Medical Ethics - Rau's IAS

Medical ethics is the applied branch of ethics which describes the moral principles by which a medical practitioners must conduct themselves.
The four pillars of medical ethics are
- Beneficence
  - The idea that medical interference will do good for the patient
- Non-maleficence
  - Not to harm your patient, but to do them good, which is part of the Hippocratic oath that doctors take.
- Autonomy
  - Right of the patient to self-determination regarding their treatment
- Justice
  - The fair distribution of healthcare resources

Ethical Issues Involved in the Medical Field

Issue of medical negligence:
Collusive termination of pregnancy:
Medical fraud for monetary benefits:
Vadodara hospital shows kidney patients as HIV positive in medical reports, organ trade, higher ills for minor diseases.

To deal with medical issues Code of medical ethics provides for the following provisions

Character of Physician
- A physician shall uphold the dignity and honour of his profession. The prime objective of the medical profession is to render service to humanity. A physician should be an upright man, instructed in the art of healing. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and all the actions of his life.
Maintaining good medical practice:
- Physicians should try continuously to improve their medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments. The physician should practice methods of healing founded on a scientific basis and should not associate professionally with anyone who violates this principle.
Maintenance of medical records:
- Every physician shall maintain the medical records about his / her indoor patients for a period of 3 years from the date of commencement of treatment.
Use of Generic names of drugs:
- Every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of drugs.
Exposure of Unethical Conduct:
- A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.
Obligations to the Sick
- Though a physician is not bound to treat each person asking for his services. A physician advising a patient to seek the service of another physician is acceptable, however, in case of an emergency, a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient.
Prognosis:
- The physician should neither exaggerate nor minimize the gravity of a patient’s condition.
Unnecessary consultations should be avoided, and Consultation should be for the Patient’s Benefit, Punctuality should be there in Consultation. In consultations, no insincerity, rivalry or envy should be indulged. The Consultant shall not criticize the referring physician.

Physician assisted suicide and euthanasia: The Hippocratic Oath states: ‘I will give no deadly medicine to anyone if asked, nor suggest any such counsel’. This has been ordained to maintain the sanctity and dignity of life so that doctors’ professional capabilities are not abused. Nevertheless, during a terminal illness and in the care of patients with an irreversible life-threatening disease, a time comes when it is appropriate for the doctor to stop further attempts to prolong the misery and allow death with dignity.
Strikes by Physicians: Even though medical services are essential; it is not uncommon for doctors to go on strikes. It is unethical for physicians to withhold medical services through strikes
Rebates, Commissions and Courtesies: It is undesirable and unethical for physicians to give and solicit any gift, bonus or ‘kickbacks’ for referring patients for consultation and investigations. It is also unethical for physicians to receive courtesies, favours and gifts from manufacturers or suppliers of equipment and pharmaceuticals.
Research and Publications: Fraud in research either by plagiarizing or quantum jugglery should be condemned and those indulging in such acts should be punishable on grounds of professional misconduct. The stipulated code of conduct and format should be followed for scientific publications.
Professional Certificates: Physicians are expected to issue several medical certificates-birth, death, vaccination, sick leave, disability, etc. It is common to see false medical certificates issued by physicians for monetary gain or due to political bureaucratic pressures.
Running an open shop (Dispensing of Drugs and Appliances by Physicians): A physician should not run an open shop for the sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for the sale of medical or surgical appliances.
Human Rights: The physician shall not aid or abet torture, nor shall he be a party to either infliction of mental or physical trauma or concealment of torture inflicted by some other person or agency in clear violation of human rights.
Adultery or Improper Conduct: Abuse of professional position by committing adultery or improper conduct with a patient or by maintaining an improper association with a patient will render a Physician liable for disciplinary action as provided under the Indian Medical Council Act, 1956 or the concerned State Medical Council Act.
Sex Determination Tests: On no account sex determination test shall be undertaken with the intent to terminate the life of a female foetus developing in her mother’s womb, unless there are other absolute indications for termination of pregnancy as specified in the Medical Termination of Pregnancy Act, 1971.
Non-disclosure of medical information of the patient: The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –
- In a court of law under orders of the Presiding Judge;
- In circumstances where there is a serious and identified risk to a specific person and/or community; and
- Notifiable diseases. In case of communicable/notifiable diseases, concerned public health authorities should be informed immediately.
A prohibition from denying the duty: The registered medical practitioner shall not refuse on religious grounds alone to give assistance in or conduct of sterility, birth control, circumcision and medical termination of Pregnancy when there is medical indication unless the medical practitioner feels /herself incompetent to do so.
A Physician shall not use touts or agents for procuring patients.
A Physician shall not claim to be a specialist unless he has a special qualification in that branch.
No act of invitro fertilization or artificial insemination shall be undertaken without the informed consent of the female patient and her spouse as well as the donor.