topic1 introductiontomedicalethics-120213023003-phpapp02
TRANSCRIPT
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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
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Outline
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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
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Which one would you drink?
WHY? Place matters?
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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!
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What do you think?
He Killed Her!!
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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
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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)
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Don’t judge things on what they first appear to you!
There is always a reason why people do things?
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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
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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)
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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
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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.
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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?
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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
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How right and wrong are distinguished?
Schools of Thought in Moral Reasoning
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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
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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
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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?
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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?!
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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?
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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?
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Islamic Bioethics
Islamic Approach to Ethical Analysis and Decision Making
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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)
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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.
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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 )
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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
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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.
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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?
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QUESTIONS AND ANSWERS
Thank You
To contact Dr. Ghaiath Hussein:Office: (+966)-(1)-2889999 Ext. 7588 Email: [email protected] Personal: 00966566511653 – email: [email protected] More Resources:http://med-ethics.com/ http://omarkasule.tripod.com/http://www.islamset.com/ethics/index.html