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170411P - INTRODUCTION: THEORY AND PRINCIPLES OF ETHICS

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Presentation at a Grand Round, King Abdullah Medical City held at Makkah AlMukarramah, Saudi Arabia on 11 April 2017 by Professor Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics Committee King Fahad Medical City.


European Ethical Theories

  • Utilitarian consequence-based theory (balance of good and bad)
  • Obligation-based theory (moral obligations)
  • Rights-based theory based on respect for human rights (individual rights)
  • Community-based theory (community decides)
  • Relation-based theory (family and physician-patient relations)
  • Case-based theory (practical case by case decision)


European Ethical Principles (Beauchamp and Childress 1994)

  • Autonomy (patient decides)
  • Beneficence (bring benefit)
  • Non-maleficence (do no harm)
  • Justice (equity vs equality)


Alternative Ethical Theory (Purposes of Medicine)

  • Protection of Morality, hifdh al ddiin
  • Protection of Life, hifdh al nafs
  • Protection of Progeny, hifdh al nasl
  • Protection of the Mind, hifdh al ‘aql
  • Protection of Wealth / resources, hifdh al maal


Alternative Ethical Principles (Principles of Medicine)

  • The Principle of Intention (actions are judged by the intentions behind them), qasd
  • The Principle of Certainty (no action is taken in extreme uncertainty), yaqiin
  • The Principle of Injury (medical intervention should cause no injury), dharar
  • Principle of Hardship (in case of difficulty the usual legal restrictions are relaxed), mashaqqat
  • The Principle of Custom or Precedent (follow usual procedures unless there is evidence to the contrary), urf


Disclosure and Truthfulness

  • Obligation to Tell the Truth (doctors should not lie to patients)
  • What is Disclosed (full disclosure unless there is a valid reason)
  • Partial Disclosure and White or Technical Lies
  • Disclosures to Others about the Patient (not generally allowed without patient consent)
  • Giving Bad News


Privacy and Confidentiality

  • Privacy
  • Confidentiality
  • Medical Records
  • Release of Confidential Information


Fidelity

  • Definition of Fidelity
  • Conflicts Regarding Fidelity