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Presentation at the Ethics Training for Hospital Staff, King Abdullah bin Abdulaziz University Hospital held via Zoom Platform, Riyadh held on 25-27 January 2022. By Prof. Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard) DrPH (Harvard) Professor of Epidemiology and Bioethics
UNDERLYING
ETHICAL PRINCIPLES
} The
principle of intention, قاعدة القصد
} The
principle of certainty, قاعدة اليقين
} The
principal of injury, قاعدة الضرر
§ Autonomy
of patient and physician
§ Beneficence
§ Non-maleficence
§ Justice
} Principle
of hardship قاعدة المشقة
} Principle
of precedent قاعدة العرف
OTHER
PRINCIPLES
} Privacy
and confidentiality
} Truthfulness
and disclosure
} Fidelity
CODE
OF ETHICS FOR HEALTHCARE PRACTITIONERS
CPP HUMAN and MEDICAL ETHICS COMMITTEE
CPP
PROCEDURES of CLINICAL ETHICAL CONSULTATIONS
DUTY
TO THE PATIENT - 1:
} Treat
your patient as a person, not just a body.
} Respect
your patient’s autonomy.
} Treat
all patients equally, without discrimination.
} Fear
God when dealing with your patients; show respect for their beliefs, religions, and traditions.
} Ask
only for the tests needed for the patient without adding any tests not
justified by the patient’s case. A doctor should base his whole diagnosis and
treatment on the best available evidence and data.
DUTY
TO THE PATIENT - 2:
} Explain
honestly to the patient or anyone representing him/her the type, causes, and
complications of the illness, and the usefulness of diagnostic and
therapeutic procedures.
} Relieve
the patient’s pain and give him the feeling that the physician is eager to give
him proper care and attention.
} Respect
Privacy.
} Respect
the patient’s autonomy.
} Inform
the patient about his/her condition.
} Keep
the patients’ secrets (confidentiality).
DUTY
TO THE PATIENT - 3:
} DO
NOT hesitate to refer the patient to a more experienced doctor or to a doctor
who has more effective equipment whenever the patient’s case calls for such a
referral, nor to refer him to a doctor whom the patient wishes to consult.
} Continue
to give an emergency patient the proper treatment until it is no longer needed
or until care for the patient is taken over by another doctor.
CLINICAL ETHICAL CASE SCENARIOS
1.
PALLIATIVE CARE FOR THE TERMINALLY ILL
Case
scenario: Palliative vs. curative care
} A
90-year-old in ICU with stage 4 widely metastasized cancer and multi-organ
failure was told by the doctors that there was nothing they could do to reverse
the course of the disease and that they could only provide symptomatic
treatment. He asked to be discharged to die at home. His children objected,
saying that he needed complex nursing that they could not provide at home. He
was finally admitted to a private hospice that provided palliative care at
great expense.
2.
END-OF-LIFE DECISION - 1:
Case
scenario: DNR physicians vs. family
} Doctors
wrote a Do Not Resuscitate (DNR) order for an 80-year-old grandmother with
disseminated untreatable ovarian cancer. Her family objected vehemently when
told of this decision and sought its reversal. Before the dispute was resolved,
the patient collapsed after an episode of acute pneumonia unrelated to her
original condition. The nurses followed the DNR order and did not call the
resuscitation team.
3.
END-OF-LIFE DECISION - 2:
Case
scenario: Withholding futile life support
} A
car accident victim in severe shock was wheeled into the Emergency Room with
unrecordable blood pressure or pulse. ECG showed low amplitude slow waves. The
doctor did not declare death, but against the insistence of family
members-refused to institute life support because he reasoned there was no
hope. The patient was declared dead one hour later. The family threatened to
sue the doctor.
4.
CASE SCENARIO - 1:
} An
80-year-old woman with severe coronary artery disease was in the ICU for the
past 6 months with repeated episodes of MI and cardiac arrest always relieved
by CPR. The physician wrote a DNR order to relieve her from further suffering.
5.
CASE SCENARIO - 2:
} Physician
A called in for consultation assessed the patient and told Physician B (the
attending physician) that the patient needed an ultrasound to rule out the acute
abdomen. Physician B quoting official hospital policy disagreed insisting that
if acute abdomen is suspected general surgeons should be called in. Physician A
suddenly started to raise his voice with a high tone and shouting in front of the
patient with all staff and patients and visitors watching. Physician A then
left while Physician B was thinking ‘This attitude is affecting me as a health
care provider. Shouting and disrespecting me in my workplace and I wonder, why
he would do such an attitude to me.