New Manual Launched to Help Physicians Facing Ethical Challenges

At a time when physicians are facing unprecedented ethical challenges in their relationships with patients, other health professionals, governments, health insurance and social security systems, and the pharmaceutical industry, the World Medical Association today launched its first-ever manual of medical ethics to help medical students, post graduates and practising physicians deal with these challenges.

The manual covers physicians' ethical relationships with patients, society, their colleagues and the pharmaceutical industry, and deals with issues including requests for euthanasia and physician-assisted suicide and assessing the claims of pharmaceutical company representatives about their products, as well as knowing when and how to ask patients to participate in medical research.

The manual's author, Professor John Williams, Director of Ethics at the WMA, explains that ethics is an essential component of everyday medical practice. Ethical principles, such as respect for people, informed consent and confidentiality, are basic to the physician-patient relationship.

Dr Delon Human, Secretary General of the WMA, said: 'It is incredible to think that although the founders of medical ethics, even Hippocrates, published their works more than 2000 years ago, the medical profession still does not have a universally used basic curriculum for the teaching of medicine.'

He said that the manual's origin was a WMA recommendation in 1999 that medical schools worldwide should include the teaching of medical ethics and human rights as a compulsory course in their curricula.

'Our ultimate aim is that the publication will be used as a reference by medical students and physicians worldwide and that it will become the benchmark on which physician behaviour is judged', that it will become the benchmark for physician behaviour,' said Dr. Human.

said Dr Human. 'Modern health care has given rise to extremely complex and multifaceted ethical dilemmas, and at times physicians are unprepared to manage these competently. This publication is specifically structured to reinforce and strengthen the ethical mindset and practice of physicians and provide tools to find ethical solutions to these dilemmas.

'It is an attempt to sensitize the conscience of the physician, which is the basis for any sound and ethical decision-making. The core will always be the patient-physician relationship. In recent times, this relationship has come under pressure due to resource constraints and other factors, and this manual shows the necessity of strengthening this bond through ethical practice.'

The manual, which is based on WMA policies but is not itself a policy document, will be available free of charge on the WMA website and a print version is being prepared for more limited distribution. The manual is being translated into Japanese and Spanish and there are plans to bring out other translations.

Note to Editors: Two Examples of Case Studies in the Manual:

Case Study 1
Dr. S is becoming increasingly frustrated with patients who come to her either before or after consulting another health practitioner for the same ailment. She considers this to be a waste of health resources as well as counter-productive for the health of the patients. She decides to tell these patients that she will no longer treat them if they continue to see other practitioners for the same ailment. She intends to approach her national medical association to lobby the government to prevent this form of misallocation of health care resources.

Advice: According to the analysis of the physician-society relationship presented in this chapter, Dr. S is right to consider the impact on society of her patient's behaviour. Even if the consultations with the other health practitioner occur outside of the health system in which Dr. S works and therefore do not entail any financial cost to society, the patient is taking up Dr. S's time that could be devoted to other patients in need of her services. However, physicians such as Dr. S must be cautious in dealing with situations such as this. Patients are often unable to make fully rational decisions for a variety of reasons and may need considerable time and health education to come to an understanding of what is in the best interests of themselves and of others. Dr. S is also right to approach her medical association to seek a societal solution to this problem, since it affects not just herself and this one patient but other physicians and patients as well.

Case Study 2
Dr. C, a newly appointed anaesthetist in a city hospital, is alarmed by the behaviour of the senior surgeon in the operating room. The surgeon uses out-of-date techniques that prolong operations and result in greater post-operative pain and longer recovery times. Moreover, he makes frequent crude jokes about the patients that obviously bother the assisting nurses. As a more junior staff member, Dr. C is reluctant to criticize the surgeon personally or to report him to higher authorities. However, he feels that he must do something to improve the situation.

Advice: Dr. C is right to be alarmed by the behaviour of the senior surgeon in the operating room. Not only is he endangering the health of the patient but he is being disrespectful to both the patient and his colleagues. Dr. C has an ethical duty not to ignore this behaviour but to do something about it. As a first step, he should not indicate any support for the offensive behaviour, for example, by laughing at the jokes. If he thinks that discussing the matter with the surgeon might be effective, he should go ahead and do this. Otherwise, he may have to go directly to higher authorities in the hospital. If they are unwilling to deal with the situation, then he can approach the appropriate physician licensing body and ask it to investigate.