|
 
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| EDITORIAL |
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| Year : 2022 | Volume
: 2
| Issue : 1 | Page : 1-3 |
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Medical ethics in practice – research
Narasimha M Kalipatnapu
Sankar Eye Hospital, Vijayawada, Andhra Pradesh, India
| Date of Submission | 31-Jul-2022 |
| Date of Decision | 01-Aug-2022 |
| Date of Acceptance | 01-Aug-2022 |
| Date of Web Publication | 05-Oct-2022 |
Correspondence Address:
Dr. Narasimha M Kalipatnapu
29-4-10, KR Reddy Street, Governorpet, Vijayawada, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jocr.jocr_10_22
How to cite this article:
Kalipatnapu NM. Medical ethics in practice – research. J Ophthalmol Clin Res 2022;2:1-3 |
The first step in the evolution of ethics is a sense of solidarity with other human beings.
-Albert Schweitzer
| Preamble | |  |
As per the Merriam-Webster dictionary, ethics is the “discipline dealing with what is good and bad and with moral duty and obligation.” But in reality, it means more
“Moral philosophy is hard thought about right action.” (Socrates)
Medical ethics define the responsibilities of the physician in taking decisions and executing the treatment, based on evidence-based medicine, for the betterment of the patient. The so-called moral lessons that we were preached in basic education will suffice to do good medical practice or else we have to improve the principles in which direction? What factors influence the behavior of health-care professionals in practice and research?
In medical practice, you may make mistakes/misinterpret in arriving at a diagnosis or in the process of treatment, but not to violate basic medical ethics or else lead to litigation. One needs to have a comprehensive idea about the medical ethics to follow them.
Medical ethics dictate a code of conduct in the patient–doctor relationship, which is an innate and inseparable part of clinical medicine. They vary from country to country, more so significantly in religious-affiliated institutions on certain issues, for example, abortion. In the medical world, there are diverse people with varied ideas but still, we move in one direction to reach higher medical standards because of the common medical ethics, with directional values. They make the medical profession more humane and benevolent.
Society expects a physician should be highly knowledgeable, selfless, honest, truthful, and sympathetic in building the patient–doctor relationship. It is the bounden ethical duty of the doctor to protect the human rights and dignity of the patients in research as well as in treatment.[1] To maintain this social trust physician should be transparent, ready to accept, and willing to correct his errors and inappropriate behavior. He should dissolve the conflicts amicably and should be enthusiastic to acquaint with the latest trends in medicine.
Regrettably, a large proportion of medical students/doctors are still unaware of health-care ethics;[2],[3]> Medical professional organizations (e.g., GMC, AMA; RCPsych, and IMA) periodically update their Codes of Ethics for their Members. These Codes of Ethics are practically useful, and widely accepted they are not legally binding.
Historical milestones of medical ethics as follows:
- Hippocratic Oath (5th Century BC)
- Formula Comitis Archiatrorum (5th Century AD)
- Thomas Percival's Code of Medical Ethics (1803)
- The Nuremberg Code (1947)
- The Declaration of Geneva (1948)
- The Tuskeqee Study (1932–1972)
- The Declaration of Helsinki (1964)[4]
- The Belmont report (1979).[5]
These milestones are the basis for the evolution of various structural reforms in medical ethics, such as guidelines relating to the duty of physicians, to curb deplorable abuse of human subjects in research, take informed consent, put before institutional review board/ethical committee, avoid the unnecessary risks, and give freedom of leaving a medical study by the participants. These factors have reshaped medical practice and research for betterment.
Keeping the diverse socio-cultural background of our country, to meet the new ethical dimensions, revised ICMR ethical guidelines 2017,[6] on the national ethical guidelines for biomedical and health research involving human participants developed in consonance with the global guidelines. This serves as a ready reckoner for physicians and researchers in India.
Four basic widely accepted principles of good medical ethics:
- Respect for autonomy
- Nonmaleficence
- Beneficence
- Justice.
| Respect for Autonomy | | |
A competent adult by intrinsic and unconditional worth can take decisions to determine what shall be done with his own body.[7] In health-care practice, respect for autonomy means, respect for people, their choices and their opinions.
The health-care provider should provide all the relevant information to the patient to take a proper choice of treatment and seek consent from the patient by asking him to sign the consent form. Autonomy is the basis for the concept of informed consent.
It is implied that the right to choose by the patient is within the purview of local laws of the society. It confers the right to refuse treatment and withdraw from medical research at any time. The health provider should not influence the patient's decision.
| Nonmaleficence | | |
This is based on the principle of “First, do no harm” (Latin: Primum nonnocere).[8] Physicians should weigh the benefits against the burdens of all interventions and treatments. The main obligation of the physician is that he should avoid causing harm either by acts of commission (providing unnecessary treatment) or omission (not providing necessary treatment) and relieve the suffering of the patient. Occasionally, the best treatment may be no treatment.
If not followed, that can lead to medical malpractice or medical negligence.
Medical trainees do require cultural and ethical competence to deal with ethical dilemmas in the field. Every medical action is weighed against all benefits, risks, and consequences; the attending physician has a moral responsibility to train medical students in this regard. It is a formidable task for medical educational institutions in balancing, to train the in-experienced medical student in bioethical value-based patient care and nonmaleficence principles with efficient medical education.[9]
| Beneficence | | |
It is a principle that refers to the obligation of the physician to act altruistically in the best interests of their patients. He should also support several moral rules to protect and defend the right of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in danger.[10] Refrain from harming and also contribute to their welfare
| Justice | | |
It has two components. Equitability and distributive justice.
Equitable justice dictates similar medical conditions should receive similar medical care, irrespective of dissimilar nonmedical factors. Distributive justice dictates the fair and equal distribution of health resources determined by the justified norms.
Justice consists not in being neutral between right and wrong, but in finding out the right and upholding it, wherever found, against the wrong.
—Theodore Roosevelt
The evolution of modern science is an ever-ending process, in which the publication of a scientific paper in a peer-reviewed journal is the building brick. The work of one researcher is built on others. Ethical research contributes many scientific facts to the development of civilized society with a healthy environment and also confers credit to the published journal.
Unethical research and misconduct promote the publication of unscientific papers far from reality, which harms the scientific guidelines and applications to patients and community health as well. This leads to misguidance to fellow researchers which is in turn responsible for colossal loss of funds and time, and distrust over the government health policies and medical practitioners by the public. The unethical publication harms the evolution of science.
Research misconduct and unethical practices may take several facets as follows:
- Inapt approval and consent
- Plagiarism and copyright infringement
- Duplicate publication
- Data fabrication and falsification
- Ethics of authorship
- Peer review misconduct
- Citation manipulation
- Improper disclosure of conflicts of interest etc.[11]
Publication misconduct has a potential negative impact on the reputation of the journal, hence the institutional scientific and ethical committee can check the relevant Committee on Publication Ethics flow charts[12],[13]> or even any reader can inform the publishing editor for corrective measures.
Let us join hands in knowing the nuances of medical ethics in practice and research and build a more civilized medical world.
Ethics is knowing the difference between what you have a right to do and what is right to do.
-Potter Stewart
| References | | |
| 1. | Kalantar Motamedi MH. Breaching medical ethics in research. Trauma Mon 2014;19:e17112.  |
| 2. | Iswarya S, Bhuvaneshwari S. Knowledge and attitude related to medical ethics among medical students. Int J Community Med Public Health 2018;5:2222-5. |
| 3. | Rajkumari B, Singh HD, Ojit K, Thounaojam T. Knowledge and attitudes regarding medical ethics among junior medical graduates in a tertiary care hospital, Manipur: A cross-sectional study. Indian J Med Ethics 2020;V: 254-5. |
| 4. | World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013;310:2191-4. |
| 5. | |
| 6. | |
| 7. | |
| 8. | Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7 th ed. New York (NY): Oxford University Press; 2013. p. 164-6. |
| 9. | Girdler SJ, Girdler JE, Tarpada SP, Morris MT. Nonmaleficence in medical training: Balancing patient care and efficient education. Indian J Med Ethics 2019;4:129-33. |
| 10. | Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract 2021;30:17-28. |
| 11. | Sengupta S, Honavar SG. Publication ethics. Indian J Ophthalmol 2017;65:429-32. [ PUBMED] [Full text] |
| 12. | Marcovitch H. Committee on Publication Ethics flow charts on suspected publication misconduct. Maturitas 2009;62:207. |
| 13. | Callaham ML. Journal policy on ethics in scientific publication. Ann Emerg Med 2003;41:82-9. |
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