Dr.Waseem Ahmed Abujamea, MDED CONSULTUNT,SBEM,AbEMPROGRAM DIRECTOR KSMC

DEPUTY CHAIRMAN EMERGENY DEPARTMENT

KSMC

Ethics … . Its importance

Medical ethics . Its Importance.

Medical ethics and the law

Facts and rules**

ETHICS

Definitions: Ethics (n):

The philosophical study of moral values and rules

الدراسة الفلسفية للقيم والقواعد األخالقية

A system of principles governing morality and acceptable conduct

نظام من المبادئ اللي تحكم االخالق والسلوك المقبول

Morality (n):

Is the value dimension of human decision making and behavior.

The language of morality includes:

Nouns: such as ‘rights’, ‘responsibilities’

and ‘virtues’

Adjectives: such as ‘good’ and ‘bad’ (or ‘evil’), ‘right’ and ‘wrong’, ‘just’ and ‘unjust’. ظالم او عادل

According to these definitions:

Ethics is primarily

a matter of knowing.

Morality is a matter of

doing.

The close relationship between ethics and morality consists in the concern of ethics to provide rational criteria for people to decide or behave in some ways rather than others i.e.: morally

For the perfect human relationship they are ought to think right “ethically” and act right “morally”.

Definition:

Medical ethics:

The branch of ethics that deals with moral issues in medical practice.

Medical ethics is pertaining to the Physician and Health care Providers behavior and decision-making.

Medical ethics: Does not deal with the scientific or technical questions such as: How to treat diabetic ketoacidosis, acute

respiratory failure, manage hypertensive patient

How to perform cholecystectomy, or how to do intubation or insert a central line..,

Medical ethics deal with the Questions about values, rights and responsibilities.

All physicians / health care providers face ethical questions just as often as scientific and technical ones.

Why medical ethics? i.e. Importance of medical ethics

Medical ethics prepares the physicians/ health care providers 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.

Ethical questions in medicine are not all equally

challenging.

Easy Ethical questions: because there is a well-developed consensus on the right way to act in the situation: Physician should

always ask for a patient’s consent for elective procedures and to serve as a research subject .

Difficult Ethical questions : Those for which no

consensus has developed or

Those where all the alternatives have drawbacks : Rationing of scarce

healthcare resources , Patients triage , DNAR decision Withholding / Withdrawing

of life sustaining measures

Medical ethics and the law is closely related but they are NOT identical

Laws differ significantly from one country to another while medical ethics is applicable across national boundaries.

Medical Ethics prescribes higher standards of behavior than does the law, and occasionally ethics requires that physicians disobey laws that demand unethical behavior. “physicians are expected to follow medical ethics rather than law”.

To be always considered in medical practice.

The Ethical Principles(1978, Beauchamp and Childress )

The principles to organize physicians’ thinking about the

ethical practice of medicine:

(1) Beneficence, the physicians’ duty to help patients

(2) Nonmaleficence, the obligation to avoid harm. (3) Respect for autonomy, the patients’ right to

self-determination. (4) Justice, to treat every one equally and the fair

allocation of medical resources. Justice situates patients and physicians within the larger society and acknowledges the importance of treating similar patients in similar ways.

(5) Veracity: Truth telling: Obligation to full and honest disclosure.

Rule #1**

Always remember the Ethical principles in every case you discuss.

(1) Beneficence, (2) Nonmaleficence, (3) Respect for autonomy, (4) Justice, and (5) Veracity.

Rule #2**

The patient-physician relationship **.

The patient-physician relationship is the cornerstone of medical practice and medical ethics.

A unique “professional’ relationship which facilitates an exchange of scientific knowledge and care within a framework of ethics and trust.

Rule # 3**

Patients come to physicians for help with their most pressing needs –

Patients allow physicians to see, touch and manipulate almost every part of their bodies.

Why?

Because Patients trust their physicians to act in their best interests**.

Rule # 4**

To meet the expectations of the patients, it is important that physicians know and represent the core values of medicine :

Compassion,

Competence and

Autonomy.

The ‘centrality’ of the patient in any discussion on medical ethics**

Most medical associations acknowledge in their foundational policies that ethically, the best interests of the individual patient should be the first consideration in any decision on care.

Rule # 5**

What does this mean?

The physicians need to know how to navigate through the many ethical challenges faced in daily practice and find effective ways TO PUT THEIR PATIENTS FIRST**

Rule # 6**

Current Health Care: since 1940s

Advanced diagnostic and therapeutic tools.

Hospital population: Older / Sicker Multiple comorbiditiesComplicated procedures /

Treatment

Expectations are high / unrealistic. Patients/ Families want it all, want it now.

Rule# 6**

Goals of medical treatment: To Preserve life ,

To Restore health and well-being

To Prevent / minimize disability and

To relief pain and suffering.

Rule # 7 **

“The task of medicine is to cure

sometimes, to relieve often, and

to comfort always.”

Ambrose Paré (1510-1590)

Rule # 8** Types of patients:

1. Patients are certain to survive the current illness (floor patients)

2. Patients are certain to die due to current illness (should receive the most appropriate terminal care under palliative care service.)

3. Patients between these two groups, have various degree of uncertainty (should receive maximum effort but be seriously evaluated in a daily basis;

Dr. Loeb’s Laws:

1. If what you are doing is working, keep doing it.

2. If what you are doing is not working, stop doing it.

3. If you do not know what to do, do nothing.

4. Never make the treatment worse than the disease. “If at all possible, keep your patient out of the

operating room.” OR “never give your patient to a surgeon”

Matz R: Principles of medicine .NY State J med 77:99-101, 1977

Rule # 9**

Always remember Dr. Loeb's laws

Dr. Robert Loeb

Rule # 10**

"I treated the patients and God healed them."

Ambrose Paré (1510-1590)

Rule# 11**

1)- To Spectate (or) (watch)

2)- To Run Away

3)- To Commit

Ways of dealing with any problem

Thank You