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Presentation at a Clinical Ethics Courses held Online at Princess Nourah bint Abdulrahman University, Riyadh on 20 September 2020. By: Professor Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Chairman of the Ethics Committee King Fahad Medical City.
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
}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 to screen 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 of 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 benefits obligatory to all
physicians.
CASE
SCENARIOS… con’t. - 3:
} A new company in Riyadh advertised on TV and in 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:
} To save a 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 a reasonable time.