Ethical Practice Of Medicine Research Articles

PERCEPTION OF MEDICAL POST GRADUATE STUDENTS ON LEARNING MEDICAL ETHICS IN THE CURRICULUM- A CROSS SECTIONAL STUDY IN A MEDICAL COLLEGE IN MAHARASHTRA

Background: Ethical practice of medicine is an area of increasing public awareness and attack on doctors on breach of the same is a growing concern nowadays. Along with a medical post graduate degree, a health personnel is expected to know all about medical ethics and mold their clinical practice accordingly. But it has not been included as a part of curriculum in most of the institutions. Improving the perception of students towards medical ethics education is an essential task. Objective: To assess medical post graduate students perception regarding incorporation of medical ethics in medical curriculum in a teaching institute. Method: A cross-sectional study including 300 post graduate medical students was conducted in a medical college in Maharashtra during October-November 2022,after obtaining informed consent from them. A self- administered questionnaire about awareness on medical ethics and their perception towards including the same in the curriculum was given to the participants. Result was entered in MS Excel and analyzed using SPSS trial version 29. Results: Among 242 postgraduates who responded,66.9% were females ,70.2% belonged to second year of course,55.4% were from class I &II of Modified BG Prasad socioeconomic scale,71.1% had place of residence as urban area. Adequate knowledge regarding medical ethics was seen among 54.1%, appropriate attitude was shown by 46.7% and practice by 33.1%.Statistically significant association was found between age, socioeconomic status, year of study and place of residence and knowledge about and practice of medical ethics(p<0.05). Conclusion: It is being concluded that even though there is adequate knowledge in medical ethics, future physicians are lacking appropriate perception on the same, which throws light towards need of improvement of awareness and also inclusion of medical ethics as an important part of postgraduate curriculum.

Medicine, torture, the death penalty and the democratic state: from collaboration to emancipation

Abstract Abuses of medicine have taken place over past decades in the context of torture and the death penalty. Serious and totally unacceptable breaches of medical ethics and human rights have occurred in institutions caring for vulnerable people. And yet there is still a need to make visible the whole spectrum of violence and breaches of human rights and to challenge them. This paper discusses a wide range of abuses in which medical professionals may take part whether as witnesses, bystanders or participants. It also addresses changes that are needed to benefit citizens at risk of abuse and to strengthen the ethical practice of medicine. The frequently-used term “empowerment” as applied to populations at risk signals a step in the right direction but usually involves the top-down giving of limited power to people. What oppressed people need is to claim their human rights – to emancipate themselves.

AMA Code of Medical Ethics Gets Long-Awaited Update

AMA <i>Code of Medical Ethics</i> Gets Long-Awaited Update

The impacts of Malaysian managed care on doctor–patient relationships, ethical practice of medicine, and quality of care: A study on primary care physicians' perception

Managed care is becoming a critical factor of healthcare delivery which assures a lower cost without compromising the quality of care. However, this practice has increased the physicians' responsibilities in terms of cost containment and patient care. This study analyzed the perception of physicians on the impact of managed care on doctor–patient relationships, the ethical practice of medicine, and the quality of care. Data were gathered from a survey of physicians in Malaysia. Variables representing doctor–patient relationships, ethical practice of medicine, and quality of care were calculated using median. The findings showed that physicians have a positive perception of managed care on doctor–patient relationships, the ethical practice of medicine, and the quality of care in clinical practice.

Obituary: juan josé lópez-ibor (1941-2015).

Obituary: juan josé lópez-ibor (1941-2015).

The use of placebos in phase III clinical trials in Brazil.

In 2008, Brazil's Federal Council of Medicine [Conselho Federal de Medicina] (CFM)--regulatory and supervisory agency on the ethical practice of medicine--banned the participation of Brazilian doctors in studies using placebos for diseases with efficient and effective treatment. This position differs with the Helsinki Declaration, which allows the use of placebos in methodologically justified conditions. To ascertain whether the CMF's ethical regulation modified the use of placebos in phase III clinical trials in Brazil, characteristics of the records in ClinicalTrials.gov were researched in the periods from 2003 to 2007 and from 2009 to 2013. The conclusions reached were: a) the regulations issued by the CFM in 2008 were ineffective and the position adopted by the Helsinki Declaration prevails; b) there was significant sponsorship by the multinational pharmaceutical industry of trials with placebos; c) the research was predominantly on new drugs for chronic diseases, with little study done of the neglected diseases which are of great importance to Brazil.

The use of placebos in phase III clinical trials in Brazil

In 2008, Brazil's Federal Council of Medicine [Conselho Federal de Medicina] (CFM)--regulatory and supervisory agency on the ethical practice of medicine--banned the participation of Brazilian doctors in studies using placebos for diseases with efficient and effective treatment. This position differs with the Helsinki Declaration, which allows the use of placebos in methodologically justified conditions. To ascertain whether the CMF's ethical regulation modified the use of placebos in phase III clinical trials in Brazil, characteristics of the records in ClinicalTrials.gov were researched in the periods from 2003 to 2007 and from 2009 to 2013. The conclusions reached were: a) the regulations issued by the CFM in 2008 were ineffective and the position adopted by the Helsinki Declaration prevails; b) there was significant sponsorship by the multinational pharmaceutical industry of trials with placebos; c) the research was predominantly on new drugs for chronic diseases, with little study done of the neglected diseases which are of great importance to Brazil.

La incapacidad como acto médico

El avance de la seguridad social y los conceptos de prestaciones económicas para cubrir los tiempos de incapacidad por razones médicas han generado una crisis entre lo administrativo y el ejercicio de la profesiones de la salud, en la cual, por el bien del paciente y el ejercicio ético de la medicina, se impone la necesidad de desarrollar un ejercicio autónomo y responsable. En el artículo se presentan definiciones, conceptos fundamentales, normas y aspectos éticos inherentes a dicho ejercicio en Colombia, al tiempo que se emiten criterios y recomendaciones para su adecuada expedición, incluidoslos efectos económicos, judiciales y sociales de la expedición de estos certificados de salud.

Where are all the bioethicists when you need them?

Is biomedical ethics just casual talk? Is it merely medical etiquette, philosophical window dressing, full of empty rituals and little substance? Do doctors take ethics seriously? What should we expect from bioethicists when the ethical practice of medicine is at stake? One cannot ignore these questions in the aftermath of a shameful saga – ‘upon which it is difficult to speak, and impossible to be silent’ – that unfolded over the election of a president-elect of the World Medical Association (WMA).1 The WMA is an international association of doctors established in the aftermath of Nazi medicine to ‘work for the highest possible standards of ethical behaviour and care by physicians at all times.’2 In keeping with its goal to provide ‘ethical guidance to physicians,’ the WMA ‘has adopted global policy statements on a range of ethical issues’ including the International code of medical ethics, and the Declarations of Geneva and Helsinki.3 The annual assembly of the WMA, hosted by the Indian Medical Association in New Delhi on October, 2009, featured ‘the unopposed election in his own country’ of Ketan Desai, [then] president of the Medical Council of India (MCI) as president-elect of the WMA.4 Six months later, in April 2010, Desai was arrested on charges of seeking a bribe of 20 million rupees (£296,000; €350,000; $450 000).5,6 No stranger to accusations of unethical behaviour, Desai was ousted from his position as president of the MCI in 2001 by order of the Delhi High Court,7–9 which observed that Desai and his family had ‘received unexplained payments totalling 6.5 million rupees (£92,000; €105,000; $150,000).’1 The Supreme Court of India dismissed this case against Desai as no evidence was found that he had ‘extended official favours to those from whom he had received payments.’ Eventually Desai was reinstated as head of the MCI in 2009.5 Reports of corruption and new bribery charges against Desai in 2010 led the government of India to disband MCI and re-establish it with a new board of governors. Undeterred by being removed as president of the MCI for a second time, WMA president-elect Desai, who had been jailed on the bribery charges, obtained bail and was about to assume his position as the new president of the WMA at its annual assembly in Canada. The MCI's new board of governors revoked Desai's license to practice medicine and informed the WMA that ‘It would be a travesty of justice if Desai, who has brought disgrace to the medical profession, is allowed to take charge as the president of the World Medical Association.’1 When the annual assembly of the WMA met in Vancouver, Canada, in October 2010, the president-elect of the WMA was found ‘unable to carry out his duties’ and his ‘inauguration’ as president was ‘suspended indefinitely.’10 In an extraordinary election, Wonchat Subhachaturas from Thailand was elected as president of the WMA. This incident – ignored or unnoticed by doctors, professional medical associations, and other stakeholders – deserves careful reflection by all who are concerned about the cause of ethics in medicine. That an ethically compromised doctor became president of a medical council or professional association is shameful but not impossible in a country like India, where corruption is endemic.9 It is difficult to believe, however, that no one in the WMA knew about Desai's past record given the fact that his removal from the MCI was reported in both national and international medical journals.7–9 The case of Desai, and the anemic reaction to his election and suspension, raise several questions about the place of bioethics in medicine: How could an ethically challenged doctor become the president-elect of the WMA? Is ethics simply a look-good decorative badge on the white coat? What will prevent this kind of ethical lapse from being repeated? This case is not about a single person or a professional association, but rather about the integrity of the medical profession and the place of ethics in medicine. Regrettably, there is no indication – at least publicly – that Desai's case generated any introspection on the part of the WMA. Corruption was noticeably absent from the agenda when the WMA adopted a number of resolutions on several health-related issues in their assembly. Is it not an ethical imperative for a professional association of the stature of the WMA to come clean and explain their position?

Quality Improvement Strategies of Medical Ethics Education in Korea

In the past twenty years, medical ethics has emerged as a priority within medical schools in Korea. This article contains important messages about the general overviews and current status, such as the educator, teaching method, and goals of medical ethics education in medical schools. The author suggests ideas of improvement and qualification of the medical ethics education in Korea. There are two points of view regarding the purpose of teaching medical ethics: (1) that it is a means of creating virtuous physicians; and (2) that it is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The field would benefit from further theoretical work aimed at better delineating the core content, core processes, and core skills relevant to the ethical practice of medicine. They are in agreement that a multidiciplinary team of ethicist-philosophers and physicians should teach medical ethics, and ethics education should be integrated longitudinally throughout the 4 years

Committee Opinion No. 466: Ethical Considerations for Performing Gynecologic Surgery in Low-Resource Settings Abroad

International humanitarian medical efforts provide essential services to patients who would not otherwise have access to specific health care services. The Committees on Ethics and Global Women's Health of the American College of Obstetricians and Gynecologists encourage College Fellows and other health care professionals to participate in international humanitarian medical efforts for this reason. However, such programs present Fellows with a unique set of practical and ethical challenges. It is important for health care providers to consider these challenges before participating in international surgical efforts in these settings. Health care professionals should ensure that they have the necessary surgical competence and training, including sufficient mentorship, prior to functioning as the primary surgeon abroad. Before they perform surgery, health care professionals should ensure that patients have access to adequate medical resources and preoperative and postoperative care. They should be willing and prepared to postpone or cancel surgery when the standards of ethical medical care cannot be met and the members of the surgical team believe that the best interest of the patient cannot be achieved with the current available resources. Health care professionals' efforts should contribute to the long-term well-being of the patients and the communities being served through the ethical practice of medicine, responsible conduct of research, and investment in the sustainability of services. The care of the patient should be the highest priority for those participating in these medical programs.

Évolution de la conscience morale hippocratique

This article is written in French.&#x0D; The article is a presentation of a lecture delivered on the International Science Session “Ethics, Finances and Responsibility”, which took place on October the 3rd and 4th, 2008 in Chateau de Bossey near Geneva. Searching for sources of ethic thoughts connected with difficult moral problems of the contemporary world, the author deals with the oldest, well known writing about the ethical practice of medicine, the Hippocratic Oath. Presenting the plenteous, philosophical- ethical contents of the Oath and the history of the growth on it the Hippocratic tradition enriched in experience of the Christian anthropology, the author identifies its norms and rules. Unfortunately, since the Enlightenment times, especially the nineteenth century Positivism the tradition has been seriously disturbed. Together with the questioning the Aristotelean-Thomism anthropology, the doubts appeared related to the matter of protection of life since the conception until the natural death. Whereas new, legal regulations connected with the progress of in medical studies request deep anthropological and philosophical reflection, which would bring back the importance of the forgotten Hippocratic tradition, where in the center of medical actions is a man who needs help.

Ethical Considerations Of Pharmaceutical Sales In The Primary Care Arena

The conflict of interest between pharmaceutical sales and the ethical practice of medicine has long existed. While pharmaceutical companies have lost much of their ability to financially incentivize clinicians, they continue to have undue influence over prescribing practice by means of “detailing.” In an attempt to gain large market shares, these companies exploit this mode of medical information dissemination, creating enormous endorsement bias, and ultimately placing patients at the mercy of these manipulation tactics. Jonsen et al. have established the four topic method of ethical discourse which includes medical indications, patient preferences, quality of life, and contextual features. These topics allow for an intelligent discussion concerning the ethics of pharmaceutical business practices. The integrity of evidence-based medicine as well as the safety and welfare of patients are at risk. How clinicians respond to these pressures will have positive or negative impact on this medical ethics dilemma.

Tools for Tomorrow??s Health Care System: A Systems-Informed Mental Model, Moral Imagination, and Physicians?? Professionalism

Physician educators have been charged with incorporating systems-based approaches into medical education and residency training to help future physicians understand how their ability to provide high-quality health care depends on other individual and organizational stakeholders with whom and, in some cases, for whom they work. In part, this also requires that physicians accept that they have responsibilities to various system stakeholders. These changes are controversial because some fear they might distract physicians from their primary ethical obligation to their patients. However, systems theories and their applications in organizational management and business ethics support the notions that individuals can maintain primary professional ethical obligations while working within complex systems and that organizational systems can be constructed to support individual professional practice. If physicians are to commit to working within and, ultimately, improving systems of care as part of their ethical practice of medicine, then they will need a new mental model. Leading thinkers have used various models of systems and have highlighted different aspects of systems theories in describing organizations, groups of organizations, and organizational processes. This essay draws from these models some basic concepts and elements and introduces a simple but comprehensive mental model of systems for physicians. If it is used with professionalism and moral imagination, physicians might have a tool that they can use to understand, work with, and, ultimately, improve the systems of care that they rely on in their practice of medicine and that critically affect the welfare of their patients.

Conscience and clinical practice: medical ethics in the face of moral controversy

Physicians sometimes refuse to provide legally permitted medical services on the grounds that they cannot do so in good conscience. Such conscientious refusals are at least as old as the Hippocratic movement. Yet new events, such as the refusal by health care professionals to prescribe or dispense post-coital (‘‘emergency’’) contraception, have kindled new debates about what physicians are obligated to do when patients request legal medical interventions to which their physicians have moral objections. In a recent national survey, we found that a large majority of physicians believe they are obligated in such circumstances to present all possible options to the patient, including information about obtaining the requested intervention, and to refer the patient to a clinician who does not object to the requested intervention. Yet a substantial minority of physicians—particularly those who are more religious and/or who themselves object to common controversial practices—disagree with these majority opinions [1]. In hopes of stimulating further discourse about these matters, eight eminent scholars were invited to participate in a conference focusing on the role of the clinician’s conscience in the ethical practice of medicine. We asked contributors to address one or more of the following questions: What is the nature of conscience and what part does it play in the moral life, both public and private? In making good clinical decisions, what role should the clinician’s conscience play relative to his or her knowledge of scientific data, the standards of professional bodies, and/or the law? What should a clinician do when patients request legal and professionally permitted medical interventions to which he or she has a religious or other moral objection? What boundaries ought the profession place, if any, on the range of

The “duty to warn” a patient’s family members about hereditary disease risks

GENETIC TESTS FOR SPECIFIC ADULT-ONSET DISORders (eg, breast and colon cancer) are now commercially available, and results of research studies for genetic polymorphisms that predict drug effects, for example, response to statin therapy, have recently been published. The failure to warn family members about their hereditary disease risks has resulted in 3 malpractice suits against physicians in the United States. This past year, the obligation, if any, to warn family members of identification of a cancer gene mutation was the topic of discussion among professional societies and advocacy groups. Concerns have been raised regarding the conflict between the physician’s ethical obligations to respect the privacy of genetic information vs the potential legal liabilities resulting from the physician’s failure to notify at-risk relatives. In many cases, state and federal statutes that bear on the issue of “duty to warn” of inherited health risk are also in conflict. This article discusses these issues and suggests that health care professionals have a responsibility to encourage but not to coerce the sharing of genetic information in families, while respecting the boundaries imposed by the law and by the ethical practice of medicine.

The "duty to warn" a patient's family members about hereditary disease risks.

Genetic tests for adult-onset disorders, including common forms of cancer, are now commercially available, and tests for genetic polymorphisms that predict drug effects or toxicity after treatment are under development. For each of these circumstances, testing of 1 individual may imply an increased risk to his/her relative. The obligation, if any, to warn family members of the identification of a genetic mutation has generated concerns regarding the conflict between the physician's ethical obligations to respect the privacy of genetic information vs the potential liabilities resulting from the physician's failure to notify at-risk relatives. A duty to warn relatives about risks due to some infectious agents has been assumed by state and local health agencies, and the duty to breach confidentiality to warn of imminent harm has been the subject of case law. In general, the special nature of genetic tests has been viewed as a barrier to physicians' breaching the confidentiality of personal genetic information. However, the failure to warn family members about hereditary disease risks has already resulted in 3 lawsuits against physicians in the United States. While the findings of case law and the state and federal statutes that bear on the issue of "duty to warn" of inherited health risk are still being defined, we believe that health care professionals have a responsibility to encourage but not to coerce the sharing of genetic information in families, while respecting the boundaries imposed by the law and by the ethical practice of medicine.

Health ethics in Pakistan: a literature review of its present state.

National literature on ethics provides an insight into the nature and development of a dialogue on health issues within a population. This study investigated the health ethics discourse in Pakistan. The purpose was to critically reflect on the nature and level of such discussions with the aim of stimulating an interest in the ethical implications of health and medicine in developing countries. The study evaluated the literature on biomedical and health ethics published in Pakistan during 1988-1999. Overall, there is a dearth of published discourse on healthcare ethics in Pakistan. Values that are considered to stem from religious teachings predominate in discussions relating to medical ethics. A lack of effective policy and legislation concerning the ethical practice of medicine is reported to have negative effects on the profession. Research ethics has not been captured in the published papers in Pakistan. Consideration of ethical issues in health is at an early stage in the country and may reflect the situation in a large part of the developing world.

Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey.

Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obligations. Primary care physicians were asked about the impact of managed care on: (1) physician-patient relationships, (2) the ability of physicians to carry out their professional ethical obligations, and (3) quality of patient care. In 1996 we surveyed 1011 primary care physicians in Pennsylvania. The survey group's responses were graded on a Likert scale. Space was provided for respondents to include written comments. The SPSS statistical software (SPSS Inc, Chicago, Ill) was used to analyze the data. The response rate was 55%. Most respondents indicated that under managed care physicians are less able to avoid conflicts of interest and less able to place the best interests of patients first. The majority responded that quality of health care is compromised by limitations in location of diagnostic tests, length of hospital stay, and choice of specialists. A significant minority (27%-49%) noted a decrease in the physician's ability to carry out ethical obligations, to respect patient autonomy, and to respect confidentiality in physician-patient communication. Most physicians expressed that managed care made no impact on ability to obtain informed consent or to provide information. There were small but statistically significant sex differences, with female physicians more negative toward managed care. Many physicians surveyed believe managed care has significant negative effects on the physician-patient relationship, the ability to carry out ethical obligations, and on quality of patient care. These results have implications for health care system reform efforts.

Integrated Health Care, Capitated Payment, and Quality: The Role of Regulation

Concerns about the effect of managed care techniques on the quality of medical care have been raised in many quarters. Physicians have advocated the reiteration of professional ethics or even the prohibition of market incentives in health care as solutions to the problem of cost-quality tradeoffs in managed care systems. However, few recognize the existing systems for the regulation of managed care or consider how additional regulation could alleviate some of the potential problems posed by market-based competition. We review the evolution and growth of managed care organizations and the payment techniques that could cause a conflict between patient welfare and physician income. We then discuss the existing types of federal and state regulation of managed care and suggest some new incentives that could buttress the ethical practice of medicine in the medical marketplace.