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SCHS Topic1: Introduction to Medical Ethics

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OUTLINE:
Definition of ethics, bioethics and medical ethics.
What is an ethical issue in healthcare?
International approaches to medical ethics
Islamic approaches to medical ethics

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SCHS Topic1: Introduction to Medical Ethics

  1. 1. Asst. Prof., Dept. of Medical Ethics King Fahad Medical City – Faculty of Medicine King Saud Bin Abdul-Aziz University for Health Scien Dr. Ghaiath M. A. Hussein Professionalism and Ethics Education for Residents (PEER) Introduction to Medical Ethics
  2. 2. OUTLINE  Definition of ethics, bioethics and medical ethics.  What is an ethical issue in healthcare?  International approaches to medical ethics  Islamic approaches to medical ethics
  3. 3. Which one would you drink? Saudi Commission for Health Specialties
  4. 4. 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 Pharmaceutical company. Shall I change the results of my research on their drug? • I need to be trained ...tell the patient you’re a specialist? Ethics is about making choices… Usually hard ones !
  5. 5. What do you think? Saudi Commission for Health Specialties
  6. 6. 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
  7. 7. Values and ethical principles • It is the process we need to go through to reach a decision about an ethical issue. • It helps us to differentiate: – Facts: description of the way the world is; an actual state of affairs (“is”) – Values: judgment about the way things should be (“ought”). – Ethical Principles: they are meant to guide actions. Key values in bioethics have corresponding (e.g., principle of respect for autonomy) Ethical/Moral Reasoning
  8. 8. 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?
  9. 9. 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)
  10. 10. 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.
  11. 11. 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).
  12. 12. 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
  13. 13. 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.
  14. 14. 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
  15. 15. How Right and Wrong are Distinguished?
  16. 16. Main Western Philosophies Other philosophies Abrahamic Philosophies Oriental philosophies Utilitarianism African, Asian, etc. Islamic Buddhist Deontology Human Rights Jewish Confucius Feminist ethics Catholic Indian Casuistry Virtue ethics Protestant Persian Principlism Jehovah Witnesses Taxonomy of Ethics Christian Ethics
  17. 17. Why do we Need to Know about Western Philosophies?  A Doctor is an international currency (you may be practicing anywhere)  Bridging the knowledge and cultural gaps  Western literature and experience are steps ahead of ours  Ethical concepts and tools are quite universal  No self-development with knowing others  To reflect Islamic concepts to non-Muslims in an appropriate manner
  18. 18.  Utilitarianism: 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 School of Thoughts in Moral Reasoning
  19. 19.  Feminist Ethic: (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. School of Thoughts in Moral Reasoning cont...
  20. 20. • Virtue Ethics: It emphasizes the virtues, or moral character • Should not a patient comply with a “don’t smoke” advice from a smoking doctor?! School of Thoughts in Moral Reasoning cont...
  21. 21. Principlism  Autonomy: respect humans' ability to choose,  Beneficence: Do Good for others,  Nonmaleficence (Do No Harm), &  Justice Saudi Commission for Health Specialties School of Thoughts in Moral Reasoning cont...
  22. 22. Islamic Bioethics
  23. 23. Main Sources 1) The Koran 2) The Sunna Secondary Sources 1) Unanimous agreement of Islamic jurists (Ijmaa) 2) Acceptance by the majority of trusted scholars (Rayul Jomhour) 3) Measurement/Analogy (Qiyas) 4) Remediation (Maslaha), (Istishab) Sources of Islamic Morality
  24. 24. The five purposes of Sharia are to preserve person’s: 1. Religion 2. Soul 3. Mind 4. Wealth and 5. Progeny All Islamic legislations came to achieve these goals. Goals of Islamic Regulations
  25. 25. 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 ) Saudi Commission for Health Specialties
  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 Islamic Principles and Maxims Applicable in Medicine
  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. Islamic Principles and Maxims Applicable in Medicine cont...
  28. 28. 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 do you think you need to know more about to be able to handle similar situations in the future? Saudi Commission for Health Specialties Cases and Group Discussion
  29. 29. More Resources • http://med-ethics.com/ • http://omarkasule.tripod.com/ • http://www.islamset.com/ethics/index.html Saudi Commission for Health Specialties
  30. 30. THANK YOU

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