Ethical, Medico legal And Administrative issues in Managing Emergencies by Prof. Adnan Albar

Conflict of interest in dealing and Emergency cases Paid Vs. Free Gov. Vs. Private

Issues related to justice Rationing Rationing Duty Duty Moral Issues in Disaster Medicine Moral Issues in Disaster Medicine Research Research

Teaching Clinical teaching Clinical teaching Burden Burden Privacy Privacy Teaching by simulation Teaching by simulation Proceedures on the newly dead Proceedures on the newly dead

Relationship with Biomedical Industry

Thank You

بسم الله الرحمن الرحيم “ On the name of Allah most graceores most merciful “

Confidentiality : Justified disclosure Reporting related to public health Reporting related to public health Vital statistics Vital statistics Contagious diseases Contagious diseases Child / Women / elder abuse Child / Women / elder abuse Criminally inflicted injuries Criminally inflicted injuries Poisoning Poisoning Loss of consciousness (the independent) Loss of consciousness (the independent)

Confidentiality : Justified disclosure Legal / justice proceedings Legal / justice proceedings Quality assurance review Quality assurance review Protection of a third party from mortal harm Protection of a third party from mortal harm

Truth telling and communication Communicating bad news Communicating bad news Protection of human subjects in biomedical and behavioural research Protection of human subjects in biomedical and behavioural research Considering the therapeutic privilege is morally licit when there is a significant probability of causing harm by truth telling ( e.g stressful news) Considering the therapeutic privilege is morally licit when there is a significant probability of causing harm by truth telling ( e.g stressful news)

Compassion and empathy: Empathy is the ability to feel the anguish of illness and struggle and treating the anguish if not the illness. Empathy is the ability to feel the anguish of illness and struggle and treating the anguish if not the illness. it’s the feeling of “I am you” or “I could be you“

The emergency rule to informed consent Unconscious pt. or otherwise incapable of cons. Unconscious pt. or otherwise incapable of cons. Harm from a failure to treat is imminent compared to the and proposed treatment. Harm from a failure to treat is imminent compared to the and proposed treatment. Lack for a substituted consent Lack for a substituted consent

A valid informed refusal of care requires The patient must have a decision making capacity. The patient must have a decision making capacity. Comprehension. Comprehension. Volantarness Volantarness

The determination of decision making capacity requires that: 1. The pt. appreciates that he or she has the power to wake decision on his or her behalf 2. The pt. understands the medical situation and prognosis, the nature of the recommended evaluation or care the a alternatives, the risks and benefits of each and the likely consequences 3. The patients decision is stable over time and is consistent with his or her life values or goals

Compassion and empathy improve patient and physician satisfaction by Promoting communication Promoting communication Minimizing conflict Minimizing conflict Maximizing patient confidence in the Dx and Rx plan Maximizing patient confidence in the Dx and Rx plan

Distributive justice seeks a morally correct distribution of benefits and burdens in society. It requires equitable but not necessarily equal allocation of resources

Distributive justice affects allocation of health care resources at 3 levels 1. At the societal interest level ( competes with education interest social services.etc ) 2. At allocating health care resources rationally 3. At institutional level of care departmental and bedside level

Gatekeepers / Limiters (third Party) Laws / eligibility Laws / eligibility Insurance Insurance Managed care Managed care

Moral issues in disaster medicine Triage is based on the ethical principle of providing the greatest benefit to the greatest number Triage is based on the ethical principle of providing the greatest benefit to the greatest number Priority to the personnel who might be able to return to the rescue effort and to those injuries most amenable to treatment Priority to the personnel who might be able to return to the rescue effort and to those injuries most amenable to treatment

The 4 Principle of health care ethics Autonomy i-e self rule Autonomy i-e self rule Beneficence Beneficence Non maleficence Non maleficence Justice is Treating equals equally and Treating non equals non equally. Justice is Treating equals equally and Treating non equals non equally.

Physicians must not act is away which in detrimental to patients.

Beneficence requires physicians to act to the best interests of their patients. They must balance goods and potential harms.

Ethical decisions can be made by considering four factors Medical indicators Medical indicators Equity of life Equity of life Patients preference Patients preference Features Features

3 rules for ethical decision Impartiality Impartiality Universability Universability Impersonal justifiability Impersonal justifiability

Informed consents involve two duties Disclose information to patients Disclose information to patients Obtain patients consent Obtain patients consent

It is the health care provider's responsibility to assure that the patient can meaningfully participate in the decisions

Shared decision making requires that the patient possess correct and complete information and that the decision promote the patients goal and life values

There are 3 elements in the consent process Information Information Comprehension Comprehension Volantariness Volantariness

The concept of Legal Competence Advanced directive A written document which explains the future wishes of a patient when he/she becomes unable to participate in the decision directly e.g -The terminally ill - The Suicide attemptlor - The Suicide attemptlor

End of life decisions Limiting resuscitation Limiting resuscitation Don’t resuscitate order “DNR” Don’t resuscitate order “DNR” Futility Futility

The physician – patient - relationship Confidentiality Confidentiality Truth telling and communication Truth telling and communication Compassion and empathy Compassion and empathy

Ensuring availability of Essential structural (Design,Space,Manpower,ambulance, equipment,supplies,…ete ) and process ( policies, procedures, job description, job distribution, referral …… ete ) requirement for the provision of effective emergency care services

Dealing with emergencies in the private medical facilities Availability Availability Suitability Suitability Problems of coverage Problems of coverage Problems and Insurance Problems and Insurance

Sources of profusion ethic in Islam ) ما فرطنا في الكتاب من شيء ) ( اليوم أكملت لكم دينكم وأتممت عليكم نعمتي ورضيت لكم الإسلام ديناً ) ( إنما بعث لأتمم مكارم الأخلاق )

Characteristic of the professional ethics in Islam Define sources Define sources Worship intent Worship intent Constant Constant Based on clear fundamental rule Based on clear fundamental rule Self accountability Self accountability

Issues in dealing with Psychiatric emergencies Ethical Ethical Administrative / legislative Administrative / legislative Medic legal Medic legal Security and safety Security and safety

Ethical Issues in dealing with police emergency cases

Financial Issues in dealing with emergency cases Payment Payment Extent of coverage Extent of coverage Approval and third party Approval and third party

Human rights in managing emergencies and disasters