Dr.Waseem Ahmed Abujamea, MD ED CONSULTUNT,SBEM,AbEM PROGRAM 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 الأخلاقية  A system of principles governing morality and acceptable conduct  نظام من المبادئ اللي تحكم الاخلاق 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’.عادل او ظالم

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

MMedical ethics and the law is closely related but they are NOT identical LLaws differ significantly from one country to another while medical ethics is applicable across national boundaries. M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 comorbidities Complicated 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 ( )

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 ( )

Rule# 11**  1)- To Spectate (or) (watch)  2)- To Run Away  3)- To Commit Ways of dealing with any problem

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