Ethical Considerations in Dermatology

Abstract

In medicine, any decision is governed by certain rules, laws or codes. Dermatology is a specialty that has evolved much in recent years and has increased its range of activity. Also, the methods of communication between the doctor and the patient have also changed, keeping pace with the technology. All these changes bring about ethical problems both through the complexity of the medical act and through the changes brought by modern medicine.

 

There are several factors that need to be taken into consideration when we talk about medical decisions: laws and social contracts, professional codes, religious traditions, or personal experience. Regarding the ethics and professionalism of a medical act, we relate to the deontological level of understanding, juggling with responsibilities and rights [1].

There are some particular features of the problems faced by the dermatologist in everyday practice:

-     prescribing isotretinoin for acne, this drug, although very effective, is teratogenic;

-     performing the epidemiological inquiry into sexually transmitted diseases [2].

A 2013 article highlighting the issue raised by social networks in dermatology is a very good example for ethical considerations in our practice. Because dermatology is a visual specialty, the use of social networking is more common in our case. Here patients exchange opinions, recommend treatments or even some doctor’s offices. We doctors, we need to be careful if we decide to use this method of communicating with the patient until we go with the medical information and the character of our response to the patient [3].

Developing smartphone devices, though greatly contributed to the ease of photographing skin lesions, highlights the importance of securing data stored in this device, but also points to the possibility of being illegitimate when storing medical data in a personal device. The photographic method is widely used by both the dermatologist and the patient for diagnosis, evolution surveillance, or treatment most often for pigmentary lesions. It is the issue of previously informed consent but also the problem of storing the information without endangering the identity of the person being photographed [2, 3].

Handling medical information in the online environment draws attention to the legal framework in which this exchange takes place. At the same time, the expression of personal views by the patient about the medical act itself, at a particular clinic or at a particular doctor raises the question of the morality of this expression in the context of the moral damage that can be brought about.

Aesthetic medicine has evolved a lot in recent times and dermatology is a direct part of this evolution. Using the filler in dermatology is an example by which we can improve the appearance of a person. There are also cases where changes required by the patient do not meet ethical standards. The question arises, where and how much do we use the aesthetic medicine methods to practice a medical act?

Are changes in aesthetic medicine part of the natural evolution of dermatology or should be included in a self-contained branch completely separated from traditional medicine? How we manage to combine the traditional methods of treatment with the modern ones, which are increasingly demanded by the patient, are strictly tied to medical tact, professionalism and medical experience.

Also, injection of own cells by plasmolysis technique (“vampire therapy”) brings to the forefront the need to redefine existing laws and reformulate them to suit the needs and tendencies of a constantly changing society.

However, no matter what specialty, each physician has to follow some general rules and ethical principles common to all. Perhaps the most common principles are those postulated by Beauchamp and Childress: the respect for autonomy principle – respecting the autonomous people’s abilities to make decisions, the “do no harm” principle, the principle of beneficence – the patient should be the recipient of benefits on behalf of the health care system, as he is the  one  who  supports  this  system  through  the  material  contribution  he  makes,  and  the principle of justice regarding the equity of distributing the risks or advantages to which the patient is subjected to by the health system [4, 5].

Cutaneous neoplasia still remains a challenge and the ethical principles involved in the therapeutic process will have to combine in a harmonious manner the society’s moral values, the religious principles of the patient, the doctor’s professional skills and the therapeutic guidelines in the field.

Fortunately for us, there are ethical codes proposed for us by the American Academy of Dermatology and adapted by other authors of our time:

•    In terms of patient physician relationship, the purpose is patient care, contract based on  confidentiality  and  trust  and  in  some  situations  the  dermatologist  can  select patients. The doctor’s obligation to correctly inform about the etiology, treatment and prognosis of the condition.

•    Conflict of interests, when it occurs, it tries to solve it for the benefit of the patient.

The dermatologist has the interest to have a longer relationship with the patient.

Attention   to   the   relationship   with   the   pharmaceutical   industry   and   medical representatives because these relationships should not influence the medical act.

•    Dermatologist  relationship  –  nurses  and  auxiliary  staff  –  we  need  to  know  our responsibilities and communicate with staff for the benefit of the patient.

•    As with any other medical branch, research should be done in accordance with the ethical, institutional and legal principles in force [6-8].

Dermatopathology is another branch of our specialty in which there are ethical issues, especially with regard to the diagnosis of the patient with cutaneous neoplasia. Given that approximately 80 percent of Non Melanoma Skin Cancer affect the cephalic extremity, head and neck, the lesion itself and a possible postoperative scar do major harm to the patient’s physical appearance. Inevitably, this gives rise to a degree of disfigurement which brings mental changes such as anxiety, depression or social isolation. Once a patient is diagnosed with cutaneous neoplasia, taking any medical decision is a challenging act for everyone involved, which requires a proper ethical conduct of the medical staff. To communicate a diagnosis has never been simple, and it requires ethical, psychological or legal considerations in order to inform the patient.

In recent years, dermatology has recorded a significant progress regarding the methods of diagnosis, evaluation and treatment, but also with regard to the way that dermatological patients promote and defend their rights [8].

In conclusion, dermatoethics is a branch of dermatology that highlights the legal or ethical issues in this field and its study brings to the fore the trends of contemporary medicine.

 

The Authors:

PORUMB-ANDRESE Elena [1,2]

VÂȚĂ Dan [1,2*]

STĂTESCU Laura [1,2]

GRĂJDEANU Ioana-Alina [1]

POPESCU Ioana-Adriana [1]

PĂTRAŞCU Adriana Ionela [2]

GHEUCĂ-SOLOVĂSTRU Laura [1,2]

 

1 “Grigore T. Popa” University of Medicine and Pharmacy Iași (ROMANIA)

2 “Sf. Spiridon” Clinical Emergency Hospital, Iași (ROMANIA)

* Corresponding author: danvata@yahoo.com

 

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