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

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. 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. Which one would you drink?
Saudi Commission for Health
Specialties

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. What do you think?
Saudi Commission for Health
Specialties

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. 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. 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. 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. 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. 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. 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. 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. 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. How Right and Wrong are
Distinguished?

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. 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.  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.  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. • 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. 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. Islamic Bioethics

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. 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. 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. 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. 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. 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. More Resources
• http://med-ethics.com/
• http://omarkasule.tripod.com/
• http://www.islamset.com/ethics/index.html
Saudi Commission for Health
Specialties

30. THANK YOU