141109P - INTRODUCTION: THEORY AND PRINCIPLES OF ETHICS

Presentation at a training program for family medicine resident s at the National Guard Madina 9-10 November 2014 by Professor Omar Hasan Kasule Sr. MB ChB (MUK). M{H (Harvard), DrPH (Harvard) Chairman of the Ethics Committee King Fahad Medical City.

1.0 EUROPEAN ETHICAL THEORIES

1.1 Utilitarian consequence-based theory (balance of good and bad)

1.2 Obligation-based theory (moral obligations)

1.3 Rights-based theory based on respect for human rights (individual rights)

1.4 Community-based theory (community decides)

1.5 Relation-based theory (family and physician-patient relations)

1.6 Case-based theory (practical case by case decision)

2.0 EUROPEAN ETHICAL PRINCIPLES (Beauchamp and Childress 1994))

2.1 Autonomy (patient decides)

2.2 Beneficence (bring benefit)

2.3 Non malefacence (do no harm)

2.4 Justice (equity vs equality)

 

3.0 ALTERNATIVE ETHICAL THEORY (PURPOSES OF MEDICINE)

3.1 Protection of Morality

3.2 Protection of Life

3.3 Protection of Progeny

3.4 Protection of the Mind

3.5 Protection of Wealth / resources

4.0 ALTERNATIVE ETHICAL PRINCIPLES (PRINCIPLES OF MEDICINE)

4.1 The Principle of Intention (actions are judged by the intentions behind them)

4.2 The Principle of Certainty (no action is taken in extreme uncertainty)

4.3 The Principle of Injury (medical intervention should cause no injury)

4.4 Principle of Hardship (in case of difficulty the usual legal restrictions are relaxed)

4.5 The Principle of Custom or Precedent (follow usual procedures unless there is evidence to the contrary)

 

5.0 MEDICAL DECISIONS

5.1 Concept of Autonomy (the patient has a right to make decisions on health care)

5.2 Informed Consent (patient decision must be based on full disclosure and understanding)

5.3 Choice of Physician (Patient has a right to choose which physician to treat him):

5.4 Choice of Treatment (patient has a right to choose the modality of treatment)

5.5 Consent by Proxy (if the patient is not capacitous alternative decision-making processes are used)

6.0 DISCLOSURE AND TRUTHFULNESS

6.1 Obligation to Tell the Truth (doctors should not lie to patients)

6.2 What is Disclosed (full disclosure unless there is a valid reason)

6.3 Partial Disclosure and White or Technical Lies

6.4 Disclosures to Others about the Patient (not generally allowed without patient consent)

6.5 Giving Bad News

7.0 PRIVACY AND CONFIDENTIALITY

7.1 Privacy

7.2 Confidentiality

7.3 Medical Records

7.4 Release of Confidential Information

8.0 FIDELITY

8.1 Definition of Fidelity

8.2 Conflicts Regarding Fidelity