Home 
Contact 
Profile 
Videos 
Lecture
for medical students at the Faculty of Medicine King Fahad Medical City Riyadh
May 29, 2014 by Professor Omar Hasan Kasule Sr.
LEARNING OBJECTIVES
General
- Outline the basic principles underlying ethical obligations and professional attitude of the physicians towards patients focusing on cardiovascular disease
- Specific
- Describe the principles of medical ethics
- Integrate the principles of ethics into clinical practice relevant to cardiovascular disease
- Define professional conduct in the Saudi Arabian context
- Describe the physician’s professional responsibility
PRINCIPLES OF MEDICAL ETHICS: Western perspective
- Principle of autonomy: the patient is the ultimate decision maker in all matters relating to medical care
- Principle of beneficence: all medical activities should aim at accruing benefit for the patient
- Principle of nonmalefacence: medical procedures should not cause harm to the patient
- Principle of justice: delivery of medical care should be equitable
PRINCIPLES OF MEDICAL ETHICS (qawa’id al fiqh): Islamic perspective
1
·
Principle of
intention (qa’idat al qasd): all medical decisions are judged by the underlying
intention (al umuur bi maqasidiha)
·
Principle of
certainty (qa’idat al yaqeen): medical procedures must be based on certainty
i.e must be evidence-based
·
Principle of
injury (qa’idat al dharar): the benefits of a procedure must exceed the side
effects for it to be carried out
PRINCIPLES OF MEDICAL ETHICS (qawa’id al fiqh): Islamic perspective
2
·
Principle of
hardship (qa’idat al mashaqqat): in case of necessity, normal rules are
suspended (al dharuuraat tubiihu al mahdhuuraat)
·
Principle of
custom (qa’idat al ‘aadat): what is generally accepted as normal practice
guidelines must be respected (al ‘aadat muhakkamat)
MAQASID AL SHARI’AT IN MEDICINE
For medical care to be considered ethical it must fulfill and not
violate the following general purposes
·
Preservation of
morality (hifdh al diin)
·
Preservation of
life (hifdh al nafs)
·
Preservation of
progency (hifdh al nasl)
·
Preservation if
intellect (hifdh al ‘aql)
·
Preservation of
resources (hifdh al maal)
CASE# 1:
·
A child is seriously ill and requiring
immediate blood transfusion and surgery
·
Both parents refuse any intervention saying
they know the child is going to die and that is the will of Allah.
·
The doctor decides to respect the parents’
wishes
CASE #2:
·
A university
professor with previous episodes of transient stroke had written a directive
and had it witnessed that if he lost consciousness he would not like to be
resuscitated.
·
Years later he
was brought to the hospital unconscious from head injuries sustained in a car
accident.
·
The doctors
reading his directive in his shirt pocket decided not to resuscitate him but
his wife insisted that he be resuscitated.
CASE #3:
·
A car accident
victim who is in severe shock was wheeled into
the Emergency Room
with un-recordable blood pressure or pulse. ECG showed low amplitude slow
waves.
·
The doctor did
not declare death, but against the insistence of family members refused to
institute life support because he reasoned there was no hope.
·
The patient was
declared dead one hour later. The family
threatened to sue the doctor.
STUDY OF
PROFESSIONAL ATTITUDES AND BEHAVIORS AT KSU[1]
·
59%
participants demonstrated high levels of professional attitudes and behaviors
·
40% did not comply with the elements of professionalism.
·
Analyses revealed highly significant
differences in certain responses with regard to gender, academic level, and
grade point average.
MEDICAL
STUDENT PERCEPTION OF PROFESSIONALISM AT UD[2]
·
The respondents
admitted that that they were deficient in the acquisition of professional
values.
·
According to
them, professionalism was not taught or assessed.
They followed "hidden curriculum".
·
They considered
very few teachers as positive role models.
·
The
deficiencies could be attributed to negative role modeling by the faculty or
deficiencies in the curriculum such as lack of rich clinical experiences,
limited interaction with health team, and absence of feedback besides
organizational issues.
NURSES
PERCEPTIONS ABOUT CONFLICTS AT KSU[3]
·
Conflict had a statistically significant
correlation with the perception of professionalism.
·
Low perception among the participating nurses
regarding their professionalism.
·
Factors of low professionalism: the workplace,
personal background of the nurses, personal interest in the nursing profession,
and views of the profession by the family, the society, and the consumer
consumers' views of the profession. Given the findings of this study, nurse
managers are encouraged to create a work environment that supports professionalism and minimizes conflict.
CONCLUSION:
A number
of factors might explain the low level of perception of professionalism.
RESPONSIBILITIES
OF A PHYSICIAN
·
Responsibility to the patient: provide the best care
·
Responsibility to the community: advise and leadership on disease
prevention
·
Responsibility to medical science: research and advancement of knowledge
·
Responsibility to the environment
·
Responsibility to posterity
·
Responsibility to self
·
Responsibility to family
RIGHTS OF THE
PHYSICIAN
·
Material comfort and financial compensation
·
Continuing
medical education
·
Professional
freedom and professional independence
·
Refusal of
medical procedures based on conscience
·
Torture or
degrading punishment
PHYSICIAN CONDUCT
·
Values,
competence, and responsibility
· Medical decisions respecting patient autonomy
·
Disclosure
and truthfulness
· Privacy and confidentiality
·
Fidelity
PHYSICIAN MISCONDUCT
·
Abuse of
professional priviledges
·
Private
mis-conduct derogatory to reputation, muru’at
·
Business
mis-conduct
·
Conflict of
interest
NOTES
[1] Al-Sudani et al. Professional
attitudes and behaviors acquired during undergraduate education in the College
of Dentistry, King Saud University.
Saudi Dent J.
2013 Apr;25(2):69-74.
[2] Adkoli et al. Medical
students' perception of professionalism: a
qualitative study from Saudi Arabia. Med Teach.
2011;33(10):840-5.
[3] Zakari et al. Conflict
and professionalism: perceptions among nurses in Saudi Arabia.
Int Nurs Rev. 2010 Sep;57(3):297-304.