Thematic Approach

Introduction

Under review

Medical practice requires that physicians know how to apply their scientific knowledge in a manner that meets the health needs of their patients, while respecting the ethical rules of the profession and legal framework in effect in their field of activity.

To illustrate how legal, ethical and organizational aspects can be incorporated into medical practice, Part ll considers four themes, accompanied by clinical examples. These are: 

A. Consent 
B. Professional secrecy 
C. End-of-life issues 
D. Personal convictions.

In our society, there is broad consensus on the subject of consent and professional secrecy, and this is expressed through legal and ethical guidelines that are quite clear. However, their application in particular cases calls for discernment and vigilance on the physician’s part.

On the other hand, issues emerging from end-of-life situations can be particularly difficult, for they oblige the physician to test his or her convictions against those of the patient, as well as reconcile them with professional obligations and legal constraints.

As for conscientious objection, it represents the extreme situation where personal convictions are irreconcilable. In this case, the moral challenge is to come to an arrangement that respects all parties involved.

Thus, the objective in Part II is to illustrate, by way of specific clinical situations, how moral, ethical and legal principles can be applied and integrated into medical practice.

The examples presented merely serve to explain, and the analyses given may not be applicable to other cases. Specific cases always require in-depth personal reflection. In some situations, it may be necessary to consult legal texts, to seek legal advice, to solicit the opinion of the Collège des médecins, or to submit the question to an ethics committee, where and if there is one. Many health care institutions in Québec have a clinical ethics committee (CEC), which must be distinguished from a research ethics committee (REC). These advisory and multidisciplinary committeees play a role in promoting awareness of ethics in the context of the care and support of caregivers grappling with sensitive situations.

2011-04-04