Medical ethics: a reference guide for guaranteeing principled care and quality

257 Pages·2019·3.994 MB·English

by  Frezza, Eldo E

Contents Contents
Medical Ethics
A Reference Guide for Guaranteeing
Principled Care and Quality

Medical Ethics
A Reference Guide for Guaranteeing
Principled Care and Quality
Eldo E. Frezza, MD, MBA, FACS
A PRODUCTIVITY PRESS BOOK
A Routledge title, part of the Taylor & Francis imprint, a member of the Taylor & Francis Group, the academic
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Published in 2019 by Routledge
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Library of Congress Cataloging-in-Publication Data
Names: Frezza, Eldo E., author.
Title: Medical ethics : a reference guide for guaranteeing principled care
and quality / Eldo Frezza.
Description: Boca Raton : Taylor & Francis, 2019. | Includes bibliographical
references and index.
Identifiers: LCCN 2018020483 (print) | LCCN 2018022124 (ebook) | ISBN
9780429506949 (e-Book) | ISBN 9781138581074 (hardback : alk. paper)
Subjects: | MESH: Ethics, Medical
Classification: LCC R724 (ebook) | LCC R724 (print) | NLM W 50 | DDC
174.2--dc23
LC record available at https://lccn.loc.gov/2018020483
Visit the Taylor & Francis Web site at
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This book is in memory of Dr Sherilyn Gordon-Burroughs
and to all women who were victims of domestic violence.
We trained in the same university. She called me one day and told me
to write a book on medical ethics. She encouraged me to
start the project and left all of us all too early.

Contents
Preface .............................................................................................................xvii
Author ...............................................................................................................xix
SECTION I PUBLIC HEALTH
1 Medical Ethics from Hippocrates to the AMA .......................................3
The Art of Medicine.....................................................................................3
History of Ethics .....................................................................................4
Ethics and Deontology ............................................................................4
Societal Values.........................................................................................6
The Search for Guidelines ............................................................................6
The Professional Code of Ethics ..............................................................7
The AMA Code of Ethics ........................................................................7
Notes ...........................................................................................................9
Suggested Reading .......................................................................................9
Ethics Summary Table ...............................................................................10
Ethics and You, The Physician ...............................................................10
2 Changes in Health Care and the Physician’s Role ................................11
First Insurance ...........................................................................................11
Cost Reimbursement .................................................................................11
First Health Maintenance Organization (HMO) and Capitation Payment ....12
No HMO Restrictions ...............................................................................12
Eight Stages of Health Care Revolution .....................................................12
Stage 1...................................................................................................12
Stage 2...................................................................................................12
Stage 3...................................................................................................12
Stage 4...................................................................................................12
Stage 5...................................................................................................13
Stage 6...................................................................................................13
Stage 7...................................................................................................13
Stage 8...................................................................................................13
How to Keep Up with the Changing Faces of Health Care .......................14
vii
viii ◾ Contents
Self-Determination ....................................................................................14
The Individual and the Group ...............................................................14
Safety .........................................................................................................15
The Attitude of Physicians Toward Their Profession ..............................15
Suggested Reading .....................................................................................16
Ethics Summary Table ...............................................................................16
How to Be Professional .........................................................................16
3 Ethical Issues in Health Care and Medical School Curricula ..............17
Not Only in Medical School ......................................................................17
Ethics at All Levels of Health Care ............................................................19
How to Solve Ethical Issues .......................................................................19
Medical School Curricula ..........................................................................20
Residency Program ....................................................................................20
The Future .................................................................................................20
Chapter from the Article .......................................................................22
Suggested Reading .....................................................................................22
Ethics Summary Table ...............................................................................23
How to Teach Ethics and Where ...........................................................23
4 Public Health and Professionalism ......................................................25
Health Delivery .........................................................................................25
Medical Profession .....................................................................................26
What Are the Goals? .............................................................................26
Professionalism Principles ..........................................................................26
Commitment to the Patient: Message and Trust ........................................27
Assessment of Professionalism ....................................................................28
Measures of Competence and Deterioration ..........................................29
Notes .........................................................................................................30
Suggested Reading .....................................................................................30
Ethics Summary Table ...............................................................................31
How to Reach Professionalism ..............................................................31
5 Sexual Harassment ...............................................................................33
Quid Pro Quo ...........................................................................................33
Unacceptable Accepted Practice .................................................................33
Policies ......................................................................................................34
Hostile Working Environment..................................................................34
Type of Harassments ..................................................................................35
Verbal (Spoken or Written) ...................................................................36
Non-Verbal ............................................................................................36
Who Needs to Watch? ...............................................................................36
Is There an Antiharassment Policy? ............................................................37
How To Report Harrassment .....................................................................38
Contents ◾ ix
Documentation ..........................................................................................38
Conclusion .................................................................................................39
Notes .........................................................................................................39
Suggested Reading .....................................................................................39
Ethics Summary Table ..............................................................................40
How to Avoid Sexual Harassment ........................................................40
SECTION II PHYSICIAN PROFESSIONAL RELATIONSHIP
6 Patient–Physician Relationship ............................................................43
Principles of Ethics for Physicians Taking Care of Patients ........................43
Doctor–Patient Relationship.....................................................................44
Informed Consent ......................................................................................45
Patient–Physician Collaborations ..........................................................45
Continuum of Care ..............................................................................46
Relationship at the End of Life .............................................................46
Advance Directives ....................................................................................47
Family Belief and Religions ...................................................................47
Note ...........................................................................................................48
Suggested Reading .....................................................................................48
Ethics Summary Table ...............................................................................49
How to Build Patient–Physician Relationship .......................................49
7 Commitment to Honesty and Trust .....................................................51
Physician Limitations .................................................................................51
Zero Dashboard .........................................................................................52
Recognize Limitations ...............................................................................52
Engage in the Relationship ........................................................................52
Honesty .....................................................................................................53
Patient Autonomy ......................................................................................53
Global Trust ..............................................................................................54
Building Trust ...........................................................................................54
Errors .........................................................................................................55
Disclosure ..................................................................................................55
Legal ..........................................................................................................55
Transparency .............................................................................................56
Arrogance ..................................................................................................56
Suggested Reading .....................................................................................57
Ethics Summary Table ...............................................................................57
How to Commit to Honesty and Trust .................................................57
8 Disclosing Medical Errors ....................................................................59
The Impact of Medical Errors ....................................................................60