity of the medical profession by adhering to legal and ethical standards. Physician-assisted dying or euthanasia is illegal in many jurisdictions and goes against the principles of many medical ethical guidelines.
Eunice, a 14-year-old girl, walks into a pharmacy and approaches Dr. Ahmed, the pharmacist on duty. She asks to buy a pack of condoms. Dr. Ahmed is aware that Eunice is a minor and he also understands the importance of promoting safe sex practices to prevent unwanted pregnancies and sexually transmitted infections (STIs).
What will you do?
Given this clarification, here’s how Dr. Ahmed should handle the situation using bioethical principles:
- Autonomy: Acknowledge Eunice’s right to make decisions about her own health, even as a minor. Respect her privacy and ability to seek contraception.
- Beneficence: Ensure Eunice’s best interests by providing access to condoms to help prevent STIs and unwanted pregnancies.
- Non-maleficence: Avoid harm by ensuring Eunice understands how to properly use condoms to prevent misuse.
- Confidentiality: Maintain Eunice’s privacy to build trust and encourage her to seek help and advice without fear of judgment.
- Justice: Ensure Eunice has equal access to health resources, including condoms, without discrimination based on age.
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Assess Understanding and Provide Education:
- Engage Eunice in a respectful, non-judgmental conversation. Ask if she understands how to use condoms and provide clear, age-appropriate information about safe sex practices, including the correct use of condoms and the importance of preventing STIs and unwanted pregnancies.
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Provide the Condoms:
- If Eunice demonstrates an understanding of how to use condoms and the importance of safe sex, provide her with the condoms. This action aligns with promoting her health and preventing potential harm.
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Offer Additional Resources:
- Provide Eunice with resources such as brochures or information about local sexual health clinics where she can get further advice and support. Encourage her to speak with a trusted adult or healthcare provider if she feels comfortable doing so.
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Maintain Confidentiality:
- Ensure the conversation and transaction are conducted privately to protect Eunice’s confidentiality, helping her feel safe and supported.
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Follow Legal and Professional Guidelines:
- Be aware of and adhere to local laws and pharmacy policies regarding the sale of condoms to minors. Ensure that actions are in compliance with legal and ethical standards.
By following these steps, Dr. Ahmed can responsibly support Eunice’s health and safety, respect her autonomy, and provide her with the necessary tools and knowledge to engage in safe sexual practices. This approach balances ethical principles and promotes a supportive, non-judgmental environment for Eunice.
What is the term given to the study of morality ??
What is the term given to a set of moral standards and a code for behaviour that govern an individual’s interactions with other individuals and within society.
Ethics is the study of morality. It is a set of moral standards and a code for behaviour that govern an individual’s interactions with other individuals and within society.
It involves the careful and systematic reflection on and analysis of moral decisions and behaviour, whether past, present or future
What is morality
Morality is the value dimension of human decision-making and behaviour.
Morality refers to the principles and values that determine what is considered right and wrong behaviour.
The language of morality includes nouns such as ‘rights’, ‘responsibilities’ and ‘virtues’ and adjectives such as ‘good’ and ‘bad’ (or ‘evil’), ‘right’ and ‘wrong’, ‘just’ and ‘unjust’.
What’s the difference between morality and ethics
Ethics is primarily a matter of knowing whereas morality is a matter of doing.
“Morality’ is what people do in fact believe to be right and good, while ‘Ethics’ is a critical reflection about morality and the rational analysis of it.”
For example; “Should I terminate pregnancy?” is a moral question, whereas “How should I go about deciding?” is an ethical concern.
What is bioethics
State the three components of bioethics
What is medical ethics
Bioethics is a field of applied ethics that deals with ethical issues arising from biological and medical sciences.
Components of Bioethics:
Medical ethics: Physician centered
Clinical ethics: Hospital care decisions with aid of committees and consultants
Health Care Ethics: nurses & other healthcare professionals
Medical Ethics describes the moral principles by which a Doctor must conduct themselves.
Medical ethics focuses primarily on issues arising out of the practice of medicine.
Medical ethics is a set of moral principles that a doctor works with
Law and Ethics:
Laws are mandatory rules to which all citizens must adhere or risk civil or criminal liability. Ethics often relate to morals and set forth universal goals that we try to meet.
However, there is no temporal penalty for failing to meet the goals as there is apt to be in law.
Laws to some extend has been a driving force in shaping our ethics.
True or false
What is the Nuremberg code
True
Laws come with sanctions.
Civil laws- between individuals
Criminal- between state and individual and needs custodian centers such as prison
Nuremberg Code 1948
• In 1946, 23 Nazi defendants were tried for war crimes and crimes against humanity hence the Nuremberg Code
Some components of the code are:
1.Requirement for voluntary participation in research
2. Informed consent
3. Favorable risk/benefit analysis: Risk vs. Benefit:
• The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.
4. Right to withdraw without penalty; Right to Withdraw:
• During the course of the experiment, the human subject should be at liberty to bring the experiment to an end if they have reached the physical or mental state where continuation of the experiment seems to them to be impossible.
5.Termination of Experiment:
• During the course of the experiment, the scientist in charge must be prepared to terminate the experiment at any stage if they have probable cause to believe, in the exercise of the good faith, superior skill, and careful judgment required of them, that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject
Experiments Should be conducted by skilled people and in proper facilities
What’s the relationship between law and bioethics
Both :
Are Case-based (casuistic)
Have existed from ancient times
Change over time
Strives for consistency
Incorporates societal values
Form the Basis for healthcare policies
Only law:
1.Has Some unchangeable directives:example Constitutions often have entrenched provisions that are difficult to amend. Another example is that Legal systems have formal processes for changing laws, often requiring significant consensus (e.g., legislative supermajorities, referenda). This makes some legal principles relatively unchangeable
2.Has Formal rules for process
3.Is Adversarial: In law, “adversarial” refers to a legal system or process in which two opposing parties present their cases to an impartial judge or jury
Only bioethics:
1.Relies heavily on individual values
2.Is Interpretable by medical personnel
3.Has the Ability to respond relatively rapidly to changing environment
How was bioethics developed
It is traceable to three
(3) different but interrelated events:
A set of unpleasant events (“scandals”) in the history of biomedical research
• advancement in medical technology
• the civil rights movement
How bioethics is developed;
Scandals- Example is the Nazis. Humans were dehumanized for research leading to nuremburg code something something
Civil rights movement- tuskegee syphilis study conducted on blacks.
The Tuskegee Syphilis Study, also known as the Tuskegee Syphilis Experiment, was a notorious clinical study conducted between 1932 and 1972 by the United States Public Health Service (USPHS). The study aimed to observe the natural progression of untreated syphilis in African American men under the guise of receiving free health care from the government.
Key Points:
- Background: The study began in 1932 in Tuskegee, Alabama, involving 600 African American men, 399 of whom had latent syphilis and 201 who did not have the disease. The men were mostly poor and illiterate sharecroppers.
- Misleading Participants: The participants were misled and were not informed of their diagnosis. Instead, they were told they were being treated for “bad blood,” a term that could refer to various ailments including syphilis, anemia, and fatigue.
- Lack of Treatment: Even after penicillin became the standard treatment for syphilis by 1947, the men were deliberately not treated with the antibiotic. The study continued without their informed consent, and they were subjected to painful and invasive procedures.
- Ethical Violations: The study was conducted without the informed consent of the participants, violating ethical standards and human rights. The men were not given adequate information about their condition or the true nature of the study.
- Exposure and Termination: The study was exposed in 1972 by a whistleblower named Peter Buxtun, leading to public outrage and its subsequent termination. By the time the study ended, many participants had died from syphilis or its complications, and others had infected their wives and children.
- Aftermath: In 1973, a class-action lawsuit was filed on behalf of the study participants and their families, resulting in a $10 million settlement. In 1997, President Bill Clinton formally apologized on behalf of the United States to the survivors of the study and their families.
- Impact on Ethics: The Tuskegee Syphilis Study had profound effects on medical ethics and research practices in the United States. It led to the establishment of the National Research Act in 1974 and the creation of the Office for Human Research Protections (OHRP). Institutional Review Boards (IRBs) were also mandated to oversee and approve the ethics of research involving human subjects.
The Tuskegee Syphilis Study remains a powerful reminder of the importance of ethical standards in medical research and the need to protect vulnerable populations from exploitation.
State three importance of medical ethics
The study of ethics prepares medical students to recognize difficult situations and to deal with them in a rational and principled manner.
Ethics is important in physicians’ interactions with society and their colleagues
The conduct of medical research in a way that serves interests of individuals, groups and/or society
Celsius believed in the first century that
What happened in the willbrook hepatitis study
Experience
“it is not cruel to inflict on a few criminals suffering which may benefit’s multitudes of
people through all centuries.”
-Celsius, a 1st century Roman historian
1950 Willowbrook
Hepatitis Study
• Children and adolescents with disabilities were deliberately exposed to the
hepatitts virus in order to discover a way of preventing the disease.
• New admission into the institution was closed.
• Parents of children on the waiting list were written to inform them that their children could be placed on a
research ward after which they could be
transferred to the facility.
• Researchers claimed they obtained consent from the parents and that various committees had reviewed and approved the study;
Who introduced use of written contract to confirm informed consent
Read also on pfizer study in northern nigerian
In 1796, Edward Jenner conducted his famous chickenpox vaccination using children and included his own as well.
• in 1900 a US surgeon general used 22 Spanish
immigrant workers in Cuba to prove that mosquitoes transmitted yellow fever.
• He introduced use of healthy participants in research and use of written contract to confirm informed consent.
Major Walter Reed, a U.S. Army physician, who is indeed a significant figure in the history of informed consent. In 1900, during his work on yellow fever in Cuba, Reed and his colleagues introduced the use of written contracts to obtain informed consent from research participants. This was a pioneering step in formalizing the process of informed consent in medical research
State four experiments the nazis did
German Nazi War Experimentation
• Sulfanilamide experiments
• Poison experiments
• Sterilization experiments
• Mustard gas experiments
• Freezing experiments
• Human twin studies
Who wasthe first person to use the expression,medical ethics
The WMA updated the Hippocratic Oath for 20th century use (First task)
The result was the Declaration of Geneva, adopted at the WMA’s 2nd General Assembly in 1948.
True or false
Percival was the first person to use the expression medical ethics
Thomas Percival (1740–1804), a physician from Manchester, England
Introduced it in his eponymous book Medical Ethics (Percival 1803b) as a description of the professional duties of physicians and surgeons to their patients, to their fellow practitioners, and to the public
Most historians treat the history of medical ethics as coextensive with the history of medicine.
The WMA updated the Hippocratic Oath for 20th century use (First task)
The result was the Declaration of Geneva, adopted at the WMA’s 2nd General Assembly in 1948.
Declaration of Geneva (1948):
• The Declaration of Geneva, adopted by the World Medical Association (WMA) in 1948, is a modern version of the Hippocratic Oath. It outlines ethical principles for physicians, emphasizing their commitment to patient care, confidentiality, respect for patients’ autonomy, and the importance of professional integrity.
After WMA updated the Hippocratic oath as the first task, what was the second task?
The second task was the development of an International Code of Medical Ethics, which was adopted at the 3rd General Assembly in 1949.
The next task was to develop ethical guidelines for research on human subjects.
The guidelines were adopted as the Declaration of Helsinki in 1964.
The WMA has adopted policy statements on more than 100 specific issues
Declaration of Helsinki (1964, with revisions):
• The Declaration of Helsinki is a set of ethical principles for medical research involving human subjects. First adopted by the WMA in 1964 and revised several times (most recently in 2013), it provides guidelines on issues such as informed consent, protection of vulnerable populations, research protocols, and the ethical responsibilities of researchers.
