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Toronto Notes 2019 Ethical and Legal Issues in Canadian Medicine Ethical, Legal, and Organizational Medicine ELOM5
• physiciancertificationisgovernednationally,whilethemedicalprofessioninCanadaself-regulates under the authority of provincial legislation
• self-regulationisbasedonthepremisethatduetotheadvancededucationandtraininginvolvedin the practice of medicine, the lay person is not in a position to accurately judge the standards of the profession; the self-regulating colleges have a mandate to regulate the profession in the public interest
• theRCPSCandCFPCareresponsibleformonitoringongoingCMEandprofessionaldevelopment
• certificationbytheLMCCpluseithertheRCPSCorCFPCisaminimumrequirementforlicensureby
most provincial licensing authorities
Role of Professional Associations
Table 3. Key Professional Associations
Association CMA
OMA and Other PTMAs
CMPA
RDoC and PHO CMFS and FMÉQ
Description
Provides leadership to doctors and advocates for access to high quality care in Canada Represents physician and population concerns at the national level
Membership is voluntary
Negotiates fee and benefit schedules with provincial governments
Represents the economic and professional interests of doctors Membership is voluntary
Physician-run organization that protects the integrity of member physicians Provides legal defence against allegations of malpractice or negligence Provides risk management and educational programs
Membership is voluntary
Upholds economic and professional interests of residents across Canada
Facilitates discussion amongst PHOs regarding policy and advocacy items
Medical students are represented at their universities by student bodies, which collectively form the CFMS or FMÉQ
FMÉQ membership includes that of francophone medical schools
Ethical and Legal Issues in Canadian Medicine
Introduction to the Principles of Ethics
• ethicsaddresses:
1. principles and values that help define what is morally permissible or not 2. rights, duties, and obligations of individuals and groups
• thepracticeofmedicineassumesthereisonecodeofprofessionalethicsforalldoctorsandthatthey will be held accountable by that code and its implications
• thedoctor-patientrelationshipisformedontrust,whichisrecognizedintheconceptoffiduciaryduty/ responsibility of physician towards patient
• afiduciarydutyisalegaldutytoactinanotherparty’sinterest.Profitfromthefiduciaryrelationship must be strictly accounted for with any improper profit (monetary or otherwise) resulting in sanctions against the physician and potentially compensation to the patient, even if no harm has befallen the patient
Table 4. The Four Principles Approach to Medical Ethics
Principle Autonomy
Beneficence
Non-Maleficence Justice
Definition
Recognizes an individual’s right and ability to decide for themselves according to their beliefs and values
May not be applicable in situations where informed consent and choice are not possible or may not be appropriate
Patient values-based best interests standard that combines doing good, avoiding harm, taking into account the patient’s values, beliefs, and preferences, so far as these are known
Autonomy should be integrated with the physician’s conception of a patient’s medically-defined best interests Aim is to minimize harmful outcomes and maximize beneficial ones
Paramount in situations where consent/choice is not possible or may not be appropriate
Obligation to avoid causing harm; primum non nocere (“First, do no harm”)
Limit condition of the Beneficence principle
Fair distribution of benefits and harms within a community, regardless of geography or income
Concept of fairness: Is the patient receiving what he/she deserves – his/her fair share? Is he/she treated the same as equally situated patients? How does one set of treatment decisions impact others?
Basic human rights, such as freedom from persecution and the right to have one’s interests considered and respected
Autonomy vs. Capacity
Autonomy: the right that patients have to make decisions according to their beliefs and preferences
Capacity: the ability to make a specific decision for oneself