Physician – Society Relationship

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Physician Society RelationshipMa. Kristina Fatima Louise GarciaIrka GarciaMark Jesreel GarciaMa. Monica Pamela GarzonCheryll GatchalianGem Minnie Mae GawIsabelle Reyna Geraldoy

Section B

HUMAN RIGHTS

It refers to the "basic rights and freedom to which all humans are entitled.

Examples of rights and freedoms which have come to be commonly thought of as human rights include civil and political rights such as:

The right to life and liberty

Freedom of expression and equality before the law and economic, social and cultural rights, including :

The right to participate in culture

The right to food

The right to work

The right to education

Article 1 of the United Nations Universal Declaration of Human Rights (UDHRHistory of HUMAN RIGHTSThe Cyrus Cylinder issued by the Persian emperor Cyrus the Great following the Persian conquest of Babylon in 539 BC

Edicts of Ashoka issued by Ashoka the Great of India between 272-231 BC

The Constitution of Medina of 622 AD, drafted by Muhammad to mark a formal agreement between all of the significant tribes including Muslims, Jews and Pagans.

The English Magna Carta of 1215 is particularly significant in the hIstory of English law, and is hence significant in international law and constitutional law today.Declaration of the Rights of Man and of the Citizen approved by the National Assembly of FranceAugust 26, 1789.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.Declaration of the Rights of Man and of the Citizen approved by the National Assembly of FranceAugust 26, 1789.Humanitarian LawThe Geneva Conventions came into being between 1864 and 1949 as a result of efforts by Henry Dunant, the founder of the International Committee of the Red Cross.

The conventions safeguard the human rights of individuals involved in armed conflict.

Convention- an international agreement (rather than an assembly of people)

Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Conventions

First Geneva Convention: for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field

Second Geneva Convention: for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea

Third Geneva Convention: relative to the Treatment of Prisoners of War

Fourth Geneva Convention: relative to the Protection of Civilian Persons in Time of War

Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.orgUniversal Declaration of Human RightsThe Universal Declaration of Human Rights (UDHR) is a non-binding declaration adopted by the United Nations General Assembly in 1948, partly in response to the atrocities of World War II.

The UDHR urges member nations to promote a number of human, civil, economic and social rights, asserting these rights are part of the "foundation of freedom, justice and peace in the world." Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

UNIVERSAL DECLARATION OF HUMAN RIGHTSRight to life ( Article 2)

Prohibition of torture, inhuman or degrading treatment or punishment (Aritcle 3)

Prohibition of slavery and forced labour (Article 4)

Right to liberty and security (Article 5)

Right to a fair trial (Article 6)

No punishment without law (Article 7)

Right to respect for private and family life (Article 8)


UNIVERSAL DECLARATION OF HUMAN RIGHTS

Freedom of thought, conscience and religion (Article 9)

Freedom of expression (Article 10)

Freedom of assembly and association (Article 11)

Right to marry (Article 12)

Prohibition of discrimination (Article 14)

Restrictions on political activity of aliens (Article 16)

Prohibition of abuse of rights (Article 17)

Limitation on use of restrictions on rights (Article 18)Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

All human beings are born free and equal in dignity and rights.They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.


Everyone is entitled to all the rights and freedom without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Everyone has the right to life, liberty and security of person.

The patient's right to life should be specifically considered in any decision to withhold or withdraw life-prolonging treatment but this does not mean that treatment must always be provided.

Treatment may be withdrawn if: providing treatment would not be in the patient's best interests; the treatment is considered futile; or the patient has effectively waived his or her right to have life prolonged by making an informed refusal of life-prolonging treatment.Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Everyone has the right to life, liberty and security of person.

May impose a duty on doctors to take steps to prevent life-threatening conditions and a duty to inform the public, or individuals, of threats to their life

This would involve a breach of confidentiality, this should be balanced against the patient's right to confidentiality.

Must be taken into account where potentially life-prolonging treatment is not provided on economic grounds. Any such decisions must be made in a non-discriminatory way and the decisions must hold up to scrutiny.


Freedom of thought, conscience and religionA patient may object to treatment, or the parents of a child may object to treatment for the child, on religious grounds, even where withholding treatment may lead to death.

The patient's right to be protected from inappropriate or unlawful treatment without consent must also be taken into account.Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Why is the Human Rights Act relevant to medical treatment?

It regulates the relationship between individuals and public authorities. It is unlawful for public authorities 'to act in a way which is incompatible with a Convention right

Many doctors are not accustomed to thinking in terms of "rights" but one of the purposes of this guidance is to show the way in which accepted good practice, focused on patients' wishes and interestsCommittee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

How will decision making differ?

Two questions to ask in each case:Are someone's human rights affected by the decision? And, if so,

Is it legitimate to interfere with them?Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

SOCIAL JUSTICESocial justice, sometimes called civil justice, refers to the concept of a society in which "justice" is achieved in every aspect of society, rather than merely the administration of law.

It is generally thought of as a world which affords individuals and groups fair treatment and an impartial share of the benefits of society.

It can also refer to the distribution of advantages and disadvantages within a society. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Catholic social teaching

Comprises those aspects of Roman Catholic doctrine which relate to matters dealing with the collective aspect of humanity.

A distinctive feature of Catholic social teaching is its concern for the poorest members of society. Committee on Medical Ethics, British Medical Association. The impact of the Human Rights Act 1998 on medical decision making. London: British Medical Association, 2000.http://www.wikipedia.org

Two of the seven key areas of Catholic social teaching are pertinent to social justice:Life and dignity of the human person The foundational principle of all Catholic Social Teaching is the sanctity of all human life and the inherent dignity of every human person. Human life must be valued above all material possessions



"Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.

The Catholic Church teaches that through words, prayers and deeds one must show solidarity with, and compassion for, the poor.

When instituting public policy the "preferential option for the poor" should always be kept at the forefront.

Preferential option for the poor and vulnerable:

The moral test of any society is "how it treats its most vulnerable members. The poor have the most urgent moral claim on the conscience of the nation. People are called to look at public policy decisions in terms of how they affect the poor."


HEALTH AND CULTUREHEALTH AND CULTURECultureEncompasses all learned patterns of human behavior (e.g. beliefs, traditions, language, customs, etc.)Shapes the experiences of a particular group of people (e.g. family relationships, approaches to healing, expectations of what it means to be a boy/girl, etc.) NormsCULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREImportant Things about CultureEveryone has a culture.There is diversity within cultures.Cultures are not static.Culture is not determinative. Cultural differences are complicated by differences in status and power between cultures.

CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREIn medical practice:Ensure good care for diverse patientsAddress cultural issues in medicine

CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTURECultural CompetencyAbility to work effectively across cultures An approach to learning, communicating and working respectfully with people different from themselves (individual)Creating the practices and policies that will make services more accessible, appropriate and effective to diverse populations (organization)

CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREImportance of Cultural CompetencyGreat urgency for service and support to reach diverse groupsTo serve all communitiesTo bridge differencesTo improve the social, health and educational outcomes of members of a specific group

CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREAreas of ConflictHistorical distrustInterpretations of disabilityConcepts of family structure and identityCommunication stylesIncompatibility of the epidemiology of the illnessMisunderstanding of language, terminologies, etc.CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREHow to Become Culturally CompetentListenExplain Acknowledge Recommend Negotiate

CULTURAL COMPETENCY: What it is and why it matters; Olsen, Bhattacharya & ScharfHEALTH AND CULTUREScenario 1A 3-year old child was brought to the emergency room because of fever. Upon interview of the mother, it was found out that the child have had recurring fever for quite some time already. When asked why the delay in taking her to the doctor, the mother revealed that they have been seeking consult from the local hilot (alternative doctors). However, since the condition of the child seems to have worsened, they decided to take her to the hospital.

HEALTH AND CULTUREScenario 1ExplainEducateProvide appropriate medical careRESPECTHEALTH AND CULTUREScenario 2Suzy, a 37-year old woman, was horseback riding one day and was thrown off her horse. She suffered massive internal injuries. At the hospital, they discovered that she lost a huge amount of blood and requires immediate transfusion. However, in her medical alert card, it was stated that she was a member of the Jehovahs witness and stating that under no circumstances was she to receive blood.

HEALTH AND CULTUREScenario 2Seek any family memberExplainOffer alternativesRespect their decisionAllocation of Scarce ResourcesAllocationassigning of resources for specific purposes

Two levels:Micro level of individualsMacro level of various groups within a national society or at the international level

Ethics of Health Care third editionAshley and ORoukesccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

Case 1

The neonatal care unit at Childrens Memorial Hospital has six respirators available and eight newborn infants in need of pulmonary assistanceEthics of Health Care third editionAshley and ORouke

Principle of Common Good and SubsidiarityThe principle maintains that human communities exist only to promote the common good of their members, and that each person or social group has a right and responsibility to participate in this effortCalls upon each person or lower social unit to be given the opportunity to exercise the responsibility to achieve the goals proper to it.

Ethics of Health Care third editionAshley and ORoukePrinciple of Common Good and SubsidiarityHuman Communities promote and share the common good among member, from each according to its ability and needDecision making:Rest vertically primarily with the person, and then the lower social levels and (horizontally) with functional social unit.The higher social unit intervene to supply the lower units with what they cannot achieve for themselves at the same time working to make it easier in the future for the lower units and individuals to satisfy the needs by their own effort.

Today we allocate resource to those who can pay and not according to the need of the personEthics of Health Care third editionAshley and ORoukePrinciple of Subsidiarity and Common Good closest to us & whose need is best known to us should be cared for firstit is not unjust for a family to seek the best obtainable care for its members, or for physicians to give special attention to their regular patients with whom a special relationship of trust has been built, as long as no one else is treated unjustly

Ethics of Health Care third editionAshley and ORoukePrinciple of Triageallocation of resources between individualsmeans, to pick or sort according to qualityAccording to Jean Larrey:Those who are dangerously wounded must be tended first, entirely without regard to rank or distinction. Ethicist generally agree that this does not violate justice if it respects the rights of patients completely as possible in a situationEthics of Health Care third editionAshley and ORouke

applying the principle of triage in emergency situations, two question must be asked

Who is in greatest need of treatment?Who will benefit most from treatment?

Ethics of Health Care third editionAshley and ORouke

Threefold division of victims:The dying need is great but will benefit least from treatment & should be made comfortable & left to die

The wounded who will survive w/o treatment - their need is little & who can be left to care for themselves

3. The wounded who will die unless treated probably survive if treatedIn here the last two both have the greatest need and benefit so they deserve more attention.Ethics of Health Care third editionAshley and ORouke

Types of TriageED triageprioritize patient assessment and treatment in the emergency department during routine functioning

Priority is given to those most in needsccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

Inpatient triageApplied day-to-day in a variety of medical settingsICU, medical imaging, surgery, and outpatient areas

Priority is given to those most in need based upon medical criteria.

sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

3. Incident triageUsed in multiple casualty incidents such as bus accidents, fires, or airline accidents

Most patients receive maximal treatment.sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdf

4. Military triageUsed on the battlefield

Reflect the original concept of triage

Resources are rationed when their supply is threatened


5. Disaster triageUsed in mass casualty incidents that overwhelm local and regional healthcare systems

Prioritize salvageable patients for treatment and ration resources to ensure the greatest good for the greatest number


Triage some problemsTriage in MicroallocationSelect which patients are to be given a new vaccine or drug when a sufficient supply for all is not yet availableRecipient of scarce organs for transplantationsTriage in Macroallocation1. Selecting funds for health programs, is it preventive or medicinal. Example: Do we give more fund to dialysis for end stage renal disease or for vaccination and immunization program for children.

sccm.org/FCCS_and_Training_Courses/ FCCS/.../13 FDM ch13 draft3.pdfEthics of Health Care third editionAshley and ORouke

Principle of Random Selection22 http://www.freerepublic.com/focus/f-news/2287233/postsSometimes, to apply triage, it may also be necessary to use random principle of selection not based on benefit or need, such as lottery and first come first serve.Such procedure are not unfair if the need and benefit are approximately the same for all, or there is no way of discriminating on the need or benefit basis.A. LotteryUsed with explicit judicial and legislative endorsement, in military conscription, immigration, education, and distribution of vaccines

Some people support this because: each persons desire to stay alive should be regarded as of the same importance and deserving the same respect as that of anyone else

Quick and requires little knowledge about recipients22 http://www.freerepublic.com/focus/f-news/2287233/postsMajor disadvantage: blindness to many seemingly relevant factors

Treating people equally often fails to treat them as equalsB. First-come, first-servedA natural lotteryan egalitarian approach for fair resource allocation.

Promotes fair equality of opportunityAllows physicians to avoid discontinuing interventions, - such as respirators

Ignores relevant differences between people, but in practice fails even to treat people equally22 http://www.freerepublic.com/focus/f-news/2287233/postsFavors people who are well-off , who become informed, and travel more quickly

Allows morally irrelevant qualitiessuch as wealth, power, and connectionsto decide who receives scarce interventions, 22 http://www.freerepublic.com/focus/f-news/2287233/postsThank you!

Physician – Society Relationship

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