OBSTETRICS 1 2D – TAMAYAO, CHRIS GERARD C.

ETHICS, LIABILITY, AND PATIENT SAFETY IN

OBSTETRICS AND GYNECOLOGY

INTRODUCTION
- Patients and their physicians sometimes
find themselves facing a dilemma
choosing or implementing a clinical
management decision, even when there is
sufficient medical information to provide
one or more logical management plans.
- Dilemmas may involve ethical, moral,
economic, or religious issues for the
patient, patient’s family, or the physician. Principle-Based Ethics
- Conflicts between the law and choice of Four ethical principles:
management decision may occur. 1. Respect for patient autonomy –
acknowledges an individual’s primary right
ETHICS to hold views, make choices, and take
- The used of an organized ethical actions based on her beliefs or values
framework in such situations is valuable in independent of those of the physician,
ensuring that evaluating situations and medical care system, or society as well as
making decisions can be done in a free of extrinsic controlling influences and
systemic manner, rather than based on limited understanding.
the physician’s emotions, personal bias, or 2. Beneficence – obligation to promote well-
social pressure. being by helping the patient make the best
- There are several perspectives and possible medical or surgical management
frameworks: decision, literally doing good.
o Principle based ethics – widely 3. Nonmaleficence – follows from
used because of its simple, user- beneficence, obliging the physician to not
friendly structure. harm or cause or allow injury to the patient
o Care ethics “primum non nocere” (first, do no harm).
o Feminist ethics Obligation to maintain medical
o Communitarian ethics competence and avoid any discrimination.
o Case-based ethics 4. Justice – physician’s obligation to render
o Virtue-based ethics to the patient what is due or owed. It is the
most complex of the ethical principles, in
part because of the physician’s role in
allocation of limited medical resources.
Treat equally.

Steps for ethical clinical management

Using stepwise, systematic approach to a difficult
clinical situation based on an ethical foundation
has been consistently found to benefit patients,
their families, physicians, the health care system,
and society.

Seven steps in the decision-making process

1. Identify the decision makers.
o Answer the question “whose
decision, is it?”
o patient has the capacity to choose
among evidence-based, medically
acceptable management
alternatives or to refuse treatment
2. Collect data.
OBSTETRICS 1 2D – TAMAYAO, CHRIS GERARD C.
3. Identify and evaluate all medically - disclosure of any actual or potential
appropriate management options. conflict of interest.
4. Systematically evaluate these options - consultation with ethics committee
5. Identify ethical conflicts and set
priorities. Medical Liability Action
6. Select the option that can best be - Can be a source of fear and anxiety to
justified. physicians.
7. Reevaluate the decision after it is acted - recognize current system of jurisprudence.
on based on the clinical outcomes.
Component of Legal Action
Medical Liability A. Certificate of Merit
• outcomes perceived to be less than - written statement (physician knowledgeable in
optional. the issues of action), saying that there is sufficient
• prevented by practice of evidence- information to support a medical liability action for
based medicines and clear, honest and litigation processes
complete communication between the B. Plaintiff and defendant are identified
patients and the physician. C. Complaint by the plaintiff
• medical record (detailed and complete) D. Medical records - Counsel for each party
is very important. requests the medical records,
- Some information is considered exempt
Informed Consent (privileged, i.e., it cannot be used) such as
- a process that is a component of care of communications with counsel.
the physician that cannot be delegated to E. Expert witness
others. - They are expected to be knowledgeable about
- discussion of the condition, management the medicine involved in the case.
options, outcome, risks, benefits and - They should not be influenced by who retains
alternatives and the options of no them or how much they are paid for their services
treatment. - The opinions of these individuals are to be
- informed consent form states the process based solely on the medical information and their
has been followed and patient agrees to knowledge of the issues.
the suggested management plan (or no
treatment), after seeking assistance or DIFFERENTIATING BETWEEN
consultation or referral to address the MALOCCURENCE AND MALPRACTICE
patient’s questions fully.
- provision is a process that is a component Medical Maloccurrence
of care provided by all physician every day - undesirable outcome irrespective of the
with every patient. quality of care provided.
- patient, witness and physician sign a
document placed in the medical record Medical Malpractice
and a copy is given to the patient - care provided fall below the expected
standard of care.
Confidentiality - Medical malpractice differs from medical
- autonomy is respected and the patient’s maloccurrence by the demonstration of
right to decide how and to whom their negligence.
personal information will be shared.
- breaches undermine and justified to After review of all available information and
protect the patient from harm the opinions of the expert witnesses, counsel
for the plaintiff and defendant have three
Conflicts of Interest primary options:
- drug prescriptions, device use or 1. agree upon a settlement, with a specific
treatments should be based on medical financial compensation being given to the
indications and should not affect the direct plaintiff, usually not involving public
or indirect or commercial promotions from disclosure;
third parties. 2. agree that the case for malpractice is
inadequate with the result that the
OBSTETRICS 1 2D – TAMAYAO, CHRIS GERARD C.
complaint is withdrawn (“dropped”) usually
without public disclosure;
3. disagree about whether or not malpractice
has occurred, resulting in the matter being
taken to court where a trial ensues

PATIENT SAFETY

To err is human
- patient safety and medical errors are
noted to play a significant role in the injury
and death of a patient

Patient safety
- system of analysis of medical errors that
maintains individual accountability while
minimizing individual blame

American College of Obstetricians and

Gynecologists’ Principles to Promote Patient
Safety:

1. Develop a culture of patient safety (focus

on system of care rather than individual
care)
- A blame-free environment (also known as
a just culture) where individuals are able
to report errors or near misses without fear
of reprimand or punishment.

2. implement recommended safe medication

practices.
3. reduce the likelihood of surgical errors.
4. improve handwashing.
5. improve communication with health care
providers (hands-off or sign-out)
o A hand-off, or sign-out, is the
transfer of patient information from
one responsible provider or team
to another.
o Handoffs should be interactive with
the opportunity for the receiving
provider/s to ask questions and
clarify points of care.
o Critical attention to all aspects of
patient hand-off is crucial to the
development of a culture of safety.
6. improve communication with patients.