03-Nada student copy THE IMPORTANCE OF LEARNING BIOETHICS.pdf

THE IMPORTANCE OF LEARNING BIOETHICS Lecture at the College of Medicine King Saud University, Riyadh By Dr Nada A AlYousefi MBBS, SBFM, ABFM Assistant Professor of Family Medicine Faculty of Medicine King Saud University...

THE IMPORTANCE OF LEARNING BIOETHICS Lecture at the College of Medicine King Saud University, Riyadh By Dr Nada A AlYousefi MBBS, SBFM, ABFM Assistant Professor of Family Medicine Faculty of Medicine King Saud University EM: [email protected] ________________ 25th September 2012  The overall objective of training in ethics for medical students is to equip them with principles and methods to enable them analyze and resolve practical clinical ethical problems that they encounter as students and as practitioners later in their life. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr.  A patient with diastolic blood pressure of 120 mmHg failed to return to the Health Center for treatment. The nurse called the head of the village and asked him to convince the patient to come. In order to press on him the urgency of the matter, she had to explain all the details of the history & examination that had been carried out on the patient. ◦ Your views on the ethical aspects of the response from the nurse ?  A 42-year-old teacher pregnant for the first time refused an elective caesarean section. She continued to refuse the procedure when labor became obstructed and signs of fetal distress appeared. The obstetrician went ahead to operate on the basis of consent by the husband. The baby was delivered alive and well. ◦ Your views on the ethical aspects of the Obstetrician’s action ?  A patient admitted to the ICU after a car accident was confirmed by 3 specialist surgeons to be in a persistent vegetative state. The doctors wanted to discontinue life support but the family refused because there were signs of life like reflex flexion of joints and blinking of the eyes. The hospital decided to seek a court injunction after keeping the patient in the ICU for 6 months without any obvious improvement. ◦ Are the requests of the doctors and hospital ethically justifiable? ◦ Please explain the reasons for your answer  A couple married for 10 years without a child decided to have IVF. Before the procedure was completed, the husband died. The wife insisted on using the stored semen of her dead husband. The relatives of the husband objected. The first wife who had been divorced 15 years earlier with one girl also asked for the semen for an IVF procedure that she hoped would enable her to have another baby to act as a bone marrow donor for her daughter who had leukemia and had failed to find a matching donor. ◦ Your Views on this scenario from Islamic Ethics perspective?  Mrs Jamila, a patient in her late sixties, is an infrequent attender at the Family practice clinic. One day, she presented to Dr. Jamal with abdominal distension and anorexia. On examination, Dr. Jamal found a large mass and ascites. He thought that the most likely diagnosis was ovarian cancer. He explained this to Mrs Jamila and advised that some investigations would help to confirm the diagnosis and then it would be possible to work out what, if any, treatment would be recommended. Mrs Jamila refused to have any investigations or to see a specialist for further assessment. She eventually died several months later. ◦ Your Views on Dr Jamal’s relative inaction from an ethical perspective?  Once a month, Dr. Hameed hosts an HIV case conference in his practice. It is a breakfast meeting attended by staff in the practice and surrounding practices, who have an interest in the care of patients with HIV/AIDS. The breakfast is provided by Links – Howard, a pharmaceutical company that produces a range of drugs used in the treatment of HIV/AIDS. One of the Links- Howard pharmaceutical representatives also attends these meetings. The meetings usually begin informally as the participants eat breakfast together.  They then spend about half an hour either discussing general treatment and management issues or one participant will bring a difficult case to the meeting. Dr. Hameed allows the Links – Howard representative to bring promotional literature and pens to the meeting, and there is also the opportunity to speak to individual doctors at the end of each meeting. ◦ Are Dr Hameed’s actions in accepting help from a medical representative ethically acceptable in this scenario? Please justify your answer?  CASES  Case #1: A 40-year old policeman refused surgery to drain a pyomyositis abscess. He still refused surgery after the abscess burst spontaneously. The surgeons sedated him and carried out the surgery without his consent.  Case #2: A 40-year old housewife with 8 living children is brought reluctantly to the contraceptive clinic by the husband. The husband asks for tubal legation because he cannot afford to look after more children. The wife insists that Allah will provide for all the children irrespective of the husband’s financial situation.  Case #3: A father of a child with end-stage renal disease got tired of taking her for dialysis every week. He had failed to find a live or a cadaveric donor for her in his country. He considered traveling to a nearby country where kidneys could be bought but he was not sure. He also considered marrying a young wife (his first wife had died) and hopefully produce a child who could be a donor. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  CASES  Case #4: A married woman fearing that she was no longer attractive wanted to undergo plastic surgery on the nose and to bleach her skin. She feared that her husband would look for another wife.  Case #5: A champion Qur’an recite was advised to have an operation to make his nose smaller for a better sound.  Case #6: a specialist surgeon working in a public hospital started referring all patients he saw to get x-ray examination from a radiology center owned by his wife. The wife charged the lowest fees of all the radiologists in town. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  DEFINITION  Ethics is the philosophy of morality.  Ethics is concerned with distinguishing the moral from the immoral and the right from the wrong.  Ethics as a discipline is not a corpus of knowledge or facts. It is principles and methodology used to analyze specific situations in order to make moral judgments  There are some matters that are not subject to ethical analysis and moral judgment because their morality is already mentioned specifically in the revelations, wahy, or the laws  Bioethics, a branch of applied ethics, is a discipline that deals with ethical implications of medical research and medical interventions. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  ETHICAL THEORIES  According to the utilitarian consequence-based theory, an act is judged as good or bad according to the balance of its good and bad consequences.  The obligation-based theory is based on Kantian philosophy. Immanuel Kant (1724-1804) argued that morality was based on pure reasoning.  The rights-based theory is based on respect for human rights of property, life, liberty, and expression. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  ETHICAL THEORIES  According to the community-based theory, ethical judgments are controlled by community values that include considerations of the common good, social goals, and tradition.  The relation-based theory gives emphasis to family relations and the special physician-patient relation.  The case-based theory is practical decision-making on each case as it arises. It does have fixed philosophical prior assumptions. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  ETHICAL PRINCIPLES ACCORDING TO BEAUCHAMPS and CHILDRESS  The Principle of Autonomy  The Principle of Beneficence  The Principle of non malefacence  The Principle of justice The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  BIO-ETHICS: AN ISLAMIC PERSPECTIVE  Divine source  Law and morality  Law and ethics  Ethics: stability and change The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  STAGES OF RATIONAL SYSTEMATIC PROBLEM SOLVING  analysis of the  collection of information environment  making assumptions and  recognition of the forecasts problem  generating decision alternatives  identification of the  Apply laws, fatawa, and problem principles  determination of the  selection of the best alternative ownership of the  analysis of the impact of the problem chosen alternative  definition of the problem  implementation, control of the  classification of the implementation problem  evaluation of the results.  prioritizing the problem The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  AUTHORITATIVE SOURCES  At the National/International Levels  The Mufti of the Kingdom of Saudi Arabia  The Grand Ulama Authority  The Fiqh Academy of the Organization of the Islamic Conference  The Fiqh Academy of the World Muslim League  Local Level  Ethics Committee in the Hospital  Local Scholar  Existing Laws and Regulations  Code of Medical Ethics by the Saudi Council for Health Specialties  Health Professions Practice Regulations by the Saudi Council for Health Specialties The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  SOLUTIONS FROM CLASSICAL SOURCES  As a source of legislation the Qur’an provides general foundations and principles.  The sunnat comes second to the Qur'an as a primary source of law.  Ijma and Qiyaas are secondary sources of law. The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011  SOLUTIONS USING MAQASID AL SHARI'AT  Protection Of Ddiin, Hifdh Al Ddiin  Protection Of Life, Hifdh Al Nafs  Protection Of Progeny, Hifdh Al Nasl  Protection Of The Mind, Hifdh Al ‘Aql  Protection Of Wealth, Hifdh Al Mal The Importance Of Learning Bioethics Professor Omar Hasan Kasule Sr. 12-14 September 2011 Thank you