1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. Organ donor card Figure 11-1

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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?

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