This document discusses medical ethics and legal medicine. It begins by defining ethics, morality, values, and their relationship. It then discusses the principles of medical ethics including autonomy, beneficence, confidentiality, non-maleficence, and justice. The document reviews several important historical documents in medical ethics like the Hippocratic Oath, Nuremberg Code, Declaration of Geneva, and others. It also outlines the duties and responsibilities of physicians to their patients, colleagues, and the public. The document provides definitions for health from the World Health Organization.

1. MEDICAL ETHICS
AND
LEGAL MEDICINE
Dr. Rami Abo Ali
Medical
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Dr.
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3. INTRODUCTION
 Ethics is concerned with moral principles, values and
standards of conduct.(WHO)
 Ethics is the study of morality – careful and systematic
reflection on and analysis of moral decisions and
behavior.
 Morality is the value dimension of human decision-
making and behavior.
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4. VALUES, MORALS, ETHICS
 Value
 signify what is important and worthwhile. They serve as a basis for
moral codes and ethical reflection.
 someone who values friendship drops everything to help a friend
 Morals
 are codes of conduct governing behavior. They are values put into
practice as actions.
 Helping a friend is a good thing to do (based on a value of friendship)
 Ethics
 provide a systematic, rational way to work through dilemmas and to
determine the best course of action in the face of conflicting choices.
 A student who helps another student cheat on a test is breaking their school's
ethics. Even though they are doing it for a moral reason (helping a friend),
they are committing an ethical violation and can be punished.
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5. WHAT IS ETHICS?
 The Greek word ēthikós (Ethos)means action, character.
 The Latin word mos (morals) means habit or custom.
 In simple words, Ethics is a set of philosophical beliefs
and practices concerned with the distinction between
right and wrong.
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6. WHAT IS ETHICS?
 Ethics is a very large and complex field of study with
many branches or subdivisions.
 Ethics is concerned with what is good for individuals and
society and is also described as moral philosophy
 Ethics covers the following dilemmas:
 how to live a good life
 our rights and responsibilities
 the language of right and wrong
 moral decisions - what is good and bad?
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7. WHAT IS MEDICAL ETHICS?
 Medical Ethics is the branch of ethics that deals with
moral issues in medical practice.
 Medical ethics is closely related, but not identical to,
bioethics (biomedical ethics)
 Whereas medical ethics focuses primarily on issues
arising out of the practice of medicine, bioethics is a
very broad subject that is concerned with the moral
issues raised by developments in the biological sciences
more generally.
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8. MEDICAL ETIQUETTE:
 The conventional laws, customs of courtesy and the
code of conduct governing the relationship of the
physician with his professional colleagues.
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9. IMPORTANCE OF MEDICAL ETHICS
 In recent times medical ethics has been greatly
influenced by developments in human rights.
 Physicians frequently have to deal with medical
problems resulting from violations of human rights, such
as forced migration and torture.
 Health care decisions are based not only on clinical and
technical grounds, but also on ethical grounds.
Although we carefully weigh the clinical and technical
aspects, ethical issues involved may be overlooked.
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10. IMPORTANCE OF MEDICAL ETHICS
 Ethical principles such as respect for persons, informed
consent and confidentiality are basic to the physician-
patient relationship.
 Application of these principles in specific situations is
often problematic , since physicians, patients, their
family members and other healthcare personnel may
disagree about what is the right way to act in a situation.
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11. IMPORTANCE OF MEDICAL ETHICS
The study of ethics prepares medical professionals to
recognize difficult situations and to deal with them in a
rational and principled manner.
Ethics is also important in physicians’ interactions with
society and their colleagues and for the conduct of
medical research.
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12. PRINCIPLES OF MEDICAL ETHICS
1) Autonomy
2) Beneficence
3) Confidentiality
4) Do no harm/ Non-maleficence
5) Equity or Justice
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13. 1- AUTONOMY
Patient autonomy refers to the patient’s right to
make decisions for themselves according to their
own system of morals and beliefs .
 Patient education and informed consent are
important elements of proper autonomy .
 Confidentiality loosely fits under the umbrella of
autonomy
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14. WHEN THE AUTONOMY CHALLENGED ?
1. Incompetence : patient is legally deemed unable to
make rational decision for themselves often due to
permanent conditions such as dementia . Assigned a
surrogate by the court .
2. Incapacity : patient is clinically determined to be
unable to make a rational decision for themselves .
Maybe due to transient conditions such as lack of
consciousness , delirium , psychosis , etc.
3. Threat to self or others : usually in psychiatric settings
.
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15.  Paternalism :
 Is the practice of making decisions for the patient
without seeking their input .
 It is when the doctor interferes with the patient's ability
to make a choice regarding their healthcare. This can
take many forms on a spectrum of intensity
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16. 2- BENEFICENCE
 Is the value in which the provider takes action or
recommends courses that are in the patient’s best
interest .
 It is not coercing or manipulating the patient into
making decision against their value , even though it may
objectively be the best decision for their health .
 Keep the individual patient in mind – beneficence is not
the same in all situations.
 When the patient autonomy is compromised ( e.g.,
incapacity ) beneficence must be the guiding ethics
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17. 3- CONFIDENTIALITY
 Based on loyalty and trust.
 Maintain the confidentiality of all personal, medical and
treatment information.
 Information to be revealed for the benefit of the patient
and when ethically and legally required.
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18. 4- DO NO HARM/ NON-MALEFICENCE
 “Above all, do no harm”
 Make sure that the procedure does not harm the patient
or others in society.
 When interventions undertaken by physicians create a
positive outcome while also potentially doing harm it is
known as the "double effect."
 Eg,. the use of morphine in the dying patient. eases pain
and suffering while hastening the demise through
suppression of the respiratory drive.
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19. 5- EQUITY OR JUSTICE
 Fair and equal distribution of scarce health resources,
and the decision of who gets what treatment.
 The burdens and benefits of new or experimental
treatments must be distributed equally among all
groups in society.
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20. HISTORICAL INTRODUCTION
 Hippocratic Oath – 5thcentury BC
 Nuremberg Code -1947
 Declaration of Geneva - 1948
 Universal Declaration of Human Rights-1948
 Helsinki Declaration -1964
 International Code of Medical ethics
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21. HIPPOCRATIC OATH
 One of the earliest document in medical ethics – 5th
century BC.
 Traditionally all doctors recite this oath at swearing in.
 It is considered sacred for its religious foundation and
sanctity.
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23. ISLAMIZED VERSION OF THE HIPPOCRATIC OATH
 I swear by Great Allah to watch his guidance while
discharging my profession, preserve human life at all its
stages in all circumstances and conditions; do my best in
saving it from destruction, illness, pain and anxiety;
preserve peoples’ dignity, hide their privacies and keep their
secret; always be a tool for Allah’s mercy; use my medical
knowledge with the near and the distant, with the good
and the sinful, with the friend and the enemy; pursue
science, and use it to help humans, not to harm them;
respect those who educate me, educate my juniors, and be
a brother to all colleagues in the profession, collaborate
with them in doing good and fearing Allah; ensure that my
life reflects my Faith in secret and in the open, pure from
anything which can defile it in front of Allah, his Messengers
and the Believers; and may Allah be a witness to what I say.
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24. NUREMBERG CODE - 1947
 The Nuremberg Code is the most important document
in the history of the ethics of medical research.
 The Code was formulated in August 1947, in
Nuremberg, Germany, by American judges sitting in
judgment of Nazi doctors accused of conducting
murderous and torturous human experiments in the
concentration camps (the so-called Doctors' Trial).
 It served as a blueprint for today's principles that
ensure the rights of subjects in medical research.
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25. NUREMBERG CODE - 1947
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26. DECLARATION OF GENEVA 1948
 Adopted at World Medical Association
 General Assembly in 1948.
 It builds on the principles of the Hippocratic Oath, and
is now known as its modern version.
 Amended in 1968, 1984, 1994, 2005 , 2006, and 2017.
 Declaration of physicians’ dedication to the
humanitarian goals of medicine.
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27. HELSINKI DECLARATION 1964
 Set of ethical principles regarding human
experimentation developed by the World Medical
Association in 1964.
 Undergone 6 revisions since then.
 Last revision in 2013.
 The Declaration of Helsinki emerged from the Nurnberg
Code and provides the “Ethical Principles for Medical
Research Involving Human Subjects”
 Since 1964, when the Declaration of Helsinki was
adopted by the World Medical Association, it represents
one of the most respected set of ethical principles to
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28. INTERNATIONAL CODE OF MEDICAL ETHICS
 Given by World Medical Association
 The International Code of Medical Ethics was adopted
by the General Assembly of the World Medical
Association at London in 1949, amended in 1968, 1983
and 2006.
 It is a code based on the Declaration of Geneva and the
main goal is to establish the ethical principles of the
physicians worldwide, based on his duties in general, to
his patients and to his colleagues.
 The code applies both in peace and war.
 It codifies the duties of physician in general, duties to
patients and colleagues
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29. DUTIES AND RESPONSIBILITIES OF PHYSICIAN IN GENERAL
 A PHYSICIAN SHALL :
 always exercise his/her independent professional
judgment and maintain the highest standards of
professional conduct.
 respect a competent patient’s right to accept or refuse
treatment.
 not allow his/her judgment to be influenced by personal
profit or unfair discrimination.
 not receive any financial benefits for referring patients or
prescribing specific products.
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30.  A PHYSICIAN SHALL :
 recognize his/her important role in educating the public
 deal honestly with patients and colleagues, and report
to the appropriate authorities those physicians who
practice unethically or incompetently or who engage in
fraud or deception.
 respect the rights and preferences of patients,
colleagues, and other health professionals.
 respect the local and national codes of ethics
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DUTIES AND RESPONSIBILITIES OF PHYSICIAN IN GENERAL

31. DUTIES OF PHYSICIAN TO THEIR PATIENTS
 A PHYSICIAN SHALL :
 always bear in mind the obligation to respect human
life.
 act in the patient’s best interest when providing medical
care
 owe his/her patients complete loyalty and all the
scientific resources available to him/her. Whenever an
examination or treatment is beyond the physician’s
capacity, he/she should consult with or refer to another
physician who has the necessary ability
 give emergency care as a humanitarian duty unless
he/she is assured that others are willing and able to give
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32. DUTIES OF PHYSICIAN TO THEIR PATIENTS
 A PHYSICIAN SHALL :
 respect a patient’s right to confidentiality. It is ethical to
disclose confidential information when the patient
consents to it or when there is a real and imminent
threat of harm to the patient or to others and this threat
can be only removed by a breach of confidentiality
 in situations when he/she is acting for a third party,
ensure that the patient has full knowledge of that
situation.
 not enter into a sexual relationship with his/her current
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33. DUTIES OF PHYSICIAN IN CONSULTATION
 Avoid un-necessary consultation
 Consulting pathologist, radiologist or asking for lab
investigation should be done judiciously .
 Consultation for patient benefit.
 Punctuality in consultation.
 Statement to patient after consultation.
 Treatment after consultation.
 Patient referred to specialist.
 Fees and other charges.
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34. RESPONSIBILITIES TO EACH OTHER
 Dependence of Physicians on each other
 Should consider it as a pleasure and privilege to render
gratuitous service to all physicians and their immediate
family dependants.
 Conduct in consultation
 Respect should be observed towards the physician in
charge of the case and no statement or remark be made
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35. RESPONSIBILITIES TO EACH OTHER
 Consultant not to take the charge of the case.
 Appointment of the substitute only when he has the
capacity to discharge the additional responsibility along
with his / her other duties
 Visiting another Physician's case
 Avoid remarks upon the diagnosis or the treatment that
has been adopted.
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36. DUTIES OF PHYSICIAN TO PUBLIC AND PARAMEDICAL STAFF
Physicians as citizens
Should particularly co-operate with the authorities in the
administration public health laws and regulations.
 Public and community health
 Should enlighten the public concerning quarantine
regulations and measures for the prevention of
epidemic and communicable diseases.
 Pharmacists/nurses
Should promote and recognize their services and seek
their cooperation. 36
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37. DEFINITION OF HEALTH
 World Health Organization (WHO) : Health is a state of
complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
 Somatic - pSychiatric - Social (3 ‘S’)
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