Lecture2 introduction-to-medical-ethics(29.09.16)

Dr. Ghaiath M. A. Hussein
Asst. Prof. (Bioethics)
Alfarabi College of Medicine, (29.09.2016)

What we will try to learn today?
•Section I: Definitions & Concepts
•What is morality?
•What is ethics?
•What is bioethics?
•What is medical ethics?
•Section II: Western approaches to medical
ethics
•Section III: Islamic approaches to medical
ethics
http://ghaiathme.wixsite.com/mep-course

Why do we do what we do?

Which one would you drink?

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 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?

What do you think?

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

Ethical reasoning
Values and ethical principles
The Fact-Value Distinction
• Fact: description of the way the world is; an actual
state of affairs (“is”)
• Value: judgment about the way things should be
(“ought”)
▫ no “ought” can be deduced from an “is”
• Value = something a person/community has identified
as important (e.g., autonomy/self-determination)
• Values by themselves don't tell us what we ought to do
• Key values in bioethics have corresponding ethical
principles meant to guide action (e.g., principle of
respect for autonomy)

What is ethics?
What is bioethics?
What is medical/clinical ethics?
What is an ethical issue?

Ethics
•explicit critical reflection on moral
beliefs, practices and problems
•philosophical study of morality
This is at the reflective level…
(contrast with “descriptive ethics”)

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.

Ethics
Bioethics
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?
•Clinical ethics is a practical discipline that provides
a structured approach to assist physicians in
identifying, analyzing and resolving ethical issues in
clinical medicine.
•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

•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?

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 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

How right and wrong are distinguished?

Ethical justification
In ethics, the support/reasons ultimately come from
moral values, principles and theories:
• “I think we should do X because A and B are really
important values”
• “Y wouldn’t be appropriate because it violates
principles A and B”
• “X would be the right thing to do because of our
obligation to do A”
Jonathan Breslin, 2006

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 with knowing others
•To call for Allah on guidance ‫تعالى‬ ‫هللا‬ ‫إلى‬ ‫الدعوة‬

General characteristics of western
philosophies
•Secularism: people are free to practice
their religion but no particular religious
guidance to right & wrong
•Individualism: It’s all about I, me and
myself!
•The individual and nuclear family structure are
the societal building block.
•The individual's interest is what should come
first (vs. more collective extended family
ethics in our region)

Schools of thought in moral reasoning
 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.
 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

(cont.)
 Feminist ethics (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.http://ghaiathme.wixsite.com/mep-course

(cont.)
 Virtue ethics: It emphasizes the virtues, or
moral character
 A patient should not comply with a “don’t smoke”
advice from a smoking doctor?

(cont.)
 Principlism:
 Autonomy: respect humans'
ability to choose,
 Beneficence: Do Good for others,
 Nonmaleficence (Do No Harm), &
 Justice

Other philosophies...
• Taxonomy of ethics
Other philosophies Abrahamic Philosophies Oriental philosophies
African, Asian, etc. Islamic Buddhist
Human Rights Jewish Conficious
Catholic Indian
Protestant Persian
Jehovah Witnesses

Section IV:
Islamic approach to ethical analysis and
decision making

Ethics in Islam… not a separate entity!

How should Muslims decide their acts?
 And I (Allâh) created not the jinn and mankind except
that they should worship Me (Alone). َّ‫ن‬ ِ‫ج‬ْ‫ال‬ ُ‫ت‬ْ‫ق‬َ‫ل‬َ‫خ‬ ‫ا‬َ‫م‬ َ‫و‬
ِ‫ُون‬‫د‬ُ‫ب‬ْ‫ع‬َ‫ي‬ِ‫ل‬ ‫ال‬ِ‫إ‬ َ‫س‬ْ‫ن‬ِ‫اإل‬ َ‫و‬(‫الذاريات‬56)
 Worship in Islam includes:
 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)

1)The Koran and 2) the Sunna,
• Ijmaa means a unanimous agreement among Muslim Scolars on any Shariah ruling
• Qiyas refers to likening a new case in question without textual evidence to an original
ruling which is supported by explicit legal text which shares the same cause.
• Maslahah means deciding a ruling based on the principle of general public interest in
issues which do not have clear and specific ruling from text of either Al-Quran or Al-
Sunnah.
• Istihsan refers to setting aside an established ruling backed by dalil (evidence) on a
matter in favor of an alternative ruling which is stronger and more convincing than the
first ruling, based on the support by dalil.
• Istishab refers to the presumption of continuity of the original ruling as long as there
is no other dalil to establish the contrary.10
• Sadd Zari`ah signifies an approach used to prevent any means to evil in order to avoid
from forbidden acts. It is regarded as an early preventive measure to keep away a
Muslim from committing actions prohibited by Allah SWT.
• `urf is defined as established norms and common to the majority of people in a
community either in the form of sayings or doings as long as it does not contradict the
Shariah ruling.

 The are to preserve person’s:
1. Religion;
2. Soul;
3. Mind;
4. Wealth; &
5. Progeny.
All Islamic legislations came to achieve these goals.

• 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 )

• Clear and fixed sources
• Clear goals of morality (Maqasid Alshariya)
• Its moral style endorses values of:
▫ Bringing hope (‫تنفروا‬ ‫وال‬ ‫بشروا‬)
▫ Softness (‫لينا‬ ‫قوال‬ ‫له‬ ‫فقوال‬)
▫ Kindness (‫زانه‬ ‫اال‬ ‫شيء‬ ‫في‬ ‫الرفق‬ ‫كان‬ ‫ما‬)
▫ Respect for vulnerable (‫بالقوارير‬ ‫رفقا‬( )‫يوقر‬ ‫لم‬ ‫من‬ ‫منا‬ ‫ليس‬
‫صغيرنا‬ ‫ويرحم‬ ‫كبيرنا‬)

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

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.

Lecture2 introduction-to-medical-ethics(29.09.16)

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