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Hippocratic oath to currentmedical ethnics I will follow that system of regimen, which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel.
(Primum non nocere) That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice.
Lets start by defining.. The principle of “Non-Maleficence” requires an intention to avoid needless harm or injury that can arise through acts of commission or omission. In common language, it can be considered “negligence” if you impose a careless or unreasonable risk of harm upon another
DUE CARE Taking sufficient and appropriate care to avoid causing harm , as the circumstances demand of a reasonable and prudent person
NAGLIGENCE Two types1. Intentionally , which is an unreasonable risk of harm2. Unintentionally , by carelessnessDue to absence of ‘due care’ , leads toprofessional malpractice, because physiciansare not following the professional standard care
Moral dilemmas Situates the moral dilemma withwhich physicians arefaced in real lifecircumstances.
Case 1 Male patient of his 40s suffering from advance and terminal skin cancer, the patient is experiencing acute pain. If his physicians continued with the current and standard line of treatment, he would live for about a year and probably more but all the time he would be in acute and unrelenting pain. The physicians decided to purpose a stronger pain killer , that have unintended effect of shortening the patient life.
Argument Theargument usually made in favour of physicians when they help to relieve pain and suffering with double effect drugs that hasten death is that it is the physician’s obligation to alleviate pain and suffering. Patients (and Indeed everyone) have the right not to suffer when it can be avoided.
Another side of the storywould be..It is argued on the other side ofthe divide that physicians must at all timesadhere to the code of medical ethics not toinflict harm, that is, the obligation ofnonmaleficence.
On the use of double effect medicationsin relieving pain and suffering, it might benecessary to know the innate quality ofhuman life in general and particularly thequality of human life at the moment of death.
Case 2 2 year old male, physical deformities and mental retardation, the physician informed that he would probably have lived to his fifth birthday but not more. Parents have no formal education and are working at a factory with a monthly salary of US$500 , to sustain their life and another 3 children with no health insurance Monthly expense for medication and special diet for the child is US$450 The parents have requested for the physician to let the child die as the child could never live a normal life, the physician consented the request. stop giving the child his medication and diet The child died after 2 days
Have the physicianbreached the obligationof Non-maleficence
The physician can argue thathe follows the parents requestdue to the fact that: Theability of the family to support the child is really low as they also need to feed another 5 mouth and the other 3 child need to go to school and they are prone to be suffering from malnutrition , its morally wrong for the other child to suffer as well
But … physicians inflicted harm, even if on compassionate grounds, hence, the moral dilemma remains.
I must say… It seems the moral dilemma remains: whichever way the pendulum swings, the physician must at all times be conscious of the dictum: aegroti salus suprema lex (that is, the good of the patient is the highest law)