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Bio-Medical Ethics - E-Book
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | Cover | ||
| Biomedical ethics | iii | ||
| Copyright page | iv | ||
| Preface | v | ||
| Acknowledgments | vii | ||
| Dedication | ix | ||
| Table of contents | xi | ||
| 1 Introduction to medical ethics | 1 | ||
| Learning objectives | 1 | ||
| Why do we need medical ethics? | 2 | ||
| Introduction | 2 | ||
| Ethics in medical practice | 3 | ||
| Definition of ethics | 7 | ||
| Definitions of related terminology | 8 | ||
| Who is a “professional”? | 9 | ||
| A solemn undertaking | 9 | ||
| Aspirations and expectations | 10 | ||
| Professional responsibility | 12 | ||
| History of medical ethics | 13 | ||
| A brief overview of the history of medical ethics | 13 | ||
| Revival of medical ethics | 15 | ||
| Indian tradition in medical ethics: A legacy | 18 | ||
| Medical ethics in ayurveda | 18 | ||
| The vedic period—athreya anushasana | 18 | ||
| The samhita period—charaka and sushruta | 19 | ||
| Excerpts and teaching from the samhitas11–13 | 20 | ||
| Commentary | 23 | ||
| References | 24 | ||
| 2 Principles of medical ethics | 26 | ||
| Learning objectives | 26 | ||
| How do we decide what is ethical? | 27 | ||
| Is morality absolute? | 27 | ||
| What about medical practice? | 29 | ||
| Theories of morality | 30 | ||
| Virtue ethics | 30 | ||
| Deontology | 31 | ||
| Teleology or utilitarianism | 32 | ||
| Nonrational approaches | 33 | ||
| Imitation | 33 | ||
| Obedience | 33 | ||
| Habit | 33 | ||
| Intuition | 34 | ||
| Principles of medical ethics | 34 | ||
| Principle of beneficence | 35 | ||
| Principle of nonmaleficence | 36 | ||
| Principle of respect for autonomy | 37 | ||
| Principle of justice | 38 | ||
| Making ethical decisions | 39 | ||
| Core values in medicine | 40 | ||
| The need for a code | 40 | ||
| Who decides what is ethical? | 41 | ||
| Changing ethics | 42 | ||
| Religious beliefs and medical ethics | 43 | ||
| References | 45 | ||
| 3 Codes of medical ethics | 47 | ||
| Learning objectives | 47 | ||
| Codes and laws | 48 | ||
| Codes are not laws | 48 | ||
| Duty and responsibility | 49 | ||
| Oath of initiation (charaka samhita)2 | 50 | ||
| Commentary on the oath of initiation | 52 | ||
| The hippocratic oath3 | 53 | ||
| Commentary | 54 | ||
| Wma declaration of geneva4 | 55 | ||
| Commentary | 56 | ||
| International code of medical ethics5 | 58 | ||
| Commentary | 58 | ||
| Indian medical council (professional conduct, etiquette and ethics) regulations 20027 | 59 | ||
| Commentary | 74 | ||
| References | 76 | ||
| 4 The doctorpatient relationship | 77 | ||
| Learning objectives | 77 | ||
| What is unique about the doctor–patient relationship? | 78 | ||
| Trust | 78 | ||
| Physical contact | 79 | ||
| Respect | 79 | ||
| Expectations of the patient | 80 | ||
| Respect | 80 | ||
| Honesty | 81 | ||
| Collusion | 82 | ||
| Rights | 82 | ||
| Rights of the patient | 83 | ||
| Rights of the doctor | 84 | ||
| Physician autonomy versus patient autonomy | 85 | ||
| Autonomy of the physician | 85 | ||
| Can the doctor refuse to treat a patient? | 87 | ||
| Conscientious objection | 88 | ||
| Patient autonomy | 89 | ||
| Autonomy in cultural and social context | 89 | ||
| Income | 90 | ||
| Women | 90 | ||
| Social groups | 90 | ||
| Marginalized sections | 91 | ||
| Communication and informed consent | 91 | ||
| Communication | 91 | ||
| Therapeutic privilege | 92 | ||
| Informed consent | 93 | ||
| What information should be given before consent? | 94 | ||
| Consent forms | 95 | ||
| Vulnerable groups | 96 | ||
| Surrogate decisions | 97 | ||
| Best interest of the patient | 98 | ||
| Privacy and confidentiality in health care | 100 | ||
| Challenges to confidentiality | 101 | ||
| Limits to confidentiality | 103 | ||
| References | 104 | ||
| 5 Ethics at the beginning of life | 105 | ||
| Learning objectives | 105 | ||
| The abortion debate | 106 | ||
| History | 106 | ||
| The present debate | 108 | ||
| Is the fetus a human being? | 109 | ||
| Let US look at the newborn child | 110 | ||
| Wrongful birth and wrongful life | 116 | ||
| The medical termination of pregnancy act 1971 | 117 | ||
| Comments on the mtp act 1971 | 117 | ||
| Ethical concerns | 118 | ||
| Vulnerability of women | 121 | ||
| Contraception | 122 | ||
| Assisted reproductive technologies | 124 | ||
| Prenatal diagnosis and genetic testing | 132 | ||
| Ethical issues | 132 | ||
| Sex selection and female feticide | 133 | ||
| Severely defective neonates | 135 | ||
| References | 138 | ||
| 6 Ethics at the end of life | 139 | ||
| Learning objectives | 139 | ||
| Ethical dilemmas at the end of life | 140 | ||
| Death, dying, and the doctor | 143 | ||
| Definitions | 143 | ||
| A “good” death | 144 | ||
| A wish for death | 145 | ||
| Euthanasia | 146 | ||
| Definitions | 146 | ||
| Types of euthanasia | 147 | ||
| Arguments against euthanasia | 148 | ||
| Arguments for euthanasia | 154 | ||
| Brain death and states of altered consciousness | 159 | ||
| Definitions | 159 | ||
| Brain stem death | 159 | ||
| Whole brain death | 159 | ||
| Cortical death | 160 | ||
| Ordinary and extraordinary life support measures | 161 | ||
| Disorders of consciousness | 163 | ||
| Advance directives | 164 | ||
| Do not resuscitate/allow natural death | 165 | ||
| Religious views on euthanasia and death | 165 | ||
| Hinduism | 166 | ||
| Buddhism | 167 | ||
| Sikhism | 167 | ||
| Islam | 167 | ||
| Christianity | 167 | ||
| Breaking bad news | 168 | ||
| Ethical decisions at the end of life | 170 | ||
| References | 171 | ||
| 7 Research ethics | 173 | ||
| Learning objectives | 173 | ||
| History of research ethics | 174 | ||
| Research in medicine | 174 | ||
| Research in clinical practice | 175 | ||
| What is a clinical trial? | 175 | ||
| Medical research in india | 176 | ||
| A brief history of research ethics | 177 | ||
| Codes of ethics in research | 179 | ||
| Principles of research ethics | 181 | ||
| Beneficence and nonmaleficence | 181 | ||
| Scientific merit | 182 | ||
| Social merit | 182 | ||
| Harm | 182 | ||
| Risk analysis | 182 | ||
| Role of the ethics committee | 183 | ||
| Respect | 183 | ||
| Informed consent | 184 | ||
| Confidentiality | 185 | ||
| Vulnerable groups in research | 186 | ||
| Justice | 186 | ||
| Integrity | 189 | ||
| Conflict of interest | 190 | ||
| Therapeutic obligation | 191 | ||
| Ethics in epidemiology and community research | 192 | ||
| Ethics of biobanking and research | 192 | ||
| Ethical treatment of animals in research | 194 | ||
| References | 196 | ||
| 8 Emerging medical technologies: Ethical concerns | 198 | ||
| Learning objectives | 198 | ||
| Introduction | 199 | ||
| Genetics | 200 | ||
| Genetic testing | 202 | ||
| Ethical concerns | 202 | ||
| 1. Confidentiality | 202 | ||
| 2. Genetic information—the right to know | 203 | ||
| 3. Consent | 205 | ||
| 4. Gene data banks | 206 | ||
| Gene therapy | 206 | ||
| Drawbacks of gene therapy | 207 | ||
| Types of gene therapy | 208 | ||
| Ethical considerations | 209 | ||
| Gene enhancement | 212 | ||
| Somatic cell gene enhancement | 213 | ||
| Germ cell gene enhancement | 214 | ||
| Eugenics | 215 | ||
| Guidelines and declarations | 217 | ||
| Medical biotechnology | 218 | ||
| Ethical issues with medical biotechnology | 219 | ||
| Stem cell therapy | 220 | ||
| Types of stem cells | 221 | ||
| Complications of stem cell therapy | 221 | ||
| Regulation of stem cell research | 221 | ||
| Ethical issues in stem cell research and therapy | 223 | ||
| Cloning | 224 | ||
| Possible applications of cloning | 225 | ||
| Ethical concerns with research on cloning | 227 | ||
| Robotics in medicine | 228 | ||
| Ethical concerns | 228 | ||
| References | 229 | ||
| 9 Ethics of organ donation | 231 | ||
| Learning objectives | 231 | ||
| Introduction | 232 | ||
| Types of transplant | 233 | ||
| Live donor | 234 | ||
| Deceased donor | 234 | ||
| Kidney paired donation or domino donor kidney transplant | 235 | ||
| Ethical considerations | 236 | ||
| Transplantation of human organs act 1994 | 238 | ||
| 2. Dignity of the human body | 238 | ||
| 3. Possibility of exploitation | 240 | ||
| 4. Brain death | 243 | ||
| 5. Fetal transplantation | 245 | ||
| 6. Allocation of resource | 246 | ||
| 7. Education and awareness | 248 | ||
| Amendments to transplantation of human organs act 1994 | 248 | ||
| References | 250 | ||
| 10 Public health ethics | 252 | ||
| Learning objectives | 252 | ||
| Introduction | 253 | ||
| Moral theories and principles of public health ethics | 254 | ||
| Moral theories | 254 | ||
| Principles of public health ethics | 255 | ||
| Personalism | 256 | ||
| Subsidiarity | 257 | ||
| Ethics of epidemiological research | 258 | ||
| Ethical guidelines for epidemiological studies | 259 | ||
| Challenges in public health ethics | 261 | ||
| Introduction | 261 | ||
| Distributive justice | 268 | ||
| Resource allocation | 270 | ||
| How should resources be allocated? | 273 | ||
| Which approach to resource allocation is best? | 278 | ||
| Global health | 279 | ||
| Globalization | 280 | ||
| References | 283 | ||
| 11 Medical errors and negligence | 285 | ||
| Learning objectives | 285 | ||
| Medical errors | 286 | ||
| Introduction | 286 | ||
| Types of medical errors | 288 | ||
| Response to medical errors | 289 | ||
| Individual response | 290 | ||
| Systemic response | 290 | ||
| Medical errors and negligence | 291 | ||
| Medical negligence | 291 | ||
| Introduction | 291 | ||
| Medical liability | 294 | ||
| Civil liability | 294 | ||
| Consumer courts | 295 | ||
| Criminal liability | 296 | ||
| Is unethical behavior linked to medical liability? | 298 | ||
| Introduction | 298 | ||
| Can ethical behavior minimize medical errors and medical liability? | 299 | ||
| Communication and informed consent | 299 | ||
| “i’m sorry” laws | 301 | ||
| Medical competence | 302 | ||
| Protocols of care and safety | 304 | ||
| Peer learning | 305 | ||
| Whistle-blowers | 306 | ||
| Doctor as witness | 307 | ||
| Careless whispers | 307 | ||
| References | 308 | ||
| 12 The medical professional and society | 310 | ||
| Learning objectives | 310 | ||
| Introduction | 311 | ||
| Social expectations | 311 | ||
| Choice of career in medicine | 312 | ||
| Medical education | 314 | ||
| Working conditions | 315 | ||
| Pressures of work | 316 | ||
| Social roles and responsibilities | 317 | ||
| Are strikes by doctors unethical? | 318 | ||
| Doctors and social media | 319 | ||
| Dual loyalty | 321 | ||
| What about police or military orders and medical torture of prisoners? | 321 | ||
| Conflict of interest | 322 | ||
| Doctor in the health team | 323 | ||
| Working with colleagues | 326 | ||
| Treating other physicians | 328 | ||
| Physicians as teachers | 329 | ||
| Ethical challenges faced by medical students | 330 | ||
| Working with doctors from other systems of medicine | 332 | ||
| Appropriate use of technology | 335 | ||
| Ethical prescription of drugs | 339 | ||
| Generic names | 339 | ||
| Irrational prescriptions | 340 | ||
| Boundary violations | 343 | ||
| References | 345 | ||
| 13 Publication ethics | 347 | ||
| Learning objectives | 347 | ||
| Introduction | 348 | ||
| Why is it important to publish ethically? | 349 | ||
| Professional image | 349 | ||
| Professional environment | 349 | ||
| Scientific knowledge | 350 | ||
| Importance of integrity | 350 | ||
| Areas of misconduct in publication | 351 | ||
| What are some reasons for publication misconduct? | 351 | ||
| Types of misconduct in publication | 352 | ||
| Authorship | 352 | ||
| Redundant or multiple publications | 354 | ||
| Plagiarism | 355 | ||
| Copyright and permission | 356 | ||
| Salami publication | 358 | ||
| Data manipulation | 359 | ||
| Reporting | 360 | ||
| Conflict of interest | 361 | ||
| Confidentiality | 362 | ||
| Data access and retention | 363 | ||
| Ethical guidelines in review and publication | 363 | ||
| Icmr guidelines | 363 | ||
| Committee on publication ethics | 364 | ||
| International committee of medical journal editors (icmje) | 365 | ||
| Consolidated standards of reporting trials (consort) | 365 | ||
| Benefits of peer review | 365 | ||
| Action on research misconduct | 366 | ||
| Conclusion | 367 | ||
| References | 368 | ||
| Appendix a | 370 | ||
| Appendix a1 (chapter 3) | 370 | ||
| Indian medical council (professional conduct, etiquette and ethics) regulations 2002 | 370 | ||
| Declaration (appendix 1) | 370 | ||
| Appendix a2 (chapter 3) | 371 | ||
| Medical council of india | 371 | ||
| Amendment notification | 371 | ||
| New delhi, the 10th december, 2009 | 371 | ||
| Appendix a3 (chapter 4) | 373 | ||
| Wma declaration of lisbon on the rights of the patient 1981 | 373 | ||
| Appendix a4 (chapter 5) | 377 | ||
| Extract of the medical termination of pregnancy act 1971 | 377 | ||
| Permissible reasons and conditions | 377 | ||
| Appendix a5 (chapter 7) | 379 | ||
| The nuremberg code 1947 | 379 | ||
| Appendix B Teaching medical ethicsan integrated approach | 382 | ||
| References | 387 | ||
| Appendix C Further reading | 388 | ||
| Further reading | 388 | ||
| Chapter 1. introduction to medical ethics | 388 | ||
| Chapter 2. principles of medical ethics | 389 | ||
| Chapter 3. codes of medical ethics | 390 | ||
| Chapter 4. the doctor–patient relationship | 390 | ||
| Chapter 5. ethics at the beginning of life | 391 | ||
| Chapter 6. ethics at the end of life | 391 | ||
| Chapter 7. research ethics | 392 | ||
| Chapter 8. emerging medical technologies | 393 | ||
| Chapter 9. ethics of organ donation | 394 | ||
| Chapter 10. public health ethics | 394 | ||
| Chapter 11. medical errors and negligence | 395 | ||
| Chapter 12. the medical professional and society | 396 | ||
| Chapter 13. publication ethics | 396 | ||
| Appendix D Movies related to the theme | 397 | ||
| Chapter 1. introduction to medical ethics | 397 | ||
| Chapter 2. principles of medical ethics | 397 | ||
| Chapter 4. the doctor–patient relationship | 397 | ||
| Chapter 5. ethics at the beginning of life | 398 | ||
| Chapter 6. ethics at the end of life | 398 | ||
| Chapter 7. research ethics | 399 | ||
| Chapter 8. emerging medical technologies | 399 | ||
| Chapter 9. ethics of organ donation | 399 | ||
| Chapter 10. public health ethics | 400 | ||
| Chapter 11. medical errors and negligence | 400 | ||
| Chapter 12. the medical professional and society | 400 | ||
| Index | 401 | ||
| A | 401 | ||
| B | 401 | ||
| C | 401 | ||
| D | 402 | ||
| E | 402 | ||
| G | 403 | ||
| H | 403 | ||
| I | 403 | ||
| J | 404 | ||
| K | 404 | ||
| L | 404 | ||
| M | 404 | ||
| N | 404 | ||
| O | 405 | ||
| P | 405 | ||
| Q | 406 | ||
| R | 406 | ||
| S | 406 | ||
| T | 406 | ||
| U | 407 | ||
| V | 407 | ||
| W | 407 | ||
| X | 407 | ||
| Z | 407 |