Category: Non maleficence slideshare

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Non maleficence slideshare

27.11.2020 Non maleficence slideshare

In the management of complex medical cases such as a multifetal pregnancy, knowledge of the ethical and legal implications is important, alongside having competent medical skills.

This article reviews these principles and applies them to scenarios of multifetal pregnancy and fetal reduction. Such a discussion is not solely theoretical, but is also relevant to clinical practice.

The importance of topics such as bioethical principles and informed consent are also herein addressed. Legal concepts of informed consent and ethical theories are universal and applicable to a variety of situations. To most clinicians, legal and ethical principles may be considered an academic indulgence due to the gap between such principles and clinical practice. However, the approach to many clinical problems requires a certain degree of knowledge and application of medical ethics and the law.

The incidence of multifetal pregnancies has increased over the last few decades — largely a result of assisted reproductive technology ART. This trend has necessitated the development of fetal reduction to manage multifetal pregnancies, in order to improve perinatal survival and reduce maternal risk. Although fetal reduction techniques have emerged to be effective in improving pregnancy outcomes, this has been an area of great controversy where ethical and legal issues have not been clearly addressed.

While individual doctors reserve the right of conscientious objection, one should be aware of the issues surrounding this complex subject matter, so as to be able to better manage and counsel patients. This approach may be applied to similar medical dilemmas with ethical and legal implications.

Application of legal principles and medical ethics: multifetal pregnancy and fetal reduction

The natural incidence of twins and triplets is 1 in 80 and 1 in 8, pregnancies, respectively. The increase in the incidence of multifetal pregnancies is of much concern, as this also increases the morbidity and mortality of both the mother and fetuses. Furthermore, the economic and psychosocial impact of multiple births on the patient and family has to be acknowledged. The economic and social burden of multifetal pregnancy on the family cannot be belittled.

Fetal reduction may be indicated in various circumstances. In selective termination, one or more anomalous fetuses in a multifetal pregnancy are terminated. Assessment of the fetus for genetic abnormalities via chorionic villus sampling is performed prior to the decision to proceed with fetal reduction. Fetal reduction is preferably performed between 10 and 13 weeks of gestation, with the transabdominal approach most commonly undertaken.

Ultrasonography-directed percutaneous intracardiac injection of potassium chloride is performed using a gauge needle.The duty of professionals should be to benefit a party, as well as to take positive steps to prevent and to remove harm from the party. Non-maleficence reminds you that the primary concern when carrying out a task is to do no harm. Beneficence promotes action that will support others. These two theories taken together state that you must act in a manner that cultivates benefit for another, and at the same time protects that person from harm.

A single action can be analyzed and balances through both frameworks. You must look to reduce and eliminate negative impact of what work is being done and simultaneously find the means to support the welfare of the recipient. If you neglect to control certain aspects of your work that have undesirable and harmful consequences upon others then you are not abiding by the principle of non-maleficence.

Similarly, in the case of beneficence, if you attempt to carry out a task in a given environment, you must be sure that your action has positive impact in that context. These theories discourage selfish behavior which may directly or indirectly harm or deprive a recipient community. Notions of harm and benefit are molded by context, and thus cultural, economic, social, religious, political and other factors tie into how non-maleficence and beneficence are used for ethical decision-making.

Many situations encountered by students and others during international engagement fall into the boundaries of these two theories. In all cases you must avoid action that may be harmful non-maleficence and attempt to carry out action that will benefit a host community beneficence.

Non-maleficence and beneficence support the consideration of sustainability from a social, economical and ecological perspective. Dependency relationships may be harmful for the people or environment once the organization where services are provided withdraw their help.

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Example: A volunteer gives toothbrushes and toothpaste to a rural community and educates them about dental health. However, the toothpaste is quickly used up and the community has no access to commute to town to purchase toothpaste so they burn their plastic tooth-brushes along with the rest of their garbage in the backyard creating harmful fumes burning of certain plastics can create dioxins-a human carcinogen.

This prevents mis-communication and the harm that can arise from being cultural miscommunication. Locals often have more knowledge than volunteers on the subjects the volunteers have come to teach. Without cultural knowledge, service-learning projects cannot deliver effective information or know what negative impacts may be involved.

Example: A short-term health-promotion project may be appropriate when aiding an already established project eg. However, this project may be ineffective and possibly damaging when the service providers are interacting firsthand with communities they know little about. Example: Students want to experience living among the community members in a local community.

However, it may not always be appropriate to ask locals to open up their homes to strangers from abroad and it may create an unfavorable power dynamic. Example: A 1st year medical student who wishes to get hands-on experience goes to Nicaragua and begins to diagnose and treat patients in an understaffed urban clinic with little supervision.

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This is especially relevant when volunteers present themselves as educators. Students should reflect on whether their work in a international setting would be considered acceptable at home based on their level of training.Basket Login Register. The four common bioethical principles.

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As the principles of beneficence and non-maleficence are closely related, they are discussed together in this section. Beneficence involves balancing the benefits of treatment against the risks and costs involved, whereas non-maleficence means avoiding the causation of harm. As many treatments involve some degree of harm, the principle of non-maleficence would imply that the harm should not be disproportionate to the benefit of the treatment.

Ethics: Nonmaleficence White Board Animation

For example, it may be necessary to provide treatment that is not desired in order to prevent the development of a future, more serious health problem. The treatment might be unpleasant, uncomfortable or even painful but this might involve less harm to the patient than would occur, were they not to have it. In cases where the patient lacks legal competence to make a decision, medical staff are expected to act in the best interests of the patient.

non maleficence slideshare

In doing so, they may take into account the principles of beneficence and non-maleficence. However, it would be helpful for medical staff in such cases, if the patient lacking capacity had made an advance directive.

In Western medicine, the principles of beneficence and non-maleficence derive historically from the doctor-patient relationship, which for centuries was based on paternalism. According to Kaothis is not the same in non-Western medicine.

What Is the Difference Between Beneficence and Nonmaleficence?

She explains that in Islamic medical ethics, a greater emphasis is placed on beneficence than on autonomy especially at the time of death.

Aksoy and Tenikwho investigated the existence of the four principles in the Islamic tradition by examining the works of Mawlana, a prominent Sufi theologian and philosopher, support this claim.

They found evidence of all four principles in one form or another, with a clear emphasis on the principle of beneficence. Is Alzheimer's disease hereditary? Is there a test that can predict Alzheimer's disease? How is Alzheimer's disease diagnosed? Diagnosis of dementia Disclosure of the diagnosis Facing the diagnosis Taking care of yourself Developing coping strategies Maintaining a social network Attending self-help groups Accepting help from others Dealing with feelings and emotions Changing roles and how you see yourself On a more positive note Organising family support Dealing with practical issues Financial and administrative matters Driving Safety issues Employment issues Healthy eating Contact and communication Speaking, listening and communication Signs, symbols and texts Personal relationships Talking to children and adolescents Changing behaviour Lack of interest in hobbies Disorientation Managing everyday tasks Keeping an active mind Services Caring for someone with dementia The onset of the disease Diagnosis: should the person with dementia be told?

non maleficence slideshare

Dealing with emotions Arranging who will be responsible for care Determining to what extent you can provide care How will Alzheimer's disease affect independent living?Toggle navigation. Help Preferences Sign up Log in. Featured Presentations. Beneficence - Title: - Author: Dr. Title: - Author: Dr. The Duty of Beneficence - Over 10 million children die each year from easily preventable causes: disease, Over 10 million children die each year from easily preventable causes: disease, I have learned From my mother, piety and beneficence, and abstinence, not only from evil deeds, but - Born on April 26, AD at Rome.

Parents were Annius Verus and Domitia Lucilla The Internet Classics Archive. January 7, Born on April 26, AD at Rome. Minimize risks to subjects Beneficence and Respect for Persons. Right to withdraw.

Confidentiality of subject data. Non-maleficence and Beneficence. Stage 28 Derivatives - Benefaction, benefactor, beneficence, beneficent, beneficial, beneficiary, benefit Benefaction, benefactor, beneficence, beneficent, beneficial, beneficiary, benefit Educational Action Research Todd Medical Ethics - II.

International Research Ethics - Stimulate further ethical review of your own projects. Ethics: ways of Stimulate further ethical review of your own projects.Print PDF What are ethics? The scope of bioethics is wide-ranging, dealing with a vast array of issues such as those arising from issues like abortion, euthanasia, clinical trial design, surrogacy, organ donation, termination of life support, stem cell research, genetic testing, cloning and more.

Two additional ethical values are also often discussed in light of certain events like those listed below. Prior tono informed consent was needed from participants in research studies.

Without an ethical approach to experimentations we end up with the likes of…. Inmates were forced to stand for hours in freezing water or naked in the bitterly cold air. Josef Mengele. Other experiments were also carried out on prisoners such as sea-water ingestion, sterilisation through radiation, surgery and injections, gangrene, poisonings, low-pressurisation, and head-injuries. Prisoners were forced into participating; refusal meant execution; they did not willingly volunteer and there was never informed consent.

Typically, the experiments resulted in death, disfigurement or permanent disability, and as such are considered examples of medical torture. Early subjects were fed extracts of stools from infected individuals in milkshakes and later subjects received injections of more purified virus preparations.

These studies were designed to gain an understanding of the natural history of infectious hepatitis and subsequently to test the effects of gamma globulin in preventing or ameliorating the disease. Investigators defended the deliberate injection of these children by pointing out that the vast majority of them acquired the infection anyway while at Willowbrook, and perhaps it would be better for them to be infected under carefully controlled research conditions.

They treated most subjects with antibiotics, but the study resulted in at least 83 deaths. The experiments were led by Dr. The Tuskegee study enrolled impoverished sharecroppers from Macon County, Alabama who had syphilis — they were never told they had syphilis, nor were they ever treated for it. Penicillin had been vaildated as an effective cure for syphilis in Unit was a covert biological and chemical warfare research and development unit of the Japanese Army that undertook lethal human experimentation during the Second Sino-Japanese War and World War II.

It was responsible for some of the most notorious war crimes carried out by Japanese personnel. Between 3, and 12, men, women, and children died as a result of human experimentation carried out in Unit Limbs were cut off in the same way to study blood loss or allowed to develop gangrene to observe decomposition. Organs were removed without anaesthesia. Following the revelations during the Nuremberg Trials of the atrocities carried out under the name of medical research in the Nazi concentration and extermination camps, the Nuremberg Code was drafted.

The Declaration of Helsinki is a set of ethical principles regarding human experimentation developed in for the medical community by the World Medical Association originally, which has been revised on several occassions, most recently in 7th revision.

The Declaration is morally binding on physicians, and that obligation overrides any national or local laws or regulations, if the Declaration provides for a higher standard of protection of humans than the latter. Cite this article as: Alan Batt.A fundamental distinction between a profession and any other occupation, is that individuals engaged in a profession have an ethical obligation to whomever they offer their services.

In other words, a profession is required to have a Code of Ethics. Optometry ranks amongst the leading healthcare professions and various national Codes of Ethics for Optometry exist 1. These can all be traced back to one of the original sources of medical ethics in the Western world: the famous oath of Hippocrates 1. Hippocrates lived around BC and was believed to be part of a physician's cult in ancient Greece who were faithful to Asclepius, the god of medicine and healing.

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Indeed, the memory of the worship of Asclepius lives on in modern medicine: the snake around the physician's staff is attributed to this god as snakes were part of the ancient healing ritual. Whilst reptilian remedies do not form part of medicine and healthcare today and Hippocrates original oath as we understand it through modern translations 2 includes statements that would not concord with modern practice: e.

The oath has been transposed through history and more recently was incorporated into the Declaration of Geneva that followed the aftermath of the Second World War 1. This has formed the basis of the codes of ethics of a number of healthcare professions. The ethical codes contain guiding principles. These serve to help practitioners in their decisions and in practicing in accordance with a set of standards that are expected of a healthcare practitioner.

Beauchamp and Childress 3 cite beneficence, non-maleficience, respect for autonomy and justice as the four major ethical principles in healthcare.

non maleficence slideshare

These principles can be described as follows:. In addition to beneficence, non-maleficence, respect for autonomy and justice, the principles of confidentiality, protection of the vulnerable and collegiality have been included to form the ethical principles that should guide optometric practice 1. Confidentiality means non-disclosure of patient details and health records in order to respect the privacy and preserve the dignity of each patient.

Protecting the vulnerable involves standing up for the rights of those who may be unable to speak or act for themselves. Although all patients are to some extent vulnerable for they come for help to the practitioner, some are more vulnerable than others.

These include children, the frail elderly and patients who are unable to make decisions for themselves. Whilst some of these patients may not be considered autonomous by law such as children and others may be mentally unable to exercise autonomy, their dignity must at all times be respected and the duty of care the practitioner owes them may require a degree of protection that extends beyond the usual duty of care.

Collegiality calls for support of colleagues and fellow practitioners and professionals. This is the only ethical principle that does not apply to patients but to the way practitioners treat one another. Collegiality means mutual respect and understanding for fellow optometrists, for other professionals and for their respective roles in the health care team. Each of these principles would appear to be sound and simple to follow, almost too obvious to need stating. Yet, for each one of them situations that may render that principle limiting or difficult to apply will arise.

This illustrates the paradox that whilst these principles are essential tools for ethical practice, if applied too rigidly, they can be problematic. No principle can be applied absolutely. Take the example of beneficience. Should a practitioner become so completely selfless that s he commits his entire life and all available time to helping patients at the expense of a private life and duties to family?

The difficulty with beneficence is that it is limitless and every practitioner needs to decide how far s he wants to take this principle.According to the University of California San Francisco School of Medicine, beneficence refers to acting for the good of others.

Nonmaleficence, on the other hand, means to do no harm. Beneficent acts include rescuing a person from danger or helping a person to improve their situation. Specific examples of beneficent acts include rescuing a drowning person, providing vaccination for the general population and advising a smoker to quit smoking.

Examples of nonmaleficence include not giving a person a harmful drug and refraining from saying hurtful things to another other person. Beneficence and nonmaleficence are principles that apply to doctors in their clinical practice. The doctors' code of ethics includes the principle of first doing no harm, which refers to nonmaleficence.

Therefore doctors must not provide treatments that are known to be harmful to their patients and must not provide treatments that are known to be ineffective.

non maleficence slideshare

Also, doctors have a duty to help their patients. They have to provide effective treatment, which is a beneficent act, if a patient requires it.

In medical practice, treatments often have benefits as well as risks involving side effects or complications. By weighing the benefits against the risks, doctors are balancing the principles of beneficence and nonmaleficence. Home World View. What Are Poor Communication Skills? What Are Examples of Computer Ethics?


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