Ethical and Bioethical Issues in Medicine Chapter 11 2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Medical Law and Ethics, 2nd Edition Bonnie F. Fremgen

Early History Code of Hammurabi, 1800 B.C. Hippocratic Oath, 400 B.C. Hippocrates, “Father of medicine” Principles for his medical students to follow Principles stated in oath found in many professional codes of ethics today

Ethical Standards and Behavior Moral principles or practices Customs of the medical profession Matters of medical policy If accused of unethical behavior or conduct Can be issued warning or censure (criticism) The AMA Board of Examiners may recommend expulsion (forced out) or suspension If convicted of crime, may result in fine, imprisonment, or revocation of license

Codes of Ethics Professional organizations have them Summarize basic principles and behavior expected by all in that discipline Meant to govern conduct of members of given profession

American Medical Association (AMA) Principles of Medical Ethics Discusses Human dignity Honesty Responsibility to society Confidentiality Need for continued study Patient autonomy Responsibility to improve community

Judicial Council Opinions of the AMA Comprised of nine members Interpret Principles of Medical Ethics Council’s interpretation or clarification published for AMA members All members are expected to cooperate with physician in upholding these principles

Nurses’ Code of Ethics People, their practice, society, coworkers, Developed by International Council of Nurses Discusses role of nurses as they relate to People, their practice, society, coworkers, and profession American Nurses Association (ANA) Code discusses nurses’ obligation to protect privacy, respect dignity of patient, maintain competence, and assume responsibility and accountability for judgments

Code of Ethics of the American Association of Medical Assistants (AAMA) Provides guidance for many of the dilemmas regarding right and wrong that medical assistants face on an almost daily basis Concerned with doing the right thing at the right time

Ethics Committees Examine ethical issues relating to patient care Contain a variety of members from many health care disciplines Can serve in advisory capacity to patients, families, and staff for case review of difficult ethical issues Develop and review health policies and guidelines regarding ethical issues

Bioethical Issues Issues resulting from advances in medical technology Examples: cloning, harvesting embryos, and in-vitro fertilization

The Ethics of Transplant Rationing Criteria for rationing transplants are controversial In donation model, organs are taken (harvested) with consent of donor (or donor’s surrogate representative) The Uniform Anatomical Gift Act permits competent adults to allow or forbid use of their organs after death

Organ donor card Figure 11-1

Other Methods of Allocation Social utility method allocates organs to patients who will benefit most Justice—everyone equal chance Seniority—first-come, first-served basis Lottery method—random allocation In combination approach, “medical suitability” measures medical need with benefit

United Network for Organ Sharing (UNOS) Legal entity in United States Responsible for allocating organs for transplant Gives half weight to consideration of medical need and other half to considerations of justice National Organ Transplant Law of 1984 forbids sale of organs in interstate commerce

Ethical Issues and Personal Choice May have a personal, religious, or ethical reason for not wishing to be involved in particular procedure Preference should be stated before one is hired Ethics of employer must be in agreement with ethics of the health care professional

The Ethics of Biomedical Research Human beings cannot be used for testing unless they consent to participate Must obtain consent Justification for all medical research is that benefits must outweigh risks Researcher must abide by established standards for testing Institutes that receive federal research funds must have Institutional Review Board (IRB) to oversee research

Consent Informed consent necessary when patient involved in therapeutic research Must be made aware of all risks involved Must be informed about type of research design that is used Physician must explain all facts of research, even if this means patient may decide not to participate

Conflicts of Interest May arise if researcher’s interests are placed above interests of the patient

Ethics of Randomized Test Trials Many believe it is unethical to use control groups because participants have no hope of benefiting from the study Race-based control group may produce ethical dilemmas; for example, it is unethical unless evidence suggests participants will benefit by the therapy

Problems with the Double-Blind Test Neither experimenter nor patient knows who is getting research treatment Ethical question arises with informed consent Are patients fully aware that they may not be receiving any treatment whatsoever?

Medical Etiquette Certain rules, or standards of professional behavior, that physicians practice in their relationships or conduct with other physicians