clinical ethics, dr. lisawati 26.9.12

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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clinical ethics, dr. lisawati 26.9.12

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