AHMAS

A. Professionaliteit

• A. Professionaliteitsleer
  • Inleiding
  • 1. Uitgangspunten
  • 1.1 Belangen
  • 1.1.1 Doeltreffend
  • 1.2 Context
  • 1.2.1 Contextuele kennis
  • 1.2.2 Prof.stijl
  • 1.2.3 Pers.waarden
  • 1.3 Cultuur
  • 1.3.1 Balanceren
  • 1.3.1.1 Fractaal
  • 1.4 Perspectief
  • 1.5 Positie
  • 1.6 Succescriteria
  • 1.7 Wederkerigheid
  • 1.8 Interactiviteit
  • 1.9 Randvoorwaarden
  • 2. Ordenen
  • 2.1 Begrippen
  • 2.1.1 Soc.normativiteit
  • 2.1.1.1 Prof.sering
  • 2.1.1.2 Handelen
  • 2.1.1.3 Doen (arts)
  • 2.1.2 Kwaliteiten
  • 2.1.2.1 Functionaliteit
  • 2.1.2.1.1 Pers.kwaliteit
  • 2.1.2.1.1.1 Kwetsbaarh.
  • 2.1.2.1.1.1 Zelfregulatie
  • 2.1.2.1.1.2 Accountability
  • 2.1.2.1.1.2.1 Tuchtzaken
  • 2.1.2.1.1.3 Bewijsvoering
  • 2.1.2.1.1.4 Bekwaamh.
  • 2.1.2.1.1.5 Bewustw.
  • 2.1.2.1.1.6 Metakwaliteit
  • 2.1.3 Kwantiteit
  • 2.1.4 Doelen
  • 2.1.4.1 Dilemma's
  • 2.1.5 Kaders
  • 2.1.6 Prof.posities
  • 2.1.7. Professional
  • 2.1.8 Voorwaarden
  • 2.2 Modellen
  • 2.3 Theorieen
  • 2.3.1 Interactietheorie
  • 2.3.2 Meervoudig-sociaal
  • 2.3.2.1 Intrapersoonlijk
  • 2.3.2.2 Interpersoonlijk
  • 2.3.2.3 Maatschappelijk
  • 3. Levensloop
  • 4. Historie
  • 4.1 Grondslagen
  • 4.2 Pioniers
  • 4.2.1 Medical deontology
  • 4.3 Onderzoek
  • 5. Contrasten
  • 5.1 Vier steenhouwers
  • 6. Bronnen
• B. Methode
• C. Professional
• D. Ervaringsdesk.
• E. Studiemodules

4.2.1 Medical deontology

Are We Truthfully the “Good Doctors”? The Forgotten Science of Medical Deontology!

Introduction

As the medicine is technologically evolving, there is a paradigm shift towards the protocol based practice, so that there is very little margin for error. Sadly, in the pursuit of ‘perfection’, ‘standardization’ and ‘quality’, the clinicians tend to forget, that we are not dealing with the ‘mechanical objects’, but living beings, who:

• Take into account complexity beyond standardization
• Do require to be treated with the attitude of respect, understanding and kindness, which according to them, may have much more significance than only ‘quality assurance’.

Because the process becoming more and more complex, the attitude on the part of doctors, while dealing with their patients/ their relatives is of, divulge only what is ‘ needed to know’. This ‘lack of communication’ can be considered as one of the main causes of ‘litigation’. As this vicious process of self- perpetuating and self-destructive hostilities, is relentlessly unfolding, it’s becoming time for the science of “ Medical Deontology”.

Definitions:

• Medical deontology is defined as the discipline for the study of norms of conduct for the health care professions, including moral and legal norms as well as those pertaining more strictly to professional performance.
• It is a system of moral principles that apply values and judgments to the practice of medicine. In fact one can visualize it as “set of ethical standards and principles of behavior of medical practitioners while executing their professional duties, professional ethics of medical workers and principles of behavior of medical personnel, directed toward maximum benefit of treatment.
• It is the science of understanding the rights and duties/ responsibilities of mainly Physicians but also, the other health care professionals.

At its core are the intricately inter-related 3 sub divisions: 

1. Medical Jurisprudence or also known as Forensic Medicine, by some, can be defined as the science which applies the principles and practice of the different branches of medicine to the elucidation of doubtful questions in courts of justice. According to some authorities, it is used in a more extensive sense and also comprehends Medical Police, or those medical precepts which may prove useful to the legislature or the magistracy.
2. Medical ethics: teaching of morals, Medical ethics is defined as 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 as well as work on its history, philosophy, theology, and sociology
3. Medical hodegetics; literally means, guidelines for the study of medicine. The guidelines which cover the ideal principles which must be learnt while studying medicine as were once envisioned by the ancient “Fathers of the Medicine.’

So as medical professionals, when we come in contact with the patient, we are governed by the principles and practices involving the above-mentioned three areas. Medical deontology includes problems of observing medical confidentiality, the problem of the extent of the medical worker’s responsibility for the life and health of the patient, and problems of relationships of medical workers to each other. 

Thus the “Triad of Medical Deontology” is understanding the interpersonal dynamics between the three players involved:

• Medical worker with Patient
• Medical worker with the Relatives of the patient
• Medical worker with other Medical workers, who might or might not be their colleagues/ team members.

Historical aspect

This science has its roots very deep from ancient times. 

• The Laws of Hammurabi” (Laws of Ancient Babylon, 18th century B. C.)
• Hippocrates’ (5-4 century B. C.) Oath in order to differentiate the ‘magic’, ‘religion’ from ‘medicine’ and introduced the ‘scientific observational methodology as the part of ‘medical treatment of patients’.
• Indian “The Book of Life” (“Ayurveda” – 5-4 centuries B. C.) also describes criteria for a good teacher and who should study medicine. 
• Aristotle (384-322 B. C.) introduced the term “ethics”, meaning “a concept of human morals”
• In middle Ages: IbnSina (Avicenna, 10-11 centuries) prominently is noted, for his work “The Canon of Medical Science” and “Ethics”
• Jeremy Bentham (English philosopher, lawyer, priest; 1748-1832), who introduced the notion of deontology as meaning “… the teaching on the due behavior of a person while achieving his end” (18 century).
• Russian medicine, e.g. “The Word Concerning Piety and Moral Qualities of a Hippocratic Physician” and “The Word Concerning the Ways of Teaching and Learning the Practical Medicine” by Matvey Yakovlevich Mudrov (1776-1831), “Letters from Heidelberg” and “The Diary of an Old Doctor” by Nikolay Ivanovich Pirogov (1810-1881) are noteworthy. 
• The controversial Nuremberg process (1947), which depicts the verdict to the Nazi physicians, “The Nuremberg Code”, postulates not legal, but also moral regulations of medical experiments. 
• Post 1947 - the World Medical Association was created. Its main action was the adoption of “The Geneva Declaration” – the oath of a physician – the doctor (1948), the International Code of Medical Ethics (1949), “The Helsinki Declaration of Human Rights” (1964), “The Helsinki-Tokyo Declaration” (1975), and “The International Declaration on Human Rights” (1983).

Principles of Medical deontology/Ethics

1. PRIMUM NON NOCERE (Latin) - FIRST, DO NO HARM – this maxim is the main ethical principle in medicine.
2. Six of the values that commonly apply to medical ethics discussions are:

•  Autonomy - the patient has the right to refuse or choose their treatment; the principle of autonomy recognizes the rights of individuals to self determination. This is rooted in society’s respect for individuals’ ability to make informed decisions about personal matters.
• Beneficence - a practitioner should act in the best interest of the patient. The term beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients.
• Non-maleficence - concept of non-maleficence is embodied by the phrase, “first, do no harm,” or the Latin, primum non nocere. Many consider this should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than to do them good.
• Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).
• Dignity - the patient (and the person treating the patient) have the right to dignity [4].
• Truthfulness and honesty.

 NB. Finance: It has been argued that mainstream medical ethics is biased by the assumption of a framework in which individuals are not simply free to contract with one another to provide whatever medical treatment is demanded, subject to the ability to pay. 

We can add some principles such as:

• Medical privacy - allows a person to keep their medical records from being revealed to others.
• Confidentiality - is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court. 
• Fidelity - is the quality of being faithful or loyal to one’s patients as if it is the service rendered in relation with the cause of ‘Lord Almighty’. 
• Veracity- Truth telling or Obligation to full and honest disclosure, of the information, concerns or any such matter, in context with a patient’s health/ disease state to  himself/herself and their near and dear ones.

Prof. Mridul M. Panditrao, Consultant Anesthesiologist Grand Bahama, The Bahamas

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