APPROACH TO THE

PATIENT: ETHICAL ISSUES

Dr Patience Odusolu
Associate Professor
Obstetrics & Gynaecology
 Introduction
As is the case in most areas of medicine,
a careful history and physical
examination should form the basis for
patient evaluation and clinical
management in obstetrics and
gynaecology.

Necessary to be sensitive to the

emotional and psychological needs of the
patient.
 Introduction
Ensuring that each patient’s privacy and dignity
are respected while providing the highest level
of medical care.

Ethical decision-making in obstetrics and

gynaecology is complicated by factors that are
peculiar to the field.

 The most significant of these being that in

obstetrics the provider is simultaneously caring
for two patients—the mother and the foetus—
both of whose interests the provider owes a
duty to protect.
 Approach to the Patient
 Greet patient politely.

 Identify yourself and state purpose.

 Meet the patient initially when she is fully

dressed, if possible.

 Address the patient courteously and respectfully.

 Respect the patient’s privacy and dignity during

the interview and examination/ presence of a
chaperone.
 Approach to the Patient Cont’
 Ensure cleanliness, good grooming, and
good manners in all patient encounters.
 Beware that a casual and familiar
approach is not acceptable to all patients;
it is generally best to avoid addressing an
adult patient by her first name.
 Maintain the privacy of the patient’s
medical information and records.
 Be mindful and respectful of any
cultural preferences.
Approach to the Patient Cont’
Finally, any appropriate cultural beliefs and
preferences for care and treatment should be
recognized and respected.

Use opportunities that arise while taking history to

establish rapport and a supportive patient–physician
encounter.

 A complete physical examination provides an

opportunity to detect previously unrecognized
abnormalities. Normal baseline levels must also be
established, particularly those of weight, blood
pressure, etc.
 Ethics
Ethics is the branch of philosophy
concerned with the study or evaluation of
human behaviour /conduct to identify the
norms, rules, values, and principles that
guide our moral life.

 Considers the rightness and wrongness

of actions and the goodness or badness of
motives and the outcomes (ends) of such
actions.
Medical ethics
 These are values and guidelines
governing decision making in medical
practice.
Medical ethics traces its roots to the
beginning of the Hippocratic oath,
which emphasizes the concept of duty
to patient and provides guidelines for
physician behaviour when interacting
with patients.
The ethical principles that impact on p
atients, physicians and health care
Medical ethics
Medical ethics has been dominated by principle-based ethics
In this approach, four principles offer a systematic and
relatively objective way to identify, analyze, and address
ethical issues, problems,
 However, critics claim that a principle-based approach
cannot adequately resolve or even helpfully evaluate many
difficult clinical problems.
 As a result, several other perspectives and frameworks have
emerged: virtue-based ethics, an care based ethics, feminist
ethics.
These different perspectives and frameworks are not
necessarily mutually exclusive. They often are
complementary
 Medical Ethics Core Principles
Core principles of medical ethics as they pertain to the
physician’s actions.
Autonomy
The physician should respect the right of the patient
to make decisions regarding their care.
Beneficence
The physician should act in a way that promotes the
patient’s best interests and promotes patient
wellbeing
Nonmaleficence
The physician should avoid harming the patient
Justice
The physician should give the patient what is his or
her due and should treat similar patients equally
 Autonomy
Autonomy, which derives from the Greek autos (“self ”)
and nomos (“rule” or “governance”), literally means self-
rule.
To be an autonomous entity the individual must
be: (1) free from coercion or other controlling
influence or influences, and (2) possess the
capacity for “intentional action.”(no limitations)
If these two standards for autonomy are
reasonably met, the individual has the right to
make decisions regarding their medical care
Even if the decision conflicts with what the
provider believes is in their best interest.
 Autonomy cont’
The principle of autonomy, and obligation to try
to ensure that the patient is an autonomous
entity, underlies the concept of informed
consent.

Respect for autonomy provides a strong moral foundation

for informed consent, in which a patient.

 Respect for patient autonomy, like all ethical principles,

cannot be regarded as absolute. At times it may conflict with
other principles or values and sometimes must yield to them.
 Beneficence
which literally means doing or producing good,
expresses the obligation to promote the well-being of
others.
 It requires a physician to act in a way that is likely to
benefit the patient.
Beneficence is to act in the best interests of
the patient, to balance benefits against risks.
The benefits that medicine is competent
to seek for patients are the prevention and
management of disease.
Nonmaleficence
 Nonmaleficence is the obligation not to harm or cause
injury.
It means that a health personnel should
prevent causing harm and is best understood
as expressing the limits of beneficence.

It is best known in the maxim;

‘primum non nocere’ (first do no harm).
These two principles taken together are operative in
almost every treatment decision because every medical
or surgical procedure has both benefits and risks,
which must be balanced knowledgeably and wisely.
Justice
Justice signifies, to treat patients fairly and
without unfair discrimination, there should be
fairness in the distribution of benefits and risks.
Medical needs, and medical benefits should be
properly weighed.
Patients should be treated equally.
Justice is the principle of rendering to others what is due to
them.
 It is the most complex of the ethical principles to be
considered because it deals not only with the physician’s
obligation to render to a patient what is owed but also with
the physician’s role in the allocation of limited medical
resources
Moral Ethics
In addition to the principles outlined above, there are
values or “moral rules” that also are an important part
of ethical decision-making and behavior in the medicine.
This is due, in large part, to the fact that in many
clinical cases these principles are actually in conflict
with one another, and there is no clear hierarchy among
them to help resolve such ethical dilemmas.
Virtue ethics: Moral conduct should be guided by
virtues such as kindness, compassion, integrity, fairness,
trustworthiness, fortitude, respect for others, etc.
Rights-based ethics: Moral conduct should ensure
that basic individual rights (autonomy, privacy,
confidentiality) are upheld
 Confidentiality
Confidentiality is based on the principle of respect for patient
autonomy, which includes a patient’s right to privacy, and on
the physician’s responsibility to respect a patient’s privacy.

Confidentiality is the basis of trust between health
.

personnel and patient:

A patient’s family, friend or spiritual guide has no
right to medical information regarding the patient
unless authorized by the patients.
The following points of confidentiality are to be kept
in mind:
Health care providers duties to protect patient’s
information against unauthorized disclosures.
By acting against this principle one destroys the
patient trust.
 Consent
Informed consent is a central concept to ethical decision-
making,
 Most times informed consent is confused with the consent form.
 Informed consent is “the willing acceptance of a medical intervention by
a patient after adequate disclosure by the physician of the nature of the
intervention with its risks and benefits and of the alternatives with their
risks and benefits”
The consent form is the single most important document,
created in the presence of the patient, which removes
obstacles to effective communication concerning choice.
The key to effective communication is:
- Engaging with the patient empathizing with her
needs
- Educating her as to the available options.
- Enlisting her approval for the appropriate choice
Consent:
MEDICO-LEGAL ASPECTS OF
GYNAECOLOGY & OBSTETRICS

 REASONS FOR LITIGATION

 Displeasure against medical professional
due to
 Lack of communication
Poor attitude
Perceived negligence
 poor or adverse outcome.
MEDICO-LEGAL ASPECTS OF
GYNAECOLOGY & OBSTETRICS
High risk in litigations
The fetus as a patient with rights
Termination of pregnancy
Contraception
ART
Surogacy
Delivery
Surgeries
Drugs
Documentation and record keeping:
 Documentation and record keeping:
History and Examination
Medications,
Plan of management,
 Investigations done,
Operation notes,
Record of discussions with patient &
relatives
Record of feedback from patient
Record of patients not following instruction
Date and time of all above.
ANYTHING THAT IS NOT DOCUMENTED IS
Documentation and record keeping:
Good interpersonal relationship
clear communication & counselling
The health professionals must be polite and
courteous showing empathy towards patient.
The patient must not be given false
guarantees and needs to understand what to
expect from the treatment.
Good counselling instils enormous confidence
and faith. It helps to remove fear and
misconceptions that may exist in the mind of
the patient.
Conclusion:
THANK
YOU…