lecture2 introduction-to-medical-ethics(29.09.16)

L2. INTRODUCTION TO MEDICAL ETHICS

Dr. Ghaiath M. A. HusseinAsst. 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

SECTION I: OVERVIEW OF ETHICS & BIOETHICS

Why do we do what we do?


Which one would you drink?

Place matters? WHY?


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?

Ethics is about making choices... Usually hard ones!http://ghaiathme.wixsite.com/mep-course

What do you think?

He Killed Her!!


Levels of moral responseThe 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 principlesThe 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)


SECTION II: DEFINITIONS & CONCEPTS

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


Brainstorming...

•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


SECTION III: WESTERN APPROACH TO ETHICS AND ETHICAL REASONING

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 الله 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 http://ghaiathme.wixsite.com/mep-course

Schools of thought in moral reasoning (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


Virtue ethics: It emphasizes the virtues, or moral character

A patient should not comply with a “don’t smoke” advice from a smoking doctor?http://ghaiathme.wixsite.com/mep-course


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 WitnessesChristian Ethics


ISLAMIC BIOETHICS

Section IV:Islamic approach to ethical analysis and decision making

Ethics in Islam… not a separate entity!

Law

Ethics

Religious Practice

Economy


How should Muslims decide their acts?

And I (Allâh) created not the jinn and mankind except that they should worship Me (Alone). الجن خلقت وما

الذاريات ) ليعبدون إال (56واإلنس

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)


Sources of Islamic Morality Main sources: 1)The Koran and 2) the Sunna, Secondary sources: • 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. http://ghaiathme.wixsite.com/mep-course

Goals of Islamic Regulations

The five purposes of Sharia are to preserve person’s:

1. Religion;

2. Soul;

3. Mind;

4. Wealth; &

5. Progeny.

All Islamic legislations came to achieve these goals.


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 )


What’s unique about Islamic Bioethics?

• 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 لم ) (رفقا من منا ليس

صغيرنا ويرحم كبيرنا (يوقر


Islamic Principles & Maxims Applicable in Medicine

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 & Maxims ...cont.

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.


THANK YOUQUESTIONS AND ANSWERS


lecture2 introduction-to-medical-ethics(29.09.16)

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