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.
-
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.
-
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.
-
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.
-
Maintain Confidentiality:
- Ensure the conversation and transaction are conducted privately to protect Eunice’s confidentiality, helping her feel safe and supported.
-
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 (how to go about something) 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
In the 1950 Willowbrook Hepatitis Study…
a. new admissions were closed.
b. children were not deliberately exposed to hepatitis viruses.
c. researchers obtained consent from the parents.
d. approval was given by the committee in charge.
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;
Answer is c. Researchers did obtain consent from the parents, but it was controversial because parents were pressured to give consent in exchange for their children being admitted to the overcrowded institution.
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.
State six ethical theories
Consequentialism
Deontology
Utilitarianism
Virtue ethics
Communitarianism
Principlism
These are ethical theories that guide decision-making in moral dilemmas. Here’s a concise breakdown:
1. Consequentialism – Judges actions based on their outcomes. If the consequences are good, the action is morally right.
• Example: Lying is acceptable if it saves a life.
2. Deontology – Focuses on duties and rules rather than consequences. Actions are right or wrong based on set moral principles.
• Example: Lying is wrong, even if it saves a life, because honesty is a duty.
3. Utilitarianism – A type of consequentialism that seeks the greatest good for the greatest number.
• Example: Sacrificing one person to save many is justified.
4. Virtue Ethics – Focuses on the character of the person rather than rules or consequences. Encourages moral virtues like honesty, courage, and kindness.
• Example: A good doctor should cultivate compassion, not just follow rules.
5. Communitarianism – Emphasizes the importance of community values and social good over individual rights.
• Example: Vaccination is necessary because it benefits society, even if some individuals object.
6. Principlism – Uses four key ethical principles (autonomy, beneficence, non-maleficence, and justice) to guide decisions.
• Example: A doctor respects a patient’s choice (autonomy) while ensuring no harm (non-maleficence).
Would you like a more detailed comparison or application in healthcare ethics?
What is deontology
Explain the Two Major Deontological Theories
Deontology:these are the rules and you must follow them no matter what
This involves a search for well-founded rules that can serve as the basis for making moral decisions. It provides a framework for ethical decision-making based on adherence to rules, duties, and principles.
It emphasizes the intrinsic morality of actions, respect for individuals, and consistency in ethical judgments.
Two Major Deontological Theories (Kantian & Command Theories)
Kantian Theory, Immanuel Kant (1724-1804):
The concept of the categorical imperative – principle that one must follow, regardless of desires or extenuating circumstances.
Certainly! Deontological ethics, which focuses on duties, rules, and principles, includes several major theories. Here are explanations for Kantian ethics and divine command theory:
1. Kantian Ethics (Immanuel Kant, 1724-1804): Kantian ethics is founded on the philosophical ideas of Immanuel Kant. The central concept is the categorical imperative, which is a principle that directs actions regardless of desires or circumstances. According to Kant, the morality of an action depends not on its consequences but on whether it conforms to a principle that could be universally applied. This principle ensures consistency and fairness in moral reasoning, emphasizing duty, respect for others, and the intrinsic value of moral actions themselves. 2. Divine Command Theory: Divine command theory holds that an action’s morality is determined by whether it aligns with the commands or will of a divine being or beings. In this theory, moral obligations are seen as stemming from divine authority, such as God’s commands or scriptures. Actions are morally right if they conform to divine commands and wrong if they violate them, irrespective of their consequences or other considerations.
These two deontological theories provide different perspectives on moral decision-making: Kantian ethics emphasizes rationality, universalizability of moral principles, and respect for persons as autonomous agents, while divine command theory grounds morality in religious authority and obedience to divine commands. Both theories offer structured frameworks for evaluating ethical dilemmas
Certainly! Here’s another clinical scenario where Kantian ethics could be applied:
Scenario: A medical student is on rotation in a hospital and witnesses a senior resident making disparaging remarks about a patient’s cultural background in front of the medical team. The remarks are offensive and derogatory, potentially impacting patient care and team dynamics.
Application of Kantian Ethics:
- Universalizability: The medical student considers whether it would be morally acceptable for all healthcare professionals to make derogatory remarks about patients based on cultural background. Kantian ethics would argue against such behavior, as it undermines the dignity and respect owed to all individuals, regardless of cultural differences.
- Respect for Persons: Kantian ethics emphasizes treating individuals as ends in themselves, not as means to an end. Making derogatory remarks about a patient based on cultural background violates this principle by disregarding the patient’s inherent dignity and worth.
- Duty to Act Ethically: The medical student has a duty to uphold ethical standards in patient care and professional conduct. Kantian ethics would guide the student to speak up against the senior resident’s behavior, as it aligns with the duty to prevent harm, promote respect for patients, and maintain professional integrity.
- Consistency and Moral Principles: By adhering to Kantian principles, the medical student can advocate for a respectful and inclusive healthcare environment where all patients are treated with dignity and healthcare professionals uphold moral duties to act ethically and responsibly.
In this scenario, Kantian ethics helps the medical student navigate the ethical dilemma of witnessing inappropriate behavior and guides them in taking actions that uphold respect for patients and ethical standards in healthcare practice.
Command Theory:
This approach asserts that moral duties are derived from the commands of a divine being. Certain actions are morally obligatory, forbidden, or permissible based on God’s will or decrees.
Eg., “Treat all people as equals.”
Religious (for example, the belief that all God’s human creatures are equal)
Non-religious (for example, human beings share almost all of the same genes).
Certainly! Here’s another clinical scenario where aspects of Divine Command Theory could be relevant:
Scenario: A physician is consulting with a patient who has been diagnosed with a terminal illness and is experiencing severe pain. The patient expresses a desire to explore options for assisted suicide or euthanasia, which are legally prohibited in the physician’s jurisdiction but are supported by the patient’s deeply held religious beliefs.
Application of Divine Command Theory:
- Divine Commands and Moral Decisions: According to Divine Command Theory, the physician must consider whether assisting in suicide or euthanasia aligns with religious principles and divine commands. Some religious beliefs may view the sanctity of life as paramount and prohibit actions that intentionally end life, even in cases of terminal illness and severe suffering.
- Obedience to Religious Teachings: The physician may believe that respecting the sanctity of life and avoiding actions that directly cause death aligns with divine commands or religious teachings. This belief may guide the physician’s decision-making process, emphasizing the moral prohibition against euthanasia or assisted suicide.
- Ethical Dilemma and Resolution: The physician faces an ethical dilemma between respecting the patient’s autonomy and religious beliefs regarding end-of-life decisions and adhering to legal and professional obligations that prohibit assisted suicide or euthanasia. They may seek ethical guidance from religious authorities, engage in discussions with the patient and their family, and explore palliative care options to alleviate suffering while upholding moral and legal responsibilities.
- Balancing Religious Principles and Patient Care: Divine Command Theory provides a framework for the physician to navigate the complex ethical terrain of end-of-life care, ensuring that decisions respect religious convictions, uphold moral principles, and prioritize compassionate patient care.
In this scenario, Divine Command Theory offers insights into how healthcare providers can approach ethical dilemmas involving conflicting moral obligations, legal constraints, and deeply held religious beliefs regarding life and death decisions.
What is the application of deontology in medical ethics
Applications in Medical Ethics
Confidentiality: Upholding the duty to keep patient information confidential.
Informed Consent: Respecting patients’ autonomy by ensuring they are fully informed and voluntarily consent to treatment.
Truth-Telling: Being honest with patients about their diagnoses and treatment options.
Respect for Persons: Treating all patients with dignity and respect, recognizing their inherent worth.
Explain consequentialism and it’s application to medical ethics
Bases ethical decision-making on an analysis of the likely consequences or outcomes of different choices and actions.
Consequentialism: what are the effects or consequences of the decisions you take?
The right action is the one that produces the best outcomes.
One of the best-known forms of consequentialism, namely utilitarianism, uses ‘utility’ as its measure and defines this as ‘the greatest good for the greatest number’.
Other outcome measures in healthcare decision-making include cost-effectiveness and quality of life.
Applications in Medical Ethics
Resource Allocation, Public Health Policies, End-of-Life Decisions
Eg: A doctor has limited doses of a life-saving drug and must decide how to allocate it among patients.
Consequentialism Applied to End-of-Life Decisions
When applying consequentialist thinking to end-of-life decisions, the focus is on the outcomes of the decisions rather than the actions themselves. Key considerations include:
1. Maximizing Benefit and Minimizing Harm: • Example: Deciding to withdraw life-sustaining treatment because continuing it may prolong suffering without significant benefit. The decision is justified if it leads to a better overall outcome (e.g., relief from suffering). 2. Quality of Life Considerations: • Example: A consequentialist might argue that it’s ethical to forgo aggressive treatment if it significantly diminishes the patient’s quality of life without meaningful improvement, thereby prioritizing comfort and dignity in the final days. 3. Impact on Others: • Example: The consequences for family members and healthcare providers are also considered. If prolonging life causes significant emotional, financial, or psychological burden on loved ones, a consequentialist might argue that allowing a natural death could lead to a better overall outcome. 4. Resource Allocation: • Example: In a utilitarian framework, resources might be allocated to treatments that benefit more people rather than those that prolong the life of one person without significant improvement, especially in cases of limited healthcare resources.
Challenges and Criticisms
• Subjectivity of Outcomes: Predicting outcomes can be difficult and subjective, making it challenging to apply consequentialism consistently. • Conflict with Deontological Ethics: Consequentialism may conflict with deontological ethics, which focus on duties and rights. For instance, some might argue that it’s inherently wrong to withdraw life-sustaining treatment, regardless of the outcome. • Autonomy vs. Consequences: In end-of-life care, respecting patient autonomy is crucial. However, a strict consequentialist approach might prioritize outcomes over the patient’s expressed wishes.
Explain virtue ethics and how it is applied to medical ethics
Focuses less on decision-making and more on the character of decision-makers as reflected in their behaviour.
A virtue is a type of moral excellence. Examples: compassion, honesty, prudence and dedication.
Virtue ethics: depends on who is taking the decisions and the character of the person making the decisions. Upholding virtue ethics supports patient centered care
Physicians who possess these virtues are more likely to make good decisions and to implement them. Even virtuous individuals often are unsure how to act in particular situations and are not immune from making wrong decisions.
Applications in Medical Ethics
Professional Virtues are crucial.
Patient-Centered Care: It supports a patient-centered approach.
Moral Character of Healthcare Providers:
Eg: A doctor faces a situation where telling a patient the full truth about their terminal diagnosis might cause significant distress.
Explain what principlism is and state the Four principles or pillars of medical ethics which is under principlism
Four principles or pillars of medical ethics which is under principlism:
Autonomy
Beneficience
Justice
Non malevolence
It uses ethical principles as the basis for making moral decisions.
“Principles are general guides that leave considerable room for judgment in specific cases and that provide substantive guidance for the development of more detailed rules and policies” (Beauchamp & Childress, 1994).
Applies principles (the four principles of medics ethics which are under principlism) to particular cases or situations in order to determine what is the right thing to do, taking into account both rules and consequences.
What is autonomy?
Which people are an exception to the application of autonomy?
Which three things spring from the principle of autonomy
Autonomy, or more accurately, respect for autonomy, defined as the obligation of doctors to respect the right of individuals to make decisions on their own behalf.
Such respect is not simply a matter of attitude, but a way of acting so as to recognize and even promote the autonomous actions of the patient.
The autonomous person may freely choose loyalties or systems of religious belief that may adversely affect him
The patient must be informed clearly the consequences of his/her action that may affect him adversely.
Desiring to “benefit” the patient, the physician may strongly want to intervene believing it to be a clear “medical benefit.”
But the physician should give greater priority to the respect for patient autonomy than to the other duties.
However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals.
The principle does not extend to persons who lack the capacity (competence) to act autonomously;
examples include infants and children and incompetence due to developmental, mental or physical disorder.
Informed consent, truth-telling, and confidentiality spring from the principle of autonomy.
Explain the components of informed consent as a concept under autonomy
Requirements of an Informed consent for a medical surgical procedure
Or research are that the patient:
a.understand
competent and decide,
b. Receives a full disclosure
с.comprehends the disclosure
d.acts voluntarily, and
е.consents to the proposed
action.
Explain truth telling as a concept under autonomy
Truth-telling is a vital component in a physician-patient relationship; without this component, the physician loses the trust of the patient.
An autonomous patient has not only the right to know (disclosure) of his/her diagnosis and prognosis, but also has the option to forgo this disclosure.
Providing full information, with tact and sensitivity, to patients who want to know should be the standard.
Present the truth in a manner that’s compassionate(truth telling plus virtue ethics)
Explain confidentiality as a concept under autonomy
Healthcare providers are obligated not to disclose confidential information given by a patient to another party without the patient’s authorization.
In the present-day modern hospitals with multiple points of tests and consultants, and the use of electronic medical records, there has been an erosion of confidentiality.
Can be broken in exceptional situations that may cause major harm to another (epidemics of infectious diseases,partner notification in HIV disease, relative notification of certain genetic risks,etc)
What are the exceptions to confidentiality
When ordered by a Judge in a court of law or by a Tribunal established by an act of parliament
When necessary to protect the interests of the patient.
03
When necessary to protect the welfare of
society.
When necessary to safeguard the welfare of another individual or patient.
Explain beneficence
Read the children’s act
The practitioner should act in “the best interest” of the patient - the procedure be provided with the intent of doing good to the patient.
It is the obligation of the healthcare provider to act for the benefit of the patient.
This needs health care provider to:
Develop and maintain skills and knowledge by continually updating training
Consider individual circumstances of all patients
Supports several moral rules to protect and defend the right of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in danger.
Explain non-maleficence
An act or omission by a health care provider that deviates from accepted standards of practice in the medical community which causes injury to the patient is ?
A. Medical negligence
B. Medical malpractice
What is the double effect
Above all, do no harm” – Make sure that the procedure does not harm the patient or others in society
Remember that is Non Maleficence and it is not Maleficence
When interventions undertaken by physicians create a positive outcome while also potentially doing harm it is called the “double effect”
An act or omission by a health care provider that deviates from accepted standards of practice in the medical community which causes injury to the patient is medical malpractice.
(apparently, malpractice is when they now sue the negligent person. If they don’t sue, there’s negligence but once they sue, it becomes malpractice)
Explain Justice as a principle
The distribution of scarce health resources, and the decision of who gets what treatment “fairness and equality”
The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society
Justice- example is knowing who to take off ventilator during COVID issues
This is particularly important and pertinent in difficult end-of-life care decisions on withholding and withdrawing life-sustaining treatment.
What are the five principles of social Justice
Access: financial access, geographical access
Equity: equality is sharing ten cedis equally for ten people. Equity is sharing that ten cedis for ten people but based on those who need it more. So for equality you’re giving each one cedi. Equity is sharing the ten cedis and giving three cedis to one, 50 pesewas to another, 1 cedi to another based on their needs
Diversity: people from different backgrounds
Participation: involving community and patient and relatives
Human Rights
Beneficence and autonomy are conflicting
True or false
True
What are ethical dilemmas
State five situations that you would call ethical dilemmas
An ethical dilemma or ethical paradox or moral dilemma is a problem in the decision-making process between two possible options, neither of which is absolutely acceptable from an ethical perspective
Most ethical problems come with relatively straightforward solutions
Situations :
Allocation of limited resources
End-of-life care
Patient autonomy vs. paternalism
Confidentiality and Privacy
Research with vulnerable populations
Ethical dilemmas are extremely complicated challenges that cannot be easily solved
The ability to find the optimal solution is critical
Nowhere in the arena of ethical decision-making is conflict as pronounced as when the principles of beneficence and autonomy collide.
Certainly! Here are ethical development situations for each of the specified areas:
-
Allocation of Limited Resources:
- Scenario: A hospital is facing a shortage of ventilators during a pandemic. Ethical considerations arise regarding how to fairly allocate limited resources among patients who need them. Healthcare providers must balance principles of distributive justice, maximizing benefits, and prioritizing patients based on clinical need and prognosis.
-
End-of-Life Care:
- Scenario: A terminally ill patient expresses a wish to discontinue life-sustaining treatment and opt for palliative care. Ethical dilemmas involve respecting the patient’s autonomy in decision-making, ensuring adequate pain management, and addressing family dynamics and cultural beliefs surrounding death and dying.
-
Patient Autonomy vs. Paternalism:
- Scenario: A patient refuses a recommended treatment that healthcare providers believe is necessary for their health. Ethical considerations include respecting the patient’s right to make informed decisions (autonomy) while balancing the duty of healthcare professionals to act in the patient’s best interest (beneficence), which may involve paternalistic interventions in cases of incapacity or imminent harm.
-
Confidentiality and Privacy:
- Scenario: A healthcare provider discovers that a teenage patient is engaging in risky behavior (e.g., substance abuse) but has explicitly asked that this information not be shared with their parents. Ethical dilemmas arise concerning maintaining confidentiality to build trust with the patient versus disclosing information to protect their health and safety, especially in cases involving minors.
-
Research with Vulnerable Populations:
- Scenario: Researchers propose a clinical trial involving elderly patients with cognitive impairments. Ethical considerations include ensuring informed consent, minimizing risks, and balancing potential benefits with the vulnerability of the participants. Additional challenges may include addressing power differentials, ensuring equitable access to research benefits, and safeguarding against exploitation.
These scenarios highlight complex ethical issues that healthcare professionals, researchers, and policymakers encounter in their practices. Addressing these dilemmas requires thoughtful consideration of ethical principles, professional guidelines, legal frameworks, and the unique circumstances of each situation to promote ethical development and decision-making in healthcare and research settings.
What’s the difference between ethical obligation and ethical dilemma
“Ethical Obligation”?
An ethical obligation is a required action that must be met
“all things considered.”
Obligations may be strong or weak, or vary from one person to another
“Ethical Dilemma”?
When two or more obligations require mutually exclusive actions
When some evidence suggests that an act is right but other
evidence suggests it is wrong.
“Mutually exclusive” refers to a situation where two or more events or conditions cannot occur at the same time. If one event happens, it rules out the possibility of the other event(s) happening
From diagnosis to bereavement doc must provide what kind of care?
If the disease is incurable, what kind of care must be provided?
If the disease is terminal, what kind of case must be provided
From diagnosis to bereavement doc must provide supportive care
If the disease is incurable, palliative care
If the disease is terminal, end of life care
Palliative Care
• Focuses on relieving pain, symptoms, and stress of a serious illness.
• Can be given at any stage of illness — not just when dying.
• Can be provided alongside curative treatment (e.g., chemo, surgery).
• Goal: Improve quality of life, not necessarily to prolong or end life.
End-of-Life Care
• A type of palliative care, but specific to the final weeks or months of life.
• Given when the illness has no cure and death is near.
• Focus is on comfort, dignity, and emotional support in the last stage of life.
• No curative treatments are given at this point — only comfort care.
What is euthanasia?
What are the four main types
For Med interviews:Euthanasia concepts are common
The word “euthanasia” comes from the Greek words “eu” (good) and “thanatos” (death)
Euthanasia is the practice of ending the life of a patient to limit the patient’s suffering
There are 4 main types of euthanasia:
Active, Passive, Indirect, And Physician-assisted Suicide
Define the four types of euthanasia
Active euthanasia: the direct administration of a lethal substance to the patient by another party with mercifulintent
Passive euthanasia: withholding or withdrawing of life-sustaining treatment either at the request of the patient or when prolonging life is considered futile
Indirect euthanasia refers to the prescription of painkillers that may be fatal in an attempt to relieve suffering.
Indirect euthanasia-you using precisption to reduce pain but the side effect or adverse effect is that it can take patients life
Physician-assisted suicide refers to a medical professional aiding a patient in terminating their life upon the patient’s request.
a physician provides the means or medication that allows a terminally ill patient to end their own life.
• The patient administers the lethal medication themselves, following a prescription and guidance from the physician.
• The physician’s role is to assist the patient in ending their life by providing the means to do so, rather than directly administering the lethal substance.
How to make ethical decisions
1.Determine whether the issue at hand is an ethical one.
- Consult authoritative sources such as medical association codes of ethics and policies and respected colleagues to see how physicians generally deal with such issues.
- Consider alternative solutions in light of the principles and values they uphold and their likely consequences.
- Discuss your proposed solution with those whom it will affect.
- Make your decision and act on it, with sensitivity to others affected
Issue of making a decision concerning good or right or bad but it’s not concerning the law or legalistic-ethical issue or ethical decision making
Whoever will be affected- nurses, relatives, etc
A doctor fails to diagnose a treatable condition, leading to harm. This could be considered a violation of:
a) Duty of care
b) Standard of care
c) Patient autonomy
d) Non-maleficence
Now it’s saying the answer is b wai.
Answer is duty of care.
Yes, harm was caused in both cases, but the key difference is what the question is focusing on:
- When the focus is on the doctor’s responsibility to care for the patient → Duty of Care
• If the doctor completely neglects the patient, refuses treatment, or abandons them, it’s a duty of care issue.
• Example: A doctor refuses to treat a patient in critical condition, leading to their death.
• ✅ Duty of care was violated because the doctor had an obligation to provide care but failed to act at all. - When the focus is on whether the doctor’s actions were medically appropriate → Standard of Care
• If the doctor tried to treat the patient but did it incorrectly or below the accepted medical standard, then it’s a standard of care issue.
• Example: A doctor misdiagnoses a pneumonia patient and prescribes an incorrect antibiotic, leading to complications.
• ✅ Standard of care was violated because the doctor provided treatment, but it was incorrect and did not follow accepted medical guidelines.
But Didn’t the Doctor Also Breach Duty of Care?
Yes! If a doctor fails to meet the standard of care, they often also breach their duty of care. But in exams, if you’re asked to choose between the two:
• Pick “Duty of Care” when the question is about whether the doctor took responsibility for the patient.
• Pick “Standard of Care” when the question is about whether the doctor’s treatment followed proper medical guidelines.
Here are some clear examples to help you differentiate duty of care and standard of care in different scenarios:
🟢 Duty of Care Violations (Failure to Take Responsibility for a Patient)
1. A doctor in the ER refuses to treat a critically ill patient because their shift is ending.
• ✅ Breach of duty of care → The doctor had a responsibility to provide care but abandoned the patient.
2. A physician walks past a collapsed patient in a hospital hallway and does nothing.
• ✅ Breach of duty of care → The doctor ignored a situation where they were expected to help.
3. A surgeon leaves a patient on the operating table mid-surgery to take a personal call, leading to complications.
• ✅ Breach of duty of care → The surgeon had a responsibility to continue the surgery but neglected it.
🟡 Standard of Care Violations (Failure to Follow Medical Guidelines)
4. A doctor misdiagnoses appendicitis as food poisoning and sends the patient home. The appendix ruptures later.
• ✅ Breach of standard of care → The doctor provided care but failed to diagnose and treat correctly.
5. A nurse administers 10 times the normal dose of insulin by mistake, causing severe hypoglycemia.
• ✅ Breach of standard of care → The nurse performed the task but did it in a medically inappropriate way.
6. A doctor prescribes a medication for a heart attack that is known to be dangerous for this condition.
• ✅ Breach of standard of care → The doctor gave treatment, but it was medically incorrect.
🔴 Cases Where Both Are Breached
Sometimes, a case violates both duty of care and standard of care:
7. A doctor refuses to see a patient with chest pain, and when they finally do, they misdiagnose it as acid reflux.
• 🔹 Breach of duty of care (for delaying treatment).
• 🔹 Breach of standard of care (for misdiagnosing and giving incorrect treatment).
• 🚀 If forced to choose one, pick the one the question emphasizes more.
🚀 Quick Trick to Choose
• Ask: “Did the doctor completely ignore their responsibility?” → Duty of care
• Ask: “Did the doctor try to help but do it wrongly?” → Standard of care
Which statement best describes “duty of care” in medicine?
a) Physicians must prioritize financial considerations over patient needs
b) Healthcare providers must ensure the safety and well-being of their patients
c) Doctors are legally required to treat all patients equally, regardless of circumstances
d) Physicians must follow only the policies of their healthcare institutions
Answer is b
I see where you’re coming from! Doctors do have a duty to treat patients fairly, but the key issue with option C is the phrase “regardless of circumstances.”
While duty of care requires fairness, it doesn’t mean equal treatment in all situations—it means appropriate treatment based on the patient’s condition and medical needs.
Why Option C is Incorrect
1. Triage in Emergencies – In an ER, a patient with a heart attack is treated before someone with a minor cut. This isn’t equal treatment, but it follows duty of care by prioritizing urgent cases.
2. Resource Limitations – A doctor in a rural clinic with one ventilator must decide which patient benefits most from it. Treating both “equally” isn’t possible.
3. Legal and Institutional Policies – Some hospitals have specific policies (e.g., specialists treating only certain conditions), meaning doctors aren’t legally required to treat all patients equally.
Why Option B is Correct
“Duty of care” means ensuring that every patient receives safe and appropriate care—which may not always be equal, but should always be fair and ethical.
Sure! Here’s a clearer way to explain it:
Doctors have a duty of care to ensure that every patient receives safe, competent, and appropriate treatment. However, this does not always mean treating all patients equally—it means treating them fairly based on their medical needs.
For example:
• In an emergency, a critically ill patient is treated before someone with a minor injury. This isn’t equal treatment, but it is fair and medically justified.
• A specialist may not be legally required to treat conditions outside their expertise, even if another doctor would.
So, option C is incorrect because “treating all patients equally” ignores real-world medical priorities, while option B correctly defines duty of care as ensuring patient safety and well-being.
Fidelity in healthcare ethics primarily refers to:
a) A physician’s ability to make sound moral decisions
b) A healthcare professional’s commitment to patient welfare and trust
c) The duty to keep medical records secure
d) The requirement to always follow hospital policies
Why isn’t the correct answer C?
Keeping medical records secure is an important ethical duty, but it falls under privacy and confidentiality, not fidelity.
• Fidelity is about a healthcare professional’s loyalty, faithfulness, and commitment to their patient’s well-being and trust.
• Privacy/confidentiality is about protecting patient information from unauthorized access or disclosure.
Key Difference:
• A doctor can keep medical records secure but still break fidelity by not following through on commitments to the patient.
• Fidelity is broader—it covers being truthful, keeping promises, and prioritizing patient trust, not just securing records.
Example of Fidelity Violation:
• A doctor promises to advocate for a patient’s treatment but later neglects to do so.
• A nurse reassures a patient that their pain will be managed, but then ignores their concerns.
Sure! Here’s a clearer explanation:
Why isn’t the correct answer C?
Keeping medical records secure is important, but it falls under privacy and confidentiality, not fidelity.
• Fidelity means being loyal, trustworthy, and committed to the patient’s well-being. It involves keeping promises, acting in the patient’s best interest, and maintaining trust.
• Privacy and confidentiality refer specifically to protecting patient information from unauthorized access or disclosure.
Key Difference:
• A doctor can keep medical records secure but still violate fidelity if they fail to act in the patient’s best interest or break their trust.
• Fidelity is about more than just protecting information—it’s about honoring commitments and prioritizing patient care.
Example of Fidelity Violation:
• A doctor promises to explore all treatment options but doesn’t follow through.
• A nurse reassures a patient that they’ll manage their pain but then ignores their requests.
Would you like me to adjust anything further?
Negligence It may include performing an action incorrectly (commission) as well as failing to take appropriate action (omission).
Explain: Where the practitioner wishes to terminate relationship, there are specific requirements to protect patient’s interests:
1. Noncompliance
2. Nonadherence
3. Obnoxiousbehaviour 4. Disruptivebehaviour
When a healthcare practitioner wants to end a relationship with a patient, they must follow specific steps to ensure the patient’s well-being is not compromised. This prevents patient abandonment, which can lead to legal and ethical issues.
Here’s how each factor plays a role in justifying termination:
1. Noncompliance
• The patient fails to follow medical advice or treatment plans (e.g., refusing essential medications for a chronic condition).
• This can make it difficult for the practitioner to provide effective care.
2. Nonadherence
• The patient misses appointments, does not take prescribed medications, or ignores follow-ups, making proper treatment impossible.
• This differs from noncompliance because it focuses on failure to engage in care rather than refusal to follow advice.
3. Obnoxious Behavior
• The patient is rude, aggressive, or abusive toward the healthcare provider or staff.
• If this behavior makes it difficult to maintain a professional and safe environment, termination may be necessary.
4. Disruptive Behavior
• The patient’s actions interfere with the care of others (e.g., causing disturbances in the clinic or threatening staff).
• This affects the safety and function of the healthcare setting.
How to Properly Terminate the Relationship:
• Provide a written notice explaining the reason.
• Give the patient enough time (usually 30 days) to find another provider.
• Offer referrals to other healthcare professionals.
• Ensure ongoing care for urgent or emergency needs before termination.
Would you like an example of how a practitioner might formally notify a patient?
• Dr. Rowe is a Biomedical Lab Scientist. While writing up a report on the psychiatry unit, one of nurses he knows asks him what he would recommend that her husband try for his “heartburn.” Dr. Rowe recommends that he try an antacid and if that doesn’t work, an acid- reducing medication.
• Later that week, the nurse’s husband goes to emergency with his “heartburn” – tests reveal unstable angina, and he is admitted for treatment.
• Did Dr. Rowe have a duty of care towards the nurse’s husband?
Yes, once you give medical advice, you assume a duty of care, even if you are not a doctor.
Why?
1. Expectation of Expertise – If you are in a healthcare profession, people assume you have knowledge, so your advice carries weight.
2. Influencing Medical Decisions – If your advice leads someone to delay or avoid proper treatment, you can be held responsible.
3. Legal & Ethical Responsibility – Even informal advice can create liability if it causes harm.
Exceptions:
• General health discussions (e.g., “Eating less spicy food may help with heartburn.”)
• Clearly stating “I’m not a doctor, you should see one.”
Key Lesson:
If you give advice that influences someone’s health decisions, you may have a duty of care and can be held accountable if harm occurs.
Why Does It Matter?
The moment advice sounds like a diagnosis or treatment plan, it creates a duty of care, meaning you can be held responsible if it leads to harm.
Dr. Lee is a family physician in a rural community. One of his regular patients, John, comes to see him, complaining of worsening headaches over the last few weeks. Dr. Lee is concerned and is considering whether John should be seen by a neurologist and/or referred for a CT or MRI. The nearest CT, MRI and neurologist is 10 hours drive away. A memo was recently sent out from the regional hospital regarding “unnecessary” referrals for CT’s, MRI’s and specialists.
• What does an adequate standard of care require?
Standard of Care - Locality & Facilities Considerations
• In applying standard of care, the court may consider medical resources (facilities, equipment) available to the practitioner and the type of community in which the practitioner practices.
• Evolving area of law, ethics and policy
• Tension between interests of individual patients and
cost constraints on societal level
• Practitioners are often caught in the middle
• Judicial comments –
• Practitioner’s responsibility to individual patient takes precedence over responsibility to NHIS system
Dr. Lee must prioritize John’s health over cost-saving policies. If a serious neurological condition is suspected, he should refer for imaging or a specialist despite the distance. He must use clinical judgment, explore local alternatives, and document his decision carefully. Courts consider resource limitations, but patient care takes precedence, and failure to act on warning signs could be negligence.
QUALITIES OF AN ‘ETHICAL’
HEALTHCARE PRACTITIONER; (VIRTUE ETHICS);
• Trust
• Respect
• Compassion
• Professionalism
• Empathy
•Capacity for self reflection: you must have the capacity for self regulation. Being a doctor is both a calling (vocation) and a skilled career (profession). It requires dedication to helping others and adherence to high professional standards.
•veracity or truthfulness ; Obfuscation refers to deliberately making information unclear or difficult to understand. In a medical context, this could mean a doctor withholding or complicating information, possibly to avoid distressing the patient. However, this raises ethical concerns, as transparency is essential in patient care. The challenge lies in balancing honesty with compassion when delivering difficult news. The existence of these arguments simply
emphasises that effective medical practice has
to combine veracity with compassion, patience, discernment and good
communication skills.
•fidelity or trustworthiness
•discernment or judgement
MODELS OF DOCTOR (HEALTHCARE
PROFESSIONAL)-PATIENT
RELATIONSHIP:
No single model perfectly defines the ideal healthcare professional-patient relationship, as it varies with context. While different models exist, a combination of them is often needed to address real-life complexities. However, these models can still be useful in specific situations.
The models are in the answer part
The Fiduciary or Trustee Model
• In this model the patient places his body and his health
‘in trust’ with the physician. The physician is morally obligated to act in that patient’s best interests.
• The physician must consider the wishes of the patient but ultimately it is he who must take responsibility for the decision. While there are elements of this model in all professional-patient relationships, it is perhaps best suited to the medical care of an incompetent patient.
• It also applies where the patient requests that the physician (assuming he accepts the responsibility) make the decision for him.
Fiduciary refers to a relationship based on trust, where one party (the fiduciary) has a duty to act in the best interest of another party.
In healthcare, a doctor has a fiduciary duty to their patient, meaning they must prioritize the patient’s well-being, act with honesty, and avoid conflicts of interest.
The Priestly Model
• This represents the traditional paternalistic doctor-patient relationship, its main ethical principle is “benefit and do no harm to the patient”, which takes precedence over the patient’s autonomy.
• It is a paternalistic model that ascribes a religious or spiritual authority to the doctor and creates an unbalanced ethical situation that devalues individual freedom and dignity, truth-telling, promise-keeping and justice.
• It enhances the doctor’s power at the expense of the patient, and tends to focus on the patient’s medical needs to the exclusion of other considerations such as respect and autonomy.
The Engineering Model
• This results from the impact of science. The doctor behaves like an applied scientist and vainly attempts to divorce himself from all value judgments. The physician presents all the facts to the patient and leaves the entire responsibility of making the decision to the patient. Veatch (1972)
suggests that this ‘would make him an engineer, a plumber making repairs, connecting tubes and flushing out clogged systems, with no questions asked’.
The Customer-Sales Person Model
• In this model the patient takes the role of the customer. The essential
feature of the model is that ‘the customer is always right’. The duty of
care of the physician is simply to respond honestly to any requests for
information but he is under no obligation to volunteer the information.
• The physician is under a duty to only provide ‘goods’ that are suitable for
their purpose and must also warn of any dangers or risks. Ultimately,
however, sole responsibility lies with the patient and the physician
accepts no moral responsibility for the treatment decision.
• This model gains credibility from the political drive to run healthcare
along the lines of a market economy. However, it reduces the role, duty
and moral responsibility of the physician too far. It also means that a
healthcare professional may sometimes have to provide a service to
which they are morally opposed (see Randall and Downie, 1996).
The Collegial or Partnership Model
• The physician and patient are colleagues working in partnership towards the common goal
of restoring and maintaining the patient’s health. It enhances the roles of trust, confidence
and commitment creating an ‘equality of dignity and respect’ (Veatch, 1972).
• Both parties share the responsibility for decision-making. This model is wholly
inappropriate when the patient lacks sufficient autonomy. It also fails to recognise the
reality that the doctor usually has a far greater knowledge than the patient. Furthermore,
the doctor’s autonomy is not diminished by ill health and the interaction is usually on the
doctor’s ‘home ground’.
• All these factors result in a power imbalance that makes a truly equal partnership difficult
to achieve. It is perhaps also unrealistic, because of ethnic, class, religious, economic and
value differences, to expect doctors and their patients to share common goals.
The Contractual Model
• This is to be seen as a symbolic contract or covenant, which provides
expected obligations and benefits for both parties arrived at through
negotiation. It recognises that there may not be common goals and it respects
the ‘basic norms of freedom, dignity, truth-telling, promise-keeping and justice’
(Veatch, 1972).
• It requires the trust and confidence of both parties and respects the autonomy
and moral values of both doctor and patient. It means that a doctor is not
obliged to provide a treatment they disagree with and it means that a patient
cannot be treated against their will. The patient accepts moral
responsibility for his decision while the doctor retains responsibility
for the choices offered to the patient, assistance given to help the
patient understand and make their decision, and in the performance
of the treatment agreed upon.
• Again, it is an inappropriate model for incompetent patients. Also, since the
provision of the goods is in the hands of the doctor, there may be an undue
imbalance of power. This is especially true in a healthcare setting where the
patient does not directly pay for the doctor’s services. Theoretically, the patient
can shop around for a doctor willing to provide the required service but this is not often practical in a system that operates through regional funding.
What will cause the practitioner patient relationship to breakdown?
Features of good patient practitioner communication
State four clinical setting related obstacles to communication
State four practitioner related obstacles to communication
State four patient related obstacles to communication
Causes could
include:
1. Perceived failure
2. Unhappiness
3. Breach of trust
4. Threat
5. Attitude
6. Sexual advances
Features:
Active listening
Maintain eye contact
Read body language
Clinical setting related obstacles to communication:
Nature of consulting/ lab/ward room
Uncomfortable environment
Screen/ Barriers between you and patient
Waiting area
Secure environment
Attitude of staff
Accessibility
Practitioner related obstacles to communication:
Subconscious anxieties
Lack of attention to
emotional content
Unresolved emotional/
psychological content
Upbringing/ lifestyle/
culture/ religion
Lack of training
Lack of role models
Lack of insight into communication deficiencies
Misapprehensions
Patient related obstacles to communication:
Language
Illness
Intimidation
Embarrassment
Use of Medical Jargons
Age
Gender
Social Class
Emotional Response
Reluctance to answer questions
Non maleficence:concerns of life care decisions, withdrawal of life sustaining treatment,pain and symptom control,
Beneficence: helping people in need helping people with disabilities
Autonomy: This means that, in practice, whether a patient is declared incapable of making healthcare decisions by a doctor or incompetent by a court, the outcome is the same—the patient loses the ability to make their own medical decisions, and a substitute decision-maker steps in.
Even though incapacity is a medical judgment (made by healthcare professionals) and incompetence is a legal judgment (determined by a court), the effect is similar: the patient’s autonomy is overridden due to their inability to make informed choices. This is why the distinction is not always practically useful in clinical settings.
Surrogate Decision-Maker
•Individual with authority to consent to medical treatment for an incapacitated patient.
Examples: Spouse
• Adult child with Power of Attorney or majority of adult children
• Parents
• Clearly identified individual
• Nearest living relative
• Patient’s clergy
This framework outlines who can provide medical consent for a minor when their parents are available or unavailable.
1. When Parents Are Available
• The child’s natural or adoptive parents have the primary right to make healthcare decisions.
• If the parents are divorced, the sole managing conservator (the parent with primary custody) has full authority.
• A possessory conservator (the non-custodial parent) can only consent to non-invasive procedures during their time with the child.
2. When Parents Are Not Available
• The responsibility falls to close relatives such as grandparents, adult siblings, or adult aunts/uncles who can step in to make medical decisions.
• If the child is in school, the educational institution may consent with written authorization from the parents.
3. Additional Cases When Parents Are Not Available
• An adult with legal custody who has written authorization can give consent.
• A court with jurisdiction can order medical treatment.
• If the child is involved in the juvenile system, an adult responsible for their care can consent.
• In emergencies, a peace officer may authorize treatment if the child’s safety is at risk.
This structure ensures that minors receive necessary medical care even when their parents are absent.
State some sills needed to resolve ethical dilemmas and explain the framework needed for making ethical decisions
How are “Ethical Dilemmas” resolved?
Consider whether obligations are being violated
Examine all viewpoints carefully, critically and openly
Respect legitimate diversity
The development of bioethics is largely influenced by
Skills for Resolving Ethical Dilemmas
1. Listening – Understanding different perspectives by actively listening to patients, families, and colleagues. This helps clarify concerns and ethical conflicts.
2. Conflict Resolution – Finding a middle ground when ethical issues create disagreements among patients, families, or healthcare teams.
3. Tolerance for Ambiguity – Accepting that ethical issues often have no clear-cut answers and being comfortable making decisions in uncertain situations.
4. Ability to Apply Ethical Principles and Carry Out Duties – Using principles like autonomy, beneficence, non-maleficence, and justice to guide decision-making while fulfilling professional responsibilities.
Framework for Ethical Decisions
1. Medical Indications – What is the medical problem? What are the treatment options? What are the risks and benefits?
2. Patient Preferences – What does the patient want? Are they competent to decide? Is their decision voluntary?
3. Quality of Life – How will the treatment impact the patient’s well-being and long-term life quality?
4. Contextual Features – Are there social, legal, financial, or cultural factors influencing the decision? Are there family or institutional constraints?
This framework helps ensure that ethical decisions are made in a structured and balanced way.
Bioethics development is influenced by:
Healthcare Policy
• health care insurance, health policy & biological research
• Politics vs. Economics
• These are forces that shape medicine & access to it.
• Societal Issues
• Involves access, allocation & distribution of health care resources.
• Scientific Advances
• New subjects, most recently in genetics, genomics, cloning, etc.
State some non rational approaches to ethical decision making
Rational approaches are the deontology utilitarianism et
Informed consent principles:
Principles of Consent
• The first principle underscores the importance of providing comprehensive information to the patient, ensuring a clear understanding of the proposed treatment, potential risks, benefits, and available alternatives. Transparency becomes paramount as patients must be equipped with the knowledge necessary to make informed choices
State six ways for which consent will be considered null and void.
• Obedience
• A common way of making ethical decisions, especially by children and those who work within authoritarian structures (e.g., the military, police, some religious organizations, many businesses)
• Imitation
• Very similar to obedience in that it subordinates one’s judgement about right and wrong to that of another person, in this case, a role model.
18-Dec23
• Feeling or desire
• A subjective approach to moral decision making and behaviour
• Intuition
• an immediate perception of the right way to act in a situation.
• Habit|
• a very efficient method of moral decision-making since there is no need to repeat a systematic decision-making process each time a moral issue arises similar to one that has been dealt with previously
14:
• (a) a consent is void if the person giving it is under twelve years (12) of age, or in the case of an act involving a sexual offence, sixteen years (16), or is, by reason of insanity or of immaturity, or of any other permanent or temporary incapability whether from intoxication or any other cause, unable to understand the nature or consequences of the act to which he consents”.
• (b) a consent is void if it is obtained by means of deceit or of duress;
December 18, 2023 10
THE CRIMINAL CODE, 1960 (ACT 30)
• (c)aconsentisvoidifitisobtainedbytheundueexercise of any official, parental, or any other authority; and any such authority which is exercised otherwise than in good faith for the purposes for which it is allowed by law, shall be deemed to be unduly exercised;
• (d)aconsentgivenonbehalfofapersonbyhisparent, guardian, or any other person authorized by law to give or refuse consent on his behalf, is void if it is given otherwise than IN GOOD FAITH for the benefit of the person on whose behalf it is given;
• (e)aconsentisofnoeffectifitisgivenbyreasonofa fundamental mistake of fact;
December 18, 2023 11
THE CRIMINAL CODE, 1960 (ACT 30)
• (f)aconsentshallbedeemedtohavebeenobtained by means of deceit or of duress, or of the undue exercise of authority, or to have been given by reason of a mistake of fact, if it would have been refused but for such deceit, duress, exercise of authority, or mistake, as the case may be;
• (g)forthepurposesofthissection,exerciseof authority is not limited to exercise of authority by way of command, but includes inf luence or advice purporting to be used or given by virtue of an authority;
• (h)apersonshallnotbeprejudicedbytheinvalidity of any consent if he did not know, and could not by the exercise of reasonable diligence have known, of the invalidity.
December 18, 202
As a doctor, obtaining valid informed consent is crucial to ensure that the patient’s agreement to a medical procedure or treatment is legally and ethically sound. To avoid issues that would make consent void under the Criminal Code, 1960 (Act 30) in Ghana, follow these steps:
- Ensure the Patient is Competent
• Confirm that the patient is above the legal age for consent (usually ≥18 years, but ≥16 years for sexual matters).
• If the patient is underage, obtain consent from a parent/guardian.
• Assess mental capacity: Ensure the patient is not intoxicated, unconscious, mentally ill, or in any condition that affects decision-making. - Avoid Deceit or Duress
• Be truthful: Provide accurate, complete information without misleading the patient.
• Avoid coercion: The patient should freely choose to consent without pressure from doctors, family, employers, or religious leaders.
• Respect refusals: If a patient refuses consent, document it properly and explore alternatives. - Prevent Undue Influence or Authority Abuse
• If you’re in a position of authority (e.g., a senior doctor over a junior doctor, a doctor over a patient, or a doctor advising a patient’s guardian), ensure advice is neutral and evidence-based.
• Avoid forcing or pressuring a guardian or patient to give consent. - Obtain Consent in Good Faith
• Ensure consent benefits the patient and is not for personal or institutional gain.
• If a guardian is providing consent on behalf of a minor or incapacitated patient, confirm that it is genuinely in the patient’s best interest. - Ensure There is No Fundamental Mistake
• Clearly explain the procedure, risks, benefits, and alternatives.
• Verify that the patient understands what they are consenting to.
• Ask the patient to repeat key points in their own words to confirm understanding. - Use Proper Documentation
• Obtain written consent where required, especially for major procedures.
• Document verbal consent in the patient’s medical records.
• If doubts arise, involve a witness (e.g., a nurse or another doctor).
By following these steps, you reduce the risk of invalid consent and uphold ethical and legal standards in medical practice.
What is implied consent permittedand what is surrogate consent
How do you ascertain capacity?
Itispermittedinspecialcircumstanceslikewhenpatient is not competent by age, physical or mental condition, when guardian is not available & patient’s condition is life threatening (To prevent death or grievous hurt).
• Surrogateconsent:-Anybodywhoisinvalidcustodyofthe individual is permitted to give consent.
Common steps and considerations in assessing Capacity 1. Context-Specific Evaluation:
1. Capacity assessments are context-specific. The ability to make decisions can vary depending on the complexity and nature of the decision. For example, an individual may have the capacity to make simple everyday choices but may struggle with more complex medical decisions.
2. Understanding of Relevant Information:
1. The individual’s ability to understand information related to the decision is a key focus. Assessors evaluate whether the person comprehends the facts, risks, benefits, and consequences associated with the decision.
Common steps and considerations in assessing Capacity 3. Communication Skills:
1. The ability to effectively communicate one’s choices is crucial. Assessors look at whether the individual can express their preferences, values, and decisions clearly, either verbally, in writing, or through other means.
4. Appreciation of Consequences:
1. The individual should appreciate the potential consequences of their decisions. This involves understanding the likely outcomes and the impact of the decision on their well-being.
Common steps and considerations in assessing Capacity 5. Ability to Reason:
1. Assessors examine the person’s reasoning ability. This includes evaluating whether the individual can weigh different options, understand cause-and-effect relationships, and make logical connections in their decision-making process.
6. Freedom from External Pressure:
1. Capacity assessments consider whether the individual is making decisions voluntarily, free from coercion or undue influence. This ensures that the person’s choices are not manipulated by external factors.
Common steps and considerations in assessing Capacity 7. Temporal Consistency:
1. Evaluators may consider the temporal consistency of decision-making capacity. This involves assessing whether the individual’s capacity is stable over time or whether it fluctuates based on specific circumstances or health conditions.
8. Use of Support and Aids:
1. In some cases, individuals may require support or aids to enhance their capacity. For example, the use of visual aids, simplified language, or support from family members may help individuals better understand information.
9. Documentation:
1. Comprehensive documentation is essential. The results of the capacity assessment, including the specific aspects evaluated and the conclusions drawn, should be thoroughly documented. This documentation serves as a record and can be crucial in legal and healthcare decision-making processes.
What do you do if a patient lacks capacity
What to do during lack of Capacity 1. Best Interests Assessment:
1. Conduct a best interest’s assessment to determine the course of action that would be in the person’s best interests. This involves considering the person’s values, preferences, and any expressed wishes when they had capacity. Consultation with family members, close friends, or other relevant individuals may also be part of this process.
2. Consultation with Relevant Parties:
1. Engage in discussions with family members, friends, and any legally appointed representatives to gather insights into the person’s preferences and values. These individuals can provide valuable information to guide decision-making in the absence of the person’s capacity.
What to do during lack of Capacity
3. Legal Frameworks and Documentation:
1. Adhere to legal frameworks governing decision-making for individuals lacking capacity. This may involve seeking guidance from guardianship laws, advanced care directives, or similar legal instruments. Ensure that decisions are made in accordance with applicable laws and regulations.
4. Multidisciplinary Collaboration:
1. Engage a multidisciplinary team, including healthcare professionals, social workers, and legal experts, to collectively assess the individual’s situation and make decisions in their best interests. Collaborative decision-making helps ensure a comprehensive and holistic approach.
What to do during lack of Capacity 5. Regular Review:
1. Periodically review the individual’s capacity, as it may fluctuate based on factors such as medical conditions, treatment, or changes in circumstances. Regular assessments help in adapting the care plan to the person’s evolving needs.
6. Advocate for the Person’s Rights:
1. Advocate for the protection of the person’s rights and dignity. Even when lacking capacity, individuals retain certain fundamental rights, and decisions made on their behalf should respect these rights to the greatest extent possible.
7. Court Involvement if Necessary:
1. In some cases, legal proceedings may be necessary, especially if there are disputes regarding the best interests of the individual. Seeking court involvement may provide a formal process for decision-making and ensure that all relevant considerations are thoroughly examined.
What to do during lack of Capacity 8. Communication with Care Team:
1. Maintain open communication with the care team, ensuring that all members are informed about the decisions made in the best interests of the individual. Clear and transparent communication fosters a collaborative and supportive environment.
9. Documentation:
1. Thoroughly document the decision-making process, including the factors considered, individuals consulted, and the rationale behind the decisions. Proper documentation is crucial for legal and ethical accountability.
10. Training and Education:
1. Provide ongoing training and education for healthcare professionals and caregivers involved in the care of individuals lacking capacity. This ensures that they are well-informed about relevant legal and ethical considerations and can navigate complex decision-making scenarios appropriately.
What is an advanced decision or directive
State some types of consent forms
Advance Decisions/ Directives
• An advance decision, also commonly known as an advance directive or living will, is a legal document in which an individual outlines specific medical treatments or interventions they would like to refuse or accept in the event they become incapacitated and are unable to communicate their wishes.
• The purpose of an advance decision is to allow individuals to maintain control over their healthcare decisions, particularly in situations where they may lose the capacity to make informed choices.
Advance Decisions/ Directives
• Key components of an advance decision may include preferences regarding life-sustaining treatments, resuscitation, organ donation, and other medical interventions.
• The document typically outlines under what circumstances and conditions the individual wishes these treatments to be withheld or administered.
• Advance decisions are legally binding in many jurisdictions, provided they meet specific legal requirements. These requirements may include the document being in writing, signed, witnessed, and, in some cases, registered with relevant healthcare authorities.
• It is important for individuals to regularly review and update their advance decisions to ensure that they accurately ref lect their current wishes.
Advance Decisions/ Directives
• The primary goal of an advance decision is to respect an individual’s autonomy and ensure that their healthcare preferences are honoured, even when they are unable to express them directly.
• Healthcare providers are legally obligated to adhere to the directives outlined in a valid advance decision, making it a crucial tool for individuals who wish to have a say in their medical care under different circumstances
Consent forms:
1.General Consent Form:
1. This form is a broad consent document that patients may sign upon admission to a healthcare facility. It grants general permission for routine medical procedures, diagnostic tests, and other common healthcare interventions that may be part of the standard care provided by the facility.
Types of Consent Forms
2.
Surgical Consent Form:
1. Patients undergoing surgical procedures are typically required to sign a specific consent form for the surgery. This form provides details about the specific procedure, potential risks, benefits, and alternative treatment options. Surgeons often review this information with patients before obtaining their signature.
3. Anaesthesia Consent Form:
1. For surgeries or medical procedures involving anaesthesia, a separate consent form may be necessary. This form outlines the potential risks and side effects associated with anaesthesia administration and ensures that patients understand and accept these risks.
Types of Consent Forms
4. Informed Consent for Medical Treatment:
1. This form is used for various medical treatments or interventions, such as medications, physical therapies, or other non-surgical procedures. It outlines the details of the treatment, including its purpose, potential risks, benefits, and alternatives.
5. Consent for Blood Transfusion:
1. In situations where a blood transfusion is necessary, patients may be required to sign a consent form specifically for this procedure. The form provides information about the process, potential risks (such as transfusion reactions), and the need for blood products.
Types of Consent Forms 6. Research Consent Form:
1. Individuals participating in clinical trials or medical research studies sign a research consent form. This document explains the study’s purpose, procedures, potential risks, benefits, and the voluntary nature of participation.
7. Psychiatric Treatment Consent Form:
1. Patients receiving psychiatric treatment or interventions, such as electroconvulsive therapy (ECT) or certain medications, may sign a specific consent form detailing the proposed treatment and its implications.
8. Consent for Minors or Incapacitated Adults:
1. In cases where the patient is a minor or lacks the capacity to provide informed consent, a legal guardian or healthcare proxy may sign a consent form on their behalf. This process often involves adhering to specific legal requirements.
Types of Consent Forms
9. EmergencyTreatmentConsentForm:
• In emergency situations where immediate treatment is necessary and obtaining traditional written consent is not feasible, healthcare providers may use a verbal or implied consent process.
• However, in non-urgent situations, healthcare facilities may request patients to sign an emergency treatment consent form in advance.
State some factors to consider when obtaining consent
Factors To Consider When Obtaining Consent
• The principle of voluntariness
• This is paramount, necessitating an environment free from coercion,
pressure, or any form of undue influence.
• Patients should feel empowered to make decisions autonomously, devoid of external forces impacting their choices.
• The information provided.
• Healthcare providers must offer clear, understandable, and detailed explanations about the nature of the proposed treatment, potential risks and benefits, available alternatives, and the anticipated outcomes.
• Ensuring that the information is tailored to the individual’s level of comprehension and cultural background is equally essential.
Factors To Consider When Obtaining Consent
• The capacity of the patient to make informed decisions must be assessed.
• Healthcare professionals should evaluate the individual’s cognitive ability to understand the provided information, weigh the consequences, and communicate their preferences.
• This assessment becomes particularly critical when dealing with vulnerable populations or individuals with diminished decision-making capacity.
• The Communication.
• Consent is not a one-time event; it is a dynamic process that may require continuous dialogue, especially in situations where treatment plans evolve, or unexpected developments arise.
• Maintaining an open line of communication fosters a collaborative partnership between healthcare providers and patients, allowing for the ongoing exchange of information and addressing any concerns that may emerge.
Factors To Consider When Obtaining Consent
• The documentation of the consent process.
• A thorough and well-documented record should include the details of the information provided, discussions held, and the agreement reached. This documentation serves as a safeguard, ensuring transparency and accountability in the event of future inquiries or disputes.
• Respecting cultural and individual preferences.
• Recognizing and accommodating diverse cultural norms, beliefs, and communication styles enhances the patient’s comfort and understanding, fostering a more inclusive and patient-centered approach to obtaining consent.
11 rights and 11 responsibilities of the patient
Problem with consequentialism is that it doesn’t tell you how to go about making the decision. It just tells you that do whatever creates the greatest good or best action or what is right and what is right is what is good. However you’ll arrive at that good is your own business. So it prioritizes good over what is actually right.
Freedom imperatives Nd duties
Types of utilitarianism:
