Asst. Prof., Dept. of Medical EthicsKing Fahad Medical City – Faculty of MedicineKing Saud Bin Abdul-Aziz University for Health Sciences

Dr. Ghaiath M. A. Hussein

Introduction to Medical Ethics

King Saud bin Abdulaziz University for Health SciencesKing Fahad Medical City

Faculty of Medicine

Faculty of Medicine, Feb. 13, 2012

Outline

✓

Definition of ethics, bioethics, and medical ethics1

What is an ethical issue in healthcare?2

International approaches to medical ethics3

Islamic approach to medical ethics4

Which one would you drink?

WHY? Place matters?

Less embarrassing choices…

I need to pass the exam..cheat or not? I need the organs of this dying patient... Let

him die fast? He’s dying anyway! 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!

What do you think?

He Killed Her!!

Levels of moral response

The expressive level (unanalyzed expressions or feelings 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/Moral reasoning

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)

Don’t judge things on what they first appear to you!

There is always a reason why people do things?

What is ethics?What are the branches of ethics?What is bioethics?What is medical/clinical ethics?What is an ethical issue?

Key definitions and concepts

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)

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 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.

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.

Questions answered by Bioethics

deciding what we should do (what decisions are morally right or acceptable);

Example: Should patient A or B have the ICU bed?explaining why we should do it (how do

we justify our decision in moral terms); and Why did we decide to admit A & not B?

describing how we should do it (the method or manner of our response when we act on our decision).

What are we going to do for patient B?

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

How right and wrong are distinguished?

Schools of Thought in Moral Reasoning

Taxonomy of Ethics

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

Christian Ethics

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 without knowing

others To reflect Islamic concepts to non-

Muslims in an appropriate manner

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. Examples: quarantine, isolation, vaccination, etc. Where does utilitarianism (dis)agrees with Islam?

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 Examples: Doctor’s duties to care for their patients

Where does Duty-Based Ethics (dis)agrees with Islam?

Schools of thought in moral reasoning (cont.)

Virtue ethics: It emphasizes the virtues, or moral character (who is your virtuous model?)

Examples: Doctors as role models. Should not a patient comply with a “don’t

smoke” advice from a smoking doctor?!

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. Where does feminisme (dis)agrees with Islam?

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. Where does Casuistry (dis)agrees with Islam?

Schools of thought in moral reasoning (cont.)

Principlism: Autonomy: respect humans'

ability to choose, Beneficence: Do Good for

others, Nonmaleficence (Do No Harm),

& Justice (Be fair to your patients)

Where do these principles meet with Islam?

Islamic Bioethics

Islamic Approach to Ethical Analysis and Decision Making

Sources of Islamic Morality

Main sources: 1)The Koran and 2) the Sunna,

Secondary sources Unanimous agreement of Islamic jurists

(Ijmaa) Acceptance by the majority of trusted

scholars (Rayul Jomhour) Measurement/Analogy (Qiyas), Remediation (Maslaha), (Istishab)

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 )

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.

Cases & Group Discussion

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 AND ANSWERS

Thank You

To contact Dr. Ghaiath Hussein:Office: (+966)-(1)-2889999 Ext. 7588 Email: ghussein@kfmc.med.sa Personal: 00966566511653 – email: ghaiathme@gmail.com More Resources:http://med-ethics.com/ http://omarkasule.tripod.com/http://www.islamset.com/ethics/index.html