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Lecture for 6th year medical students at KFMC 16th January 2010 1-3pm by Professor Omar Hasan Kasule Sr
Summary
Ethical issues and problems are never easy because there are 2 or more alternative decision alternatives to a problem. Such conflicts can be resolved by referring to ethical theories and principles. In this lecture we will discuss Islamic and Western theories and principles of ethics and analyze case studies on how these theories and principles can assist is resolving ethical conflicts.
1.0 EUROPEAN THEORIES OF ETHICS
According to the utilitarian consequence-based theory, an act is judged as good or bad according to the balance of its good and bad consequences. The theory permits acts that are clearly immoral on the basis of utility.
According to the obligation-based theory based on Kantian philosophy ethics or morality are based on pure human reasoning with rejection of the role of tradition, intuition, conscience, or emotions.
According to the rights-based theory ethical decisions must respect individual human rights of property, life, liberty, and expression. Individual rights may conflict with community rights.
According to the community-based theory, ethical judgments are controlled by the community consensus of what are moral values with this consensus changing from time to time.
According to the relation-based theory gives emphasis to family relations and the special physician-patient relation.
The case-based theory is practical decision-making on each case as it arises. It does have fixed philosophical prior assumptions.
2.0 EUROPEAN PRINCIPLES OF ETHICS
The 4 basic ethical principles according to Beauchamps and Childress (1994) are: autonomy, beneficence, non malefacence, and justice.
The Principle of Autonomy is the power of the patient to decide on medical procedures.
The Principle of Non-maleficence is avoiding causation of harm.
The Principle of Beneficence is the providing benefits and balancing them against risks and costs.
The principle of justice is distribution of benefits, costs, and risks fairly
3.0 MAQASID AL SHARI'AT: THE ISLAMIC THEORY OF ETHICS
Protection of ddiin, hifdh al ddiin, essentially involves morality and ensuring that patients' health is restored to the normal so that they can undertake ‘ibadat in the wide sense that every human endeavor is a form of ‘ibadat.
Protection of life, hifdh al nafs: The primary purpose of medicine is to fulfill the second purpose of the Law, the preservation of life, hifdh al nafs. Medicine cannot prevent or postpone death since such matters are in the hands of Allah alone. It however tries to maintain as high a quality of life until the appointed time of death arrives.
Protection of progeny, hifdh al nasl: Medicine contributes to the fulfillment of the progeny function by treating infertility, and providing obstetric and pediatric care.
Protection of the mind, hifdh al ‘aql, involves treatment of mental disorders or those physical disorders that lead to mental stress.
Protection of wealth, hifdh al mal, is making sure that human and material resources are not wasted.
4.0 QAWA"ID AL
The principle of intention, qa’idat al qasd, ensures that each action is judged by the intention behind it which must be moral and sincere. No useful medical purpose should be achieved by using immoral methods.
The principle of certainty, qa’idat al yaqeen, ensures that medical decisions are based on evidence.
The principle of injury, qa’idat al dharar, ensures that the benefits of a medical intervention must be more than its side effects. If a choice has to be made between 2 alternatives both being harmful the one with least harm is chosen, ikhtiyaar aqall al dhararain.
The principle of hardship, qaidat al mashaqqat, allows medical interventions that would otherwise be prohibited actions if there is a necessity. Necessities legalize the prohibited, al daruuraat tubiihu al mahdhuuraat.
The principle of custom or precedent, qaidat al urf, ensures that the standard of medical care is defined by custom or existing policies and procedures.
5.0 CASE STUDIES
In each case identify the ethical conflict and define the 2 sides to the conflict. Mention what theory or principle you can use to resolve the conflict.
Case #1: A patient with diastolic blood pressure of 120 mmHg failed to return to the Health Center
Case #2: A community pediatrician had reported abuse of a couple’s first child to the authorities. The authorities called in the parents to discuss the matter. The abusing father was so angry that he divorced his wife for giving information to the pediatrician. He later took the wife back under the rujuk provisions of the Law. At the next visit the pediatrician noted signs of child abuse and asked the mother. The mother confirmed the abuse but asked the pediatrician not to follow up the matter for the sake of her marriage and family. The pediatrician this time did not report to the authorities.
Case #3: A patient was brought to the emergency room by the police after attempting to kill himself by hanging. He was unconscious when first brought in and had a signed suicide note in his shirt pocket saying that he wanted to die. The doctors ignored the note and started resuscitation measures. The patient became conscious after 30 minutes and protested at the medical treatment arguing that he wanted to die. The doctor was thinking of stopping resuscitation measures when the patient’s father and wife arrived and instructed the doctor to continue resuscitation.