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Presentation at the “Summer Training Course for Medical Students, held at KFMC Riyadh on 03 August 2021. By Prof. Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard) DrPH (Harvard) Chairman, Institutional Review Board - KFMC
WORDS,
MEANINGS, AND TERMINOLOGIES:
- Ethics:
a branch of philosophy that studies what is right and wrong.
- Akhlaqiyyat is not an Arabic translation for ethics; the difference between ethics
and law.
- Western
perspective ethical is not always legal and vice versa.
- Islamic
perspective ethics = law. Haram = unethical and halal is ethical.
ETHICS
FOR SOLVING DILEMMAS IN THE GREY ZONE:
- The absolute vs the relative: (makruuh and mustahabb).
- Avoiding semantic problems by looking at ethics
as the science of resolving dilemmas (2 or more solutions each with
benefits and potential harm).
- Most dilemmas can be resolved by asking your hear
but a few require theories and principles to guide us.
DILEMMA
OF THE PROSTATE-DO YOU TELL?
- 45 year old man getting married in a few days
goes to then urologist for routine examination. He has symptoms that
prompt the urologist to make further examinations and leads to a prostate
cancer diagnosis.
- Prostate cancer is low grade, does not spread
and most people die with it but from other conditions.
- Do you hide the diagnosis from him so that he
can get happily married?
DILEMMA
OF THE PROSTATE-DO YOU OPERATE?
- The man is very obese, has hypertension, high
cholesterol, does not exercise, and smokes 10 packs of cigarettes a day.
These are likely to kill him before the prostate cancer metastasizes if at
all.
- After getting married, the man asks your
advice: should he consent to a radical prostatectomy or not? The operation
will interfere with his marital and reproductive functions but will get
rid of the cancer completely.
- If no operation the chance of the cancer
growing and metastasizing is very low he may die of other competing causes
of death.
THE
HIPPOCRATIC OATH - 12TH BYZANTINE MANUSCRIPT AS A CROSS B. 460 BC D.
370 BC
THE
HIPPOCRATIC OATH OLD ENGLISH VERSION
THE
OATH OF A MUSLIM PHYSICIAN – MODERN FORMULATION
MALAYSIAN
MEDICAL GRADUATES TAKING THE OATH OF THE MUSLIM PHYSICIAN
EUROPEAN
THEORIES OF ETHICS
Theories explain why things are
right or wrong:
o Kantian
(deontological) ethics by Immanuel Kant (1724-1804). Ethics based on rules,
logic, and religion with no emotion or consideration of consequences. The same
rules are true in all places and times. It is a moral duty to follow those
rules.
o Utilitarianism
theory of Jeremy Bentham and John Stuart Mill. What is moral is what brings
maximum happiness or good consequences without regard to intentions.
Kantian or Utilitarian?
o The
Ministry of Health wants to import a new flu vaccine found to be more effective
overseas but wants to test it locally to make sure it is safe.
o Negative
press coverage discourages the public from volunteering for the testing.
o The
Ministry decided to force its staff aged 50 years and above to take part in the
trial.
o What do
you think?
Other European Theories of Ethics
o Right =
majority community opinion.
o Right =
respect of individual rights.
o Right =
maintaining the best physician-patient relations.
o Case by
case.
4 European Principles of Ethics
o Autonomy
= the patient decides.
o Beneficence
= assure benefits.
o Non
maleficence = avoid harm.
o Justice.
Ethics Theory Based on Purposes, maqasid al shari’at
o Protection
of morality, hifdh al ddiin.
o Protection
of life and health, hifdh al nafs.
o Protection
of the family and procreation, hifdh al nasl.
o Protection
of the intellect/mind, hifdh al aql.
o Protection
of resources, hifdh al maal.
ETHICAL
PRINCIPLES DERIVED FROM THE MAXIMS OF THE LAW
Ethical Principles Derived from the
Maxims of the Law
o Principle
of intention, qaidat al qasd (actions are judged by the underlying
intention).
o Principle
of certainty, qaidat al yaqeen (evidence based decisions).
o Principle
of harm, qaidat al dharar (balance of harm vs benefit).
o Principle
of hardship, qaidat al mashaqqat (rules suspended in difficult
situations to save life).
o Principle
of custom, qaidat al urf (customary practices/guidelines are respected).
Derived Ethical Principles
o Privacy
and confidentiality.
o Disclosure.
o Fidelity.
History of Research Ethics
o Nuremberg
Declaration - 1946.
o Declaration
of Helsinki - 1964 and 2013.
o UNESCO
Universal Declaration on Bioethics and
Human Rights - 2005.
o The
Tuskegee Syphilis Study - 1932-1972.
o The
Belmont Report - 1972.
o Implementing
Regulations of the Law of Ethics of Research on Living Creatures - 2010.
Nuremberg
Declaration 1946
Declaration
Of Helsinki 1964 AND 2013
The
Tuskegee Syphilis Study 1932 - 1972
The
Belmont Report 1972
Implementing
Regulations of the Law of Ethics of Research on Living Creatures
History of General Bioethics
o UNESCO
Universal Declaration on Bioethics and Human Rights 2005.
o Code of
Ethics for Medical Practitioners.
o Professionalism
and Ethics.
o CPP Human
and Medical Ethics Committee.
o CPP
Procedures of clinical ethical consultations.
o CPP
Procedures of non-clinical ethical consultations.
o Book of
medical jurisprudence.
UNESCO
Universal Declaration on Bioethics and Human Rights 2005
Code
of Ethics for Medical Practitioners
Professionalism
and Ethics
CPP
Human and Medical Ethics Committee
CPP
Procedures of Clinical Ethical Consultations
CPP
Procedures of Non-Clinical Ethical Consultations
Book
of Medical Jurisprudence
Autonomy and Disclosure: Our Local
Experience
o Family
tells doctor not to tell the patient the diagnosis.
o Patient
tells doctor not to tell the family.
o Consent
process for clinical trials.