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Medical ethics – Past, Present, and Future

Medical ethics – Past, Present, and Future. Presented By: Perin Suthakar MS, MD. History of Medical Ethics. Medical ethics was practiced by most ancient cultures Chinese (based on Confucius teaching) and Indians had medical oaths

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Medical ethics – Past, Present, and Future

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  1. Medical ethics – Past, Present, and Future Presented By: PerinSuthakar MS, MD

  2. History of Medical Ethics • Medical ethics was practiced by most ancient cultures • Chinese (based on Confucius teaching) and Indians had medical oaths • Hippocratic Oath from Ancient Greece influenced the Western medical culture

  3. Traditional Ethical Theories • Utilitarianism • Deontology • Virtue Theory

  4. Modern Medical Ethical Principles By Beauchamp and Childress • Autonomy • Beneficence • Non-maleficence (Do no harm) • Justice

  5. Autonomy • Capacity to think and decide • Mental Competence • Free choice of the individual; even choosing against family and medical advice

  6. Beneficence • What is best for the patient • Related at some level to autonomy • Considers the overall scenario-pain, quality of life, mental suffering, inherent risk for disability and death • Not intervening may be best sometimes

  7. Non-Maleficence • Do no harm • Diagnosis/treatment leading to more harm than good? • Experimental protocols • Immunizations

  8. Justice • Limited Resource • Set Priority • Equal Access • Fairness • Burden to others

  9. Analysis of Recent Popular Cases in Media • Munoz • McMath

  10. Most Common Reasons for Ethical Dilemmas In Popular Cases • Ignorance • Failure to teach or communicate • Monetary benefit • Violation of obvious ethical principles or moral values • Secondary market/benefit • Misunderstanding or misinterpretation of existing laws

  11. Most Common Ethical Dilemmas For Physicians Today • End of life care issues • Tug-of-war with insurance companies • Should I falsify records to get the procedure/medication approved? • Electronic Medical Records – Click happy • Accepting Gifts from Pharmaceutical companies • Dropping poorly reimbursing insurance companies and losing long term patients • Dropping poorly compliant patients to improve performance numbers • Reporting abuse and impaired professionals • Choice of care models – ACO, IPA • Google search patient

  12. Ethical Dilemmas of the Future • Physician assisted suicide • Medical/legalized marijuana – what is next? • Genetically modified babies • Health care rationing • Technology and medicine – EMR data breach

  13. Resources Available for Physicians • AMA Guidelines • Specialty medical associations • State medical associations • Malpractice insurance carrier • Hospital ethics committee consultation

  14. Sources Anspach , Renee . Chapter 2, Theorizing about life and death, a critical review, univ of California press Avitzur, Orly MD.,MBA Who else is paying your doctor? Neurology now: August-September 2012, vol 8 Issue 4 P 34-37 Beaucamp, Tom and Childress, James. Principles of bioethics, May 15 2008 Brody, Howaard. January 28, 2010 Medicine’s ethical responsibility for health care reform- the top five list. NEJM, 2010 362:283-285 Code of medical ethics of the American medical association, 2012-2013 Ehrenreich ,John . The cultural crisis of modern medicine , Science and society Vol 43 no 4, page 503 1979 Goldman, Alan The moral foundations of professional ethics ,Totowa, NJ 1980 Gostlin, Lawrence JD. Legal and ethical responsibilities following brain death , the Mcmath and Munoz cases. JAMA January 24, 2014 doi:10.1001 Koisos, Nikolasosetal . Evolution of medical ethics and bioethics in Greece: “ Ancient –c hristian –comtemporary Greece “ Elefterna”- scientific yearbook- vol III-2006 Maeda, Yoshiro. A Method to solve ethical dilemmas in Medicine. Journal of philosophy and ethics in health care and medicine, August 2012 No.6,9-28 Charka Samhita, Shree GalabkuverdaAyurvedic society Jamnagar India 1947, vol.5 pg,326 The medical student oath of ancient India Skinner, Jonathan and Wennberg ,John . How much is enough?efficiency and Medicare spending in the last six months of life. National Bureau of economic research,working paper no 6513 April 1998

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