The document discusses the principle of autonomy in medical ethics. It states that autonomy focuses on a patient's independence and right to make their own medical decisions if they are mentally competent. A key part of autonomy is that patients must be able to make decisions freely without manipulation or coercion. The document also discusses how autonomy has become a more important principle as social values have shifted to prioritize patient outcomes and preferences over those of medical professionals alone.

1. Autonomy

2. Principle of medical ethics
• 1: Autonomy: (person can lives with the
consequences of his decision) ‫الذاتي‬ ‫الحكم‬
.
• It focused on the patient's independence or
liberty. A competent adult has the right to make
decisions about what happens to his body. The
person must be capable of rational thought and
not be manipulated or coerced into any decision.
An adult can refuse medical care or treatment or
accept treatment when his provider suggests it.

3. • 2: Beneficence: providers must help their
patients.
• This principle states that a physician must act
in the best interest of the patient. Providers
are required to promote their patient's health
and well-being. Most doctors agree that
healing is the main purpose of modern
medicine.

4. • 3: Nonmaleficence: ) First do no harm.
• Physicians must not harm a patient through
carelessness, malice ‫الخبث‬
, vengeance ‫االنتقام‬
,
or dislike, or even through treatments
intended to help the patient.

5. • This principle is balanced with beneficence in
that any risks of a treatment or procedure to a
patient must be outweighed by benefit. Some
treatments always carry a risk of harm. But
when the treatment is very risky, the benefit
must be great, or the risk of not performing
the procedure must be great.

6. • 4: Justice: Justice refers to fairness with
respect to the distribution of medical
resources. This principle draws upon ethics,
the law, and public policy. Who should receive
scarce ‫النادره‬medical resources, and how
should we distribute them in order to realize
the best outcomes? Making the system as a
whole more fair is one of the goals of justice.

7. • The principle of autonomy recognizes the rights
of individuals to self-determination ‫تقريرالمصير‬
. This
is rooted in society's respect for individuals'
ability to make informed decisions about
personal matters.
• Autonomy has become more important as social
values have shifted to define medical quality in
terms of outcomes that are important to the
patient rather than medical professionals.

8. • The increasing importance of autonomy can
be seen as a social reaction to a "paternalistic"
tradition within healthcare

9. • Autonomy is a general indicator of health.
Many diseases are characterised by loss of
autonomy, in various manners. This makes
autonomy an indicator for both personal well-
being, and for the well-being of the
profession.

10. • This has implications for the consideration of
medical ethics: "is the aim of health care to do
good, and benefit from it?"; ??????????? or
"do good to others, and have them, and
society, benefit from this?".
• (Ethics - by definition - tries to find a beneficial
balance between the activities of the
individual and its effects on a collective.)

11. How should doctors go about breaking
bad news?
• 1. In a private place.
• 2. To both parents together
• 3. As soon as possible.
• 4. In clear and appropriate language,
with supplementary written material
when possible.
• 5. In an empathic and non-judgmental
manner.

12. • 6. With time for parents to ask questions.
• 7. With a follow up consultation made for
soon after (parents take in little of the
information given after they hear the initial
news).
• 8. Use appropriate language (“intellectual
disability” instead of “mental retardation”)

13. 9. What are the main issues the doctor
should discuss with the parents about
Down’s syndrome?
• The intellectual disability inherent in the
diagnosis should be carefully explained in
particular the uncertainty about the
degree of severity might have.
In addition to mental subnormality,
delayed developmental milestones

14. • and probable lifespan (particularly in view of
the presence of congenital heart problems)
should also be discussed.
• He should also offer them some hope and
address the importance of achieving some
sort of balance as well as remind the parents
that this little boy could also bring great joy to
their lives.

15. • 10. Open discussion about the reactions of the
parents to the news of disability.
• shock and emotions that form part of the grief
reaction. Denial, anger, blame, shame, guilt
and a profound sadness.
• In many cultures there are gender differences
in the reaction (Women may cry, men may
express through anger or distancing
themselves from the situation).