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How to approach an ethical issue in clinical practice
 

How to approach an ethical issue in clinical practice

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    How to approach an ethical issue in clinical practice How to approach an ethical issue in clinical practice Presentation Transcript

    • Faculty Development Session (January 11, 2011) Prepared and presented by: Dr. Ghaiath Hussein [email_address]
    • Which one would you drink?
    • A less embarrassing choice…
        • Um Abdallah is 56 years old and has a learning disability. She is admitted to hospital with an ovarian cyst. The cyst is blocking her ureter and if left untreated will result in renal failure. She would need an operation to remove the cyst.
        • Um Abdallah does not want a needle inserted for the anaesthetic for the operation to remove the cyst- she is uncomfortable in a hospital setting and is frightened of needles.
        • The clinician is concerned that if the cyst is not removed Um Abdallah will develop renal failure and require dialysis. The anaesthetist is concerned that if she does not comply with the procedure then she would need to be physically restrained. Um Abdallah’s sons are adamant that their mother should receive treatment.
    • Outline
        • What is ethics?
        • What is bio ethics?
        • What is an ethical issue?
        • Schools of thought
        • Tools for ethical analysis and decision making
        • Islamic approach to ethical decision making
    • Introduction:
        • 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).
    • 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
    • What else could it be?
        • Miscommunication stands for 70-80% of problems in healthcare
          • E.g. Doctors don’t know to tell medical info
        • Management issue
          • “ when shall I get promoted? All my colleagues did. This is not ethical!”
        • Financial issue
          • “ I am underpaid for my workload. This is not ethical!”
    • Schools of thought in moral reasoning (how right and wrong are distinguished?)
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        • The principle of Intention (Qasd): Each action is judged by the intention behind it
        • The principle of Certainty (Yaqeen): Certainty can not be removed by doubt
        • 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
        • 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.
        • What are the medical/scientific facts?
        • What are the Sharia Goals involved?
        • What are applicable principles?
        • Weighing of principles?
        • Is there a text on the issue from Koran and/or Sunna?
        • Applying the relevant secondary sources (matching the scripts to goals and principles)
        • Is there a previous Fatwa on the issue?
        • Um Abdallah is 56 years old and has a learning disability. She is admitted to hospital with an ovarian cyst. The cyst is blocking her ureter and if left untreated will result in renal failure. She would need an operation to remove the cyst.
        • Um Abdallah does not want a needle inserted for the anaesthetic for the operation to remove the cyst- she is uncomfortable in a hospital setting and is frightened of needles.
        • The clinician is concerned that if the cyst is not removed Um Abdallah will develop renal failure and require dialysis. The anaesthetist is concerned that if she does not comply with the procedure then she would need to be physically restrained. Um Abdallah’s sons are adamant that their mother should receive treatment.
    • More Resources: http://med-ethics.com/ http://omarkasule.tripod.com/ http://www.islamset.com/ethics/index.html