King Saud bin Abdulaziz University for Health Sciences King Fahad Medical City Faculty of MedicineAsst. Prof., Dept. of Medical EthicsKing Fahad Medical City – Faculty of MedicineKing Saud Bin Abdul-Aziz University for Health Sciences
1 Definition of ethics, bioethics, and medical ethics2 What is an ethical issue in healthcare?3 International approaches to medical ethics4 Islamic approach to medical ethics
Less embarrassing choices… I need to pass the exam..cheat or not? I need the organs of this dying patient... Let him die fast? He’s dying anyway! I need the money of this Pharma company... Shall I change the results of my research on their drug? I need to be trained ...tell the patient you’re a doctor?
Levels of moral response The expressive level (unanalyzed expressions or feelings 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
Ethical/Moral reasoning It is the process we need to go through to reach a decision about an ethical issue. It helps us to differentiate: description of the way the world is; an actual state of affairs (“is”) judgment about the way things should be (“ought”). they are meant to guide actions. Key values in bioethics have corresponding (e.g., principle of respect for autonomy)
There is always a reason why people do things?Don’t judge things on what they first appear to you!
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)
Clinical Ethics Bioethic s Research ethics Resource Allocation ethics Business ethics Public HealthEthi Environmental ethics ethics cs Social ethics Nursing ethics Organizational other ethics IT ethics Other
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. 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
Questions answered by Bioethics deciding what we should do (what decisions are morally right or acceptable); Example: Should patient A or B have the ICU bed? explaining why we should do it (how do we justify our decision in moral terms); and Why did we decide to admit A & not B? describing how we should do it (the method or manner of our response when we act on our decision). What are we going to do for patient B?
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
Main Western Other Abrahamic OrientalPhilosophies philosophies Philosophies philosophiesUtilitarianism African, Asian, Islamic Buddhist etc.Deontology Human Jewish Confucius RightsFeminist ethics Catholic IndianCasuistryVirtue ethics Protestant PersianPrinciplism Jehovah Witnesses
Why do we need to know about western philosophies? A Doctor is an international currency (you may be practicing anywhere) Bridging the knowledge & cultural gaps Western literature & experience are steps ahead of ours Ethical concepts & tools are quite universal No self-development without knowing others To reflect Islamic concepts to non-Muslims in an appropriate manner
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. Examples: quarantine, isolation, vaccination, etc. Where does utilitarianism (dis)agrees with Islam? 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 Examples: Doctor’s duties to care for their patients Where does Duty-Based Ethics (dis)agrees with Islam?
It emphasizes the virtues, or moral character (who is your virtuous model?) Examples: Doctors as role models. Should not a patient comply with a “don’t smoke” advice from a smoking doctor?!
(cont.) (Ethics of Care) commitmentto correcting male biases (e.g. women’ssubordination is morally wrong) and that the moralexperience of women is as worthy of respect as thatof men. Where does feminisme (dis)agrees with Islam? The greatest confidence in ourmoral judgments resides not at the level of theory,where we endlessly disagree, but rather at the levelof the case, where our intuitions often convergewithout the benefit of theory. Where does Casuistry (dis)agrees with Islam?
Autonomy: respect humans ability to choose, Beneficence: Do Good for others, Nonmaleficence (Do No Harm), & Justice (Be fair to your patients) Where do these principles meet with Islam?
1)The Koran and 2) theSunna, Unanimous agreement of Islamic jurists (Ijmaa) Acceptance by the majority of trusted scholars (Rayul Jomhour) Measurement/Analogy (Qiyas), Remediation (Maslaha), (Istishab)
The are to preserve person’s:1. Religion;2. Soul;3. Mind;4. Wealth; &5. Progeny. All Islamic legislations came to achieve these goals.
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 )
1. The principle of Intention (Qasd): Each action is judged by the intention behind it2. The principle of Certainty (Yaqeen): Certainty can not be removed by doubt3. 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 prohibited5. 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.
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 you think you need to know more to be able to handle similar situations in the future?