Najam Akhtar.
Ethical dimensions of clinical practice.
Professional Med J Jan ;18(3):341-3.

INTRODUCTION The Zhan and Miller study supported the Institute of The term Iatrogenic Nocere originates from the two Medicine’s (IOM) conclusion, which found that medical domains. errors caused up to 98,000 deaths annually and should be considered a national epidemic1. 1. Iatrogenic from pharmacology. 2. Nocere from the Hippocratic injunction – Primum The issue of potential harm is associated with every non nocere; Nocere meaning “harm”. pharmacological decision. The ethical pharmacological practice requires an informed consent of the patient and ‘Iatros’ means physician in Greek, and ‘genic’, meaning depends highly on the doctor patient relationship. It induced by, is derived from the International Scientific enables the patient to make his own decision among the Vocabulary. Combined, of course, they become treatment options. The treatment options are required to iatrogenic, meaning physician-induced. Thus iatrogenic be discussed by the doctor with the patient in detail, disease is ‘a disease which is caused by a physician’. aiming at the risks and benefits associated with the various options. The growing complexity of modern medicine has promoted the elasticity of language. In common usage, DISCUSSION then, iatrogenic disease is now applied to any adverse The three pillars of ethics are confidentiality, autonomy effect associated with any medical practitioner or and equity. When autonomy of patient is compromised, treatment. The practitioner need not be a physician, he the probability of Iatrogenic Nocere increases. Iatrogenic might be a nurse or a radiology technician, or any one of Nocere comprises of a triad of doctor, patient and the the scores of differentiated healthcare workers drug. The doctor’s practice is guided by the Hippocratic encountered in hospitals, clinics, nursing homes, or Oath, the patient is vulnerable and drugs are marketed offices, or for that matter in the ambulance on the way to through the pharmaceutical industry. It is the exploitation one of those places. of the vulnerable patient by the doctor who has forgotten his Hippocratic Oath and forms an unethical nexus with The Hippocratic injunction to do no harm has been an the pharmaceutical industry. axiom central to clinical pharmacology and to the education of medical and graduate students. With the Iatrogenic Nocere dwells in the concept of informed recent re-examination of the nature and magnitude of consent. Informed consent emphasizes a patient’s adverse reactions to drugs, its applicability and understanding of the information about the proposed limitations as a guide to the ethical practice of medicine treatment, potential risks and benefits of treatment, and and pharmacological research are of paramount the consequences of not taking the treatment2. It also importance. It remains a potent reminder that every requires a patient to have the capacity to make a choice. medical and pharmacological decision carries the potential for harm.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com