clinical ethics, dr. lisawati 26.9.12
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7/29/2019 Clinical Ethics, Dr. Lisawati 26.9.12
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CLINICAL ETHICS
Prof. Sulaiman Sastrawinata,dr.,SpOG(K)
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To solve ethical issues in clinical care
to improve clinical care by abiding
the rules of medical ethics
GOALS:
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1. Indications for medical interventions
2. Patient preferences
3. Quality of life
4. Contextual feature
The Four Topics Discussed inClinical Ethics:
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Is the problem acute, chronic,
critical, emergent, reversibleWhat are the goals of treatment
How can the patient be benefitedby medical and nursing care andhow can harm be avoided
Medical Indications
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The Ethical Principles of Beneficenceand non Maleficence
To appreciate the nature of disease certain
disease conditions must be distinguished to
determine the nature of diseases, treatment
and clinical outcome:
acute,
chronic,
critical or emergent,
non critical non emergent,
reversible or irreversible
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Treatment Modalities:Curative, Supportive, Burdensome,Non-burdensome
Inappropriate interventions
No scientifically demonstrated effect onthe disease
Ventilatory support for cardiac arrest but nolonger indicated when the patient suffersmulti system organ failure
Medical futility : incapable of producingany result
DNR: patient preference, expected quality
of life
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Preferences of Patient Is the patient competent Knowledge of patient: preference is
essential for good clinical care. The limits ofpatient preferences
The ethical obligations of physicians are
defined not only by the wishes of thepatient but also by the goals of medicine(competing values; beneficence andautonomy of the patient)
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Physicians have no obligation to performaction beyond or contradictory to the goals ofmedicine. Unnecessary surgery, provide falsecertificationFailure to cooperate with medicalrecommendation : Patient ignore physician recommendation
in favor of other behaviors they valuemore than health
Physician should try persuasion or adjust
therapeutic goals
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Quality of Life
What are the prospects for a return to normal life Is the patients present and future condition such that
his continued life is judged undesirable
Is there any rationale to forgo treatment Are there plans for comfort and palliative care
Relief of pain and improvement of function should
be the competence of future doctors.Sometimes the disease is treated by an intervention
that may cure the disease but at the same time
reduce quality of life.
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Quality of Life Consideration Focus on
Long Term Consequences
Quality of life :
Personal evaluation (mobility, communications,
pain)
Observer evaluation
Relief of pain and palliative care will improve quality
of life and reduces the need for euthanasiaMinimum quality of life is a factor to be considered
to forgo life sustaining intervention
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Contextual feature
Are there family issues
Are there financial and economic features
Religious of cultural features
Issues in clinical teaching
Consent to be a teaching subject Otopsi
Organ donor
Research
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