4th year medical students (May 14, 2012)
Prepared and presented by:
Dr. Ghaiath Hussein
ghaiathme@gmail.com
A less embarrassing
choice…

breast bud

Outline
 What is medical ethics?
 What is an ethical issue?
 Schools of thought (Philosophies)
 Tools for ethical anal...
What is clinical/medical
ethics?
 It is that branch of bioethics that is
related to the
identification, analysis, and res...
Questions answered by
Bioethics
○deciding what we should do
(what decisions are morally right or
acceptable);
○explaining ...
What is an “ethical issue” or
a “moral problem”?
 There is an ethical issue when:
 …we encounter conflicting
values, bel...
What else could it be?
 Miscommunication stands for 70-80%
of problems in healthcare
 E.g. Doctors don’t know to tell me...
Schools of thought in moral reasoning (how right and
wrong are distinguished?)
How to approach an ethical
issue?
I- Set of Ethical standards
Secular
Most western
philosophies
• Utilitarianism
• Ethical Egoism
• Deontology
• Social cont...
Schools of thought in moral reasoning
the value of an action is
determined by its utility; all actions should be
directed ...
Schools of thought in moral reasoning
(cont.)
(Ethics of Care)
commitment to correcting male biases (e.g.
women’s subordin...
Schools of thought in moral reasoning
(cont.)
It emphasizes the
virtues, or moral character
 A patient should not comply ...
Schools of thought in moral reasoning
(cont.)
 Autonomy: respect humans'
ability to choose,
 Beneficence: Do Good for ot...
II- Tools for Ethical
Analysis
 Why do we need tools for ethical
analysis?
 To make sure we do not miss any
information ...
Who (&what) affects ethical
decision making?
Tools & frameworks for ethical
analysis
Consider each medical condition and its
proposed treatment. Ask the following
ques...
CLEO Approach
Legal:Clinical:
Legally required process for treatment
decision making when a patient lacks
capacity to do s...
III- Modalities of resolving ethical
issues
Collect
information
• Medical
• Non-
medical
Meet
involved
parties
• Doctors
• Nurses
• Patient (&
family)
Ethical
Analysi...
Ethics in Islam… not a separate
entity!
Law
Ethics
Religious
Practice
Economy
Social
Relations
How should Muslims decide their acts?
 “And I (Allâh) created not the jinn and mankind except
that they should worship Me...
Koran and Sunna
 Unanimous agreement of Islamic jurists (Ijmaa)
 Acceptance by the majority of trusted scholars
(Rayul J...
 The are to
preserve person’s:
1. Religion;
2. Soul;
3. Mind;
4. Wealth; &
5. Progeny.
All Islamic legislations came to a...
 It is the methodology of
 defining, analysing and resolving the ethical
issues that arise in healthcare practice, or
re...
1. The principle of Intention (Qasd): Each
action is judged by the intention behind it
2. The principle of Certainty (Yaqe...
4. The principle of Hardship (Mashaqqat):
Difficulty calls forth ease, Necessity
(Dharuraat) legalizes the prohibited
5. T...
 What are the facts (medical/scientific)?
 Is there a text on the issue from Koran and/or
Sunna?
 Which Sharia Goals ar...
Summary of Islamic
Analysis
1- Which Sharia goal(s) is involved?
Religion Soul Mind Money Progeny
2- Which Grand Fiqhi Pri...
Case for discussion
 Batoul is a 36 years old Saudi lady. She is a mother
of 2 children (8 & 10 years old), and she is no...
Case for discussion…cont.
 She did not accept to terminate the pregnancy.
Accordingly, the husband was approached, he
app...
Discussion questions:
 What are the ethical issues involved in this
case?
 Describe in details the steps you will
take, ...
Download more lectures from:
https://sites.google.com/site/medicalethicscourse/
More Resources:
http://med-ethics.com/
htt...
How to resolve ethical issues in practice? Western& Islamic approaches
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How to resolve ethical issues in practice? Western& Islamic approaches

  1. 1. 4th year medical students (May 14, 2012) Prepared and presented by: Dr. Ghaiath Hussein ghaiathme@gmail.com
  2. 2. A less embarrassing choice…  breast bud 
  3. 3. Outline  What is medical ethics?  What is an ethical issue?  Schools of thought (Philosophies)  Tools for ethical analysis and decision making  Islamic approach to ethical decision making
  4. 4. 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.
  5. 5. 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).
  6. 6. 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
  7. 7. 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!”
  8. 8. Schools of thought in moral reasoning (how right and wrong are distinguished?)
  9. 9. How to approach an ethical issue?
  10. 10. I- Set of Ethical standards Secular Most western philosophies • Utilitarianism • Ethical Egoism • Deontology • Social contracts • Humanism Religious (Oriental) Bhudism Confucian ethics Daoist ethics Hindu ethics Religious (Abrahamic) Jewish ethics Christian ethics Islamic ethics
  11. 11. Schools of thought in moral reasoning the 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.  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
  12. 12. Schools of thought in moral reasoning (cont.) (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. 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.
  13. 13. Schools of thought in moral reasoning (cont.) It emphasizes the virtues, or moral character  A patient should not comply with a “don’t smoke” advice from a smoking doctor!
  14. 14. Schools of thought in moral reasoning (cont.)  Autonomy: respect humans' ability to choose,  Beneficence: Do Good for others,  Nonmaleficence (Do No Harm), &  Justice
  15. 15. II- Tools for Ethical Analysis  Why do we need tools for ethical analysis?  To make sure we do not miss any information or possible factor that could affect the decision we take  How do they help us reach ethical decision?  Tools that helps us have information about all those involved in the decision  Who is involved in ethical decision? (what do you think?)
  16. 16. Who (&what) affects ethical decision making?
  17. 17. Tools & frameworks for ethical analysis Consider each medical condition and its proposed treatment. Ask the following questions: Does it fulfil any of the goals of medicine? With what likelihood? If not, is the proposed treatment futile? Address the following: What does the patient want? Does the patient have the capacity to decide? If not, who will decide for the patient? Do the patient's wishes reflect a process that is informed? understood? voluntary? Patient's quality of life in the patient's terms. What is the patient's subjective acceptance of likely quality of life? What are the views of the care providers about the quality of life? Is quality of life "less than minimal?" Social, legal, economic, and institutional circumstances in the case that can: influence the decision be influenced by the decision e.g., inability to pay for treatment; inadequate social support
  18. 18. CLEO Approach Legal:Clinical: Legally required process for treatment decision making when a patient lacks capacity to do so Family involvement: who to involve? when and how substitute treatment decisions are to be made? Diagnoses: Irreversible? Progressive? Permanent? Prognoses: Disabling? Terminal? clinicians’ level of certainty? Organizational:Ethical: Any institutional pressures to not have a bed blocked by someone whose recovery will be long and slow or the benefits seemingly small? Any other healthcare facilities better able to provide palliative/rehabilitative care for longer periods of time? Any different views as to diagnosis, prognosis, next steps among the team or other physicians The patient’s will, desires, perception of life, relationship with their family? What cultural or religious beliefs involved? Family’s stand: why? To show their fidelity to the patient and/or deal with their individual and collective sadness/shock/grieving? No longer sure what is really going on or who to trust
  19. 19. III- Modalities of resolving ethical issues
  20. 20. Collect information • Medical • Non- medical Meet involved parties • Doctors • Nurses • Patient (& family) Ethical Analysis • Weighing collected info. vs. ethical principles (& laws) Decision Making • Single decision; or • Provide alternativ es Follow-Up • How decisions are implement ed? • Lessons learned
  21. 21. Ethics in Islam… not a separate entity! Law Ethics Religious Practice Economy Social Relations
  22. 22. How should Muslims decide their acts?  “And I (Allâh) created not the jinn and mankind except that they should worship Me (Alone)” (51:56).  Worship in Islam includes the duty to follow the orders of Allah and His Prophet Mohamed (PBUH)  “And whosoever does not judge by what Allâh has revealed, such are the Kâfirûn (i.e. disbelievers - of a lesser degree as they do not act on Allâh’s Laws” (5: 44); “And whosoever does not judge by that which Allâh has revealed, such are the Zâlimûn (polytheists and wrong-doers - of a lesser degree)” (5: 45); “And whosoever does not judge by what Allâh has revealed (then) such (people) are the Fâsiqûn [the rebellious i.e. disobedient (of a lesser degree)” (5: 47); “And whatsoever the Messenger (Muhammad gives you, take it; and whatsoever he forbids you, abstain (from
  23. 23. Koran and Sunna  Unanimous agreement of Islamic jurists (Ijmaa)  Acceptance by the majority of trusted scholars (Rayul Jomhour)  Measurement/Analogy (Qiyas),  Remediation (Maslaha), (Istishab)
  24. 24.  The are to preserve person’s: 1. Religion; 2. Soul; 3. Mind; 4. Wealth; & 5. Progeny. All Islamic legislations came to achieve these goals.
  25. 25.  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 )
  26. 26. 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
  27. 27. 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.
  28. 28.  What are the facts (medical/scientific)?  Is there a text on the issue from Koran and/or Sunna?  Which Sharia Goals are involved?  Which fiqhi principles are applicable?  Weighing of principles?  Applying the relevant secondary sources (matching the scripts to goals and principles)  Is there a previous Fatwa on similar issue?
  29. 29. Summary of Islamic Analysis 1- Which Sharia goal(s) is involved? Religion Soul Mind Money Progeny 2- Which Grand Fiqhi Principle(s) involved? Intention Hardship Harm/Injury Certainty Custom 3- Which Fiqhi Maxims are involved?
  30. 30. Case for discussion  Batoul is a 36 years old Saudi lady. She is a mother of 2 children (8 & 10 years old), and she is now pregnant in her 15th week of gestation with a normal and viable fetus.  Two weeks ago, she was found to have a huge ovarian mass (19 X 12 cm) found to be a cystoadenocarcinoma with features of metastasis.  She is a candidate for chemotherapy. Thus, the oncology board of the hospital recommended the termination of pregnancy. Three consultants, including her following obstetrician and an oncologist, had approved this recommendation.
  31. 31. Case for discussion…cont.  She did not accept to terminate the pregnancy. Accordingly, the husband was approached, he approved and signed the consent on her behalf.  Batoul felt terribly upset from what happened, and refused to start the chemotherapy. The case was submitted to the ethics committee of the hospital in which you are a member.  You were delegated by the ethics committee to resolve the case.
  32. 32. Discussion questions:  What are the ethical issues involved in this case?  Describe in details the steps you will take, including what are the information that you will collect, who you will meet, what are the questions that you may want to ask, what are the factors (medical, ethical, religious, legal, etc.) that you will consider as you recommend a decision.  Describe briefly the modality that you will suggest to implement and follow-up the
  33. 33. Download more lectures from: https://sites.google.com/site/medicalethicscourse/ More Resources: http://med-ethics.com/ http://omarkasule.tripod.com/ http://www.islamset.com/ethics/index.html
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