INTRODUCTION TO MEDICAL ETHICS

1. INTRODUCTION TO MEDICAL ETHICS Assist.Prof.Dr. Mehmet KARATAŞ Department of History of MedicineandEthics

2. CONCEPTS • ETHICS • MORALS • DEONTOLOGY • BIOETHICS • ACTION • VIRTUE

3. ETHICS • In Greek “Ethos” • Good, well • The code of ethics are defined by the reactions of the society • It has no legal obligation • It depends on the time and place • A systematic thinking on morals • The theory of the action

4. MORALS • Arabic “Halak”, creation, temperament • The practice of the action • The rules that regulate the relationship between the other beings according to certain values • Signification and value depend on relationship between human beings • Intention, action and result must be good • Preferring the better one instead of wicked one

5. DEONTOLOGY • Science of duty • Medical deontology contains responsibilities to “yourself” “your colleagues” “the society”

6. BIOETHICS • Concurrence of the ethics and the vitality sciences • It deals with the moral values problems of medicine, health-care services and biologic sciences • Subheadings of bioethics “Clinical Ethics” on supplying health-care services “Research Ethics” protects the research participants “Work Ethics” on duties and responsibilities “Public Policy and Governmental Ethics ” prepare the ground for the law

7. ACTION • It is the object of the ethics • Action consists of “evaluation” “related life” “execution” • Ethics deal with the intention, form, aim and result of the action

8. VIRTUE • Honesty, justice, respect, love, trust • Wisdom, continence, courage • Moral perfection • It is the basis of the ethical behaviors

9. MedicineandtheEthics • Medicine is both an art and a science • The art of medicine is the practice of medical sciences and technologies on people, families and societies, which are very different from each other • Differences between individuals, families and societies are recognized and considered together

10. Purpose of the Ethics Classes • To decide the best behavior • To know what to do in hard situations • The code of ethics and regulations

11. Purpose of the Ethics Classes • Healthworkersshould be exhibittoappropriateethicalvalues of theidentitybesidesmedicalknowledgeandskills • In the problems of society to follow, to analyzeand the scientific perspective to create your own opinion

12. Ethical Issues • Informed Consent • Patient Rights • Privacy Rights and Medical Privacy • Ethical Issues on Telling the Truth

13. Ethical Issues • Ethical Issues Related to the Beginning of Life (pregnancy, abortion, assistedreproductivetechnologies, cloning, genetic and embryoresearch) • EthicalIssuesRelated to End of Life (euthanasia, CPR, DNR, refusal of treatment, futilityand discontinuation of treatment) • Ethical Issues Related to Organ and Tissue Transplantation • Clinical Research and Ethics of Science

14. Elements of Inform • Disclosure • In clear language the patient can understand • Patient can understand the disclosure • Competence • Voluntariness • Signed document

15. CONSENT • Thereshouldn’t be enforcement. • Thereshouldn’t be coaction • Don’tconvince • Thepatientshould be competence

16. Patient Rights • Benefit from health services in a fair manner • Benefit from information on how to request this service • Choosing the establishment of health/the right to change • Health worker selection/right to change • Right to diagnosis/treatment/care comply with the medical requirements • The right to medical care

17. Patient Rights • Not-to-intervene without consent • The right to refuse the medical intervention • Emergency/Forensic/Elderly/Disabled patients have the right to priority • The right to privacy/respect for medical confidentiality • The right to be informed of your health status • The right to access informationcontained in your clinical record

18. Patient Rights • The right to request correction of the records • The right to have your information kept confidential • The right to consent orrefuse to be involved in research protocols • The right to access protective services/intervention • The right topastoral and other spiritual services • The right to have a family member or representative of your choice notified promptly of your admission to the hospital

19. Regulation of Patient Rights • The right to live in physical, emotional, and social well-being • Everyone's right to life, preserve and develop tangible and intangible assets • Differences inrace, language, religion or creed, sex, political opinion, philosophical belief, and economic and socialsituations can not be considered • Except in cases ofmedical necessity and the written law, the person's bodyand other personal rights are inviolable integrity. These can’t be changed without the consent of patient • Personshan’t be subjected to medical researchwithout the consent and permission of the Ministry • Privacy of person and his/her family is inviolable

20. WMA (World Medical Association) Declaration of Lisbon on the Rights of the Patient(1981) The patient has the right • to choose freely and change his/her physician • to refuse/accept the recommended treatment • to privacy • to die with dignity •  to receive or to decline spiritual and moral comfort including the help of a minister of his/her chosen religion

21. WHO (World Health Organization) The Amsterdam Declaration (1994) • Observance of human rights and values ​​in health care • Care/treatment right • Being informed/consent • Privacy

22. ETHICS IN SCIENCE • Scientific data must be obtained by experiment and observation • The data should be evaluated scientifically • Conclusions should be accurate • The conclusions which aren’t obtained by experiment and observation shouldn’t be placed on research • Sources should be clearly stated • “Someone else”s data shouldn’t be stated as yours

23. ETHICS IN SCIENCE • Human subjects should be informed about the potential risks and consented • Research shouldn’t harm “subjects” “researchers” “environment” “human health” • avoid all unnecessary suffering and injury to the animal subjects

24. ETHICS IN SCIENCE • Scientists inform the community about the results of research and warn about the possible loss and damage • They shouldn’t participate in researches which are causing disapproved applications • They shouldn’t give the names of people who were ineffective at designing, planning, implementing and preparing for publication of the research • Knowing how to treat (academic progress and the scientific merit of the award jury)

25. Regulation on Clinical Trials (2011) • Protecting the participants in researches • Research protocol should be created, researchers should be sufficient, research-places should be adequate and volunteers should be informed in order to ensure that the research accords with legislation

26. ETHICS COMMITTEE • Counseling services on ethical issues related to health • Patient-centered health-care services • Protectingsubjects • Increasingthebenefits of thesociety • Gainingandusingtheinformationabouthealthandhealth-care services

27. Ethical Principles • Autonomy • Beneficience • Nonmaleficence • Justice

28. “The allegory of the Medical Profession” (1587) Engravings of HendrikGoltzius

29. “The allegory of the Medical Profession” (1587) Engravings of HendrikGoltzius

30. References A. Selim ATAY, İnönü Üniversitesi Tıp Fakültesi, translation Tolga GÜVEN, Marmara Üniversitesi Tıp Tarihi ve Etik AD ders notları Gürkan SERT, Hasta Hakları Robert M VEATCH, MedicalEthics Emine ATABEK, Mebrure DEĞER, Tıbbi Deontoloji Konuları Hasta Hakları Yönetmeliği, 1998 Klinik Araştırmalar Hakkında Yönetmelik, 2011 Çağlar Boyu Tıp, Roche Yayınları http://en.wikipedia.org/wiki/Main_Page