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Chapter 3 Index
A. Ethics:
-- Anencephalic
Newborn: Person, Patient or Potential Organ Donor |
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The Physician as a Professional
Medical Ethics: Brian Carter, MD
Definition of Professionalism: should include:
- service to others (doctors, lawyers, clergy, military, teachers);
inherent in this critical aspect of the definition is that one has the
trust of society and that individuals within each group are not
self-serving. “How can I help you?”
- special knowledge and expertise
- standards of performance as defined by peers
Six Models of Medicine:
“What we think is right and wrong in professional ethics depends on
what we think is the proper moral role for the physician in meeting the
patient’s needs.”... Pellegrino
- Applied Biology: responsibility of technical and scientific competence
(academia)
- Contract for services: negotiated with no fixed obligation or trust
implied (legalistic)
- Covenant: binding promise/trusting relationship (quasi religious)
- Commodity Transaction: marketplace; medical knowledge proprietary as
is to be used for the physician’s (or corporation’s) profit.
- Social Functionary: utilitarian; advocates for the institution or
social-political agenda
- As a Moral Human Activity: emphasizes beneficence in trust, fidelity
to promises, and effacement of physician self interest.
Considerations of Your Duties and Role as a “Professional":
1. The impaired physician: impaired professional capability
- obligations to self, to patients, and to fellow professionals as well
as the profession need to be considered.
2. The incompetent physician: failure to meet standards of care
- competence is the first act of compassion
- breach of trust/expectation on the part of individual patient and
society
3. Conflicting Interests:
- Self: fame, fortune, favoritism can influence who you are and who you
become
- Research: if done with money from drug companies does this affect the
self?
- Institutional: corporate or social-political agendas can all be
conflicting factors.
Questions you Might Need to Ask Yourself and Observe in Others:
Private Practice or Academics:
1. How much are you going to accept from outside sources as a physician?
Where is your limit?
- e.g. pens, pencils, dinners, parties, paid trips to exciting places,
publications for office, salary from company to publicize product,
support for research, clinical studies?
2. Is an outside influence having an effect on your “sense of
professional self?”
- e.g.: If you receive a bonus from a hospital for moving to the area,
are you indebted to that hospital, or can you choose the best hospital for
your patient’s care?
- e.g.: If you accept things listed in #1 from drug companies, could
that have a psychological effect on your prescribing habits?
- e.g.: If a lawyer asks you to testify against another pediatrician,
and you think that that doctor has erred, will you do that? What if you
are offered huge sums of money?
- e.g. $400/hour? What if you are asked to testify in the defense of
that MD?
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