Asst. Prof., Dept. of Medical EthicsKing Fahad Medical City – Faculty of MedicineKing Saud Bin Abdul-Aziz University for Health Sciences

Dr. Ghaiath M. A. Hussein

Saudi Commission for Health SpecialtiesProfessionalism and Ethics Education for Residents

(PEER)

Introduction to Medical Ethics

OUTLINE

Definition of ethics, bioethics and medical ethics.

What is an ethical issue in healthcare?

International approaches to medical ethics

Islamic approaches to medical ethics

Which one would you drink?

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WHY? Place matt ers?

Less Embarrassing Choices

• I need to pass the exam..cheat or not?• I need the organs of this dying patient... Let him die fast?• I need the money of this Pharmaceutical company. Shall I change

the results of my research on their drug?• I need to be trained ...tell the patient you’re a specialist?

Ethics is about making choices…Usually hard ones!

What do you think?

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He Killed Her!!

Levels of moral response The expressive level (unanalyzed expressions or feeling that, by

themselves, don’t provide reasons or justification)

The pre-reflective level (justification via law, religious tenets, social values, codes of ethics, etc.; accepted uncritically)

The reflective level (reasoned ethical argument/defense based on ethical principles, rules, virtues, values to which we consciously subscribe; justification provided)

Thomas J and Waluchow W, 1998

Values and ethical principles• It is the process we need to go through to reach a decision about an ethical issue.• It helps us to differentiate:

– Facts: description of the way the world is; an actual state of affairs (“is”)

– Values: judgment about the way things should be (“ought”).– Ethical Principles: they are meant to guide actions. Key values in

bioethics have corresponding (e.g., principle of respect for autonomy)

Ethical/Moral Reasoning

KEY DEFINITIONS AND CONCEPTS

What is ethics?

What are the branches of ethics?

What is bioethics?

What is medical/clinical ethics?

What is an ethical issue?

What is Ethics? A system of moral principles or standards governing

conduct. a system of principles by which human actions and

proposals may be judged good or bad, right or wrong; A set of rules or a standard governing the conduct of a

particular class of human action or profession; Any set of moral principles or values recognized by a

particular religion, belief or philosophy; The principles of right conduct of an individual.

(UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)

What is Bioethics? It is derived from Greek bio- life and ethicos moral.

The science/art that aims at identification, analysis, and resolution of the ethical issues in almost any field that is related to human life and health.

Questions Answered by Bioethics

deciding what we should do (what decisions are morally right or acceptable);

explaining why we should do it (how do we justify our decision in moral terms); and

describing how we should do it (the method or manner of our response when we act on our decision).

EthicsBioethics

Clinical Ethics

Research ethics

Resource Allocation ethics

Public Health ethics

Nursing ethics

other

Business ethics

Environmental ethics

Social ethics

Organizational ethics

IT ethics

Other

What is Clinical/Medical Ethics?

It is that branch of bioethics that is related to the identification, analysis, and resolution of moral problems that arise in the healthcare of individual patients.

What is an “Ethical Issue” or a “Moral Problem”?There is an ethical issue when:

– we encounter conflicting values, beliefs, goals, or responsibilities

– we are concerned that persons or their rights are not being respected

– we are concerned about fairness and justice– we are unsure what we should do or why we should do it,

morally speaking

Schools of Thought in Moral Reasoning

How Right and Wrong are Distinguished?

Main Western Philosophies

Other philosophies Abrahamic Philosophies

Oriental philosophies

Utilitarianism African, Asian, etc. Islamic Buddhist

Deontology Human Rights Jewish Confucius

Feminist ethics Catholic Indian

Casuistry

Virtue ethics Protestant Persian

Principlism Jehovah Witnesses

Taxonomy of Ethics

Christian Ethics

Why do we Need to Know about Western Philosophies?

A Doctor is an international currency (you may be practicing anywhere)

Bridging the knowledge and cultural gaps Western literature and experience are steps ahead of ours Ethical concepts and tools are quite universal No self-development with knowing others To reflect Islamic concepts to non-Muslims in an appropriate manner

Utilitarianism: value of an action is determined by its utility; all actions should be directed toward achieving the greatest happiness for the greatest number of people.

Deontology: actions are judged based upon inherent right-making characteristics or principles rather than on their consequences. Emphasis on duty, rules and regulations, principles and moral obligations which govern ones right action

School of Thoughts in Moral Reasoning

Feminist Ethic: (Ethics of Care) commitment to correcting male biases (e.g. women’s subordination is morally wrong) and that the moral experience of women is as worthy of respect as that of men.

Casuistry: The greatest confidence in our moral judgments resides not at the level of theory, where we endlessly disagree, but rather at the level of the case, where our intuitions often converge without the benefit of theory.

School of Thoughts in Moral Reasoning cont...

• Virtue Ethics: It emphasizes the virtues, or moral character

• Should not a patient comply with a “don’t smoke” advice from a smoking doctor?!

School of Thoughts in Moral Reasoning cont...

Principlism Autonomy: respect humans' ability to choose,

Beneficence: Do Good for others,

Nonmaleficence (Do No Harm), &

Justice

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School of Thoughts in Moral Reasoning cont...

Islamic Approach to Ethical Analysis and Decision Making

Islamic Bioethics

Main Sources1) The Koran 2) The Sunna

Secondary Sources1) Unanimous agreement of Islamic jurists (Ijmaa) 2) Acceptance by the majority of trusted scholars (Rayul Jomhour) 3) Measurement/Analogy (Qiyas)4) Remediation (Maslaha), (Istishab)

Sources of Islamic Morality

The five purposes of Sharia are to preserve person’s:1. Religion2. Soul3. Mind4. Wealth and5. Progeny

All Islamic legislations came to achieve these goals.

Goals of Islamic Regulations

What is Islamic Bioethics?It is the methodology of

defining, analysing and resolving the ethical issues that arise in healthcare practice, or research;

based on the Islamic moral and legislative sources (Koran, Sunna & Ijtihad); and

aims at achieving the goals of Islamic morality (i.e. preservation of human’s religion, soul, mind, wealth & progeny )

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1. The principle of Intention (Qasd): Each action is judged by the intention behind it

2. The principle of Certainty (Yaqeen): Certainty can not be removed by doubt

3. The principle of Injury/Harm (Dharar): Injury should be relieved; An individual should not harm others

or be harmed by others An injury is not relieved by inflicting or causing a harm of the same degree Prevention of harm has priority over pursuit of a benefit of equal worth the lesser harm is committed

Islamic Principles and Maxims Applicable in Medicine

4. The principle of Hardship (Mashaqqat): Difficulty calls forth ease, Necessity (Dharuraat) legalizes the prohibited

5. The principle of - Custom or precedent (Urf): Custom is recognized as a source of law on which legal rulings are based unless contradicted specifically by text from the main

legislative sources, i.e. Koran and Sunna.

Islamic Principles and Maxims Applicable in Medicine cont...

Give example of an ethical issue/problem you faced or witnessed, mentioning the following:

What was the situation? What was your feeling towards it? What did you do? Do you think you did the best thing? why? What do you think you need to know more about to be able

to handle similar situations in the future?

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Cases and Group Discussion

More Resources

• http://med-ethics.com/ • http://omarkasule.tripod.com/• http://www.islamset.com/ethics/index.html

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THANK YOU