Lecture 1 Introduction to Medical Ethics 2025 PDF

Level 1- Semester 1 Communication and Ethics module Level 1- Semester 1- Module 1A Introduction to Medical Ethics  Instructor information Contact: Professor Rania Abdel-Rahman Ethics & Communication module Co-ordinator E-mail: Academic hours:  Saturday...

Level 1- Semester 1 Communication and Ethics module Level 1- Semester 1- Module 1A Introduction to Medical Ethics  Instructor information Contact: Professor Rania Abdel-Rahman Ethics & Communication module Co-ordinator E-mail: Academic hours:  Saturday 10:00-1:00 PM  Wednesday  Lecture Outline 1. Clinical correlate. 2. History of medical ethics. 3. Ethical dilemmas. 4. Basic concepts of medical ethics. 5. Rationale for building up medical ethics. 6. Case discussion. 7. Self-reflection and feedback. 8. Criticize a case (assignment). 9. Summary, references, learning resources.  Learning Outcomes By the end of this lecture, the students will be able to: 1. Differentiate between ethics and laws and define basic terms in medical ethics and. 2. Recognize the importance of the key concepts of medical ethics. 3. Demonstrate the four basic principles of medical ethics. 4. Criticize different medical situations with regard to the basic principles of ethics.  Clinical Correlate, Practice points Carl Clauberg was a highly respected German professor of gynecology. In 1942, he made sterilization experiments in prison camps to sterilize millions of people. He used radiation/ surgery/ chemical injection in female reproductive organs (severe inflammation). Women were coerced to do this. Those who refused, or unsuitable were usually killed in gas chamber.  History of Ethics 1. World War II unethical experiments Nuremberg Trials & evolution of many codes of ethics. 2. In 2010, Hilary Clinton apologized for syphilis & gonorrhea experiments conducted on Guatemalans between 1946-1948 without their knowledge or permission.  The first principle of the Nuremberg Code “The voluntary consent of the human subject is absolutely essential”. Followed by clarification of all the associated requirements, making it extremely difficult for researchers to twist its meaning.  Question What are the other principles of Nuremberg Code 1947? (search for it) Watch the following video https://youtu.be/WlV_aR4995I  Ethical Dilemmas Behaviour: what should I do? Motivation: Why should I do? Should you help to select gender of the coming baby  Who should get an organ transplantation with the limited number? Learning outcome 1 Differentiate between ethics and laws and define basic terms in medical ethics.  Difference between ethics & laws: Ethics: Principles & rules that give standards of good & bad, right & wrong Moral standards developed to guide physicians behavior mainly for the benefit of the patient & society. Laws? Systematic set of universally accepted rules created by the government. They govern the action & behavior of society members & can be enforced by imposing penalties.  Basic terms in medical ethics Bioethics (a living discipline): It is the division of ethics that helps to define, analyze & resolve ethical issues which arise while providing health care services or the conduct of health-related research.  Ethical dilemmas: They arise when there are two or more options, both may be good raising conflict in various situations (different people’ s rights or wishes). Learning outcome 2 2. Recognize the importance of key concepts of medical ethics.  Key concepts in medical ethics 1. Respect self-determination or autonomy: Autonomy: It is the ability to think, decide and act for oneself. Adults with capacity who understand the options could accept or refuse them. Patients’ decisions should be respected as long as they do not adversely affect the rights or welfare of others.  Key concepts in medical ethics Competent adults could make choices that seem very harmful for them (refusing treatment for example), but they cannot choose things that harm others. Conflicts between physician autonomy and respect for patient autonomy usually arise in medical practice.  Key concepts 2. Mental capacity: Mental capacity is essential to understand & weigh up the options to make a choice (fundamental for autonomy). Practically, most adults (unless unconscious or mentally retarded) are capable of making some decisions. Adults’ decisions can still be valid when they appear unconventional ‫غير تقليدية‬, irrational ‫غير عقالنية‬or unjustified ‫ غير مبررة‬. 3. Truth telling and Honesty: A major challenge to the doctor??? Honesty is the best policy  Key concepts 4. Good communication skills: Very essential. Must be positive and ethical. A failure to communicate can undermine trust & invalidate patient consent if important information is not told to him clearly.  5. Confidentiality: Key concepts Confidentiality means maintaining the data of the patient as secrets Confidentiality is not absolute, especially if other people are at serious risk of harm.  Key concepts 6. Fairness and equity: Fairness in healthcare means equitable distribution of resources among patients. Equity means everyone is provided with what they need to reach equal outcomes. Equality means each patient is given the same resources regardless of his needs. Patients with equal needs should be given equal treatment without discrimination.  Distributive justice: fair distribution of limited healthcare resources. Sufficiency view: everyone has the essential care. 7. Harm and benefit: Key concepts To do good & avoid harm and maximizing benefit & minimizing harm are among the trickiest aspects of modern medical ethics. Medical interventions are justified when the anticipated benefits exceed the harms. 8. Compassion: Key concepts Compassion means understanding & concern for another person’s problems. The physician must identify the patient complaints & the underlying causes. Patients respond better to treatment if they feel that the physician appreciates their concerns & is treating them rather than just treating their illness. 9. Competence: Key concepts A lack of competence can result in death or serious harm for patients. Physicians undergo a long training period to ensure a high degree of competence. It is not just the scientific knowledge & technical skills to be maintained. You must also update ethical knowledge, skills and attitudes since new ethical issues arise every day. 10. Virtue ethics: Key concepts It focuses on the character of decision makers as reflected in their behaviour (moral excellence). Physicians who possess good virtues are more likely to make good decisions & to implement them in a good way. Empathy, wisdom, dedication‫االخالص‬, integrity‫ النزاهة‬, fidelity‫ & االخالص‬altruism‫االيثار‬, etc….. However, even virtuous individuals are unsure how to act in particular situations & are not immune from making wrong decisions. What is the rationale for building up medical ethics? Learning outcome 3 3. Demonstrate the four basic principles of medical ethics.  Principlism: This term uses ethical principles as the basis for making moral rational decisions. It applies the following principles to determine what is the right thing to do, taking into account both rules & consequences: 1. Respect for autonomy 2. Beneficence 3. Non-maleficence 4. Justice  Principlism 1. Respect for autonomy. 2. Beneficence: A physician should act in the best interest of the patient (doing good & promotes well-being). 3. Non-maleficence: Physicians should do no harm. 4. Justice: Treat equitably & distribute benefits fairly. Learning outcome 4 4. Criticize different medical situations with regard to the basic principles of ethics.  Case Discussion What happened in world war II criminal experiments? General Taylor, the prosecutor at the Nuremberg Trials, summed up: “The true aim of these experiments was not how to rescue or to cure, but how to destroy and kill.”  Give your self-reflection on this case (criticize): Dr. Zain, an experienced and skilled surgeon, is about to finish his night duty at a local hospital. A young female patient (20 years) is brought to the hospital by her mother, who leaves immediately after telling the nurse that she has to look after her other children. The patient has vaginal bleeding and is in a great deal of pain.  Dr Zain examines her and decides that she has had either a miscarriage or a self-induced abortion. He does a quick dilatation and curettage. He tells the nurse to ask the patient whether she can afford to stay in the hospital until it is safe for her to be discharged. Dr. Marawan comes in to replace Dr. Zain who goes home without having spoken to the patient.  Summary and wrap up Ethics is not just a set of rules and morals; it is a way of life for physicians for the benefit of patients. Key principles of medical ethics: 1. Autonomy. 2. Beneficence. 3. Non-maleficence. 4. Justice.  Assignment Define the following:  Ethics.  Law.  Autonomy.  Beneficence. Non-maleficence.  Justice.  Principlism  Questions 1.The ethical principle indicating that the patients have the right to choose or refuse a treatment, is: A. Respecting autonomy. B. Beneficence. C. Non-maleficence. D. Justice. E. Integrity. 2.Beneficence may be defined as……… A. Avoiding causing harm to a patient. B. Promoting well-being for a patient. C. Respecting the decisions of a patient. D. Treating patients equitably and fairly. E. Performing the required examination. 3. Stopping a medication that is found to be harmful is an example of : A. Non-maleficence. B. Autonomy C. Altruism. D. Beneficence. E. Justice. Discussion & Feedback  References World Medical Association (2009): Medical Ethics Manual. 2nd edition, Chapter 1, P.P.14-34. World Medical Association (2017): John R. Williams, Department of Medicine, University of Ottawa, Canada. Editor: Bjørn Oscar Hoftvedt, The Norwegian Medical Association, last modified: 14 February 2017. Ueda, D., Kakinuma, T., Fujita, S. et al. Fairness of artificial intelligence in healthcare: review and recommendations. Jpn J Radiol 42, 3–15 (2024). https://doi.org/10.1007/s11604-023-01474-3 Learning resources Principles of Medical Ethics - YouTube https://www.youtube.com › watch