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220125P - MEDICAL ETHICS-THEORIES, PRINCIPLES, AND DILEMMAS

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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.