Transcript Introduction to Medical Ethics (Dr Leena Al

Introduction to medical ethics
Dr Leena Al-Qasem
Topics covered:

Introduction

Definition of Ethics

Principles of ethical guidelines

Informed consent

Confidentiality
Philosophy
Ethics
Descriptive Ethics
Metaethics
Epistemology
Logic
Normative ethics
Bioethics
Page  3
Metaphysics
Why was ethics born:
Clinical ethics
Research ethics
Expansion of technological
capacities
Extend human life
? the quality of patient’s
lives
Control cost
Moral and legal interests of
individuals
Beecher,
Berber,
and
paperworth
Chronic disease hospital
Tuskegee syphilis study
Willobrook hepatitis study
Radiation experiments
Oral contraceptives trials
Thalidomide
Holmesburg
prison
experiments
Allen memorial/ CIA, prison
experiments
(hallucinogenic
drugs)
Page  4
What does ethics mean to you?
Page  5
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 absolute
may 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.
Beneficence:
Requires physicians to take positive actions for the benefit of
patients.
Because patients do not possess medical expertise and
maybe vulnerable because of their illness, they rely on
physicians to provide sound advice and to promote their well
being.
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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
Page  15
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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Nonmaleficence:
DO NO HARM" forbids physicians:
From providing ineffective therapies
From acting maliciously or selfishly
provides limited guidance since many interventions
also entail serious risks and side effects.
Provide standard care
If no benefit, at least do not harm or make situation
worse
If benefit equals harm, do not intervene
Page  17
Social Justice:
The term in a general sense means fairness.
In the health care setting, justice usually refers to the
allocation of health care resources.
Allocation is usually unavoidable because resources
are limited and could be spent on other social goods,
such as education or the environment, instead of
health 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.
Difficulty with guidelines:
However guidelines may be difficult to apply in
new cases for several reasons
Page  22
1. Guidelines need to be interpreted in the context
of specific cases:
Case to case variations inherent
Different priorities and goals for care
Distinguishing cases in ethically meaningful ways
Page  23
2. Exceptions to guidelines may be appropriate:
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
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3. Different guidelines may conflict:
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
Page  25
Questions?