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📚 ICMHE Exam Notes - Easy Language

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PART 1: PROFESSIONAL CODE OF ETHICS & PROFESSIONALISM

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1. What are the General Principles of Medical Ethics?

Exam tip: These are NOT laws - they are standards of conduct that define honorable behavior for physicians.

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2. What is Professional Code of Ethics?

• It is a fundamental guide for all doctors.
• Doctors must follow it as part of their professional responsibility.
• A medical practitioner should be a qualified, competent person who:
  • Upholds the highest standards of medical professionalism
  • Maintains ethical conduct
  • Places the patient's interests above their own

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3. Importance of Communication in Medical Ethics

• Good communication forms the foundation of trust, professionalism, and ethical behavior in medicine.
• Poor communication can:
  • Impact the diagnosis or treatment plan
  • Lead to ethical consequences

1. Autonomy and Informed Consent - patient was not properly informed
2. Beneficence and Non-maleficence - patient was harmed due to lack of info
3. Justice and Fair Treatment

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4. Professional Conduct in Nepal's Healthcare

1. Patient-centered care
2. Confidentiality
3. High ethical standards

Key Requirements (5-mark answer material):

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5. Regulatory Bodies in Nepal (Important!)

• Public Health Service Act, 2075 (2018) - governs health service delivery
• Privacy Act, 2075 (2018) - protects patient privacy
• Telemedicine Guidelines - for online/remote health services

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6. Neglect by Physician - What qualifies?

• Seriously neglects or disregards professional duties to the patient
• Improperly delegates duties to someone who is NOT competent

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7. Abuse of Professional Privileges (Very Important!)

• Abuse of Alcohol and Drugs
• Dishonesty
• Indecency and Violence

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8. PROFESSIONALISM

"Professionalism = Translation of ethical values into daily actions"

Key Attributes of a Health Professional (remember at least 5):

1. Competence - skilled and knowledgeable
2. Integrity and ethical behavior
3. Communication skills
4. Compassion and empathy
5. Respect for patients and colleagues
6. Confidentiality and Privacy
7. Accountability and Responsibility
8. Teamwork
9. Commitment to Continuous Learning
10. Professional Appearance
11. Time Management
12. Adaptability

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9. Duties of Physicians to Their PATIENTS

When can a doctor STOP treatment?

1. Patient refuses to pay the fee
2. Patient does not comply with recommended treatment
3. Patient pressures doctor to prescribe unnecessary drugs
4. Patient forces an immoral act
5. Doctor himself is unwell

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10. Duties to the Medical Profession

• Uphold the dignity and honor of medical profession
• Join medical societies and contribute
• Do NOT employ unregistered physicians (not registered with NMC)
• Report incompetent, corrupt, dishonest doctors to NMC
• Maintain physical and mental fitness

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11. Duties to Colleague's Family Members

• NOT mandatory to give free service, but it is encouraged as a pleasure and privilege
• It is unethical to make defamatory or slanderous comments about another doctor that undermine their competence

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12. Duties in Consultation

• When in doubt, request consultation with other colleagues
• No rivalry, envy, or insincerity during consultation
• Do NOT visit another doctor's patient during the same illness except in emergency
• If you do in emergency, explain to your colleague what treatment you gave

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13. Duties Towards Society

• Spread health advice and information on public health
• Help prevent spread of epidemic and communicable diseases
• Notify notifiable diseases to health authorities

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14. Duties Regarding Prescribing Medicines

• Write rational prescriptions with proper labelling
• Follow rules for scheduled/controlled drugs
• Handle physician sample drugs properly

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15. Benefits of Professionalism (5-mark answer)

1. Enhanced Reputation and Trust
2. Career Advancement and Opportunities
3. Improved Job Satisfaction
4. Reduced Risk of Legal Issues
5. Better Patient Outcomes
6. Effective Teamwork and Collaboration
7. Personal Well-Being and Work-Life Balance
8. Increased Patient and Family Satisfaction
9. Stability and Continuity of Care

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PART 2: JUSTICE (in Healthcare & Research)

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1. What is Justice?

Justice = Fair distribution of benefits and burdens of health and care

• It is NOT just about "equal shares" - it's about fitting to need, merit, rights, and opportunities
• Balances liberty, equity, efficiency, and dignity
• Works at 2 levels:
  • Macro level - the whole health system
  • Micro level - bedside decisions (individual patient care)

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2. Why is Justice Needed in Healthcare? (5 marks - memorize these!)

1. Ensures fair access to healthcare for all, reducing disparities
2. Guides ethical allocation of scarce resources based on need and fairness
3. Protects vulnerable groups from discrimination in care
4. Maintains trust and legitimacy in healthcare through impartial treatment
5. Fulfills the moral obligation of health as a fundamental human right

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3. Four Big Theories/Families of Justice (MOST IMPORTANT!)

A. UTILITARIAN JUSTICE

• Core idea: Greatest good for the greatest number
• Justice = maximize overall happiness/welfare of the whole population
• Decisions are based on outcomes
• Actions are just if they produce the most benefit over harm for the population
• Healthcare example: Vaccines/resources given to those who will benefit the MOST people
• Problem: May sacrifice minority interests for majority benefit

B. EGALITARIAN JUSTICE

• Core idea: All people are fundamentally equal in moral worth
• Everyone deserves equal treatment and rights
• Equal access to opportunities, resources, and social status regardless of gender, race, religion, or economic background
• Aims to reduce inequalities and ensure fairness
• Supports both:
  • Distributive equality = equal shares of resources
  • Relational equality = no hierarchies or exploitation
• Healthcare example: Universal access to health services, reducing health disparities

C. LIBERTARIAN JUSTICE

• Core idea: Individual freedom and property rights come first
• Justice = protecting individuals' right to make their OWN choices
• Rejects enforced redistribution (taking from rich to give to poor is unjust)
• Focuses on negative rights (non-interference, not provision of services)
• Healthcare example: Opposes government-mandated universal healthcare; supports paying for your own insurance/services
• Example in practice: Privatized healthcare where individuals pay for their own services

D. CAPABILITIES APPROACH

• Core idea: What are people actually able to do and be?
• Justice = ensuring people have the capabilities to achieve well-being
• Goes beyond just money/resources - focuses on developing full human potential
• Includes: health, education, and agency
• Recognizes barriers: social, economic, structural factors (like discrimination, disability)
• Healthcare example: Programs for disabled people, marginalized groups, children lacking basic healthcare

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Quick Comparison Table (Very Useful!):

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4. Research Justice

Why it matters:

• Justice is a core ethical principle ensuring fairness in medical research
• Governs fair distribution of research benefits AND burdens
• Originates from the Belmont Report (emphasizing equity in research participation)

Definition of Justice in Research:

1. Fairness in recruitment and inclusion of diverse populations
2. Equal opportunity to benefit from and contribute to research
3. Avoid exploitation of vulnerable groups (not burdening the poor/weak with risky research while benefits go to the rich)

Historical Example - Tuskegee Syphilis Study (1932):

• Black men with syphilis were denied treatment even after penicillin was discovered
• Major injustice in medical research history
• Led to important ethical reforms in clinical trials and research policies

Principles of Justice in Research:

1. Equitable distribution of risks and benefits
2. Inclusion of underrepresented groups (women, minorities)
3. Scientific validity through diverse study populations
4. Voluntary and informed participation

Applications in Clinical Studies:

• Avoiding undue burden on vulnerable groups
• Fair selection criteria for study participants
• Research questions should reflect community health needs
• Monitoring ethics through review boards (IRB/ethics committees)

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5. Critical Thinking Questions from Slides (Your professor may ask!)

• From Utilitarian view: Give to the young patient - maximizes overall survival benefit
• From Egalitarian view: Both have equal moral worth; need a fair process (lottery, first-come)
• From Capabilities view: Focus on who has the greatest capability to be restored
• No single correct answer - this is an ethical dilemma requiring balancing multiple principles of justice, patient autonomy, and medical prognosis

• From Libertarian view: No - individual freedom to refuse should be respected
• From Utilitarian view: Yes - the greater public good may justify limits on individual choice
• From Egalitarian view: Everyone deserves healthcare regardless of choices
• This is the tension between individual autonomy vs. public/community welfare

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Quick Revision Summary

From "Professional Code of Ethics":

• 4 Principles: A (Autonomy) - B (Beneficence) - N (Non-maleficence) - J (Justice)
• Key conduct: Patient first, confidentiality, informed consent, no conflicts of interest
• Nepal bodies: NMC, NNC, NHPC, MoHP
• Consent age: above 16 years
• Professionalism = ethical values in daily actions
• Can stop treatment in 5 specific situations only

From "Justice":

• Justice = fair distribution of benefits and burdens
• 4 theories: U (Utilitarian) - E (Egalitarian) - L (Libertarian) - C (Capabilities)
• Research justice comes from Belmont Report
• Tuskegee Study (1932) = historical example of injustice in research
• Why justice needed: fairness, allocation, protecting vulnerable, trust, human right

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1. The 4 principles of medical ethics (ABNJ)
2. The 4 theories of justice (UELC) with examples
3. Duties of physicians (to patients, profession, society)
4. Research justice and the Belmont Report