10 Community Medicine

Ethics in Health
Services
Lecture 10
Dr. Iqra Ayaz (PT)
What is Ethics?
Ethics is a system of moral principles. They
affect how people make decisions and lead
their lives.
The terms ethics and morality are often
used interchangeably - indeed, they
usually can mean the same thing, and in
casual conversation there isn't a problem
with switching between one and the other.
However, there is a distinction between
them in philosophy!
Ethics and Morality
What are they?
Ethics and morals both relate to “right”
and “wrong” conduct. However, ethics
refer to the series of rules provided to an
individual by an external source. e.g. their
profession. On the other hand, morals
refer to an individual’s own principles
regarding right and wrong.
Types of Ethics:
1. Medical Ethics:
Primarily physician centered
System of moral principles that apply to the
practice of medicine.
2. Health care Ethics:

Deals with the issues of nurses and other
health care providers.
3.Bioethics
Study of ethical issues and decision-making
associated with the use of living organisms
General issues of reproduction, fair
distribution of organ etc..
4- Clinical medical ethics:
• Aims to improve patient care and patient
outcomes by focusing on reaching a right
and good decision in individual cases.
• Focused on hospital care decisions with
the aid of committees and consultants.
Ethical Principles
Conflict is inevitable. Ethical principles
provide the framework/ tools which may
facilitate individuals and society to resolve
conflict in a fair, just and moral manner.
7
1. Autonomy
Respect a person’s right to make their own
decisions
Teach people to be able to make their own
choices
Support people in their individual choices
Do not force or coerce people to do things
‘Informed Consent’ is an important
outcome of this principle
Beneficence (to do good)
 Our actions must aim to ‘benefit’ people –
health, welfare, comfort, well-being,
improve a person’s potential, improve
quality of life
 ‘Benefit’ should be defined by the person
themselves. It’s not what we think that is
important.
 Act on behalf of ‘vulnerable’ people to
protect their rights
 Prevent harm
 Create a safe and supportive environment
Non-maleficence (to do no harm)
do not inflict harm on people
do not cause pain or suffering
do not cause offence
do not deprive people
do not kill
Justice
Treating people fairly
Not favouring some individuals/groups
over others
Acting in a non–discriminatory way
Respect for peoples rights
Respect for the law
Distributive Justice – sharing the resources
in society in a fair and just manner (e.g.
health services, professional time)
Nuremberg Code
Developed after the world war 2.
When the prisoners were used to perform
experiments using coercive procedure without
any consent.
Includes principles such as
Proper formulated experiment, informed
consent, absence of coercion and beneficence
towards study participants.
Cont..
1. The voluntary consent of human subject is
essential.
2. The experiment should yield fruitful result
for the sake of society.
3. The experiment should be based on the
results of animal experimentation and a
knowledge of natural history of disease.
4. Conduct the experiment in such a way to
avoid the unnecessary mental and physical
sufferings.
Cont..
6. The degree of risk should be taken into
account.
7. Proper preparation and protection of the
experimental subjects from disability, injury or
death.
8. The experiment should be conducted by
scientifically qualified professionals.
Cont..
9. During the experiment human subjects
should be at liberty to bring the experiment to
an end.
10. Similarly the scientific incharge for the
experiment must be prepared to terminate
the experiment at any stage.
American Medical Association(AMA)
Principles
1. A physician shall be competent, dedicated
and respect the human dignity and rights.
2. A physician shall respect the law, honest in
all the professional interactions and can
change those requirements which are contrary
to the best interest of patient.
3. A physician shall respect the rights of the
patients and other health care professionals
and safeguard the patient confidence and
privacy.
cont,..
4. A physician shall continue to study, apply
and advance the scientific knowledge and make
relevant information available to patients,
colleagues and the public.
5. A physician except in emergencies shall be
free to choose who to serve.
6. A physician shall participate in the activities
related to betterment of community.
7. A physician while caring for the patient
regard responsibility to the patient as
paramount importance.
8. Physician shall support the access to medical
care for all the people.
Informed Consent
“Autonomous authorization of a medical
intervention by individual patient”.
Patient have the right to make decision
regarding their medical care and the
availability of all the relevant information.
Patient have the right to refuse the treatment.
Reference:
Chapter: 20 Biomedical Ethics from text book
of community medicine
Thank you

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Ethics in Health

2. Health care Ethics:

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