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100320P - BASICS OF MEDICAL ETHICS

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Paper presented at an ethics training program for family physicians at the Riyadh Castle Hotel on 20th March 2010 by Professor Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Department of Bioethics Faculty of Medicine KFMC omarkasule@yahoo.com



1.1 Theories, principles, and methodology
  • Ethical theories: liberalism, communitarianism, deontology, Kantian ethics, Feminist theories, Virtue, Moral relativism
  • Ethical principles: autonomy, beneficence, nonmalefacence, and justice
  • Methodological approaches to ethical analysis: casuistical reasoning, narrative ethics, empirical approaches to ethics, thought experiments, deliberative ethics, medical humanities, law and ethics, reflective equilibrium,
  • Other considerations: hermeneutics, paternalism, rights, needs, doctrine of double effect, acts and omissions, ordinary and extra ordinary means, personhood and moral status, commodification.

1.2 Ethical issues in clinical practice
  • Issues of consent: informed consent, decisions for the incapacitous/incompetent, consent for children,
  • Issues of confidentiality and disclosure: disclosure of surgical risk, confidentiality, truth telling
  • Physician’s dilemmas: conscience, dual responsibilities
  • Start of life issues: abortion, maternal-fetal conflict,
  • Reproduction: contraception, genetics
  • Disabilities:
  • Psychiatric issues: compulsory treatment, intellectual disability
  • Geriatric issues:
  • End of life issues: organ transplantation, euthanasia, life support

1.3 Ethics in public health:
  • Concepts: health, illness, health promotion, disease prevention
  • Health economics: priority setting, decisions, equity,
  • Ethical issues: vaccination, screening, epidemiology, infectious disease, drug addiction, smoking, disaster relief, refugee problems

1.4 Research ethics
  • Animal research
  • Governance of research
  • Informed consent
  • The pharmaceutical industry
  • Publishing
  • Cloning and stem cell research
  • Genetic research



2.0 DEFINITION and CLASSIFICATION
2.1 DEFINITION OF ETHICS
  • Ethics is the philosophy of morality.
  • It is a discipline of study concerned with distinguishing the moral from the immoral and the right from the wrong.
  • Ethics is defined as various ways of understanding and examining the moral life.
  • The approach to a moral problem in medicine is determined by the background culture, philosophy of life and worldview.

  • Ethics is principles and methodology used to analyze specific situations in order to make moral judgments. Ethics is not a theoretical discipline.

2.2 CLASSIFICATION OF ETHICS
  • Normative ethics: The normative is what ought to be done.

  • Non-normative ethics: Non-normative ethics is what most people do.

  • Applied ethics: It seeks to find practical solutions to actual problems without necessarily theoretical considerations.

  • Bioethics, a branch of applied ethics, is a discipline that deals with ethical implications of medical research and medical interventions.

  • Comparative ethics: Comparative ethics, also called descriptive ethics, is concerned with empirical description and comparison of moral beliefs and practices of different communities and to understand underlying causative factors.

3.0 HISTORICAL BACKGROUND
·         3.1 The rise of secular European bioethics
  • 3.2 Main landmarks in the development of European secular bioethics

4.0 EUROPEAN ETHICAL THEORIES
  • 4.1 Definition of an ethical theory:
  • 4.2 Eight ethical theories
  • 4.3 Consequence-based theory
  • 4.4 The obligation-based theory
·         4.5 The rights-based theory
  • 4.6 Community based theory
  • 4.7 The relation-based theory
  • 4.8 The case-based theory
5.0 EUROPEAN ETHICAL PRINCIPLES
  • 5.1 Sources of ethical principles
  • 5.2 Definition of ethical principles
  • 5.3 The Principle of Autonomy is the power of the patient to decide on medical procedures.
  • 5.4 The Principle of Non-malefacence is avoiding causation of harm.
  • 5.5 The Principle of Beneficence is the providing benefits and balancing them against risks and costs.

  • 5.6 The principle of justice is distribution of benefits, costs, and risks fairly. Application of the above principles requires ethical rules.

6.0 EUROPEAN ETHICAL RULES
  • 6.1 Classification of ethical rules: The European ethical rules may be substantive, authority, and procedural rules.
  • 6.2 The substantive rules deal with veracity, confidentiality, privacy, and fidelity.
  • 6.3 The authority rules deal with surrogacy, professional authority, and rationing.