Medical Ethics

and
Deontology
 Ethics (Greek - ethos - custom, temper ,
character) is the science of morals (morality).
The term "ethics" was coined by
Aristotle in the 4th century BC.
Ethics studies the origin, features,
patterns, structure and functions of morality as
a social phenomenon.
Ethics deals with moral values in life.
Ethics is in direct relation with other
sciences such as psychology, sociology,
philosophy, history, pedagogy, aesthetics, etc.
MORAL
Definition. Morality is a system of norms and
moral values that determine human behavior
and human relationships in all spheres
social life.
Morality is a complex of principles,
that help us to live together in society.
(one should not physically or mentally hurt
other people; give help whenever needed; treat
everyone fairly and equally; do what is best).
Morality is part of the spiritual culture
and is connected primarily with the concept of
the good in interpersonal and common human
perspective.
Structure of morality incldes:
- Moral consciousness
- Moral attitude
- Moral behaviour
Moral values are
good,evil,conscience,compassion,
solidarity, humanity, honesty, dignity, justice,
devotion, responsibility, etc.
MEDICAL ETHICS
The norms of conduct of certain social orders
are different. One of the main sections of ethics
is professional medical ethics. The morality
and duty of health professionals is a specific
section of human morality with a bright
professional outlook. The science examines
the norms of conduct of health professionals
related to their professional relationships and
their attitude towards patients, who are the
object of their activity.
MEDICAL ETHICS
The subject of medical ethics are the
problems related to the professional morality
of health professionals in the performance of
their main objective - the improvement and
protection of the health of people.
The concept of professional ethics
has two main sides:
1. The attitude of man towards work
2. Moral relations between people in the
process of work activity.
MEDICAL ETHICS
The labour of all categories
health professionals is publicly useful work,as
the issue of health of people is not only
personal.
All professions related to people's health
are subject to specific moral, legal and
deontological regulation.
One part of the norms and requirements are
established through laws, rules and
regulations, and another part of the norms are
unwritten and no less binding - these are the
moral and ethical ones.
MEDICAL ETHICS
Code of Professional Ethics

Professional ethics is a set of standards

of conduct that serve life and health of
the individual and society.
The rules of professional ethics are
binding on everyone.
Ethical norms regulate the relations of
health professionals with the patient,
their relatives, colleagues and society.
MEDICAL ETHICS
Health professionals have a moral
obligation to put disease prevention
measures at the forefront of their work
and to work to raise people's health
awareness.
Ethical principles are:
- Humanity and compassion
- Primum non nocere
- Respect for human dignity
- Integrity and benevolence
- Responsibility and confidentiality
BIOETHICS
A new scientific discipline emerged in
the late 20th century in the USA.
The term BIOETHICS is used in a
broader sense and includes medical
ethics. In bioethics two directions:
The first direction has to do with
the leading role of the patient in
deciding whether and how to be treated.
The second strand focuses on the moral
issues associated with new
technologies in medical practice.
BIOETHICS
Problems subject to bioethics are:
Genetic engineering,

Assisted reproduction,

Cloning of human cells,

Euthanasia.
Ethics Committee
In recent years, there has been an
increasing focus in healthcare on addressing
ethical issues. The link between healthcare
stakeholders (institutions, doctors and
patients) in the resolution of various ethical
issues, cases and problems is the ethics
committee.
The role of the ethics committee is:
1. To address the need for a systematic and
principled approach to medical-ethical
decision-making dilemmas in medical practice.
2. It is an effective ethical intervention in health
care management and policy.
3. It appears as a link between the values of
society and the institution that cares for and
treats certain patients, in whose cases ethical
dilemmas.
Ethics Committee
The Ethics Committees have the following
functions:
1. Educational - involves improving the
understanding of health care personnel on
medico-legal and bioethical issues, the
importance and handling of ethical
standards, guidelines and guidelines.
2. Consultative function - involves helping
patients, their families, treating physicians
and other health professionals to identify,
formulate and resolve ethical dilemmas,
faced by modern health care.
3. Normative function - creating guidelines
and instructions for decision making in
patients who are unable to do so.
Ethics Committee
The basic principles at work of ethics
committees are:
Independence
Competence
Transparency
Interdisciplinary approach
Dialogical
The objectives of ethics committees are:
1. To encourage staff to share information
with the patient.
2. To develop standards in decision
making.
3. To develop decisions to discontinue life
support systems in certain cases.
Ethics Committee
The conditions for the
establishment and the modalities of
work of the ethics committees are set
out in the following laws and
regulations: 1. Law on Medicines and
Pharmacies in Human Medicine
(LMAHM) - defines the work of the
Central Ethics Committee. 2. Ordinance
No. 14 regulates the conditions and
procedure for conducting of clinical
trials of clinical trials of medicines on
human subjects. It defines the
conditions and procedures for the work
of local ethics committees. 3. Law on
Professional Organizations. 4. Law on
Health. 5. Code of professional ethics.
Ethical audit
The Interest in ethical auditing in
healthcare is associated with the need to
increase the quality of healthcare and by
the difficulties in establishing standards of
good practice for different professionals in
healthcare teams.
Clarifies current values, the basis on
which healthcare institutions operate.
Provides a basis for improving
their rating.
Seeks solutions to ethical issues and
conflicts of interest that arise, examines
staff motivation and enables everyone to
express their opinions.
Patient's rights
More and more attention is being paid
on patient rights and autonomy in
decision-making.
To this end, the principle of
informed consent has also been
introduced. In Bulgaria, a model of
relationship prevails with high control
on the part of the doctor and low control
on the part of the patient. e.g. decisions
are made that are not discussed with the
patient but are related to his health.
Patients are often not informed of the
existence of alternative treatment
options.
Patient's rights
Patient ethics include:
- Responsible attitude towards the
disease
- Responsiveness to other patients
- To his personal environment
- To health professionals and people
who care for him/her
- Towards society
Medical research ethics include Animal
Experimentation and Human Research.
Code of Ethics
Code of Ethics of the Doctor, Dentist
Code of Ethics for PT
Code of Ethics for Health Care
Professionals
1. Respect for the patient's decision.
2. Do no harm to the patient.
3. Not to put the patient at risk.
4. Fairness - equal chance for all in
treatment.
5. To create conditions that improve
people's health.
6. Inform patients about the disease and
methods treatment, to guard against
personal gain and manipulation.
BIOETHICS
Definition of bioethics
The science concerned with the study of
ethical problems arising in the biological
and medical sciences worldwide. The
International Association for Bioethics
was founded in 1992 with the idea of
contributing to the advancement of
bioethics by exploring ethical, social,
legal, philosophical, and other issues in
health care and the biological sciences.
The organization promotes research and
education in bioethics, seeking to affirm
the value of free, open, and reasoned
discussion of bioethical issues.
BIOETHICS
The Bulgarian Centre for Bioethics was
established in 2004 in Sofia. The Centre protects
the rights of the patient as well as the interests of
humans and animals that are the subject of medical
and pharmaceutical research. With the rapid
development of biotechnology, serious moral
issues related to the human person arise - human
rights, human dignity and the value of human life.
Bioethics deals with Мoral issues in vitro
fertilization, Ethical aspects of genetic diagnosis
during pregnancy, moral issues in transplantation
medicine and organ donation.
In Bulgaria for the period Jan - Sept 2023
were performed: 10 kidney transplants from a
cadaveric donor - 10 at the University Hospital
"Alexandrovska" and "Lozenets"; 5 - liver
transplants from a cadaveric donor at the MMA; 2
heart transplants at the Hospital "Prof. Dr.
Alexander Chirkov. "
MEDICAL DEONTOLOGY is a
Science of Debt
Duty is a universal moral norm of
ethics. There are different types of
duty - parental, friendly, professional,
etc. Duty is a conscious moral
requirement and a purposefully
realized obligation of each person to
the collective in which he finds
himself. The idea of duty is revealed
by the fact that the individual is
bound and dependent on his social
environment - family and
professional. The category of DEBT is
related to other moral qualities of the
individual such as conscience,
responsibility, discipline, etc.
 Medical deontology
Medical morality and medical ethics
are the foundation, on which the
science of medical deontology was
founded and developed in the 19th
century.
Definition - the science of the moral
duty, responsibility and obligations of
the health worker in the exercise of
his profession towards the healthy
and sick person, his relatives and
other health professionals.
Deontology includes the
principles of behaviour of health
personnel, aimed at enhancing
benefit and eliminating harmful
consequences of poor performance.
Has been an attempt to build such deontological norms since
antiquity - the Hippocratic oath, 25 centuries ago.
MEDICAL DEONTOLOGY

Another deontological and legal norm

in the work of health workers is the
issue of protection of medical
confidentiality.
In most countries, deontological codes
have been developed and adopted by
professional bodies.
The code is mandatory for all qualified
health workers.
MEDICAL DEONTOLOGY
The subject of medical deontology is the
study and formation of mandatory
professional conduct of all health
professionals. Medical deontology consists of
2 main parts:
1. General deontology, which studies the
general professional principles and rules of
compulsory professional conduct health
professional - patient.
2. Special deontology, which deals with
specific aspects of duty according to the
professional field - medicine , dentistry,
pharmacy, public health and health care.
MEDICAL DEONTOLOGY
The purpose of medical deontology
is aimed at maximizing the effectiveness
of healthcare activity
and the elimination of harmful
consequences of incomplete work.
Deontological norms and rules are of
great importance for life and for the
protection of people's health. They have
evolved from purely moral norms into
legal norms. This is how medical law
gradually emerged.
MEDICAL DEONTOLOGY
Medical law is based on laws and
regulations that govern the practice of all
health professions.
Medical law is an instrument of state
guidance in the field of health care.
It is required that health activities to be carried
out consistently at a high and qualitative level.
There are two basic principles in medical law:
1. The right of every person to medical care.
2. The right of every person to make his or her
own choices and decisions about treatment.
Issues of medical deontology
The main issues of medical
deontology are in the following
areas:
- Competence of health
professionals
- Legal obligations
- Legality of health care actions
- Relationship with the patient
Issues of medical deontology
- General duties and rights of the health
professional
- Patient's rights
-Mandatory or compulsory treatment
-Protection of professional secrecy
-Human experimentation
- Application of new methods of diagnosis and
treatment
-Assisted reproduction
-Transplantation
-Euthanasia issues
-Genetic research
There is a close relationship
between morality and law. Morality
and law are the main regulators of
human behaviour in any developed
society.
Legal norms are the written rules of
conduct and are both binding and
punitive in nature.
Moral norms are the unwritten rules
of conduct and are observed by
virtue of internal conviction or
under the influence of public
opinion.
Medical ethics, medical deontology
and medical law are interrelated and
have a common goal - preserving life
and promoting the health of society.
Medical ethics and medical
deontology include:
1. The moral conduct of the health
care worker in the workplace in
various public and private health care
institutions and medical facilities.
2. The moral qualities of each health
professional.
3. The laws that govern the
relationship between the health
professional and the patient.
Code of Ethics of the
Physiotherapist
The World Physical Therapy Organization
(WPT) expects its members to:
- have a code of ethics or code of conduct
- publish, advertise and disseminate their
code of ethics for the benefit of their
members, the general public, employers,
governments and government agencies.
- have procedures for monitoring the
performance of their members,
disciplinary proceedings and sanctions for
members whose practice is outside their
code of ethics.
 The main communicative tasks facing PT
are:
1. To gain the patient's trust by taking the
necessary time in taking the history and
performing the functional tests.
2. To communicate with the patient
according to his/her personality and
PT-patient relationship mental characteristics.
3. To have an individual approach
to the patient.
4. To reassure the patient and instil
confidence in a favourable outcome of
treatment.
 5. Do not make hasty judgments and
conclusions.
6. Make the patient an active
participant in treatment.
7. To convince the patient of the need
of treatment and compliance with the
PT-patient relationship necessary regimen.
The communicative style of
communication is a prerequisite for a
more complete clarification of the
patient's problems and a more
adequate response to his needs.
 Mutual cooperation between the CT
and the patient is useful primarily in
chronic diseases associated with
prolonged rehabilitation. This model
of relationship is called
PARTNERSHIP.
What is good and beneficial for the
PT-patient relationship
patient is decided together with the PT
in active mutual cooperation.
The skill of psychological
influence is part of the work with each
patient.
PT-patient relationship
Patient's rights
1. Every patient has the right to
accessible and quality health care
without discrimination.
2. The patient has the right to respect
and dignity.
3. The patient has the right to be
informed about his/her condition and to
decide for him/herself whether to
undergo tests and treatment.
4. The patient has the right to choose
with whom and where to be treated and
to request consultations with other
specialists.
Patient's rights
5. Has the right to know the name,
position and specialty of the persons
involved in the diagnostic, treatment and
rehabilitation process.
6. The patient has the right to refuse
participation in research or to refuse to
consent to be used in the teaching
process of students and trainees.
7. The patient has the right to
confidentiality - to keep his/her health
condition confidential.
8. In the case of terminal illness, the
patient has the right to humane care
9. The patient has the right to make
recommendations to improve the
organization and operation of the health
care facility.
Patient's Rights in Bulgaria
Right to quality care
Freedom of choice
Right to decide
Right to information
Health education
Right to die with dignity
Right to religious assistance
PATIENT INFORMED CONSENT
The patient's consent to health care
activities - diagnostic, therapeutic and
rehabilitative - is a fundamental right.
In order to give consent, the patient has
the right to appropriate information on
which to base their decisions.
Informed consent is a fundamental
principle in clinical practice and research.
It is the process of the health professional
consistently informing the patient and
giving written consent to an examination,
surgery, rehabilitation, etc.
Patient's rights. Informed consent
includes five main elements:
1. Providing information about: health
status, prognosis of the disease, type
and extent of planned diagnostic,
treatment and rehabilitation activities
and risks associated with them, what
treatment alternatives are available,
etc.
2. The patient's understanding of the
information provided (mental
capacity). Minors and the mentally ill
are unable to give consent. This is
done by parents and guardians.
3. Awareness of information - written in accessible

language.

4. Patient acquisition of competence - to reasonably

assess the consequences of making

or not making a decision.

5. Giving consent - verbally or by signing a declaration.

Explicit consent from the patient is required for surgeries,

transplants, donation, invasive tests such as coronarography,

PET scan, biopsy, etc.

PATIENT DUTIES
1. To take care of their own health.

2. To protect the health of others.

3. To give accurate and truthful information about

their illness.

4. Treat health care personnel with respect.

5. To carry out prescribed treatment strictly.

6. To observe the internal order of the health

facility.
RISK IN HEALTHCARE The legitimacy of
healthcare activity is closely linked to risk in

medicine. Risk-taking in order to preserve human life

is a deontological obligation, especially in emergency

circumstances. Inaction can have equally negative

consequences as taking unjustified risks. Health

professionals in many cases can and must anticipate

the risk to life of the patient and be prepared to

combat complications and limit its consequences.

Compulsory treatment under the
Criminal Code in Bulgaria
Compulsory treatment in our country is applied to

persons who are a danger to themselves and others

or have already committed a criminal act and require

placement in a special psychiatric clinic, regardless

of the person's wishes.

Obligatory treatment under the Health
Act in Bulgaria

-Patients with communicable diseases - AIDS,

tuberculosis, viral hepatitis, meningitis,
encephalitis, diphtheria, poliomyelitis, rabies,
etc.
-Sick with venereal diseases - syphilis,
gonorrhea
-Persons who due to alcohol abuse cannot
control their behavior and have fallen into a
helpless state.
FORENSIC EXPERTISE
Forensic medicine is a science that
studies and develops medico-biological
issues that arise in the work of the
organs of justice (pre-trial and trial), in
the investigation and trial of criminal and
civil cases. It arose from the needs of
the justice system.
The object of forensic medicine is man -
from his conception to his death and the
disappearance of his last remains, and
the aim is to assist the administration of
justice.
 The application of forensic medicine and
its methods of examination to resolve issues
in legal practice is so-called forensic
expertise. The main tasks of forensic
medicine are:
1. To develop medico-biological issues
with a view to the needs of the administration
of justice.
2. To contribute to the improvement of
the quality of and effectiveness of diagnostic,
therapeutic and prophylactic activities by
developing and analysing specific forensic
material.
3. To develop the deontological-legal issues in
medical practice.
4. To contribute to the improvement of
criminal, civil and health legislation.
Forensic medical expertise is a scientific-
practical study with a conclusion on issues of
medico-biological nature arising in the
practical activities of the investigative bodies
and the court. It is an independent forensic
evidence, which, along with the records of the
investigative actions, the defendant's
explanations, material evidence, witnesses'
testimonies, serves to build the conviction of
lawyers in a given case.
Forensic medical examination of written
data is performed in investigative and
judicial cases to clarify the following
medico-biological issues:
- nature of injuries and determination of the
type of bodily injury,
- cause of death,
- whether and what omissions were made
by health professionals.
Basic issues of forensic expertise
in professional misconduct of health
professionals
1. To establish whether the diagnosis was
made correctly and in a timely manner and
whether the necessary investigations were
carried out.
2. Did the patient need hospitalization?
3. Determine whether treatment was
adequate
4. Whether the surgical treatment and
postoperative care was properly performed,
whether any violations occurred, whether
any complications occurred, and why.
Basic issues of forensic expertise
in professional misconduct of health
professionals
5. Whether there was a direct
relationship between the healthcare
actions taken and the adverse
outcome for the patient.
6. Were there any breaches of rules
and laws concerning the diagnosis
and treatment of the patient and
what led to these lapses.
Basic issues in ethics and
deontology are:
Moral, ethical and
deontological aspects of
human reproduction, clonings,
euthanasia, donorship and
transplantation, medical
clinical research with animals
and peoples, ethical codes of
the health specialists, palliative
care and human dignity.
THANK YOU