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210919P - INTRODUCTION: THEORY AND PRINCIPLES OF ETHICS

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Presentation at a Muslim Ethics Course for Medical Students held at Princess Nourah Bint Abdul Rahman University, Riyadh on 19 September 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 ethics and principles.
  • Understand the methods and processes of clinical ethics consultation.

 

CODE OF ETHICS FOR HEALTH PRACTITIONERS:




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).
  • The rights-based theory is 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)
  • Nonmaleficence (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:

  • In order 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.