Medical Ethics in Modern Medicine

by Leandra Esfakis

Last December, the University of the West Indies School of Clinical Medicine and Research, at the Princess Margaret Hospital, hosted a symposium in Nassau on medical ethics.

The goal was “ to provide participants with an appreciation and understanding of the impact of medical ethics in the current practice of medicine. “

The three speakers at the event - two West Indian doctors and an American doctor - focused on two issues: the virtue of telling the truth to patients, or their families, and the value of having a “patient-centred practice.” This was defined as “a practice which puts the patient first, in every respect.”

This approach, it was argued, had the merit of benefitting the patient, in terms of the care received, and also the doctor, as it would reduce his/her exposure to malpractice claims.

The speakers also discussed the risk of conflict of interest among medical professionals in a small community where ancillary health care services, are often owned by the doctors themselves. In such circumstances, referrals from doctors to these additional services, or tests, may be seen as self-serving, when in fact, the doctor is properly erring on the side of caution.

More serious issues arise however, when the doctor does not err on the side of caution, and his standard of care puts the patient at risk, and injury or fatality results. The speakers at the symposium addressed stressed the advantages of telling the truth. Being truthful, they said, would short short-cut the long and costly legal process, which is likely to result in discovery of the error in any event. And by open communication with the victim, the doctor allows for the real possibility of maintaining trust.

Studies have shown that most patients are willing to understand that errors do occur, and work to a resolution. The US physician cited an example of medical negligence at his hospital, which caused the patient’s death. The hospital staff met very early with the family, and explained the error that killed the patient. Not only did the family not sue, but a year later, gave a donation to that hospital.

According to the conference speakers, human nature generally wants to forgive, and the truth from the doctor himself, or the hospital, fosters this response. Attempts to delay or deny discovery of the truth, will lead to the long and costly legal battles. Beyond that however, the “delay and deny” strategy breaks down the trust that is the only basis on which the doctor - patient relationship can exist, and the process damages the reputation of the profession as a whole.

It was acknowledged at the symposium, that the reputation of the (local) medical profession has suffered in recent times, and disciplining doctors was an issue. During the panel discussion after the
symposium, the idea of a Caribbean Disciplinary Board was raised. This was considered not to be an acceptable solution, unless the majority of such a Board were doctors from the same country- which would defeat the purpose of having a Caribbean Board.

The current local regulatory bodies - the Medical Council and the Hospital and Health Care Facilities Board - appear to have a record of not investigating or disciplining members or licencees. It may be that their duty to protect the public from sub-standard health care takes a back-seat to other considerations.

The Hospital and Health Care Facilities Board, under its previous chairman, had its own special approach to resolving a complaint of a fatality -  “since [the patient] is dead, the file should be closed.”

It seems that if these entities are going to embrace the challenge of their functions, they must apply the first principal of medical practice advocated by the symposium speakers: “What is in the best interest of patients of this doctor / hospital?”

This is the test that needs to be applied, in the public interest, and also for the reputation of the medical profession.

Comments

[larry w bowleg]

please advise if there will be a follow up to this program...interesting