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Presentation at a Clinical Ethics Courses held at Princess Nourah bint Abdulrahman University, Riyadh on 10 November 2019 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Chairman of the Human and Medical Ethics Committee as well as the Institutional Review Board King Fahad Medical City Riyadh Saudi Arabia
The learning objectives / outcomes
§ Outline
international and national ethical codes and medical practice regulations.
§ Outline the
methodology of analyzing and reasoning about ethical dilemmas using ethical and
principles.
§ Understand the
methods and processes of clinical ethics consultation.
Code of Ethics for Health Practitioners
§ http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECTION=201.html
Code
of Ethics for Health Practitioners
§ http://www.scfhs.org.sa/en/registration/ClassAndRegister/Reregister/Documents/Ethics%20for%20Health%20Practitioners.pdf
European
Ethical Theories
} Utilitarian consequence-based
theory (balance of good and bad, relative, no absolute right and wrong).
} Obligation-based theory (moral
obligations, absolute right and wrong).
} 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
Case
Scenarios
} Noticing a threefold increase in
the diagnosis of late stage colon cancer that was fatal within a year, the city
council passed a resolution requiring all men and women above 40 to undergo
colonoscopic screening once every 5 years, with the warning that those who
refused screening would not be treated for free if they got cancer. What do you
think of this? What is your moral reasoning?
Case
Scenarios… con’t. - 1
} A mentally retarded Down syndrome
youth aged 15 years had been to court several times for sexual attacks on
toddlers. The judge ordered the doctors to suppress his sexual aggression by
use of hormones and if that was not effective to remove his testes.
Case
Scenarios… con’t. - 2
} A urologist with 20 years’
experience in renal transplant refused to donate one of his kidneys to his
identical twin brother who had found no other matching kidney. The Saudi
Council for Health Specialties started de-registration proceedings for failure
to give benefit obligatory on all physicians.
Case
Scenarios… con’t. - 3
} A new company in Riyadh advertised
on TV and newspapers offering direct genetic testing services. Consumers would
pay for a kit using a credit card and they would use the kit to collect a
sample of blood by finger prick and send it back by mail. Results would be sent
back after a week.
Case
Scenarios… con’t. - 4
} A nurse manager has just discovered
that his colleague, a surgeon, is Hive, but has kept the information secret and
continued operating on patients taking infection control precautions. An
emergency case requiring immediate surgery is wheeled into the emergency room
at midnight and there is no other surgeon available.
Case
Scenarios… con’t. - 5
} A 90-year-old 100% dependent on a
respirator with no hope of independent life asks the doctor to disconnect the
machines so that he can die in peace but the doctor refuses. He has no serious
disease; he had become dependent on the respirator during a prolonged and
poorly managed episode of pneumonia.
Case
Scenarios… con’t. - 6
} In order to save life, a senior
medical officer allowed surgery under unclean conditions at the site of a major
natural disaster with too many patients who could not be transported to the
hospital in reasonable time.