introduction to medical ethics and bioethics

medical ethics
Dr. Rami Abo Ali

1. Medical Ethics and Legal medicine Dr. Rami Abo Ali Medical Ethics - Dr. Rami Abo Ali 1

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3. Introduction Ethics is concerned with moral principles, values and standards of conduct .(WHO) Ethics is the study of morality – careful and systematic reflection on and analysis of moral decisions and behavior. Morality is the value dimension of human decision-making and behavior. 3 Medical Ethics - Dr. Rami Abo Ali

4. Values, Morals, Ethics Value signify what is important and worthwhile. They serve as a basis for moral codes and ethical reflection. someone who values  friendship  drops everything to help a friend Morals are codes of conduct governing behavior . They are values put into practice as actions. Helping a friend is a  good  thing to do (based on a value of friendship) Ethics provide a systematic, rational way to work through dilemmas and to determine the best course of action in the face of conflicting choices. A student who helps another student cheat on a test is breaking their school's ethics. Even though they are doing it for a moral reason (helping a friend), they are committing an ethical violation and can be punished. 4 Medical Ethics - Dr. Rami Abo Ali

5. What is ethics? The Greek word ēthikós ( Ethos) means action, character. The Latin word mos (morals) means habit or custom. In simple words, Ethics is a set of philosophical beliefs and practices concerned with the distinction between right and wrong. 5 Medical Ethics - Dr. Rami Abo Ali

6. What is ethics? Ethics is a very large and complex field of study with many branches or subdivisions. Ethics is concerned with what is good for individuals and society and is also described as moral philosophy Ethics covers the following dilemmas : how to live a good life our rights and responsibilities the language of right and wrong moral decisions - what is good and bad ? 6 Medical Ethics - Dr. Rami Abo Ali

7. What is medical ethics ? Medical Ethics is the branch of ethics that deals with moral issues in medical practice. Medical ethics is closely related, but not identical to, bioethics (biomedical ethics) Whereas medical ethics focuses primarily on issues arising out of the practice of medicine, bioethics is a very broad subject that is concerned with the moral issues raised by developments in the biological sciences more generally. 7 Medical Ethics - Dr. Rami Abo Ali

8. Medical Etiquette: The conventional laws, customs of courtesy and the code of conduct governing the relationship of the physician with his professional colleagues. 8 Medical Ethics - Dr. Rami Abo Ali

9. Importance of Medical Ethics In recent times medical ethics has been greatly influenced by developments in human rights. Physicians frequently have to deal with medical problems resulting from violations of human rights, such as forced migration and torture. Health care decisions are based not only on clinical and technical grounds, but also on ethical grounds . Although we carefully weigh the clinical and technical aspects, ethical issues involved may be overlooked. 9 Medical Ethics - Dr. Rami Abo Ali

10. Importance of Medical Ethics Ethical principles such as respect for persons, informed consent and confidentiality are basic to the physician-patient relationship. Application of these principles in specific situations is often problematic , since physicians, patients, their family members and other healthcare personnel may disagree about what is the right way to act in a situation. 10 Medical Ethics - Dr. Rami Abo Ali

11. Importance of Medical Ethics The study of ethics prepares medical professionals to recognize difficult situations and to deal with them in a rational and principled manner. Ethics is also important in physicians’ interactions with society and their colleagues and for the conduct of medical research. 11 Medical Ethics - Dr. Rami Abo Ali

12. Principles of Medical Ethics Autonomy Beneficence Confidentiality Do no harm/ Non-maleficence Equity or Justice 12 Medical Ethics - Dr. Rami Abo Ali

13. 1- Autonomy Patient autonomy refers to the patient’s right to make decisions for themselves according to their own system of morals and beliefs . Patient education and informed consent are important elements of proper autonomy . Confidentiality loosely fits under the umbrella of autonomy 13 Medical Ethics - Dr. Rami Abo Ali

14. When the autonomy challenged ? Incompetence : patient is legally deemed unable to make rational decision for themselves often due to permanent conditions such as dementia . Assigned a surrogate by the court . Incapacity : patient is clinically determined to be unable to make a rational decision for themselves . Maybe due to transient conditions such as lack of consciousness , delirium , psychosis , etc. Threat to self or others : usually in psychiatric settings . 14 Medical Ethics - Dr. Rami Abo Ali

15. Paternalism : Is the practice of making decisions for the patient without seeking their input . It is when the doctor interferes with the patient's ability to make a choice regarding their healthcare. This can take many forms on a spectrum of intensity 15 Medical Ethics - Dr. Rami Abo Ali

16. 2- Beneficence Is the value in which the provider takes action or recommends courses that are in the patient’s best interest . It is not coercing or manipulating the patient into making decision against their value , even though it may objectively be the best decision for their health . Keep the individual patient in mind – beneficence is not the same in all situations. When the patient autonomy is compromised ( e.g., incapacity ) beneficence must be the guiding ethics 16 Medical Ethics - Dr. Rami Abo Ali

17. 3- Confidentiality Based on loyalty and trust. Maintain the confidentiality of all personal, medical and treatment information. Information to be revealed for the benefit of the patient and when ethically and legally required. 17 Medical Ethics - Dr. Rami Abo Ali

18. 4- Do no harm/ Non-maleficence “Above all, do no harm” Make sure that the procedure does not harm the patient or others in society. When interventions undertaken by physicians create a positive outcome while also potentially doing harm it is known as the " double effect ." Eg ,. the use of morphine in the dying patient. eases pain and suffering while hastening the demise through suppression of the respiratory drive. 18 Medical Ethics - Dr. Rami Abo Ali

19. 5- Equity or Justice Fair and equal distribution of scarce health resources, and the decision of who gets what treatment. The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. 19 Medical Ethics - Dr. Rami Abo Ali

20. Historical Introduction Hippocratic Oath – 5thcentury BC Nuremberg Code -1947 Declaration of Geneva - 1948 Universal Declaration of Human Rights-1948 Helsinki Declaration -1964 International Code of Medical ethics 20 Medical Ethics - Dr. Rami Abo Ali

21. Hippocratic Oath One of the earliest document in medical ethics – 5 th century BC. Traditionally all doctors recite this oath at swearing in. It is considered sacred for its religious foundation and sanctity. 21 Medical Ethics - Dr. Rami Abo Ali

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23.  Islamized version of the Hippocratic Oath I swear by Great Allah to watch his guidance while discharging my profession, preserve human life at all its stages in all circumstances and conditions; do my best  in saving it from destruction, illness, pain and anxiety; preserve peoples’ dignity, hide their privacies and keep their secret; always be a tool for Allah’s mercy; use my medical knowledge with the near and the distant , with the good and the sinful , with the friend and the enemy ; pursue science, and use it to help humans, not to harm them; respect those who educate me , educate my juniors, and be a brother to all colleagues in the profession, collaborate with them in doing good and fearing Allah; ensure that my life reflects my Faith in secret and in the open, pure from anything which can defile it in front of Allah, his Messengers and the Believers; and may Allah be a witness to what I say. 23 Medical Ethics - Dr. Rami Abo Ali

24. Nuremberg Code - 1947 The Nuremberg Code is the most important document in the history of the ethics of medical research.  The Code was formulated in August 1947, in Nuremberg, Germany, by American judges sitting in judgment of Nazi doctors accused of conducting murderous and torturous human experiments in the concentration camps (the so-called Doctors' Trial).  It served as a blueprint for today's principles that ensure the rights of subjects in medical research . 24 Medical Ethics - Dr. Rami Abo Ali

25. Nuremberg Code - 1947 25 Medical Ethics - Dr. Rami Abo Ali

26. Declaration of Geneva 1948 Adopted at World Medical Association General Assembly in 1948. It builds on the principles of the Hippocratic Oath, and is now known as its modern version. Amended in 1968, 1984, 1994, 2005 , 2006, and 2017. Declaration of physicians’ dedication to the humanitarian goals of medicine . 26 Medical Ethics - Dr. Rami Abo Ali

27. Helsinki Declaration 1964 Set of ethical principles regarding human experimentation developed by the World Medical Association in 1964. Undergone 6 revisions since then. Last revision in  2013. The Declaration of Helsinki emerged from the Nurnberg Code and provides the “ Ethical Principles for Medical Research Involving Human Subjects ” Since 1964, when the Declaration of Helsinki was adopted by the World Medical Association, it represents one of the most respected set of ethical principles to guide medical researchers protecting patients enrolling in biomedical experimentation  27 Medical Ethics - Dr. Rami Abo Ali

28. International Code of Medical Ethics Given by World Medical Association The International Code of Medical Ethics was adopted by the General Assembly of the World Medical Association at London in 1949, amended in 1968, 1983 and 2006. It is a code based on the Declaration of Geneva and the main goal is to establish the ethical principles of the physicians worldwide, based on his duties in general, to his patients and to his colleagues. The code applies both in peace and war. It codifies the duties of physician in general, duties to patients and colleagues 28 Medical Ethics - Dr. Rami Abo Ali

29. Duties and responsibilities of physician in general A PHYSICIAN SHALL : always exercise his/her independent professional judgment and maintain the highest standards of professional conduct. respect a competent patient’s right to accept or refuse treatment. not allow his/her judgment to be influenced by personal profit or unfair discrimination. not receive any financial benefits for referring patients or prescribing specific products. 29 Medical Ethics - Dr. Rami Abo Ali

30. A PHYSICIAN SHALL : recognize his/her important role in educating the public deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception. respect the rights and preferences of patients, colleagues, and other health professionals. respect the local and national codes of ethics 30 Medical Ethics - Dr. Rami Abo Ali Duties and responsibilities of physician in general

31. Duties of Physician to their patients A PHYSICIAN SHALL : always bear in mind the obligation to respect human life. act in the patient’s best interest when providing medical care owe his/her patients complete loyalty and all the scientific resources available to him/her. Whenever an examination or treatment is beyond the physician’s capacity, he/she should consult with or refer to another physician who has the necessary ability give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care. 31 Medical Ethics - Dr. Rami Abo Ali

32. Duties of Physician to their patients A PHYSICIAN SHALL : respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality in situations when he/she is acting for a third party, ensure that the patient has full knowledge of that situation. not enter into a sexual relationship with his/her current patient or into any other abusive or exploitative relationship 32 Medical Ethics - Dr. Rami Abo Ali

33. Duties Of Physician in consultation Avoid un-necessary consultation Consulting pathologist, radiologist or asking for lab investigation should be done judiciously . Consultation for patient benefit. Punctuality in consultation. Statement to patient after consultation. Treatment after consultation. Patient referred to specialist. Fees and other charges. 33 Medical Ethics - Dr. Rami Abo Ali

34. Responsibilities To Each Other Dependence of Physicians on each other Should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants. Conduct in consultation Respect should be observed towards the physician in charge of the case and no statement or remark be made 34 Medical Ethics - Dr. Rami Abo Ali

35. Responsibilities To Each Other Consultant not to take the charge of the case. Appointment of the substitute only when he has the capacity to discharge the additional responsibility along with his / her other duties Visiting another Physician's case Avoid remarks upon the diagnosis or the treatment that has been adopted. 35 Medical Ethics - Dr. Rami Abo Ali

36. Duties Of Physician To Public And Paramedical Staff Physicians as citizens Should particularly co-operate with the authorities in the administration public health laws and regulations. Public and community health Should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. Pharmacists/nurses Should promote and recognize their services and seek their cooperation. 36 Medical Ethics - Dr. Rami Abo Ali

37. Definition of health World Health Organization (WHO) : Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Somatic - pSychiatric - Social (3 ‘S’) 37 Medical Ethics - Dr. Rami Abo Ali

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