Medical Ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings
Un-Ethical: contrary to conscience or morality or law; conforming to accepted standards of social or professional behavior As a doctor, I felt uncomfortable to accept doctors or nurses making wrong diagnosis, offering wrong treatment or performing wrong procedure and lying to patients that they are OK when they were not.
“A physician must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible.”
Why is this important?
I have seen and heard people discussing their medical problem with non-medically trained person and heard the same person telling me (as their doctor) a different story. It is true patients who consult doctors often speak the truth because they believe it is not in their interest if the exaggerate or give false information. At time they may conceal some information like they have a sexually transmitted disease or HIV positive.
The best time to ask question is when the patient is on the couch with their cloths partially removed. I find this fascinating because the patient feel very comfortable and never embarrassed and always speak the truth.
How can we train a nurse or a paramedic to help diagnose and offer treatment based on protocol? As doctors we know patients are more relaxed when they know the person taking the history is not a trained doctor. The “White Collar Hypertension” is a good example to prove the patients relax and the BP recorded by nurses is often 10mm lower.
In the NHS (UK) the nurses were allowed to stop doctors treatment without obtaining doctors permission. A doctor often chooses drugs based on the knowledge, experience and understands why and how the drugs work and act. If choosing a treatment was so easy then a computer could do the same job with no mistake.
Different drugs are used for blocked noses, breathing difficulties and infections each drug has good therapeutic action and side effects. Some drugs are used to help but others are used to take advantage of the side effect.
Two drugs I will talk about are Minoxidil and Viagra. This will explain how the doctors use their knowledge and experience and to help manage other medical problems.
I have also explained the importance of physiology, pathology and drugs is very essential to manage or prevent complication. Doctors can be found negligent if they do not use the knowledge and experience to offer treatment that can reduce pain and suffering. The drug or treatment need not be listed in any book or guideline. The two questions that a doctor has to satisfy himself/herself before prescribing are
- Is this treament safe?
- Does this drug harm the patient?
I have discussed about a child treatment with Budansinde to help reduce nasal congestion to prevent complications. This case I hope will demonstarte how knowledge and experience is more important to help manage medcal symptoms and illness.
“Un-Ethical To With hold Treatment Knowing It May Help”
“The duty of a doctor is to help alleviate pain and suffering” He/she must have the independence to offer, suggest
If he/she is not capable of offering help, he or she must find some one who could or find a treatment that may help and use this, provide the treatment does not harm the patient.
With holding treatment knowing the drug, chemical or procedure could help reduce pain and suffering can be viewed as “Un-Ethical”. In the past some doctors have been struck off and prevented from working as a doctor for withholding a treatment.
“Orphan Drugs” provides incentives for doctors and sponsors to develop products for rare diseases. The program has successfully enabled the development and marketing of more than 400 drugs and biologic products for rare diseases since 1983. In contrast, fewer than 10 such products supported by industry came to market between 1973 and 1983. The Orphan Grants Program has been used to bring more than 45 products to marketing approval. The Humanitarian Use Device Program has been the first step in approval of more than 50 Humanitarian Device Exemption approvals.
World Health Association Declaration
A physician must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible.
The physician’s fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose.
I am publishing clinical scenarios that will prove NHS in UK has breeched and ignored this declaration and prevented me from doing my duty. The documents and information will be published in my blog. I think the politicians and the people in power working in the NHS have not respected Medical ethics and acted against humanity
How Doctors USe Side Effects And Help Develop New Indications
Monoxidel and Viagra were two drug developed for high blood pressure but the side effects identified by patients helped doctors to choose alternate indications. When this was claimed to be useful, the drug company conducted a trial and obtained a licence.
Minoxidil increased excessive hair growth so used in cream to increase hair growth and viagra for erectile disfunction, pulmonary hypertension and even in babies having heart problems.
Minoxidil was used exclusively as an oral drug (with the trade name ‘Loniten’) to treat hypertension (high blood pressure). However, it was discovered to have an interesting side effect: hair growth. Minoxidil may cause increased growth or darkening of fine body hairs, or in some cases, significant hair growth. When the medication is discontinued, the hair loss will return to normal rate within 30 to 60 days.
Drug companies produced solution that contained 2% minoxidil to be used to treat baldness and hair loss, under the brand name Rogaine in the United States and Canada, and Regaine in Europe and the Asia-Pacific. The patent on minoxidil expired February 11, 1996. Treatments usually include a 5% concentration solution that is designed for men, and a 2% concentration solution for women
Viagra was synthesized by a group of pharmaceutical chemists working at Pfizer’s, Kent research facility in England. It was initially studied for use in hypertension (high blood pressure) and angina. The first clinical trials was conducted in Morrison Hospital, Swansea. Patients who were given the drug in clinical trial, refused to return the left over tablets. They were very pleased with the side effect “marked penile erection”. Pfizer conducted more trials and decided to market it for erectile dysfunction, rather than for angina. The drug was patented in 1996, approved for use in erectile dysfunction by the United States FDA on March 27, 1998, becoming the first oral treatment approved to treat erectile dysfunction in the United States, and offered for sale in the United States later that year. It soon became a great success: annual sales of Viagra peaked in 2008 at US$1,934 million.
Innovations & Inventing Drugs
Over the years, doctors have always used un-licenced drugs when they are convinced it is safe to help alleviate pain and suffering. Once proved, they publish their finding and conduct clinical trial to prove it is safe.
You will probably understand this better if I tell you a clinical situation when we used a drug that helped save the life of a child.
A child aged three years with difficulty to breath because the throat had a huge access (Quincy) was brought to A&E (ER). We were finding it hard to insert a intra venous cannula to administer drugs and difficult to insert a endotracheal tube to ventilate. In other words there was no alternative other than inserting a needle through the neck to allow oxygen to enter the lungs. The child was very irritable and in severe pain.
I suggested trying steroid via nebuliser because we did not have the time nor any alternative as the child was rapidly detonating. We had not heard or read about using steroids via nebuliser for abscess in the throat. Only thing we knew was it is safe and know how this drug acts. It is indicated in the BNF and textbooks to be given via veins to help reduce inflammation.
Few minutes after nebulising, the child stopped crying, less irritable and allowed me to insert an intravenous cannula to administer antibiotics.
The consultant who arrived did not believe the child was very ill. After he looked at the Neck and Chest X Ray (taken before I gave steroid via nebuliser), he complimented me and made sure I get my first regular job in UK in 1983.
Nurses & mangers Stifle Innovation
Nurses and managers in the NHS are not only harming medical profession by preventing doctors do their duty and offer care in the interest of patients. This is Un-Ethical Medical Practice and also stifling innovations and development of new products, methods and advances in medicine.