Practice Ethics

Dr. Dinesh Kumar

Assistant Professor

Department of ENT, GMC Amritsar

Ethics

•Moral principles that govern a person's or group's behaviour.•Moral code, morals, morality, values, rights and wrongs, principles, ideals, standards, value system, virtues, dictates of conscience

Unethical

•The term "unethical" is used to refer to professional conduct which fails to conform to these moral standards or policies

The Relation of Law and Ethics

• Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties.• The fact that a physician charged with

allegedly illegal conduct is acquitted or exonerated in civil or criminal proceedings does not necessarily mean that the physician acted ethically

Issues in practice of ethics

•10 doctors lose licences for sex selection tests•5 doctors get notices for advertising their skills•Three doctors in service of quacks

Issues in practice of ethics

•Accepting gifts: Docs ask why they're singled out•HC questions ethics of doctors at Safdarjung Hospital•Max molestation case: Doctor suspended

Issues in practice of ethics

• Lack of medical ethics deplored•UGC chief laments fall in medical

ethics•Manipal University former VC

stresses on need for 'medical humanism‘• Ethics not a subject in medical

colleges

10 doctors lose licences for sex selection tests

• The Maharashtra Medical Council (MMC) suspended licences of 10 doctors, including one from Mumbai and two from Thane, for violation of rules governing pre-natal sex determination.

• Dr Ivan Martin Rocha of Malad was one of the 10 doctors whose licences were suspended. Rocha was allegedly exposed in a 2011 sting operation carried out by BMC and NGO Lek Ladki, where he was caught using a portable ultrasonography machine to reveal the gender of the foetus.

Sex Determination Tests

• On no account sex determination test shall be undertaken with the intent to terminate the life of a female foetus developing in her mother’s womb, unless there are other absolute indications for termination of pregnancy as specified in the Medical Termination of Pregnancy Act, 1971.

• Any act of termination of pregnancy of normal female foetus amounting to female foeticide shall be regarded as professional misconduct on the part of the physician leading to penal erasure besides rendering him liable to criminal proceedings as per the provisions of this Act.

A Doctor’s Dilemma

• A pregnant woman who has four female children asks you to do sex determination test.• She says she will kill the child and herself as

she is being tortured by her husband and in-laws. • Primacy of patient benefit….not unethical!• Within safe period for abortion….not immoral

either!• However it is illegal…

Professional Misconduct

• Violation of the Regulations• Non-maintenance of the medical records of

indoor patients for a period of three years • Adultery or Improper Conduct• Signing Professional Certificates, Reports and

other Documents• The registered medical practitioner shall not

disclose the secrets of a patient that have been learnt in the exercise of his / her profession except

Sexual harassment by patient forces doctors to alter their practice.

• A survey of 600 female Australian GPs published Med J of Australia found that 54.5% of the 180 who responded had experienced sexual harassment in their careers.

• Behaviors ranged from inappropriate gifts, inappropriate exposure of body parts to touching or grabbing.

• Doctors are thought of as being in control and safe. Indeed, during training they are told of their powerful position in relation to patients and taught not to abuse it.

5 doctors get notices for advertising their skills

• The Maharashtra Medical Council (MMC) issued warning notices to five doctors for advertising and promoting their skills. The council was acting on complaints by medical associations against the doctors. • Advertising is not permitted under the

code of medical ethics of the Medical Council of India (MCI).

Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical

A medical practitioner is however permitted to make a formal announcement in press regarding the following:• On starting practice.• On change of type of practice.• On changing address.• On temporary absence from duty.• On resumption of another practice.• On succeeding to another practice.• Public declaration of charges.

Accepting Gifts

• Tired of being the only ones being named and shamed for corrupt practices such as accepting gifts and hospitality from the pharmaceutical industry, prominent doctors sought legislation for "all stakeholders", including the pharma industry, involved in bribing of doctors. • The doctors questioned why they alone

were being targeted and made liable in such cases.

In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to these stipulations

A medical practitioner shall not:• Receive any gift • Accept any travel facility inside the country or

outside• Accept individually any hospitality like hotel

accommodation for self and family members under any pretext.

• Receive any cash or monetary grants

:From any pharmaceutical or allied health care industry and their sales people or representatives.

Medical Research

A medical practitioner may participate in research projects funded by pharmaceutical industry but ensure:• Research project has the clearance institutional

ethics committees.• It fulfils all the prescribed legal requirements.• Source and amount of funding is publicly

disclosed• That while accepting such an assignment a

medical practitioner shall have the freedom to publish the results

Endorsement

• A medical practitioner shall not endorse any drug or product of the industry publically. • Any study conducted on the efficacy or

otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way.

HC questions ethics of doctors at Safdarjung Hospital

• The Delhi High Court took to task Safdarjung Hospital doctors for ignoring medical ethics and denying admission to patients on the ground of shortage of beds. • "What are you (doctors) taught in medical

ethics...or is it (ethics) out of your curriculum. Do your ethics say that you (doctors) should not take in patients when they approach you."

HC questions ethics of doctors at Safdarjung Hospital

•The Hospital defended itself by claiming that there was excessive pressure on its facilities due to patient load and it was difficult to provide treatment to all patients approaching it.

Three doctors in service of quacks

Amritsar civil surgeon Dr HS Gill has offered to resign from the membership of Indian Medical Association if the association fails to take action against three doctors on moral and ethical grounds for assisting quacks in carrying out pre-natal diagnostic tests and medical termination of pregnancy

These questions are still seeking answers

•Patients dictating treatment decisions.•Turning off life support when patient is brain dead.•Patients with terminal cancers

Issues in practice of ethics

•Medical Council of India proposes medical ethics in MBBS course•Armed Forces Medical College

hosts meet on medical ethics•Crash course on medical ethics•Medical ethics course a hit among

doctors

Declaration each applicant gives at the time of registration with Medical Council

• I solemnly pledge myself to consecrate my life to service of humanity.• Even under threat, I will not use my

medical knowledge contrary to the laws of Humanity.• I will maintain the utmost respect for

human life from the time of conception.

Declaration…

• I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.• I will practice my profession with

conscience and dignity.• The health of my patient will be my first

consideration.• I will respect the secrets which are

confined in me.

Declaration…

• I will give to my teachers the respect and gratitude which is their due.• I will maintain by all means in my power,

the honour and noble traditions of medical profession.• I will treat my colleagues with all respect

and dignity.• I shall abide by the code of medical ethics

as enunciated by Indian Medical Council

Thanks for your patience !!!!