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Presentation at a medical ethics course held at the
Security Forces Hospital on May 14, 2015 by Professor Omar Hasan Kasule Sr. MB
ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics Committee King
Fahad Medical City.
Ethics of Public
Health and Health Promotion: Concepts
·
Concept of illness
·
Concept of family health
·
Concept of community health
·
Concept of preventive medicine, tibb wiqa’I
·
Concept of health promotion
Ethics of Public Health and Health Promotion:
Issues
·
Ethical issues in screening
·
Ethical issues in vaccination
·
Ethical issues in infectious disease control
·
Ethical issues in addictions
·
Ethical issues in disasters
·
Ethical issues in health economics
Case Scenario - 1
A prospective couple
who are first cousins refused to submit themselves to pre-marital genetic
screening and preferred to take the risk of producing children with genetic
defects. The Ministry of Health insisted that they buy long term health
insurance to cover life-time complex medical treatment for up to 5 children.
Case Scenario - 2
A pediatrician
living and practicing in an exclusive high class area refused to take his
children for measles vaccination arguing that the risk of immunization
complications was higher than the risk of getting measles. He had not seen or
heard of a case of measles in the community in the past 10 years.
Ethics of
Disaster and Emergency Medicine
Ethical issues in emergency care
(Dr. Abdulaziz AlKaabba PEER SCHS 2014)
·
Privacy and confidentiality
·
Informed consent
·
Standards of care
·
Triage, prioritization and resource allocation
·
Higher rate of medical errors
Case Scenario - 1 (Dr. Abdulaziz AlKaabba PEER SCHS 2014)
A 30 year-old female
came to the Emergency Department at midnight with a history of severe right
lower abdominal pain for three days with vomiting and low grade fever. She asks
to be seen by a female physician in the ED where there are no females available
and she shouts that she should only be examined by a female physician. How do
we deal with this?
Case Scenario - 2 (Dr. Abdulaziz AlKaabba PEER SCHS 2014)
Three men were in a
recent road traffic accident and were brought to the Emergency Department into
the triage area, with no privacy cloths .Two of the men were stable with minor
injuries and bruises, the third one was in a bad situation (A 25 year-old man
with difficulty in breathing, severe bleeding and a low blood pressure). When
they were brought to the ED it was crowded with other patients and there were
no beds available. How would you handle this situation?
Ethical Issues in
Resource Allocation - 1
Basis for resource allocation - 1 (Dr.
Ghaiath MA Hussein PEER SCHS 2014)
·
CEA: (Effectiveness)
·
Medical Need
·
Utility
·
Immediate Usefulness
·
General Social Value
Ethical Issues in
Resource Allocation - 2
Basis for resource allocation - 2 (Dr.
Ghaiath MA Hussein PEER SCHS 2014)
·
Principle of Conservation
·
Responsibility for Dependents
·
None if not all
·
Queue
·
Random Selection
·
Ability to Pay
·
Merit based
Case Scenario - 1
A 90-year old with
multi organ failure and clinical signs of brain stem death was on life support
was occupying the last available bed in the ICU because the doctors were afraid
to disclose death to the family that had many vocal and angry members. However
when 50 survivors from an air crash site were brought it, the doctors decided
to withdraw life support from the old man to free up at least one ICU bed.
Case Scenario - 2
A patient presented
to the clinic with vague complaints in the abdomen and worries about cancer. Physical
examination and investigations revealed no pathology. The doctor was angry with the patient for
wasting clinic time when he was in good health.
As the patient was leaving he told the doctor that his uncle had died
the week before of stomach cancer. The doctor did not respond. What should the
doctor have done? Provide your moral reasoning.