Medical Ethics:
1.    Nothing specifically unique about medical ethics; but in terms of how you walk into a room and face a patient, there are general ethics.
2.    “Do unto others as you would have done unto you.”  The ethics you would have “at your mother’s knee.”
3.    The relationship between a physician and the patient is extremely personal.
4.    Medicine has tried to set up the ethics standards with four basic principles:
a)    Do no harm
b)    Act in a patient’s best interest
c)    Respect for autonomy (the most difficult issue faced–patients, no matter how ill-advised, has the right to decide what will happen to themselves.  Patient has a right to take the choice procedure with a lower chance of recovery for whatever reason–economic, cultural, religious, etc).
d)    Moral justice–the fair apportionment of resources (seen in managed care disputes).

e)    wanted to treat.  If a physician didn’t want to treat a patient with AIDS he didn’t have to.
(1)    But, now the American Disabilities Act prohibits the exclusion of patients who have certain diseases, etc.  He could refuse to treat the patient b/c he wasn’t an expert in the AIDS/HIV area.  Physicians can no longer make these types of decisions to refuse patients.
5.    But how do we square these principles with cost containers?
a)    Example–capitation:  Managed care pays physicians through Ks made with HMOs.  Conflict regarding the principles b/c a doctor may see less capitation patients b/c he will make more $ from patients he sees on a regular basis.  But this goes against the best interest of the capitation patients.
6.    Pons v. Ohio State Medical Board:
a)    Obstetrician/Gynecologist saw a patient and then became sexually involved with her.  He also performed psychiatric counseling and removed a mole from her back, etc.
b)    The Medical Licensing Board reviewed the physician for dating a physician while he performed medical services on her, as well as the fact that the medical services that he provided her, were out of his league as a gynecologist.
(1)    The board sanctioned the doctor: (1) failure to deal objectively and honestly with the patient and exhibiting a lack of respect for her dignity.  (2) failure to adhere to ethical principles when neglecting to seek a consultation regarding the patient’s psychiatric problems.
(2)    Another physician testified as an expert, saying that the doctor violated the ethics code.  The board used the American Principles of Medical Ethics (AMA) to sanction the doctor.