Introduction to medical ethics Dr Leena Al-Qasem.

Introduction to medical ethicsDr Leena Al-Qasem

Topics covered:

Introduction

Definition of Ethics

Principles of ethical guidelines

Informed consent

Confidentiality

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Philosophy

Ethics Epistemology Logic Metaphysics

Descriptive Ethics Metaethics Normative ethics

Bioethics

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Why was ethics born:

Clinical ethics Research ethics

Expansion of technological capacities

Extend human life ? the quality of patient’s

livesControl costMoral and legal interests of

individuals

Beecher, Berber, and paperworth

Chronic disease hospitalTuskegee syphilis studyWillobrook hepatitis studyRadiation experimentsOral contraceptives trialsThalidomideHolmesburg prison

experimentsAllen memorial/ CIA, prison

experiments (hallucinogenic drugs)

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What does ethics mean to you?

Case I:You are caring for a patient with cancer. She is refusing to undergo surgery or receive chemotherapy for the treatment of her condition. What would the right action be in this case?

Case II:A patient is being treated by you for a certain condition. He wishes to use alternative forms of treatment for this condition, treatment which you do not believe is effective, due mainly to lack of scientific evidence. Moreover, you believe that the alternative treatment might interfere with the standard treatment and cause the patient’s condition to worsen. How you would handle this case?

Case III:You are a physician working in an intensive care unit with a capacity of five beds, four of which are occupied. You receive a call from the A&E where they have two patients needing ICU admission. The mother of one of those patients, whom you know, pleads with you to save her young son. The other patient, as you find out later is a foreigner with no relatives in the country. What would be the right action in this case?

Case IV:A 32 years old male is diagnosed with bacterial meningitis. After the physician explained his diagnosis to him, the risks and benefits, the patient refused to be treated for his illness and insisted on going home.

Principles of ethical guidelines:Autonomy

Beneficence

Nonmaleficence

Social Justice

Autonomy:Self-determination, independence, and freedom.

Patients may choose among medically feasible alternatives.

Patients may refuse unwanted medical interventions.

patients have the right to make choices that conflict with the wishes of family members or the recommendations of their physician.

Autonomy:Treating patients with respect entails several ethical obligations

1.Physicians must respect decisions of autonomous persons.

2.respect for persons with impaired decision making capacity

3.avoiding misrepresentation, maintaining confidentiality, and keeping promises

Autonomy is not absolutemay be justifiably restricted for several reasons:

– person is incapable of making informed decisions. Respecting autonomy < important than acting in the best interest of the patient.

– constrained by the needs of other individuals or society at large.

– not free to act in ways that violate the autonomy of other people, harm others, or impose unfair claims on society's resources.

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Requires physicians to take positive actions for the benefit of Requires physicians to take positive actions for the benefit of patients.patients.

Because patients do not possess medical expertise and Because patients do not possess medical expertise and maybe vulnerable because of their illness, they rely on maybe vulnerable because of their illness, they rely on physicians to provide sound advice and to promote their well physicians to provide sound advice and to promote their well being.being.

Beneficence:

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Promotes patient best interest by:

• Understanding patient perspective

• Address misunderstandings and concern

• Try to persuade patient

• Negotiate a mutually acceptable plan of care

• Ultimately let the patient decide

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The physician cannot be required to violate fundamental personal values, standards of scientific or ethical practice, or the law.

If the physician is unable to carry out the patient’s wishes, the physician must withdraw and/or transfer care of the patient

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DO NO HARM" forbids physicians:

From providing ineffective therapiesFrom acting maliciously or selfishlyprovides limited guidance since many interventions also entail serious risks and side effects.

Provide standard careIf no benefit, at least do not harm or make situation worse

If benefit equals harm, do not intervene

Nonmaleficence:

Social Justice:

The term in a general sense means fairness.The term in a general sense means fairness.

In the health care setting, justice usually refers to the In the health care setting, justice usually refers to the aallocation of health care resources..

Allocation is usually unavoidable because resources Allocation is usually unavoidable because resources are limited and could be spent on other social goods, are limited and could be spent on other social goods, such as education or the environment, instead of such as education or the environment, instead of health carehealth care

Social justice:

Ideally allocation decisions are made by public policy and set by government officials

Physicians should participate in debates about allocation and help set policies.

Social justice:

In general however, rationing medical care at the bedside should be avoided because it may be:

– inconsistent,

– discriminatory

– ineffective.

– At the bedside, physicians usually should act as patient advocates within constraints set by society and sound practice.

Social justice:

If patients compete to limited resource e.g. time of physicians or bed in ICU

Rationing by physicians should be done

• according to patient's medical needs

• probability and degree of benefit.

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However guidelines may be difficult to apply in new cases for several reasons

Difficulty with guidelines:

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Case to case variations inherent

Different priorities and goals for care

Distinguishing cases in ethically meaningful ways

1. Guidelines need to be interpreted in the context of specific cases:

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Guidelines are not absolute

cases may have distinctive features

To ensure fairness, physicians who make an exception to a guideline should justify their decision

The justification should apply to all similar cases faced by other physicians

2. Exceptions to guidelines may be appropriate:

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In many situations, following one ethical guideline would require the compromise of another guideline.

much easier if there were a fixed hierarchy of ethical guidelines

3. Different guidelines may conflict:

Questions?