Physician – Society Relationship

1. Physician – Society Relationship Ma. Kristina Fatima Louise Garcia Irka Garcia Mark JesreelGarcia Ma. Monica Pamela Garzon CheryllGatchalian Gem Minnie Mae Gaw Isabelle Reyna Geraldoy Section B

3. HUMAN RIGHTS • It refers to the "basic rights and freedom to which all humans are entitled”. • Examples of rights and freedoms which have come to be commonly thought of as human rights include civil and political rights such as: • The right to life and liberty • Freedom of expression and equality before the law and economic, social and cultural rights, including : • The right to participate in culture • The right to food • The right to work • The right to education Article 1 of the United NationsUniversal Declaration of Human Rights (UDHR

4. History of HUMAN RIGHTS • The Cyrus Cylinder issued by the Persian emperor Cyrus the Great following the Persian conquest of Babylon in 539 BC • Edicts of Ashoka issued by Ashoka the Great of India between 272-231 BC • The Constitution of Medina of 622 AD, drafted by Muhammad to mark a formal agreement between all of the significant tribes including Muslims, Jews and Pagans. • The English Magna Carta of 1215 is particularly significant in the hIstory of English law, and is hence significant in international law and constitutional law today. Declaration of the Rights of Man and of the Citizen approved by the National Assembly of France August 26, 1789.

5. We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. Declaration of the Rights of Man and of the Citizen approved by the National Assembly of France August 26, 1789.

6. Humanitarian Law • The Geneva Conventions came into being between 1864 and 1949 as a result of efforts by Henry Dunant, the founder of the International Committee of the Red Cross. • The conventions safeguard the human rights of individuals involved in armed conflict. • Convention- an international agreement (rather than an assembly of people) Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

7. Conventions • First Geneva Convention: for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field • Second Geneva Convention: for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea • Third Geneva Convention: relative to the Treatment of Prisoners of War • Fourth Geneva Convention: relative to the Protection of Civilian Persons in Time of War Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

8. Universal Declaration of Human Rights • The Universal Declaration of Human Rights (UDHR) is a non-binding declaration adopted by the United Nations General Assembly in 1948, partly in response to the atrocities of World War II. • The UDHR urges member nations to promote a number of human, civil, economic and social rights, asserting these rights are part of the "foundation of freedom, justice and peace in the world." Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

9. UNIVERSAL DECLARATION OF HUMAN RIGHTS • Right to life ( Article 2) • Prohibition of torture, inhuman or degrading treatment or punishment (Aritcle 3) • Prohibition of slavery and forced labour (Article 4) • Right to liberty and security (Article 5) • Right to a fair trial (Article 6) • No punishment without law (Article 7) • Right to respect for private and family life (Article 8) Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

10. UNIVERSAL DECLARATION OF HUMAN RIGHTS • Freedom of thought, conscience and religion (Article 9) • Freedom of expression (Article 10) • Freedom of assembly and association (Article 11) • Right to marry (Article 12) • Prohibition of discrimination (Article 14) • Restrictions on political activity of aliens (Article 16) • Prohibition of abuse of rights (Article 17) • Limitation on use of restrictions on rights (Article 18) Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

11. All human beings are born free and equal in dignity and rights.They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

12. Everyone is entitled to all the rights and freedom without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

13. Everyone has the right to life, liberty and security of person. • The patient's right to life should be specifically considered in any decision to withhold or withdraw life-prolonging treatment but this does not mean that treatment must always be provided. • Treatment may be withdrawn if: providing treatment would not be in the patient's best interests; the treatment is considered futile; or the patient has effectively waived his or her right to have life prolonged by making an informed refusal of life-prolonging treatment. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

14. Everyone has the right to life, liberty and security of person. • May impose a duty on doctors to take steps to prevent life-threatening conditions and a duty to inform the public, or individuals, of threats to their life • This would involve a breach of confidentiality, this should be balanced against the patient's right to confidentiality. • Must be taken into account where potentially life-prolonging treatment is not provided on economic grounds. Any such decisions must be made in a non-discriminatory way and the decisions must hold up to scrutiny. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

15. Freedom of thought, conscience and religion • A patient may object to treatment, or the parents of a child may object to treatment for the child, on religious grounds, even where withholding treatment may lead to death. • The patient's right to be protected from inappropriate or unlawful treatment without consent must also be taken into account. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

16. Why is the Human Rights Act relevant to medical treatment? • It regulates the relationship between individuals and public authorities. It is unlawful for public authorities 'to act in a way which is incompatible with a Convention right‘ • Many doctors are not accustomed to thinking in terms of "rights" but one of the purposes of this guidance is to show the way in which accepted good practice, focused on patients' wishes and interests Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

17. How will decision making differ? Two questions to ask in each case: • Are someone's human rights affected by the decision? And, if so, • Is it legitimate to interfere with them? Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

19. SOCIAL JUSTICE • Social justice, sometimes called civil justice, refers to the concept of a society in which "justice" is achieved in every aspect of society, rather than merely the administration of law. • It is generally thought of as a world which affords individuals and groups fair treatment and an impartial share of the benefits of society. • It can also refer to the distribution of advantages and disadvantages within a society. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

20. Catholic social teaching • Comprises those aspects of Roman Catholic doctrine which relate to matters dealing with the collective aspect of humanity. • A distinctive feature of Catholic social teaching is its concern for the poorest members of society. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

21. Two of the seven key areas of Catholic social teaching are pertinent to social justice: Life and dignity of the human person The foundational principle of all Catholic Social Teaching is the sanctity of all human life and the inherent dignity of every human person. Human life must be valued above all material possessions Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

22. "Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.“ The Catholic Church teaches that through words, prayers and deeds one must show solidarity with, and compassion for, the poor. When instituting public policy the "preferential option for the poor" should always be kept at the forefront. Preferential option for the poor and vulnerable: Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

23. The moral test of any society is "how it treats its most vulnerable members. The poor have the most urgent moral claim on the conscience of the nation. People are called to look at public policy decisions in terms of how they affect the poor." Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000. http://www.wikipedia.org

24. HEALTH AND CULTURE

25. HEALTH AND CULTURE • Culture • Encompasses all learned patterns of human behavior (e.g. beliefs, traditions, language, customs, etc.) • Shapes the experiences of a particular group of people (e.g. family relationships, approaches to healing, expectations of what it means to be a boy/girl, etc.) • “Norms” CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

26. HEALTH AND CULTURE • Important Things about Culture • Everyone has a culture. • There is diversity within cultures. • Cultures are not static. • Culture is not determinative. • Cultural “differences” are complicated by differences in status and power between cultures. CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

27. HEALTH AND CULTURE • In medical practice: • Ensure good care for diverse patients • Address cultural issues in medicine CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

28. HEALTH AND CULTURE • Cultural Competency • Ability to work effectively across cultures • An approach to learning, communicating and working respectfully with people different from themselves (individual) • Creating the practices and policies that will make services more accessible, appropriate and effective to diverse populations (organization) CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

29. HEALTH AND CULTURE • Importance of Cultural Competency • Great urgency for service and support to reach diverse groups • To serve all communities • To bridge differences • To improve the social, health and educational outcomes of members of a specific group CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

30. HEALTH AND CULTURE • Areas of Conflict • Historical distrust • Interpretations of disability • Concepts of family structure and identity • Communication styles • Incompatibility of the epidemiology of the illness • Misunderstanding of language, terminologies, etc. CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

31. HEALTH AND CULTURE • How to Become Culturally Competent • Listen • Explain • Acknowledge • Recommend • Negotiate CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & Scharf

32. HEALTH AND CULTURE • Scenario 1 A 3-year old child was brought to the emergency room because of fever. Upon interview of the mother, it was found out that the child have had recurring fever for quite some time already. When asked why the delay in taking her to the doctor, the mother revealed that they have been seeking “consult” from the local hilot(alternative “doctors”). However, since the condition of the child seems to have worsened, they decided to take her to the hospital.

33. HEALTH AND CULTURE • Scenario 1 • Explain • Educate • Provide appropriate medical care • RESPECT

34. HEALTH AND CULTURE • Scenario 2 Suzy, a 37-year old woman, was horseback riding one day and was thrown off her horse. She suffered massive internal injuries. At the hospital, they discovered that she lost a huge amount of blood and requires immediate transfusion. However, in her medical alert card, it was stated that she was a member of the Jehovah’s witness and stating that under no circumstances was she to receive blood.

35. HEALTH AND CULTURE • Scenario 2 • Seek any family member • Explain • Offer alternatives • Respect their decision

36. Allocation of Scarce Resources

37. Allocation • assigning of resources for specific purposes • Two levels: • Micro – level of individuals • Macro – level of various groups within a national society or at the international level Ethics of Health Care third edition Ashley and O’Rouke sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

38. Case 1 The neonatal care unit at Children’s Memorial Hospital has six respirators available and eight newborn infants in need of pulmonary assistance Ethics of Health Care third edition Ashley and O’Rouke

39. Principle of Common Good and Subsidiarity • The principle maintains that human communities exist only to promote the common good of their members, and that each person or social group has a right and responsibility to participate in this effort • Calls upon each person or lower social unit to be given the opportunity to exercise the responsibility to achieve the goals proper to it. Ethics of Health Care third edition Ashley and O’Rouke

40. Principle of Common Good and Subsidiarity • Human Communities promote and share the common good among member, “from each according to its ability and need” • Decision making: • Rest vertically primarily with the person, and then the lower social levels and (horizontally) with functional social unit. • The higher social unit intervene to supply the lower units with what they cannot achieve for themselves at the same time working to make it easier in the future for the lower units and individuals to satisfy the needs by their own effort. Today we allocate resource to those who can pay and not according to the need of the person Ethics of Health Care third edition Ashley and O’Rouke

41. Principle of Subsidiarity and Common Good • closest to us & whose need is best known to us should be cared for first • it is not unjust for a family to seek the best obtainable care for its members, or for physicians to give special attention to their regular patients with whom a special relationship of trust has been built, as long as no one else is treated unjustly Ethics of Health Care third edition Ashley and O’Rouke

42. Principle of Triage • allocation of resources between individuals • means, “to pick or sort according to quality” • According to Jean Larrey: • Those who are dangerously wounded must be tended first, entirely without regard to rank or distinction. • Ethicist generally agree that this does not violate justice if it respects the rights of patients completely as possible in a situation Ethics of Health Care third edition Ashley and O’Rouke

43. applying the principle of triage in emergency situations, two question must be asked • Who is in greatest need of treatment? • Who will benefit most from treatment? Ethics of Health Care third edition Ashley and O’Rouke

44. Threefold division of victims: • The dying • need is great but will benefit least from treatment & should be made comfortable & left to die • The wounded who will survive w/o treatment - their need is little & who can be left to care for themselves 3. The wounded who will die unless treated – probably survive if treated In here the last two both have the greatest need and benefit so they deserve more attention. Ethics of Health Care third edition Ashley and O’Rouke

45. Types of Triage • ED triage • prioritize patient assessment and treatment in the emergency department during routine functioning • Priority is given to those most in need sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

46. Inpatient triage • Applied day-to-day in a variety of medical settings • ICU, medical imaging, surgery, and outpatient areas • Priority is given to those most in need based upon medical criteria. sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

47. 3. Incident triage • Used in multiple casualty incidents such as bus accidents, fires, or airline accidents • Most patients receive maximal treatment. sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

48. 4. Military triage • Used on the battlefield • Reflect the original concept of triage • Resources are rationed when their supply is threatened sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

49. 5. Disaster triage • Used in mass casualty incidents that overwhelm local and regional healthcare systems • Prioritize salvageable patients for treatment and ration resources to ensure the greatest good for the greatest number sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

50. Triage some problems Triage in Microallocation • Select which patients are to be given a new vaccine or drug when a sufficient supply for all is not yet available • Recipient of scarce organs for transplantations Triage in Macroallocation 1. Selecting funds for health programs, is it preventive or medicinal. Example: Do we give more fund to dialysis for end stage renal disease or for vaccination and immunization program for children. sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf Ethics of Health Care third edition Ashley and O’Rouke