Medical Ethics and Professionalism Myanmar Medical Association

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Medical Ethics and ProfessionalismMyanmar
Medical Association
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Definitions

• Ethics moral beliefs about right and wrong
• - philosophy which treats of human
• character and conduct, of distinction between
  right and wrong, and moral duty and obligations
  to the community

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• Professionalism (triad)
• Level of intellectual and technical expertise
• Autonomy in the practice and regulation of the
  discipline
• Commitment to public service

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The Background

• Growing lack of trust in the profession by the
  public and society
• Changing culture, from that of traditional
  clinical culture to that of provider/purchaser
  system "care for those who can afford instead
  of for those who need"
• Too many 'stake-holders' in the system
  (privatisation)
• High cost of drugs and procedures
• The patient factor- increased expectation
  increase access to information (IT) "litigation
  culture"

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Ethics and Medicine

• Is there a deterioration of ethical standards in
  the medical profession? Likely answer Yes.
• -manifest lost of trust in doctors by the
  public/ society
• -increased instances of ethical infringements
  and lax codes of behaviour (even serial murders)
• -dishonesty and fraud in research and writing of
  scientific papers
• -Increasing reports of medical errors

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Problem Areas

• Lapses in codes of conduct and personal behaviour
  (Hippocratic oath)
• Lack of humanism, professionalism, compassion and
  compassionate care and sense of public service
• Lack of respect for confidentiality, individual
  autonomy and human rights
• Some infringement of rights in research and
  clinical trials

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Underlying Reasons

• Lack of curriculum content and exposure re
  ethics during training period
• Not enough emphasis on professionalism during
  undergrad training and later professional life
• ? Failure of self regulation by professional
  bodies
• A culture of acquisition in line with global
  "economic rationalism"- "fee for service"
  mentality

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Some remedial measures

• Ethics as essential component in undergraduate
  and post graduate curriculum
• Guidelines and directives on ethics for all
  doctors by responsible authorities such as the
  medical council, MOH and professional bodies and
  associations
• Ethics as part of professional development in
  such activities as CME programs
• Patient education- as re rights and also
  accepted codes of conduct on their part

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The Myanmar Situation

• Discipline (including ethical issues) is handled
  and appropriately dealt with according to
  standing rules by the MOH for those in service
• The Myanmar Medical Council, which has the power
  to deregister, will take disciplinary action on
  all doctors who err, including those in service
• The Myanmar Medical Association, the professional
  organization, has a code of ethics and conduct
  which it tries to enforce amongst its members
• An ethics committee is extant in all medical
  institutes, and research institutes and all which
  undertake to do research and clinical trials

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Emergent issues

• New, varied and highly complex ethical and legal
  challenges are to be faced, some arising as a
  result of meteoric advances in science and
  technology, particularly with the advent of
  application of genomics in clinical medicine.
• Some current issues-
• Abortion
• Euthanasia and assisted suicide
• Human embryonic stem cell research
• Genetic testing
• Prenatal(pre-implantation) diagnosis
• Germ cell gene intervention
• Clinical trials informed consent, fairness to
  developing countries

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Looking to the future

• More complex legal and ethical issues and
  dilemmas are to be expected in future because
  of-
• Globalisation (gap between poor and rich
  countries and question of equity)
• Issues arising from longevity, (eco. and care
  burden of looking after the old old)
• Resource allocation within the national and
  global boundaries

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• 'child enhancement', selection of children with
  desired characteristics ("designer babies")
• Biological determination of behaviour (definition
  of a criminal)
• Ethics of pharmacogenomics (therapeutic research)
  in clinical practice