1. Lecture #4 Duties toward patients
ETH 101
Ethics in Health Care
Lecture #4 Duties toward patients
L. Areej Jouhar Suliman
Prepared by: Dr. Fatmah Al-Moayad

2. Course content Orientation and introduction Plagiarism
Importance of Ethics and patients rights
Principals of health ethics
Duties toward patients
Duties toward community
Duties toward oneself and religious ruling
Duties toward the profession
Ethics in learning and teaching
Ethics in documentation
Prepared by: Dr. Fatmah Al-Moayad

3. Lecture Outline Good treatment
Achieving Patients’ Interests and Guarding their Rights
Patient’s Consent
Reassurance of Patient
Breaking bad news
Confidentiality
Photography and Voice Recording
Refusing medical treatment
Refrain from treating a patient
Prepared by: Dr. Fatmah Al-Moayad

4. Good Treatment smiling. Listening and empathizing.
Discretion and choosing appropriate words which does not embarrass the patient.
Showing humility and refrain from arrogance, demeaning, mocking, sarcasm.
Prepared by: Dr. Fatmah Al-Moayad

5. Good Treatment Respecting views, customs and social norms.
Fairness and no discrimination.
Gentle handling.
Refraining from committing religiously forbidden acts.
Reducing the patient’s physical and psychological suffering.
Prepared by: Dr. Fatmah Al-Moayad

6. Achieving Patients’ Interests and Guarding their Rights
Limit investigations, prescriptions and procedures to what is needed.
Refrain from using unproven diagnostic or therapeutic measures.
Informing and educating.
Refer patients to appropriate health care practitioners.
Prepared by: Dr. Fatmah Al-Moayad

7. Achieving Patients’ Interests and Guarding their Rights
Respect patient’s right to access medical information, have it recorded and/or be referred to another healthcare practitioner.
Continuity of care.
Make sure that patients receive appropriate medical care during your absence.
In emergencies, continue delivering the medical care until care is no longer needed.
Respect patients’ times.
Prepared by: Dr. Fatmah Al-Moayad

8. Patient’s Consent
Patients need to give consent to any medical or surgical intervention.
Enough information should be provided.
Consent should be sought from competent patients or their proxy/substitute decision maker.
Prepared by: Dr. Fatmah Al-Moayad

9. Read about (Woman’s Consent, Incompetent Patient’s Consent) Page 17-18
Risky procedures require written consent.
Women give consent to all medical procedure except what is related to their reproduction where husband’s consent should be sought.
Read about (Woman’s Consent, Incompetent Patient’s Consent) Page 17-18
Prepared by: Dr. Fatmah Al-Moayad

10. Reassurance of Patient
Explore psychological needs
Educate to reduce fear.
Interact with patients’ fears.
Correct misconceptions.
Give patients time to understand and express feelings.
Prepared by: Dr. Fatmah Al-Moayad

11. Reassurance of Patient
Remind patients that illness is chance for forgiveness.
Reassure patients that they will be taken care of as long as they need, even in incurable diseases.
Pray with and for the patient.
Prepared by: Dr. Fatmah Al-Moayad

12. Breaking bad news
Gradual approach and preparing the patient psychologically.
Suitable to patients understanding.
Appropriate time and place.
Give enough time and attention.
Prepared by: Dr. Fatmah Al-Moayad

13. Breaking bad news Focus on the positives. Continuity of care.
Assess how much knowledge is needed.
Learn communication skills.
Don’t disclose what you are not authorized to.
Prepared by: Dr. Fatmah Al-Moayad

14. Confidentiality (Maintaining Patient’s Secrets)
when can you disclose information?
Protect contacts from harm (contagious diseases, drug addiction)
Interest of the society (criminal act, communicable diseases, court, malpractice charges).
Useful for the treatment.
Education purposes (maintain patient identity).
Prepared by: Dr. Fatmah Al-Moayad

15. Photography and Voice Recording
Photography is not allowed unless there is a need (medical care, research, education, legal).
Prepared by: Dr. Fatmah Al-Moayad

16. Photography and Voice Recording
Regulations:
Inform.
Obtain consent.
Never pressure.
Used only for important and necessary purposes.
Right to withdraw.
No publishing without written consent.
Prepared by: Dr. Fatmah Al-Moayad

17. Photography and Voice Recording
Exception of consent:
Photograph of internal organs of the body.
Histology (human tissues) slides.
Endoscopic photographs.
Diagnostic imaging in any of its forms.
Prepared by: Dr. Fatmah Al-Moayad

18. Refusing medical treatment
Listen to the patient’s point of view and respect his/her wish.
Explain the importance the consequences without exaggeration.
Refer patients to their treating doctors.
Document refusal.
Prepared by: Dr. Fatmah Al-Moayad

19. Refrain from treating a patient
Non-emergency.
Have a personal or professional reasons that would jeopardize the quality of care.
Refraining does not harm the patient’s health.
There is an alternative capable practitioner.
Prepared by: Dr. Fatmah Al-Moayad

20. Any questions?
Prepared by: Dr. Fatmah Al-Moayad

21. Case scenario
A 30 year old woman was diagnosed with aggressive bone cancer. Treatment includes chemotherapy which will most probably damage her ovaries and consequently her ability to have children. When you explained the side effects to the patient she agreed to the treatment but asked you not to mention it in front of her husband. What should you do?
Prepared by: Dr. Fatmah Al-Moayad

22. Case scenario
You work in a charity clinic that is struggling to provide health care for poor patients. A representative from a medical devices company visited your clinic asking you try a new medical instrument on your patients in exchange of covering their medical expenses. The instrument has not been approved yet, but the primary studies showed promising results. What should you do?
Prepared by: Dr. Fatmah Al-Moayad

23. Case scenario
A 65 year old man came to the hospital after a car accident. The treating doctor thought a photo of him could be very helpful for his students. As the patient was unconscious his 40 year old son signed a consent form. When the patient gained his consciousness back he did not like that photos were taken and asked the doctor not to use them. The pictures were rare and would have been very useful for teaching purposes and a written consent was given. What should the doctor do?
Prepared by: Dr. Fatmah Al-Moayad

24. Reference
Chapter 1 and 2: Code of Ethics for Healthcare Practitioners (2014) The Saudi Commission for Health Specialties, Department of Medical Education & Postgraduate Studies.
Prepared by: Dr. Fatmah Al-Moayad