Ethical Medical Practice Research Articles

Bioethics In Neurospinal Patient Care

Neurosurgery is among the newest of surgical disciplines, appearing in its modern incarnation at the dawn of twentieth century with the work of Harvey Cushing and contemporaries. Neurosurgical ethics involves challenges of manipulating anatomical locus of human identity and concerns of surgeons and patients who find themselves bound together in that venture.In recent years, neurosurgery ethics has taken on greater relevance as changes in society and technology have brought novel questions into sharp focus. Change of expanded armamentarium of techniques for interfacing with the human brain and spine— demand that we use philosophical reasoning to assess merits of technical innovations.Bioethics can be defined as systematic study of moral challenges in medicine, including moral vision, decisions, conduct, and policies related to medicine. Every surgeon should still take the Hippocratic Oath seriously and consider it a basic guide to follow good medical ethics in medical practice. It is simple and embodies three of the four modern bioethics principles – Respecting autonomy, beneficence, nonmaleficence, and justice.Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. Currently, scientists are pressured on many fronts to develop an all-encompassing “cure” for paralysis. While scientific understanding of central nervous system (CNS) regeneration has advanced greatly in the past years, there are still many unknowns with regard to inducing successful regeneration. A more realistic approach is required if we are interested in improving the quality of life of a large proportion of the paralyzed population in a more expedient time frame.

Ethics in Medical Practice

Abstract not availableJ Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 41-42

An Agenda for Improving Legal Claims for Medical Malpractice in Nigeria

The law and ethics of medical practice enjoy a relatively universal appeal, and speak the same language in different jurisdictions. This is due mainly to the fact that the practice of modern orthodox medicine is traceable to the Greek philosopher, Hippocrates (father of modern medicine) who brought scientific rationalization into medical practice, thus exploding the hitherto garb of metaphysics and Esoterism that beclouded the practice. The various works of the World medical Association in developing and disseminating ethical rules and standards of practice further strengthened the universal character of medical ethics. Accordingly, the right of patients and the duties of medical practitioners remain the same all over the world. But the extent to which these rights and duties are asserted, observed and enforced vary significantly among jurisdictions. Recent empirical investigation shows that in Nigeria only about 1.1% of all medical malpractice cases are enforced through legal action. This paper gives an analysis of the present state of medical practice in Nigeria in terms of the basic care exhibited by medical practitioners, the impression of patients about such care and other elementary requirements of doctor-patient relationship. It draws from a work which concludes that while the level of care is abysmally low leading to high level of malpractice, the level of legal claims is even lower. The paper proceeds to set out some legal and administrative remedial measures that could be taken to improve the almost non-existent claims against practitioners involved in medical malpractice in Nigeria.

Ethics Committees in Ayurvedic PG institutions: Losing opportunities of making an impact

Ethics is a crucial component of medical practice world over and also an indispensable part of medical research. Ethics in medical practice primarily refers to not harming the patients by the proposed interventions; similarly ethics in research refers to assuring optimal care of the participants and causing no harm to them on account of research. Ethics in research has come a long way from its voluntarily application on moral grounds to a mandatory condition regulated by the state of law. Ethics Committees (ECs) have been erected at research institutions to safeguard the interest of patients, to ensure their safety during any such trial and to assure the accountability of the researcher in case of any unforeseen event. Such committees therefore have a noble role to play in the form of promoting ethical practices in research. Ayurvedic clinical research also follows the similar path by erecting ECs at its research institutions. However, in reality, such committees are found much away from the principle of their inception and method of functioning. In the absence of accountability and clear objectivity, such ECs at Ayurvedic research institutions are not serving any purpose. This article critically examines the positioning of ECs at Ayurveda research institutions and suggests pragmatic mechanisms to ensure their role in improving the quality of research in Ayurveda.

Awareness about Knowledge, Attitude and Practice of Medical Ethics pertaining to Patient Care, among Male and Female Physicians Working in a Public Sector Hospital of Karachi, Pakistan - A Cross-Sectional Survey

The aim of the study is to assess the knowledge, attitudes and practices of medical ethics among male and female healthcare professionals in a public sector hospital in Karachi, Pakistan. A structured questionnaire about knowledge of medical ethics and its role in the everyday decision making in the hospital was developed, tested and distributed among residents, consultant physicians at the Abbasi Shaheed Hospital, a tertiary care teaching hospital, during June and August 2016. The paper analyzed 70 responses from doctors at various level of training comprising residents and consultants. Each question had sub parts and hence was scored accordingly. The participants encountered ethical decision making situations in a diverse regularity, varying from ‘daily’ to ‘annually’. Interestingly, 9% of the doctors were not aware of the primary contents of the Hippocratic Oath, and 89% of these were junior doctors. Details of Nuremberg Code and Helsinki Code were known only to 4% of the total sample. Female physicians had a stronger opinion as compared to male physicians regarding practice of ethics. This included topics such as complying with the consent for procedures, treating violent/non-compliant patients, listening to the patient’s wishes, autonomy and above all the attribute of maintaining confidentiality. A significant difference in the level of knowledge between diverse cadres of physicians was noted. Physicians who had cleared their qualifying and/or licensing exams exams in first attempt scored higher than those who did not. The female participants have 1.65 times the odds of having a higher knowledge about medical ethics, than male participants, keeping all other variables constant. The study highlights the need to strengthen the professional knowledge regarding medical ethics issues, among the health care workforce in public sector hospitals of the developing world. In our data, female physicians working in the government sector hospitals in Karachi, demonstrate a higher knowledge about medical ethics, than male participants, keeping all other variables constant.

Fundamentals of the Pediatric Consent Process in Louisiana.

The principle of respect for persons—autonomy—dominates most conversations regarding ethical medical practice, and informed consent is the central tenet of most of these discussions.[1][1],[2][2] Along with the concept of informed consent as the expression of respect for persons comes the

Challenges in Ethical Medical Practice

Challenges in Ethical Medical Practice

Catch them young: grooming a new generation of physicians in India

Physicians are often accused of (un)intended medical malpractice, which is linked with their economic stimulus in one way or another. To disentangle the motivation behind this claim, this article digs into India’s existing medical training and the motivation of young graduates to practice medicine. A narrative review was conducted by retrieving the existing literature from various sources. To a medical education aspirant, a doctor is perceived as someone who earns his or her daily living independently. Usually they become very rich, and popularity comes with the package. With this motivation, some clinicians come out of medical college failing to adopt ethical medical practices. India demands a new generation of young aspirants who can be guided by teachers who can teach the art and philosophy of medicine, where earning limitless money is not the sole purpose of medical education.

Treatment of a Fellow Doctor in a Public Sector Hospital: Ethnographic Study of Collegial Professionalism

Ethics and collegiality in medical profession requires a doctor to treat fellow professional as brother and sister. Ethnography was employed to study the status of collegiality in public sector hospital, where an ailing doc-tor sought clinical care from a physician. The former, on account of the latter’s cold reception and behaviour, reacted with his blood pressure shooting-up. The communication gap led the ailing doctor, who com-plied by coming to the laboratory, was perturbed, making him firstly unfit and later decided not to undergo the prescribed test. While Pakistan Medical and Dental Council have the responsibility to oversee, the under-graduate medical education and training should also lay greater emphasis on ethics in medical practice and healthy collegiality in the medical profession.

Percutaneous coronary intervention patients’ and cardiologists’ experiences of the informed consent process in Northern England: a qualitative study

ObjectiveInformed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure....

Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women’s experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.

El consentimiento informado en Colombia. Un análisis comparativo del proyecto de ley 24 de 2015 con el código vigente y otros códigos de ética

Cursa en el Congreso colombiano un proyecto de ley para renovar el Codigo de Etica Medica (Proyecto de ley 24 de 2015). Este proyecto, enraizado en el reconocimiento del principio de libertad moral, proclama el respeto por la autonomia del paciente como uno de los constituyentes de la etica asistencial moderna. Ante la valiosa iniciativa se reviso lo atinente al consentimiento informado (CI) y se efectuo un analisis comparativo con el codigo vigente (la Ley 23 de 1981) y otros contemporaneos (el chileno, el espanol y el argentino), en busca de fortalezas y debilidades. Se encontro que el proyecto de ley no cuenta con los contenidos filosoficos, bioeticos y procedimentales suficientes para cumplir con su promesa de valor. En cambio, se caracteriza, por ser extenso en temas sancionatorios. Tal desequilibrio podria derivar en una practica medica mas defensiva y menos etica

Second thoughts about who is first: the medical triage of violent perpetrators and their victims

Extreme intentional and deliberate violence against innocent people, including acts of terror and school shootings, poses various ethical challenges, some related to the practice of medicine. We discuss a dilemma...

Knowledge, attitude and practice of medical ethics among medical intern students in a Medical College in Kathmandu

This baseline study was conducted to find out the knowledge, attitudes and practices of medical ethics among the undergraduate medical interns who did not have structured ethics curriculum in their course. A descriptive, cross-sectional study was carried out using a self-administered structured questionnaire among the medical undergraduate interns of Maharajgunj Medical Campus, the pioneer medical college of Nepal which enrols 60 students in a year. A total of 46 interns participated in the study. The most common source of knowledge on ethics was lectures/seminars (35.7%) followed by experience at work (24.5%), training (21.4%) and own reading (17.3%). The main contents of Hippocratic Oath were known to 98.8% while 60.9% knew the main contents of Nepal Medical Council (NMC) code of ethics. Great majority (91.3%) regard ethics as very important in medical profession. “Doctors know the best irrespective of patients’ opinion” was disagreed by only 39.1% indicating the paternalistic attitude. However, 78.3% were in favour of adhering to the patient’s wish. None of the participant agreed to abandon confidentiality. Only about one-fourth (26.1%) claim to encounter ethical dilemma every day while the highest number (43.5%) had once in a month. To deal with the situation of ethical dilemma, majority approached to immediate supervisor followed by head of the department and colleagues. Eighty-seven percent of participating interns were involved in research activities involving human subjects. Only one of the participants had encountered the ethical issue on end-of-life and it was do-not-resuscitate consent in a terminally ill patient. On implementation of the curriculum on medical ethics focus should be - principles of biomedical ethics, sensitive ethical dilemmas like end-of-life care and practical experiences with participation in deliberations of the ethics committee.

Editorial Vol.6(3)

Editorial Vol.6(3)

Medical Ethics and Medical Professionalism in Low and Middle Income (LAMIC) Countries: Challenges and Implications.

This article examines the (bio) ethical and professionalism issues that may arise in the context of medical practice in low and middle income countries (LAMIC), and the challenges this poses for medical regulatory bodies in the regions, in upholding ethics in professional practice. A quadrangle of source of the problems given rise to the breach of ethics in medical practice is identified, and suggested steps, based on ethical principles and concept, is proposed towards the resolution of the problems presented. As LAMIC progress to improve the health of its population, this endeavour should occur hand in hand with contemporary medical ethics theories, taking in context the region’s ethnographic and cultural beliefs and practices.

The Evolution of Autonomy

There can be little doubt, at least in the Western world, that autonomy is the ruling principle in contemporary bioethics. In spite of its ‘triumph’ however, the dominance of the utilitarian concept of autonomy is being increasingly questioned. In this paper, I explore the nature of autonomy, how it came to displace the Hippocratic tradition in medicine and how different concepts of autonomy have evolved. I argue that the reduction of autonomy to ‘the exercise of personal choice’ in medicine has led to a ‘tyranny of autonomy’ which can be inimical to ethical medical practice rather than conducive to it.I take the case of Kerrie Wooltorton as an illustration of how misplaced adherence to respect for patient autonomy can lead to tragic consequences. An analysis of autonomy based on the work of Rachel Haliburton is described and applied to the role of autonomy in a recent bioethical debate — that arising from Savulescu's proposal that conscientious objection by health-care professionals should not be permitted in the NHS. In conclusion, I suggest Kukla's concept of conscientious autonomy as one promising pathway to circumvent both the limitations and adverse effects of the dominance of current (mis)understandings of autonomy in biomedical ethics.

Present Academic Status of the Department of Medicine in Different Medical Colleges of Bangladesh

Background: ‘Medicine’ is said to be the father of Medical education. The clinical phase of education of a medical student should be done in an academically oriented hospital specially Medicine Department. Lack of adequate clinical exposure must leads to inadequate learning. Methods: A cross-sectional study was done to look into the present academic scenario of the department in different Medical Colleges of Bangladesh. Here the Medicine Department of all the Medical Colleges was included; of them 22 were government and 44 were private. The allied branches were excluded. The concerned department of all the Medical Colleges was offered a prestructured questionnaire. 27 of them replied; 13 were public & 14 were private. They were regarded as Code A & Code B respectively. Results: We found that the number of functioning unit is less than requirement in Code B(2.31). Though the student bed ratio is adequate; the number of midlevel teacher is much less in both the codes. Office secretary is lacking as well as the ward side minilab facility. Most of the conference rooms are shared. There is a great vacuum regarding the integrated teaching class. We also noted that the publication & presentation is much less in Code B. Conclusion: With the rapid growth of Medical education, the need for promoting ethical medical practice is mandatory. So the lacking of existing medical content should be fulfilled in an urgent manner.DOI: http://dx.doi.org/10.3329/jom.v16i1.22372 J MEDICINE 2015; 16 : 5-9

Practice of Informed Consent, Confidentiality and Privacy by Physicians at a Tertiary Care Teaching Hospital

Objective: The aim of this paper was to assess the practice of medical ethics by the physicians at a public sector hospital in Jamshoro Sindh. Material and methods: This survey was conducted at four medical units of tertiary care hospital at jamshoro in the month of august 2014. Participants were randomly selected from patients aged over 18 years. A structured questionnaire was designed and the participants were asked about their demographic profile and their physician’s practice regarding informed consent, maintaining confidentiality, privacy and other treatment formalities. Written consent was taken from all the participants before interview.Results: A total of 100 patients were randomly selected for this study. The majority of patients reported that informed consent was taken from them. The patients also responded that privacy and confidentiality is maintained during their treatment. However, many patients agreed that they were not properly informed about the laboratory findings, role of proposed drugs and also side effects of drugs. Conclusion: There is marked improvement in the practice of medical ethics by physicians of this tertiary care hospital. However, awareness workshops should be conducted to update and improve the knowledge of medical ethics among physicians. This will surely help them translate the knowledge into practice. DOI: http://dx.doi.org/10.3329/bioethics.v5i3.21531 Bangladesh Journal of Bioethics 2014 Vol.5 (3): 1-5.

Patient safety: a developing world perspective

In the era of privatization and corporatization of health care, the costs of hospitalization and treatment have significantly increased. Developing nations are plagued by financial constraints and have been unable to establish affordable health care facilities to the poor and economically weaker sections of the society. Emergence, re-emergence, and spread of various infectious diseases (influenza virus, dengue virus, and other seasonal infectious diseases), rise of non-infectious conditions (obesity, stress, cardiovascular diseases, and diabetes mellitus) and increase in immunodeficiency disorders (malignancies, autoimmune diseases, acquired immunodeficiency syndrome caused by human immunodeficiency virus infection) are responsible for frequent hospitalization of people. Taking the advantage of such conditions, the private medical practitioners in most of the third world nations including India, have been conducting hospitals unethically in many rural and urban parts of the nations. Most of these health care facilities are not accredited and follow no specific diagnosing and treatment guidelines. Patients attending such hospitals are forced to spend a huge amount of money, undergo mental, and physical trauma with no guarantee of ethical medical practices. Private medical practitioners performing various medical, radiological (ultrasound, computed tomography scan and magnetic resonance imaging scans), and surgical procedures (termination of pregnancy, hysterectomy, appendicectomy, caesarean sections) against the Ethical Codes of medical practice are common in most of the developing countries. Unauthorized private fertility clinics practice unethical procedures for the sake of monetary benefits deceiving families wanting children.Perspective by Kachalia recently highlights the significance of transparency in health care organizations thereby making an effort to enhance confidence building measures among the patients on the status of health care facilities provided [1]. Medical errors mostly related to the delays in the attention required in a specific case, financial limitations, and accidental clinician failures have been a common cause of severe morbidity and mortality in the rural parts of developing nations including India.Here I would like to remind some valuable words from the textbook “Principles of Biomedical Ethics,” authored by Tom Beauchamp and James Childress, who have highlighted the importance of four basic moral principles in medical practice including respect for patients autonomy, acting in the best interest of patient, non-malfeasance, respecting the dignity of a patient, truthfulness, honesty in informed consent, and justice in treatment [2]. The governments including both central and the state and the Medical Council of India have hardly been successful in combating unethical clinical practices in India [3]. Regulation of industry-physician relationship is the need of the hour to check and control unethical drug marketing wherein clinicians prescribe high-cost drugs in place of equally good and cheaper generic drugs. A strict vigilance is required with regards to the recruitment of volunteers for the studies in clinical research, where, the individuals are administered drug formulations that are currently under synthesis and the resultant adverse drug reactions could cause severe morbidity and mortality.Accreditation of each and every hospital/clinic and diagnostic laboratory facilities should be considered very seriously. Medical practitioners should be given practicing license and must be made to undergo a review of their clinical practice regularly (preferably each year) and a practitioner’s license is possibly renewed every year based on their performance (continuing medical education credits earned, participation at local, national and international seminars, conferences, workshops, and other advanced training programs for professional improvement). Such procedures are successfully followed by some developed nations including United Kingdom.I finally would conclude that self-regulation and Incorporating Medical Ethics Education training to students during their medical graduation period can be useful in creating virtuous doctors who are well versed in solving Ethical dilemmas in clinical practice and prioritizing patient safety.