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Introduction to

Code of Ethics
An Interactive Lecture

Leonardi A Goenawan
What do you know about Ethics?
The Science of Human Duty
A particular system of principles & rules
concerning duty, whether true or false
Rules of practice in respect to a single
class of human actions; as, political or
social ethics; medical ethics.
According to Philosophy 1
Ethics is a major branch of philosophy,
encompassing right conduct and good life.
It is significantly broader than the
common conception of analyzing right and
wrong. A central aspect of ethics is "the
good life", the life worth living or life that
is simply satisfying, which is held by many
philosophers to be more important than
moral conduct
According to Philosophy 2
Ethics is the formal study of moral standards
and conduct. For this reason, the study of ethics
is also often called "moral philosophy."
What is good? What is evil?
How should I behave - and why?
How should I balance my needs against the needs of
others?
These are some of the questions asked in the field of
ethics, a branch of philosophy which has some of the
most immediate and obvious consequences for how
we live our lives.
Moral or Ethics ?
Ethic:
A set of moral principles;
a theory or system of moral values;
The principles of conduct governing an individual or
a group;
A guiding philosophy;
A consciousness of moral importance;
A set of moral issues or aspects (as rightness);
Ethics is usually regarded as more universal in nature.
People from all cultures share the same ethics. It
contains the idea of distinguishing what is right from
wrong, and striving to do what is right.
Moral or Ethics ?
Moral:
Relating to principles of right and wrong in behavior;
Expressing or teaching a conception of right behavior;
Conforming to a standard of right behavior;
Capable of right and wrong action;
Morality may be more local in nature, more culture
specific.
There are many cultural practices which are moral or
immoral depending where they are practiced.
Why medical ethics is important?
Physicians deal with saving humans life.
Patients want dedicated physicians they
can trust.
Physicians want to feel good about
themselves and what they do.
THE MEDICAL ECOSYSTEM
- Enlarging Circle of Influence
DOCTOR PATIENT
Disease Diagnosis Health Promotion
Disease Prevention Therapy
Medical Insurance
Managed Care
Hospital
Laboratories
Pharmaceutical
Industry
Patients Family,
Culture, Religion
Patients Work, Employer
Other Doctors
Paramedics
Clinic
Management
Public Health
Medical
Research
Medical
Students
CME,
CPD
Doctors
Employer
Doctors
Family
Doctors
Employee
Practice
Management
MDO
Medical Council
The LAW
Government
Bodies
Medical
Charities
Patient
Organisation
Alternative
Medicine
Press, Media
National Community
International Community
Natural Disasters
Political
Upheaval, War
THE PRINCIPLES IN MEDICAL
ETHICS
The Principle of Non-Maleficence
The Principle of Beneficence
The Principle of Autonomy
The Principle of Veracity
The Principle of Confidentiality (or
Fidelity)
The Principle of Social Responsibility and
Justice
The Principle of Non-
Maleficence
First do no harm
Sanctity of life
Calculated risk or risk benefit

The Principle of Beneficence
Do only that which benefits the patient
Patients welfare as the first consideration
Care consideration competence
The obligation to provide and accept
beneficial treatment
The Principle of Autonomy
Right to information and self
determination
Free and informed consent
Free will and accord - intentional
participation in treatment
Respect and dignity maintained
The right of an individual to choose
between various alternatives presented to
them
The Principle of Veracity
Truth telling
Obligation to full and honest disclosure
The Principle of Confidentiality
Based on loyalty and trust
Maintain the confidentiality of all personal,
medical and treatment information
Information to be revealed with consent and
for the benefit of the patient
Except when ethically and legally required
Disclosure should not be beyond what is
required

The Principle of Justice and
Social Responsibility
Actions are consistent, accountable and
transparent
Not to discriminate on age, sex, religion,
race, position or rank
Greater good of society
Respect of the Law
Equity and distribution of burden &
benefits
Principle of Double-Effect
The act itself must be morally good or at least
indifferent.
The agent may not positively will the bad effect
but may merely permit it. If he could attain the
good effect without the bad effect, he should do
so. The bad effect is sometimes said to be
indirectly voluntary.
The good effectmust be produced directly by
the action, not by the bad effect. Otherwise, the
agent would be using a bad means to a good
end, which is never allowed.

Principle of Double-Effect
The good effect must be sufficiently desirable to
compensate for the allowing of the bad effect. In
forming this decision many factors must be weighed and
compared, with care and prudence proportionate to the
importance of the case. Thus, an effect that benefits or
harms society generally has more weight than one that
affects only an individual; an effect sure to occur
deserves greater consideration than one that is only
probable; an effect of a moral nature has greater
importance than one that deals only with material things


St Thomas Acquinas. New Catholic Encyclopedia, vol 4, 1967 (internet edition).

What is an Ethical Dilemma?
A conflict between moral imperatives, i.e., what
is the right thing to do?
What is medically right vs. patient preference
Jehovahs Witnesses and transfusions
What is preferred by patient vs. proxy decision maker
Rights of minor vs. legal guardians
What is best for patient vs. what is best for society
Commitment laws, notification of sexual partners of patients
with HIV
How to Analyze an Ethics Case
What is being proposed?
What are the medical issues?
Risks, benefits, alternatives
Case and statutory law
Who are the stakeholders?
Patient, family, medical staff, hospital, state
Cultural and religious concerns
Are possible consultants to medical, legal, and ethical issues
When does this need to be done?
Emergency exceptions to informed consent
Why is an ethical dilemma being created?
Conflicts between decision makers, law and ethics
How can this be resolved?
Meeting(s), consultation(s)
Withdrawing vs. Withholding Care
Withdrawing care
Decision to remove an active intervention
that is already being provided to a patient

Withholding care
Decision not to provide an active
intervention to a patient


Withdrawing vs. Withholding Care
In medical ethics today, there is no distinction made
between withdrawing and withholding care.

In the past, withholding was considered ethically
superior to withdrawing.

Most recently, ethicist are espousing the position
that withdrawing is ethically superior to withholding,
since a trial of treatment gives information on its
efficacy for the particular patient.