DR SAMIN AMIN

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 A 59 year old man is admitted for alcohol
withdrawal. He requires aggressive IV fluids
and electrolyte replacement but no IV access is
available. You want to put in a central venous
catheter, but he refuses. No family is available.
What are the ethical issues and what will you
do?

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 A 44 year old male with HIV does not believe
that he has this illness. He presents requesting
treatment for erectile dysfunction. What will
you do?

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 Yesterday, you saw a 19-year old woman who is
suffering from depression, has a history of drinking
and has had increasing thoughts of suicide. She reports
she would not act on these thoughts because it would
hurt her family, but you are worried about her. This
morning, you received notification that your patient
was brought into emergency last night following an
overdose and was admitted to the ICU. You are now
wondering if you should have spoken with her mother
about your concerns. A colleague reports you could not
talk to the mother because of privacy legislation, but
you wonder if this is correct, and even if so, should you
have tried to ensure your patients safety?
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 Greek word ethickos meaning character,
manners and morals.
Oxford dictionary defines ethics to include :
(i) Science of morals.
(ii) Rules of conduct.
(iii) Science of human duty.

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 To guide the conduct of a person before an act
is undertaken.
Define what is considered an honorable
behavior.

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 Application of general ethical principles to the
morals problem of medical profession.

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 Plato : physician judge action of
another physician.
Aristotle : penalty only on the reputation
of physician.
Hippocrates : created an oath regarding
medical ethics.

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i. Need for proper instruction and registration of
doctors.
ii. Doctors is for benefit of patient.
iii. Perform to the best of ability and refrain from
harm.
iv. Euthanasia and abortion proscribed.
v. Nature of doctor & patient relationship.
vi. Doctrine of confidentiality.

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 1948 Declaration of Geneva by the World
Medical Association.
1968 Amended in Sydney and led to the
International Code of Medical Ethics.
1981 International Organization of Islamic
Medicine adopted Oath of a Muslim doctor.

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1. Consequentialism
- an action is right if and only if it promotes the
best consequences.

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2. Utilitarianism
- consequences of an action does matter.

- the best consequences are those in which

human happiness is maximized.
- the greater good for the greater number.

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3. Duty-bound or Deontology
- focus on the duties rather from the
consequences

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4. Virtue ethics
- developed by Aristotle on 4B.C.

- focus on the character and a habits of a person.

- places better value upon moral character rather

than acts or outcome of acts

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1.Beneficence
- positive duty to do good.

2.Paternalism
- doctor knows what is best for patient.

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3.Autonomy
- self determination

- autos(self) + nomos(governance)

- special liberty, where individual are free to

choose and implement their own decision, free
from deceit, duress, constraint and coercion.

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4.Non-maleficence
- A duty to do no harm, i.e. obligation not to
inflict harm intentionally.
5.Justice
- Deals with equitable distribution of benefits and
burdens.

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6.Fidelity
- Obligations to keep promises and not deceive.

7.Confidentiality
- Information regarding his patient confidential
aspect of trust.

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7. Veracity
- Need for truth-telling in the doctor - patient
relationship.
- Mutual trust and confidence.

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Bioethics is about the study of ethical
issues arising along health care or
research, and the associated decision
making process to resolve them.

Ethics in Public Health (JPCMFM) Jan.2010