Introduction and principles

Dr. Shaween Ziyad Jamil Al-Talabany

Medical Ethics/MA 220
Spring Semester
Week 2
4&5/Feb/2024
Outline
 What is Ethics
 Historical background of ethics
 Why we need medical ethics
 Principles of ethics
Objectives

◦ -To define Ethics and the reason of studying Ethics

◦ To identify the main 4 principles of Ethics

Ethics is not:

 Ethics is not the same as feelings.

 Ethics is not religion.
 Ethics is not following the law.
 Ethics is not following culturally accepted norms.
 Ethics is not a science
Ethics is …

 Moral Principles
 What is good and bad
 What is right and wrong
 Based on value system
 Ethical norms are not universal – depends on the subculture of the society.
 Definition

 Ethics is the study of morality – careful and systematic reflection on and

analysis of moral decisions and behaviour, whether past, present or
future.
 Morality is the value dimension of human decision-making and
behaviour. The language of morality includes nouns such as ‘rights’,
‘responsibilities’ and ‘virtues’ and adjectives such as ‘good’ and ‘bad’ (or
‘evil’), ‘right’ and ‘wrong’, ‘just’ and ‘unjust’.
 According to these definitions, ethics is primarily a matter of knowing
whereas morality is a matter of doing.
 Definition/Cont..
-Ethics refers to standards of behavior that tell us how human
beings ought to act in the many situations in which they find
themselves as friends, parents, children, citizens,
businesspeople, teachers, professionals, and so on

-Medical ethics, the branch of ethics that deals with moral

issues in medical practice. including clinical research.

It focuses on the relationship between healthcare professionals

and their patients, and also addresses the broader obligations of
healthcare systems to society.
Historically
Thomas Percival (1740–1804),
a physician from
Manchester, England,

Eponymous book
Medical Ethics
(Percival 1803b)

Description of the professional

duties of physicians and surgeons to
their patients, to their fellow practitioners,
and to the public
 As a health professional we must recognize

1-Responsibility to patients first and foremost, as well as to society, to other

health professionals, and to self.

2-These are not laws, but standards of conduct which define the essentials of
honorable behavior for the health professional.
 Why study medical ethics?
 The study of ethics was regarded not essential du to the following:

 “As long as the health professional is a knowledgeable and skillful clinician, ethics
doesn’t matter.”
 “Ethics is learned in the family, not in medical school.”
 “Medical ethics is learned by observing how seniors act, not from books or lectures.”
 “Ethics is important, but our curriculum is already too crowded and there is no
room for ethics teaching.”
What is the need for medical ethics?

 The practice of medicine and the ethics are inseparable.

 Every clinical decision invokes an ethical decision.

 In many instances the ethical principles may not be readily apparent.

 Conflicts arise between ethical principles and clinical decisions which

requires the health profession to be versed with the former to guide the
latter.
 “The study of ethics prepares
students to recognize difficult
situations
and to deal with them in a rational
and principled manner.”
Medical ethics, medical professionalism,
human rights and law

 Human rights agreements can provide a

foundation for medical ethics that is acceptable
across national and cultural boundaries

 In most countries there are laws that specify how

health professionals are required to deal with
ethical issues in patient care and research
 How do individuals decide what is
ethical?
Non- Rational approaches Rational approaches

A-Obedience A-Deontology
B- B-Consequentialism
Limitations C-Ethics Virtue
C-feeling/desire
D- D-Principlism
Intuition
E-Habit
Four basic Principles of Medical Ethics

-Autonomy

-Beneficence

-Non-maleficence

-Justice
1-Autonomy

-Is usually expressed as the right of

competent adults to make informed
decisions about their own medical care.

-Patient has freedom of thought, intention

and action when making decisions
regarding health care procedures.
 Elements to apply Autonomy

 Telling the Truth

For a patient to make a fully informed decision, she/he must understand all
risks and benefits of the procedure and the likelihood of success.

 Privacy and confidentiality of the patient

Such respect is not simply a matter of attitude, but a way of acting to
recognize and even promote the autonomous actions of the patient.
 Sufficient information to be supplied
The autonomous person may freely choose loyalties or systems of
religious belief that may adversely affect him ( however we need to
inform about the harms).

 Desiring to "benefit" the patient

The health professional may strongly want to intervene believing
it to be a clear "medical benefit.

◦ Protection of patients
Patient with impaired or diminished autonomy.
Consent

 Verbal (Blood test )

 Written (Surgery)
How Is Capacity Assessed?
 Patients over the age of 18 are assumed to have capacity unless this is
proven otherwise.

 In order to have capacity, a person must be able to:

 1-Understand the information they are given
 2-Remember the information
 3-Use the information (weighing up benefits and risks, etc) to make a
decision
 4-Communicate their decision
Conditions where we override Autonomy

• Emergency life-saving treatment in which a patient is unable to

give consent because they are incapacitated (such as being
unconscious).

• Additional emergency procedures during an operation.

• The patient has a severe mental health condition such as

schizophrenia, bipolar disorder or dementia which renders them
incapable of giving consent.
 Conditions where we override Autonomy
CONT
• Hospitalization for a severe mental health condition but a competent patient
has self-harmed, attempted suicide and refuses treatment, their relatives or
social workers must make an application to forcibly keep the patient in a
hospital. Two Doctors will assess the patient’s condition.

• If there is a wider risk to public health if the patient goes untreated, such as
rabies or tuberculosis.

• When someone is extremely ill, unhygienic and living in poor conditions,

they can be taken in for treatment.
Who will take the decision when autonomy is
overridden?
 Another person(Descending order)
If there is a disagreement (Senior member or voting)
But serious disagreement:
Physician/healthcare provider will decide according to
Declaration on the Rights of the Patient.

 In case no legally representative for the patient, physician /Healthcare

provider will take decisions.

-Should apply what is the best interest of the patient.

 The WMA Declaration on the Rights
of the Patient
 If the patient is unconscious or otherwise unable to express his/her will,
Informed consent must be obtained, whenever possible, from a legally
entitled representative.

 If a legally entitled representative is not available, but a medical

intervention is urgently needed, consent of the patient may be
presumed.

 unless it is obvious and beyond any doubt on the basis of the patient’s
previous firm expression or conviction that he/she would refuse consent to
the intervention in that situation.
 2-Non-maleficence
 States that a medical practitioner has a duty to do no harm or
allow harm to be caused to a patient through neglect.

 It acts as a threshold for treatment. If a treatment causes more

harm than good, then it should not be considered.
3-Beneficence

 Means that all medical practitioners have a moral duty to

promote the course of action that they believe is in the best
interests of the patient.

 It’s better to think of beneficence as the process of ranking the

available options for the patient from best to worst.

 You will notice that several considerations are concerned with

the patient’s expectations or circumstances. This is also
known as holistic or patient-centric care.
4-Justice

 Is the principle that when weighing up if something is ethical or not,

we have to think about whether it’s compatible with the law, the
patient’s rights, and if it’s fair and balanced.

 It also means we must ensure no one is unfairly disadvantaged when

it comes to access to healthcare
 In brief
 A handy checklist of the ethical angles to cover when considering morally
problematic cases or questions.

 1-‘‘What will do good, avoid harm, or at least do more good than harm for
the patient concerned?’’

2-‘‘Are the wishes of the persons involved being taken seriously?’’

3-‘‘What is most equitable, not just for this patient or group of patients but
also for others and for society?’’
 If there is a conflict during a medical practice

 1. Determine whether the issue at hand is an ethical one.

 2. Consult authoritative sources such as medical association codes of ethics and

policies and respected colleagues to see how healthcare providers generally deal
with such issues.

 3. Consider alternative solutions considering the principles and values they uphold
and their likely consequences.
 4. Discuss your proposed solution with those whom it will affect.

 5. Make your decision and act on it, with sensitivity to others affected.

 6. Evaluate your decision and be prepared to act differently in future

References

◦ World Medical Association. (2016). Ethics_manual_3rd_Nov2015_en.pdf.

Retrieved from
https://www.wma.net/wp-content/uploads/2016/11/Ethics_manual_3rd_Nov
2015_en.pdf

◦ The Medic Portal. (2023, September 20). Medical Ethics - The Four Pillars
Explained.
https://www.themedicportal.com/application-guide/medical-school-intervie
w/medical-ethics