1. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Patient Safety Training Code of Ethics

2. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department

3. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What is Ethics? Ethics is a system of moral principles. They affect how people make decisions and lead their lives. Ethics is concerned with what is good for individuals and society and is also described as moral philosophy.

4. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethics Dilemmas Ethics covers the following dilemmas: how to live a good life our rights and responsibilities the language of right and wrong moral decisions - what is good and bad?

5. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What is Medical Ethics? Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine.

6. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Basic principles of medical ethics A) respect for patient autonomy. b) not inflicting harm on patients. c) a positive duty to contribute to the welfare of patients. d) justice or fair treatment of patients.

7. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Nowadays, conflicts of interests between the government and medical institutions, between medical institutions and medical personnel, between physicians and patients are getting more and more serious and complex. High technologies not only brought us hopes of cure but have also created a heavy economic burden. The ethical dilemmas of high technology medicine-brain death, organ transplantation, and concerns about quality of life-have become increasingly prominent. A new and more specific code of ethics must be developed to meet the demands of social development and medical service. This new code integrates the traditional medical ethics with modern principles and values Why Ethics Become Important?

8. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethics and Morality What are they? The terms ethics and morality are often used interchangeably - indeed, they usually can mean the same thing, and in casual conversation there isn't a problem with switching between one and the other. However, there is a distinction between them in philosophy!

9. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethics and Morality What are they? Ethics and morals both relate to “right” and “wrong” conduct. However, ethics refer to the series of rules provided to an individual by an external source. e.g. their profession. On the other hand, morals refer to an individual’s own principles regarding right and wrong.

10. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Comparison chart Ethics The rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc. It defines how thing are according to the rules. Moral Principles or habits with respect to right or wrong conduct. It defines how things should work according to an individuals' ideals and principles.

11. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Comparison chart Ethics Social system – External Why we do it? Because society says it is the right thing to do. What if we don't do it? We may face peer/societal disapproval, or even be fired from our job. Moral Individual – internal Why we do it ? Because we believe in something being right or wrong. What if we don't do it? Doing something against one's morals and principles can have different effects on different people, they may feel uncomfortable, remorse ندمان, depressed etc.

12. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Comparison chart Ethics Acceptability Ethics are governed by professional and legal guidelines within a particular time and place Moral Acceptability Morality transcends cultural norms

13. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethics vs Laws 1. Ethics are rules of conduct. Laws are rules developed by governments in order to provide balance in society and protection to its citizens. 2. Ethics comes from people’s awareness of what is right and wrong. Laws are enforced by governments to its people.

14. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethics vs Laws 3. Ethics are moral codes which every person must conform to. Laws are codifications of ethics meant to regulate society. 4. Ethics does not carry any punishment to anyone who violates it. The law will punish anyone who happens to violate it. 5. Ethics comes from within a person’s moral values. Laws are made with ethics as a guiding principle.

15. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Section 2: Professional ethics, medical ethics, bioethics, clinical ethics

16. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department 1.Professional Ethics Professional ethics are standards of conduct that apply to people who occupy a professional occupation or role. A person who enters a profession acquires ethical obligations because society trusts them to provide valuable goods and services that cannot be provided unless their conduct conforms to certain standards. Professionals who fail to live up to their ethical obligations betray this trust. Professional ethics studied by ethicists include medical ethics.

17. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department 2.Medical ethics Medical ethics Concerns issues related to practice of medicine Explores and promotes principles guiding conduct of health care professionals Involves the consideration of others in deciding how to act It is applied ethics. It consists of the same moral principles and rules that we would appeal to,and argue for, in ordinary circumstances.

18. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department 3.Bioethics Bioethics could be defined as the study of ethical issues and decision-making associated with the use of living organisms Bioethics includes medical ethics. Bioethics is learning how to balance different benefits, risks and duties.

19. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department 4- Clinical medical ethics is a practical and applied discipline that aims to improve patient care and patient outcomes by focusing on reaching a right and good decision in individual cases. It focuses on the doctor-patient relationship and takes account of the ethical and legal issues that patients, doctors, and hospitals must address to reach good decisions for individual patients.

20. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department The content of clinical ethics includes Specific issues such as truth-telling, informed consent, end of life care, palliative care, allocation of clinical resources, the ethics of medical research. The study of the doctor-patient relationship, including such issues as:  honesty,  competence,  integrity,  respect for persons.

21. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department STANDARDIZED ARMED FORCES HOSPITAL BYLAWS ARTICLE VIII CODE OF ETHICAL CONDUCT

22. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department The code of conduct established to help create and maintain a culture of integrity and to clearly and concisely outline the types of behaviors that are expected in the workplace. It is the responsibility of all us to act in a manner consistent with this Code and to hold others accountable to its terms and related policies. All individuals subject to this policy have an obligation to and are required to report violations of the Code of Ethical Conduct. A process is established that allows persons bound by the Code of Ethical Conduct to safely report unethical and illegal actions, without fear of retaliation or consequence targeted to any member who reports Code violations CODE OF ETHICAL CONDUCT AS PER MSD GUIDELINE

23. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What is a Code of Ethical Conduct? A Code of Ethical Conduct is a tool to help create and maintain a culture of integrity it is a set of rules that clearly and concisely outline the types of behaviors that are expected in the workplace

24. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Why is it important to have a Code of Ethical Conduct? A Code of Ethical Conduct helps all employees to follow the same behavior standards to ensure sound clinical practice and patient satisfaction which is consistent with the customs and traditions of the Kingdom of Saudi Arabia.  The ethical decision making framework is a tool to assist all employees when dealing with ethical dilemmas involving the care of a patient.

25. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What are the responsibilities of each employee with regard to the Code? Understand how to comply and apply it to your job and seek assistance and clarification from your supervisor when you have questions related to your work. Report any conduct that you think may be in violation of the Code. listen and respond to questions, complaints or concerns expressed by patients, family members, visitors, or co- workers.

26. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What are the responsibilities of the managers and other supervisors? Know, understand, and follow the rules and regulations that govern your area(s) of responsibility. Encourage employees to raise conduct and ethical questions and concerns. Use employee actions and judgments in promoting and complying with this Code and other policies as considerations when evaluating and rewarding employees. Provide education and counseling to assist employees to understand the Code. Promote an environment that permits employees to raise concerns without fear of retaliation Report any conduct that may be in violation of the Code. Coordinate investigations concerning potential violations of Code. Apply appropriate disciplinary action when necessary.

27. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department What are the responsibilities of volunteers, contractors, vendors, and agents? Read the standards of the Code and have a basic understanding of their application to the services furnished to MSD Facilities. The code is the foundation to the values upheld and practiced by all personnel at the Hospital, and outlines expected behaviors for all employees. The Hospital expects that every employee conducts business fairly, impartially, in an ethical and proper manner, and in full compliance with all applicable laws and regulations and the highest standards of ethical business code of conduct. All employees without exception shall adhere to the highest ethical standards of conduct in all professional and business activities and shall act in a manner that enhances the Hospital standing as a vigorous and ethical contributor within the health care professions and the community.

28. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Conduct between Male and Female Employee:  All members male and female should at all times practice the principle of modesty and respectable interaction and proper decorum during activities, gatherings or when dealing with each other. Gifts:  No staff member shall accept any gift, favors, services or other things of value under the circumstances from which it might be inferred that these were offered for the purpose of influencing them in the discharge of their duties

29. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Conflict of Interest  All employees shall abide by the Conflict of Interest Policy, or activities that may raise questions to the Hospital’ Values or otherwise cause embarrassment to the Hospital, disclose any potential conflict of interest and remove the conflict as required.  Employees will ensure that they do not engage in any activity that might create a conflict of interest for the Hospital or for themselves individually.  All employees shall not take advantage of their position to seek personal gain through the inappropriate use of information or abuse of their position.

30. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Disclosure of Information  All employees shall follow all restrictions on use and disclosure of information. This includes following all requirements for protecting information and ensuring that non-Hospital proprietary information is used and disclosed only as authorized by the owner of the information or as otherwise permitted by law.  All employees shall observe that fair dealing is the foundation for all of our transactions and interactions.  All employees are responsible for safeguarding the confidentiality of information related to privacy of patients, Hospital information, and information owned by others.

31. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department How to Report Violations of the Standards  Every employee has the responsibility to ask questions, seek guidance and report suspected violations of this Code of Conduct.  Revenge against employees who come forward to raise genuine concerns will not be tolerated  In the event that an employee has a question or concern or believes that someone is conducting their business in an illegal, unethical, or otherwise questionable manner, or violating Hospital policies, it is preferred that the employee first contact his or her supervisor to discuss the matter.  When either the response the employee receives may be inadequate or the employee may feel uncomfortable in discussing the matter with his or her supervisor. In those cases, the employee should contact extension number: (0000).  All calls to this line are confidential, and the caller will remain anonymous. For more info see page 88 onwards in the Bylaws

32. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Ethical issue Report to Supervisor/Director or Call 0000 All calls to this line are confidential, and the caller will remain anonymous.

33. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department ARTICLE IX MANAGEMENT OF ETHICAL FRAMEWORK

34. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department  To facilitate resolution of ethical issues confronting patients and their families, physicians and patient care personnel.  To advises personnel on the processes to be used to address clinical and administrative ethical decisions that can or cannot reach consensus. PURPOSE OF AN ETHICAL FRAMEWORK :

35. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department  Everyday Ethics: The way we approach each other; the care/services we provide and receive, and our commitment to each other. This includes: Respect, Safety, Dignity, Privacy, Integrity, Honesty, and Confidentiality.  Ethical Concerns/Dilemmas: Situations that arise when ethical reasons both for and against a particular course of action are recognized and a decision must be made.  Ethical Uncertainty: When one is unsure what ethical principles or values to apply to a situation or even what the moral problem is. TYPES OF ETHICAL SITUATIONS:

36. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department FUTILE MEDICINE: AN ETHICAL DILEMMA (…) our most cruel failure on how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; (…) A. Gawande

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38. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Clinical:  Breaching participant's right to confidentiality and privacy.  Knowingly exceeding what the organization is realistically capable of doing or sustaining.  Ignoring individual's right to self-direction.  Participant engaging in substance abuse which has obvious consequences.  Observing interactions between employees and the participant or their family members that challenge your own beliefs and morals.  Receiving information you wish you did not have. Examples of Ethical Dilemma:

39. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Human Resources:  Attacking or blaming others.  Harassment towards a fellow employee  Contravention of the organizations policies  Controlling information in efforts to limit the opportunities of a rival employee  Misrepresentation of credentials

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43. King Fahd Armed Forces Hospital, Jeddah Continuous Quality Improvement & Patient Safety Department Thank You