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Presentation at a Summer Training Course for Medical Students held at King Fahad Medical City, Riyadh on 15 June 2021. By Professor Omar Hasan Kasule Sr. MB ChB (MUK). MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Bioethics
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 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, an 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
SCENARIO - 1:
} 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 colonoscopy 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
SCENARIO - 2:
} 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
SCENARIO - 3:
} 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
SCENARIO - 4:
} 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
SCENARIO - 5:
} 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
SCENARIO - 6:
} 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
SCENARIO - 7:
} 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 a reasonable time.