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Introduction to Medical Ethics Overview; Definitions &Concepts of ethics & bioethics; Western approach to ethics; Islamic ...
What we will try to learn today? <ul><ul><li>Section I: Definitions & Concepts </li></ul></ul><ul><ul><ul><li>What is ethi...
Section I: Overviewof ethics & bioethics
Which one would you drink?
Less embarrassing choices… <ul><ul><li>I need to pass the exam..cheat or not? </li></ul></ul><ul><ul><li>I need the organs...
Levels of moral response <ul><ul><li>The  expressive  level (unanalyzed expressions or feeling that, by themselves, don’t ...
Ethics Ghaiath <ul><ul><li>explicit critical reflection on moral beliefs, practices and problems </li></ul></ul><ul><ul><l...
What do you think?
The Fact-Value Distinction Ghaiath <ul><ul><li>Fact:  description of the way the world is; an actual state of affairs (“is...
Ethical reasoning <ul><li>Values and ethical principles </li></ul><ul><ul><li>Value =  something a person/community has id...
Section II: Definitions & Concepts What is ethics? What are the branches of ethics? What is bioethics? What is medical/cli...
What is ethics?  <ul><ul><li>A system of moral principles or standards governing conduct.  </li></ul></ul><ul><ul><li>a sy...
What is bioethics? <ul><ul><li>It is derived from Greek  bio - life and  ethicos  moral.  </li></ul></ul><ul><ul><li>The s...
<ul><ul><li>Give example of an ethical issue/problem you faced or witnessed, mentioning the following: </li></ul></ul><ul>...
Questions  answered by Bioethics <ul><ul><ul><li>deciding  what   we should do   (what decisions are morally right or acce...
What is clinical/medical ethics? <ul><ul><li>Clinical ethics is a practical discipline that provides a structured approach...
 
What is an “ethical issue” or a “moral problem”? <ul><ul><li>There is an ethical issue when: </li></ul></ul><ul><ul><ul><l...
Domains of Ethics in Health Care <ul><ul><li>Shared decision making with patients </li></ul></ul><ul><ul><li>Ethical pract...
What else could it be? <ul><ul><li>Miscommunication  stands for 70-80% of problems in healthcare </li></ul></ul><ul><ul><u...
Section III: Western approach to ethics and ethical reasoning How right and wrong are distinguished?
Ethical justification <ul><li>In ethics, the support/reasons ultimately come from moral values, principles and theories: <...
Ethical theories and principles as lenses “ Doing bioethics well requires appeal to the insights provided by multiple theo...
Why do we need to know about western philosophies? <ul><ul><li>A Doctor is an international currency (you may be practicin...
General characteristics of western philosophies <ul><ul><li>Secularism:  people are free to practice their religion but no...
<ul><ul><li>Utilitarianism:  the value of an action is determined by its utility; all actions should be directed toward ac...
 
 
<ul><ul><li>Principlism:  </li></ul></ul><ul><ul><ul><li>Autonomy: respect humans' ability to choose, </li></ul></ul></ul>...
Other philosophies... <ul><ul><li>Taxonomy of ethics </li></ul></ul>Other philosophies Abrahamic Philosophies  Oriental ph...
Section IV: Islamic approach to ethical analysis and decision making
Ethics in Islam… not a separate entity!
How should Muslims decide their acts? <ul><ul><li>And I (Allâh) created not the jinn and mankind except that they should w...
 
 
<ul><ul><li>It is the methodology of  </li></ul></ul><ul><ul><ul><li>defining, analysing and resolving the ethical issues ...
<ul><ul><li>Clear and fixed sources </li></ul></ul><ul><ul><li>Clear goals of morality (Maqasid Alshariya) </li></ul></ul>...
<ul><ul><li>The principle of  Intention  (Qasd):  Each action is judged by the intention behind it </li></ul></ul><ul><ul>...
<ul><li>4.  The principle of  Hardship  (Mashaqqat): Difficulty calls forth ease, Necessity (Dharuraat) legalizes the proh...
Section V: Tools & Frameworks
 
Box 1:  Medical Indications <ul><ul><li>Medical Indications  are those facts about the patient's physiological or psycholo...
Box 2: preferences of patients  <ul><ul><li>The choices that persons make when they are faced with decisions about thier h...
Box 3: Quality of life <ul><ul><li>refers to that degree of satisfaction that people experience and value about their live...
Box 3: Quality of life...cont’d <ul><ul><li>Relevant ethical questions </li></ul></ul><ul><ul><li>What are the prospects, ...
Box 4: Contextual Features <ul><ul><li>It addresses the ways in which professional, familial, religious, financial, legal,...
CASES Approach
The CASES Approach  <ul><ul><li>The CASES approach was developed by the National Center for Ethics in Health Care </li></u...
C larify the facts & requirements <ul><ul><li>Characterize the type of problem </li></ul></ul><ul><ul><li>Obtain informati...
A ssemble the Relevant Information <ul><ul><li>Consider the types of information needed ( Medical facts, Patient’s prefere...
S ynthesize the Information <ul><ul><li>Determine whether a formal meeting is needed </li></ul></ul><ul><ul><li>Engage in ...
E xplain the Synthesis <ul><ul><li>Communicate the synthesis to key participant </li></ul></ul><ul><ul><li>Provide additio...
S upport the Consultation Process <ul><ul><li>Follow up with decisions taken </li></ul></ul><ul><ul><li>Evaluate the outco...
Islamic Approach to Resolving Ethical Issues in Clinical Practice
<ul><ul><li>The principle of  Intention  (Qasd):  Each action is judged by the intention behind it </li></ul></ul><ul><ul>...
<ul><ul><li>Is there a previous Fatwa on the issue? </li></ul></ul><ul><ul><li>Is there a text on the issue from Koran and...
Cases for discussion & Group Work
The case of Dax Cowart <ul><ul><li>Dax Cowart, was very badly burned and sustained a long, painful treatment and rehabilit...
The case of Dax Cowart...cont’d <ul><ul><li>Later, Dax revised his earlier assessment as he gradually overcame depression....
Exercise  <ul><ul><li>Analysize Mr. “Dax” Case according to  </li></ul></ul><ul><ul><ul><li>Group A: the 4 boxes model </l...
Thank You To contact me: Office:  (+966)-(1)-2889999 Ext. 7588 Email:  [email_address]   Personal: 00966566511653 – email:...
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Introduction To Medical Ethics (University of Tabuk)

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Introduction to Medical Ethics Course in Faculty of Medicine, University of Tabuk

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Introduction To Medical Ethics (University of Tabuk)

  1. 1. Introduction to Medical Ethics Overview; Definitions &Concepts of ethics & bioethics; Western approach to ethics; Islamic approach; Tools & Frameworks Tabuk FOM, medical students (Feb. 28, 2011) Dr. Ghaiath M. A. Hussein Asst. Prof., Dept. of Medical Ethics King Fahad Medical City – Faculty of Medicine King Saud Bin Abdul-Aziz University for Health Sciences Email: [email_address] Office : 01-2889999 Ext.7588, Mob .: 0566511653
  2. 2. What we will try to learn today? <ul><ul><li>Section I: Definitions & Concepts </li></ul></ul><ul><ul><ul><li>What is ethics? </li></ul></ul></ul><ul><ul><ul><li>What is bioethics? </li></ul></ul></ul><ul><ul><ul><li>What is medical ethics? </li></ul></ul></ul><ul><ul><ul><li>Development of medical ethics </li></ul></ul></ul><ul><ul><li>Western approaches to ethics </li></ul></ul><ul><ul><li>Islamic approaches to ethics </li></ul></ul><ul><ul><li>Tools and Frameworks to resolve ethical issues in healthcare </li></ul></ul>
  3. 3. Section I: Overviewof ethics & bioethics
  4. 4. Which one would you drink?
  5. 5. Less embarrassing choices… <ul><ul><li>I need to pass the exam..cheat or not? </li></ul></ul><ul><ul><li>I need the organs of this dying patient... Let him die fast? </li></ul></ul><ul><ul><li>I need the money of this Pharma company... Shall I change the results of my research on their drug? </li></ul></ul>
  6. 6. Levels of moral response <ul><ul><li>The expressive level (unanalyzed expressions or feeling that, by themselves, don’t provide reasons or justification) </li></ul></ul><ul><ul><li>The pre-reflective level (justification via law, religious tenets, social values, codes of ethics, etc.; accepted uncritically) </li></ul></ul><ul><ul><li>The reflective level (reasoned ethical argument/defense based on ethical principles, rules, virtues, values to which we consciously subscribe; justification provided) </li></ul></ul><ul><li>Thomas J and Waluchow W, 1998 </li></ul>
  7. 7. Ethics Ghaiath <ul><ul><li>explicit critical reflection on moral beliefs, practices and problems </li></ul></ul><ul><ul><li>philosophical study of morality </li></ul></ul><ul><li>This is at the reflective level… </li></ul><ul><li>(contrast with “descriptive ethics”) </li></ul>
  8. 8. What do you think?
  9. 9. The Fact-Value Distinction Ghaiath <ul><ul><li>Fact: description of the way the world is; an actual state of affairs (“is”) </li></ul></ul><ul><ul><li>Value: judgment about the way things should be (“ought”) </li></ul></ul><ul><ul><ul><li>no “ought” can be deduced from an “is” </li></ul></ul></ul>
  10. 10. Ethical reasoning <ul><li>Values and ethical principles </li></ul><ul><ul><li>Value = something a person/community has identified as important (e.g., autonomy/self-determination) </li></ul></ul><ul><ul><li>Values by themselves don't tell us what we ought to do </li></ul></ul><ul><ul><li>Key values in bioethics have corresponding ethical principles meant to guide action (e.g., principle of respect for autonomy) </li></ul></ul>
  11. 11. Section II: Definitions & Concepts What is ethics? What are the branches of ethics? What is bioethics? What is medical/clinical ethics? What is an ethical issue?
  12. 12. What is ethics? <ul><ul><li>A system of moral principles or standards governing conduct. </li></ul></ul><ul><ul><li>a system of principles by which human actions and proposals may be judged good or bad, right or wrong; </li></ul></ul><ul><ul><li>A set of rules or a standard governing the conduct of a particular class of human action or profession; </li></ul></ul><ul><ul><li>Any set of moral principles or values recognized by a particular religion, belief or philosophy; </li></ul></ul><ul><ul><li>The principles of right conduct of an individual. (UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4) </li></ul></ul>
  13. 13. What is bioethics? <ul><ul><li>It is derived from Greek bio - life and ethicos moral. </li></ul></ul><ul><ul><li>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. </li></ul></ul>
  14. 14. <ul><ul><li>Give example of an ethical issue/problem you faced or witnessed, mentioning the following: </li></ul></ul><ul><ul><ul><li>What was the situation? </li></ul></ul></ul><ul><ul><ul><li>What was your feeling towards it? </li></ul></ul></ul><ul><ul><ul><li>What did you do? </li></ul></ul></ul><ul><ul><ul><li>Do you think you did the best thing? why? </li></ul></ul></ul><ul><ul><ul><li>What you think you need to know more to be able to handle similar situations in the future? </li></ul></ul></ul>
  15. 15. Questions answered by Bioethics <ul><ul><ul><li>deciding what we should do (what decisions are morally right or acceptable); </li></ul></ul></ul><ul><ul><ul><li>explaining why we should do it (how do we justify our decision in moral terms); and </li></ul></ul></ul><ul><ul><ul><li>describing how we should do it (the method or manner of our response when we act on our decision). </li></ul></ul></ul>
  16. 16. What is clinical/medical ethics? <ul><ul><li>Clinical ethics is a practical discipline that provides a structured approach to assist physicians in identifying, analyzing and resolving ethical issues in clinical medicine. </li></ul></ul><ul><ul><li>The practice of good clinical medicine requires some working knowledge about ethical issues such as informed consent, truth-telling, confidentiality, end-of-life care, pain relief, and patient rights </li></ul></ul>
  17. 18. What is an “ethical issue” or a “moral problem”? <ul><ul><li>There is an ethical issue when: </li></ul></ul><ul><ul><ul><li>… we encounter conflicting values , beliefs, goals, or responsibilities </li></ul></ul></ul><ul><ul><ul><li>… we are concerned that persons or their rights are not being respected </li></ul></ul></ul><ul><ul><ul><li>… we are concerned about fairness and justice </li></ul></ul></ul><ul><ul><ul><li>… we are unsure what we should do or why we should do it, morally speaking </li></ul></ul></ul>
  18. 19. Domains of Ethics in Health Care <ul><ul><li>Shared decision making with patients </li></ul></ul><ul><ul><li>Ethical practices in end-of-life care </li></ul></ul><ul><ul><li>Patient privacy and confidentiality </li></ul></ul><ul><ul><li>Professionalism in patient care </li></ul></ul><ul><ul><li>Ethical practices in resource allocation </li></ul></ul><ul><ul><li>Ethical practices in management </li></ul></ul><ul><ul><li>Ethical practices in research </li></ul></ul><ul><ul><li>Ethical practices in the everyday workplace </li></ul></ul>
  19. 20. What else could it be? <ul><ul><li>Miscommunication stands for 70-80% of problems in healthcare </li></ul></ul><ul><ul><ul><li>E.g. Doctors don’t know to tell medical info </li></ul></ul></ul><ul><ul><li>Management issue </li></ul></ul><ul><ul><ul><li>“ when shall I get promoted? All my colleagues did. This is not ethical!” </li></ul></ul></ul><ul><ul><li>Financial issue </li></ul></ul><ul><ul><ul><li>“ I am underpaid for my workload. This is not ethical!” </li></ul></ul></ul>
  20. 21. Section III: Western approach to ethics and ethical reasoning How right and wrong are distinguished?
  21. 22. Ethical justification <ul><li>In ethics, the support/reasons ultimately come from moral values, principles and theories: </li></ul><ul><ul><li>“ I think we should do X because A and B are really important values” </li></ul></ul><ul><ul><li>“ Y wouldn’t be appropriate because it violates principles A and B” </li></ul></ul><ul><ul><li>“ X would be the right thing to do because of our obligation to do A” </li></ul></ul>Jonathan Breslin, 2006
  22. 23. Ethical theories and principles as lenses “ Doing bioethics well requires appeal to the insights provided by multiple theories… the metaphor of lenses provides a more accurate and a more productive understanding of the role of theories in bioethics…” (Sherwin, The Politics of Women’s Health , 205).
  23. 24. Why do we need to know about western philosophies? <ul><ul><li>A Doctor is an international currency (you may be practicing anywhere) </li></ul></ul><ul><ul><li>Bridging the knowledge & cultural gaps </li></ul></ul><ul><ul><li>Western literature & experience are steps ahead of ours </li></ul></ul><ul><ul><li>Ethical concepts & tools are quite universal </li></ul></ul><ul><ul><li>No self-development with knowing others </li></ul></ul><ul><ul><li>To call for Allah on guidance الدعوة إلى الله تعالى </li></ul></ul>
  24. 25. General characteristics of western philosophies <ul><ul><li>Secularism: people are free to practice their religion but no particular religious guidance to right & wrong </li></ul></ul><ul><ul><li>Individualism: It’s all about I, me and myself! </li></ul></ul><ul><ul><ul><li>The individual and nuclear family structure are the societal builidng block. </li></ul></ul></ul><ul><ul><ul><li>The indivdual’s interest is what should come first (vs. more collective extended family ethics in our region) </li></ul></ul></ul>
  25. 26. <ul><ul><li>Utilitarianism: 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. </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  26. 29. <ul><ul><li>Principlism: </li></ul></ul><ul><ul><ul><li>Autonomy: respect humans' ability to choose, </li></ul></ul></ul><ul><ul><ul><li>Beneficence: Do Good for others, </li></ul></ul></ul><ul><ul><ul><li>Nonmaleficence (Do No Harm), & </li></ul></ul></ul><ul><ul><ul><li>Justice </li></ul></ul></ul>
  27. 30. Other philosophies... <ul><ul><li>Taxonomy of ethics </li></ul></ul>Other philosophies Abrahamic Philosophies Oriental philosophies African, Asian, etc. Islamic Buddhist <ul><ul><li>Human Rights </li></ul></ul>Jewish <ul><ul><li>Conficious </li></ul></ul><ul><ul><li>Catholic </li></ul></ul>Indian Protestant Persian <ul><ul><li>Jehovah Witnesses </li></ul></ul>
  28. 31. Section IV: Islamic approach to ethical analysis and decision making
  29. 32. Ethics in Islam… not a separate entity!
  30. 33. How should Muslims decide their acts? <ul><ul><li>And I (Allâh) created not the jinn and mankind except that they should worship Me (Alone). وَمَا خَلَقْتُ الْجِنَّ وَالإِنْسَ إِلا لِيَعْبُدُونِ ( الذاريات 56 ) </li></ul></ul><ul><ul><li>Worship in Islam includes: </li></ul></ul><ul><ul><ul><li>To follow the orders of Allah and His Prophet Mohamed (PBUH) </li></ul></ul></ul><ul><ul><ul><li>“ 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) </li></ul></ul></ul>
  31. 36. <ul><ul><li>It is the methodology of </li></ul></ul><ul><ul><ul><li>defining, analysing and resolving the ethical issues that arise in healthcare practice, or research; </li></ul></ul></ul><ul><ul><ul><li>based on the Islamic moral and legislative sources (Koran, Sunna & Ijtihad); and </li></ul></ul></ul><ul><ul><ul><li>aims at achieving the goals of Islamic morality (i.e. preservation of human’s religion, soul, mind, wealth & progeny ) </li></ul></ul></ul>
  32. 37. <ul><ul><li>Clear and fixed sources </li></ul></ul><ul><ul><li>Clear goals of morality (Maqasid Alshariya) </li></ul></ul><ul><ul><li>Its moral style endorses values of: </li></ul></ul><ul><ul><ul><li>Bringing hope ( بشروا ولا تنفروا ) </li></ul></ul></ul><ul><ul><ul><li>Softness ( فقولا له قولا لينا ) </li></ul></ul></ul><ul><ul><ul><li>Kindness ( ما كان الرفق في شيء الا زانه ) </li></ul></ul></ul><ul><ul><ul><li>Respect for vulnerable ( رفقا بالقوارير ) ( ليس منا من لم يوقر كبيرنا ويرحم صغيرنا ) </li></ul></ul></ul>
  33. 38. <ul><ul><li>The principle of Intention (Qasd): Each action is judged by the intention behind it </li></ul></ul><ul><ul><li>The principle of Certainty (Yaqeen): Certainty can not be removed by doubt </li></ul></ul><ul><ul><li>The principle of Injury/Harm (Dharar): </li></ul></ul><ul><ul><ul><li>Injury should be relieved; An individual should not harm others or be harmed by others </li></ul></ul></ul><ul><ul><ul><li>- An injury is not relieved by inflicting or causing a harm of the same degree </li></ul></ul></ul><ul><ul><ul><li>- Prevention of harm has priority over pursuit of a benefit of equal worth </li></ul></ul></ul><ul><ul><ul><li>- the lesser harm is committed </li></ul></ul></ul>
  34. 39. <ul><li>4. The principle of Hardship (Mashaqqat): Difficulty calls forth ease, Necessity (Dharuraat) legalizes the prohibited </li></ul><ul><li>5. The principle of - Custom or precedent (Urf): </li></ul><ul><ul><li>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. </li></ul></ul>
  35. 40. Section V: Tools & Frameworks
  36. 42. Box 1: Medical Indications <ul><ul><li>Medical Indications are those facts about the patient's physiological or psychological condition that indicate which forms of diagnostic, therapeutic, or educational interventions are appropriate. </li></ul></ul><ul><ul><li>Is the Problem Acute? Chronic? Critical? Reversible? Emergent? Terminal? </li></ul></ul><ul><ul><li>What Are the Goals of Treatment? </li></ul></ul><ul><ul><li>InWhat Circumstances Are Medical Treatments Not Indicated? </li></ul></ul><ul><ul><li>What Are the Probabilities of Success of Various Treatment Options? </li></ul></ul><ul><ul><li>How Can This Patient Be Benefited by Medical and Nursing Care, and How Can Harm Be Avoided? </li></ul></ul>
  37. 43. Box 2: preferences of patients <ul><ul><li>The choices that persons make when they are faced with decisions about thier health and medical treatment. </li></ul></ul><ul><ul><li>Ethical issues included:1)respect for the autonomy of the patient; (2) the legal, clinical, and psychological significance of patient preferences; (3) informed consent; (4) decisional capacity; (5) truth telling; (6) cultural and religious beliefs; (7) refusal of treatment; (8) advance directives; (9) surrogate decisions; (10) the challenging patient; and (11) alternative medicine. </li></ul></ul>
  38. 44. Box 3: Quality of life <ul><ul><li>refers to that degree of satisfaction that people experience and value about their lives as a whole, and in its particular aspects, such as physical health. </li></ul></ul><ul><ul><li>The main ethical principles involved are: Beneficence & Autonomy </li></ul></ul>
  39. 45. Box 3: Quality of life...cont’d <ul><ul><li>Relevant ethical questions </li></ul></ul><ul><ul><li>What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds? </li></ul></ul><ul><ul><li>Are there biases that might prejudice the provider's evaluation of the patient's quality of life? </li></ul></ul><ul><ul><li>What ethical issues arise concerning improving or enhancing a patient's quality of life? </li></ul></ul><ul><ul><li>Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment? </li></ul></ul><ul><ul><li>What are the plans and rationale to forgo life-sustaining treatment? </li></ul></ul>
  40. 46. Box 4: Contextual Features <ul><ul><li>It addresses the ways in which professional, familial, religious, financial, legal, and institutional factors influence clinical decisions </li></ul></ul><ul><ul><li>Involved ethical principles are: beneficence, respect for autonomy and justice </li></ul></ul><ul><ul><li>Justice refers to those moral and social theories that attempt to distribute the benefits and burdens of a social system in a fair and equitable way among all participants in the system . </li></ul></ul>
  41. 47. CASES Approach
  42. 48. The CASES Approach <ul><ul><li>The CASES approach was developed by the National Center for Ethics in Health Care </li></ul></ul><ul><ul><li>C larify the facts & requirements </li></ul></ul><ul><ul><li>A ssemble the relevant information </li></ul></ul><ul><ul><li>S ynthesize the information </li></ul></ul><ul><ul><li>E xplain the synthesis </li></ul></ul><ul><ul><li>S upport the ethical decision making process </li></ul></ul>
  43. 49. C larify the facts & requirements <ul><ul><li>Characterize the type of problem </li></ul></ul><ul><ul><li>Obtain information about the case </li></ul></ul><ul><ul><li>Establish the goal from the ethical analysis (consultation process) </li></ul></ul><ul><ul><li>Formulate the ethics question </li></ul></ul><ul><ul><ul><li>Given [uncertainty or conflict about values], what decisions or actions are ethically justifiable? or </li></ul></ul></ul><ul><ul><ul><li>Given [uncertainty or conflict about values], is it ethically justifiable to [decision or action]? </li></ul></ul></ul>
  44. 50. A ssemble the Relevant Information <ul><ul><li>Consider the types of information needed ( Medical facts, Patient’s preferences, QOL, Contextual features) </li></ul></ul><ul><ul><li>Identify the appropriate sources of information </li></ul></ul><ul><ul><li>Gather information systematically from each source </li></ul></ul><ul><ul><li>Summarize the information and the ethics question </li></ul></ul>
  45. 51. S ynthesize the Information <ul><ul><li>Determine whether a formal meeting is needed </li></ul></ul><ul><ul><li>Engage in ethical analysis </li></ul></ul><ul><ul><li>Identify the ethically appropriate decision maker() </li></ul></ul><ul><ul><li>Facilitate moral deliberation about ethically justifiable options </li></ul></ul>
  46. 52. E xplain the Synthesis <ul><ul><li>Communicate the synthesis to key participant </li></ul></ul><ul><ul><li>Provide additional resources </li></ul></ul><ul><ul><li>Document the consultation in the health record </li></ul></ul><ul><ul><li>Document the consultation in consultation service records </li></ul></ul>
  47. 53. S upport the Consultation Process <ul><ul><li>Follow up with decisions taken </li></ul></ul><ul><ul><li>Evaluate the outcome of the decision </li></ul></ul><ul><ul><li>Adjust the consultation process </li></ul></ul><ul><ul><li>Identify underlying systems issues </li></ul></ul>
  48. 54. Islamic Approach to Resolving Ethical Issues in Clinical Practice
  49. 55. <ul><ul><li>The principle of Intention (Qasd): Each action is judged by the intention behind it </li></ul></ul><ul><ul><li>The principle of Certainty (Yaqeen): Certainty can not be removed by doubt </li></ul></ul><ul><ul><li>The principle of Injury/Harm (Dharar): </li></ul></ul><ul><ul><ul><li>Injury should be relieved; An individual should not harm others or be harmed by others </li></ul></ul></ul><ul><ul><ul><li>An injury is not relieved by inflicting or causing a harm of the same degree </li></ul></ul></ul><ul><ul><ul><li>Prevention of harm has priority over pursuit of a benefit of equal worth </li></ul></ul></ul><ul><ul><ul><li>The lesser harm is committed </li></ul></ul></ul><ul><ul><li>The principle of Hardship (Mashaqqat): Difficulty calls forth ease, Necessity (Dharuraat) legalizes the prohibited </li></ul></ul><ul><ul><li>The principle of - Custom or precedent (Urf): </li></ul></ul><ul><ul><li>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. </li></ul></ul>
  50. 56. <ul><ul><li>Is there a previous Fatwa on the issue? </li></ul></ul><ul><ul><li>Is there a text on the issue from Koran and/or Sunna, or secondary sources? </li></ul></ul><ul><ul><li>What are the medical/scientific facts? </li></ul></ul><ul><ul><li>What are the Sharia Goals involved? </li></ul></ul><ul><ul><li>What are applicable fiqhi principles? </li></ul></ul><ul><ul><li>Weighing of principles? </li></ul></ul><ul><ul><li>Applying the relevant secondary sources (matching the scripts to goals and principles) </li></ul></ul>
  51. 57. Cases for discussion & Group Work
  52. 58. The case of Dax Cowart <ul><ul><li>Dax Cowart, was very badly burned and sustained a long, painful treatment and rehabilitation. He believed that his disabilities caused by the explosion—blindness, disfigurement, and crippling—would make his life intolerable and not worth living. </li></ul></ul><ul><ul><li>He refused treatment and wished to die. </li></ul></ul><ul><ul><li>He personally assessed his future quality of life as not worth living. </li></ul></ul>
  53. 59. The case of Dax Cowart...cont’d <ul><ul><li>Later, Dax revised his earlier assessment as he gradually overcame depression. </li></ul></ul><ul><ul><li>He learned to appreciate mental activities, to enjoy social interaction, and to cope with his frustrations. </li></ul></ul><ul><ul><li>He became a lecturer about his own story and an advocate for patients' rights and personal autonomy. </li></ul></ul><ul><ul><li>He graduated from law school, passed the bar, and practiced law. </li></ul></ul><ul><ul><li>Confronting death: Who chooses? Who decides? A dialogue between Dax Cowart and Robert Burt. Hastings Cent Rep. 1998;28(1):14–28. </li></ul></ul>
  54. 60. Exercise <ul><ul><li>Analysize Mr. “Dax” Case according to </li></ul></ul><ul><ul><ul><li>Group A: the 4 boxes model </li></ul></ul></ul><ul><ul><ul><li>Group B: CASES approach </li></ul></ul></ul><ul><ul><ul><li>Group C: Islamic Approach </li></ul></ul></ul>
  55. 61. Thank You To contact me: Office: (+966)-(1)-2889999 Ext. 7588 Email: [email_address] Personal: 00966566511653 – email: [email_address] More Resources: http://med-ethics.com/ http://omarkasule.tripod.com/ http://www.islamset.com/ethics/index.html

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