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King Saud bin Abdulaziz University for Health Sciences
                            King Fahad Medical City
                              Faculty of Medicine




Asst. Prof., Dept. of Medical Ethics
King Fahad Medical City – Faculty of Medicine
King Saud Bin Abdul-Aziz University for Health Sciences
1   Definition of ethics, bioethics, and medical ethics

2   What is an ethical issue in healthcare?


3   International approaches to medical ethics


4   Islamic approach to medical ethics
Which one would you drink?
Less embarrassing choices…
   I need to pass the exam..cheat or not?
   I need the organs of this dying patient... Let him
    die fast? He’s dying anyway!
   I need the money of this Pharma company... Shall
    I change the results of my research on their drug?
   I need to be trained ...tell the patient you’re a
    doctor?
What do you think?
Levels of moral response
 The expressive level (unanalyzed
  expressions or feelings that, by
  themselves, don’t provide reasons or
  justification)
 The pre-reflective level (justification via
  law, religious tenets, social values, codes
  of ethics, etc.; accepted uncritically)
 The reflective level (reasoned ethical
  argument/defense based on ethical
  principles, rules, virtues, values to which
  we consciously subscribe; justification
Ethical/Moral reasoning
 It is the process we need to go through to
  reach a decision about an ethical issue.
 It helps us to differentiate:

            description of the way the world is; an
    actual state of affairs (“is”)
               judgment about the way things should be
    (“ought”).
                           they are meant to guide
    actions. Key values in bioethics have
    corresponding (e.g., principle of respect for
    autonomy)
There is always a reason why
      people do things?
Don’t judge things on what they
      first appear to you!
Key definitions and concepts
    What is ethics?
    What are the branches of ethics?
    What is bioethics?
    What is medical/clinical ethics?
    What is an ethical issue?
What is ethics?
   A system of moral principles or standards
    governing conduct.
   a system of principles by which human actions
    and proposals may be judged good or bad, right
    or wrong;
   A set of rules or a standard governing the
    conduct of a particular class of human action or
    profession;
   Any set of moral principles or values recognized
    by a particular religion, belief or philosophy;
   The principles of right conduct of an individual.
    (UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)
Clinical Ethics

       Bioethic
          s             Research ethics


                            Resource
                        Allocation ethics
        Business
         ethics
                         Public Health
Ethi   Environmental
           ethics
                            ethics


 cs     Social ethics
                         Nursing ethics



       Organizational        other
          ethics



          IT ethics




         Other
What is bioethics?
   It is derived from Greek bio- life and ethicos
    moral.
   The science/art that aims at identification,
    analysis, and resolution of the ethical issues in
    almost any field that is related to human life
    and health.
    What   is clinical/medical
      ethics?
   It is that branch of bioethics that is related to
    the identification, analysis, and resolution of
    moral problems that arise in the healthcare of
Questions answered by Bioethics

 deciding     what we should do (what
  decisions are morally right or acceptable);
    Example:   Should patient A or B have the ICU bed?
 explaining   why we should do it (how do
  we justify our decision in moral terms); and
    Why did   we decide to admit A & not B?
 describing     how we should do it (the
  method or manner of our response when we
  act on our decision).
    What are   we going to do for patient B?
What is an “ethical issue” or a
“moral problem”?
   There is an ethical issue when:
     …we  encounter conflicting
      values, beliefs, goals, or responsibilities
     …we are concerned that persons or their rights
      are not being respected
     …we are concerned about fairness and justice

     …we are unsure what we should do or why we
      should do it, morally speaking
Main Western      Other             Abrahamic           Oriental
Philosophies      philosophies      Philosophies        philosophies

Utilitarianism    African, Asian,   Islamic             Buddhist
                  etc.

Deontology            Human         Jewish              Confucius
                      Rights

Feminist ethics                     Catholic            Indian
Casuistry
Virtue ethics                       Protestant          Persian

Principlism                         Jehovah Witnesses
Why do we need to know about
       western philosophies?
 A Doctor is an international currency (you may
  be practicing anywhere)
 Bridging the knowledge & cultural gaps

 Western literature & experience are steps
  ahead of ours
 Ethical concepts & tools are quite universal

 No self-development without knowing others

 To reflect Islamic concepts to non-Muslims in

  an appropriate manner
the value of an action is
    determined by its utility; all actions should be
    directed toward achieving the greatest happiness
    for the greatest number of people.
       Examples: quarantine, isolation, vaccination, etc.
       Where does utilitarianism (dis)agrees with Islam?
                     actions are judged based upon
    inherent right-making characteristics or principles
    rather than on their consequences. Emphasis on
    duty, rules and regulations, principles and moral
    obligations which govern ones right action
        Examples: Doctor’s duties to care for their patients
       Where does Duty-Based Ethics (dis)agrees with
        Islam?
It emphasizes the
    virtues, or moral character (who is your
    virtuous model?)




   Examples: Doctors as role models.
       Should not a patient comply with a “don’t smoke”
        advice from a smoking doctor?!
(cont.)
                       (Ethics of Care) commitment
to correcting male biases (e.g. women’s
subordination is morally wrong) and that the moral
experience of women is as worthy of respect as that
of men.
   Where does feminisme (dis)agrees with Islam?

               The greatest confidence in our
moral judgments resides not at the level of theory,
where we endlessly disagree, but rather at the level
of the case, where our intuitions often converge
without the benefit of theory.
   Where does Casuistry (dis)agrees with Islam?
 Autonomy: respect humans'
      ability to choose,
     Beneficence: Do Good for
      others,
     Nonmaleficence (Do No Harm),
      &
     Justice (Be fair to your patients)
   Where do these principles meet with
    Islam?
1)The Koran and 2) the
Sunna,

   Unanimous agreement of Islamic jurists (Ijmaa)
   Acceptance by the majority of trusted scholars
    (Rayul Jomhour)
    Measurement/Analogy (Qiyas),
   Remediation (Maslaha), (Istishab)
    The                          are to
     preserve person’s:
1.   Religion;
2.   Soul;
3.   Mind;
4.   Wealth; &
5.   Progeny.
     All Islamic legislations came to achieve
                     these goals.
What is Islamic Bioethics?


   It is the methodology of
     defining, analysing and resolving the ethical issues
      that arise in healthcare practice, or research;
     based on the Islamic moral and legislative sources
      (Koran, Sunna & Ijtihad); and
     aims at achieving the goals of Islamic morality (i.e.
      preservation of human’s religion, soul, mind, wealth
      & progeny )
1.           The principle of Intention (Qasd): Each action
             is judged by the intention behind it
2.           The principle of Certainty (Yaqeen): Certainty
             can not be removed by doubt
3.           The principle of Injury/Harm (Dharar):
              Injury should be relieved; An individual should not harm others or
               be harmed by others
             An injury is not relieved by inflicting or causing a harm of the same
              degree
             Prevention of harm has priority over pursuit of a benefit of equal
              worth
             the lesser harm is committed
4. The principle of Hardship (Mashaqqat):
    Difficulty calls forth ease, Necessity
    (Dharuraat) legalizes the prohibited
5. The principle of - Custom or precedent (Urf):
 Custom is recognized as a source of law on

   which legal rulings are based unless
   contradicted specifically by text from the main
   legislative sources, i.e. Koran and Sunna.
   Give example of an ethical issue/problem you
    faced or witnessed, mentioning the following:
       What was the situation?
       What was your feeling towards it?
       What did you do?
       Do you think you did the best thing? why?
       What you think you need to know more to be able
        to handle similar situations in the future?
Thank You
To contact Dr. Ghaiath Hussein:
Office: (+966)-(1)-2889999 Ext. 7588 Email: ghussein@kfmc.med.sa
Personal: 00966566511653 – email: ghaiathme@gmail.com
More Resources:
http://med-ethics.com/
http://omarkasule.tripod.com/
http://www.islamset.com/ethics/index.html

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Here are the key points we discussed:- Ethics deals with principles of right and wrong conduct- Bioethics examines ethical issues in health/life sciences - Medical ethics focuses on healthcare specifically- An ethical issue arises when values conflict or rights are unclear- Moral reasoning is the process to analyze issues and make decisions- Major philosophical approaches include utilitarianism, deontology, virtue ethics- Principlism outlines key ethical principles like autonomy, beneficence, nonmaleficence- Islamic bioethics derives from primary sources like Quran and hadiths- Key Islamic principles guide decision-making around issues like intention, harm, hardshipThank you for the informative discussion on medical

  • 1. King Saud bin Abdulaziz University for Health Sciences King Fahad Medical City Faculty of Medicine Asst. Prof., Dept. of Medical Ethics King Fahad Medical City – Faculty of Medicine King Saud Bin Abdul-Aziz University for Health Sciences
  • 2. 1 Definition of ethics, bioethics, and medical ethics 2 What is an ethical issue in healthcare? 3 International approaches to medical ethics 4 Islamic approach to medical ethics
  • 3. Which one would you drink?
  • 4. Less embarrassing choices…  I need to pass the exam..cheat or not?  I need the organs of this dying patient... Let him die fast? He’s dying anyway!  I need the money of this Pharma company... Shall I change the results of my research on their drug?  I need to be trained ...tell the patient you’re a doctor?
  • 5. What do you think?
  • 6. Levels of moral response  The expressive level (unanalyzed expressions or feelings that, by themselves, don’t provide reasons or justification)  The pre-reflective level (justification via law, religious tenets, social values, codes of ethics, etc.; accepted uncritically)  The reflective level (reasoned ethical argument/defense based on ethical principles, rules, virtues, values to which we consciously subscribe; justification
  • 7. Ethical/Moral reasoning  It is the process we need to go through to reach a decision about an ethical issue.  It helps us to differentiate: description of the way the world is; an actual state of affairs (“is”) judgment about the way things should be (“ought”). they are meant to guide actions. Key values in bioethics have corresponding (e.g., principle of respect for autonomy)
  • 8. There is always a reason why people do things? Don’t judge things on what they first appear to you!
  • 9. Key definitions and concepts What is ethics? What are the branches of ethics? What is bioethics? What is medical/clinical ethics? What is an ethical issue?
  • 10. What is ethics?  A system of moral principles or standards governing conduct.  a system of principles by which human actions and proposals may be judged good or bad, right or wrong;  A set of rules or a standard governing the conduct of a particular class of human action or profession;  Any set of moral principles or values recognized by a particular religion, belief or philosophy;  The principles of right conduct of an individual. (UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)
  • 11. Clinical Ethics Bioethic s Research ethics Resource Allocation ethics Business ethics Public Health Ethi Environmental ethics ethics cs Social ethics Nursing ethics Organizational other ethics IT ethics Other
  • 12. What is bioethics?  It is derived from Greek bio- life and ethicos moral.  The science/art that aims at identification, analysis, and resolution of the ethical issues in almost any field that is related to human life and health. What is clinical/medical ethics?  It is that branch of bioethics that is related to the identification, analysis, and resolution of moral problems that arise in the healthcare of
  • 13. Questions answered by Bioethics deciding what we should do (what decisions are morally right or acceptable);  Example: Should patient A or B have the ICU bed? explaining why we should do it (how do we justify our decision in moral terms); and  Why did we decide to admit A & not B? describing how we should do it (the method or manner of our response when we act on our decision).  What are we going to do for patient B?
  • 14. What is an “ethical issue” or a “moral problem”?  There is an ethical issue when:  …we encounter conflicting values, beliefs, goals, or responsibilities  …we are concerned that persons or their rights are not being respected  …we are concerned about fairness and justice  …we are unsure what we should do or why we should do it, morally speaking
  • 15.
  • 16. Main Western Other Abrahamic Oriental Philosophies philosophies Philosophies philosophies Utilitarianism African, Asian, Islamic Buddhist etc. Deontology Human Jewish Confucius Rights Feminist ethics Catholic Indian Casuistry Virtue ethics Protestant Persian Principlism Jehovah Witnesses
  • 17. Why do we need to know about western philosophies?  A Doctor is an international currency (you may be practicing anywhere)  Bridging the knowledge & cultural gaps  Western literature & experience are steps ahead of ours  Ethical concepts & tools are quite universal  No self-development without knowing others  To reflect Islamic concepts to non-Muslims in an appropriate manner
  • 18. the value of an action is determined by its utility; all actions should be directed toward achieving the greatest happiness for the greatest number of people.  Examples: quarantine, isolation, vaccination, etc.  Where does utilitarianism (dis)agrees with Islam?  actions are judged based upon inherent right-making characteristics or principles rather than on their consequences. Emphasis on duty, rules and regulations, principles and moral obligations which govern ones right action  Examples: Doctor’s duties to care for their patients  Where does Duty-Based Ethics (dis)agrees with Islam?
  • 19. It emphasizes the virtues, or moral character (who is your virtuous model?)  Examples: Doctors as role models.  Should not a patient comply with a “don’t smoke” advice from a smoking doctor?!
  • 20. (cont.) (Ethics of Care) commitment to correcting male biases (e.g. women’s subordination is morally wrong) and that the moral experience of women is as worthy of respect as that of men.  Where does feminisme (dis)agrees with Islam? The greatest confidence in our moral judgments resides not at the level of theory, where we endlessly disagree, but rather at the level of the case, where our intuitions often converge without the benefit of theory.  Where does Casuistry (dis)agrees with Islam?
  • 21.  Autonomy: respect humans' ability to choose,  Beneficence: Do Good for others,  Nonmaleficence (Do No Harm), &  Justice (Be fair to your patients)  Where do these principles meet with Islam?
  • 22.
  • 23. 1)The Koran and 2) the Sunna,  Unanimous agreement of Islamic jurists (Ijmaa)  Acceptance by the majority of trusted scholars (Rayul Jomhour)  Measurement/Analogy (Qiyas),  Remediation (Maslaha), (Istishab)
  • 24. The are to preserve person’s: 1. Religion; 2. Soul; 3. Mind; 4. Wealth; & 5. Progeny. All Islamic legislations came to achieve these goals.
  • 25. What is Islamic Bioethics?  It is the methodology of  defining, analysing and resolving the ethical issues that arise in healthcare practice, or research;  based on the Islamic moral and legislative sources (Koran, Sunna & Ijtihad); and  aims at achieving the goals of Islamic morality (i.e. preservation of human’s religion, soul, mind, wealth & progeny )
  • 26. 1. The principle of Intention (Qasd): Each action is judged by the intention behind it 2. The principle of Certainty (Yaqeen): Certainty can not be removed by doubt 3. The principle of Injury/Harm (Dharar):  Injury should be relieved; An individual should not harm others or be harmed by others  An injury is not relieved by inflicting or causing a harm of the same degree  Prevention of harm has priority over pursuit of a benefit of equal worth  the lesser harm is committed
  • 27. 4. The principle of Hardship (Mashaqqat): Difficulty calls forth ease, Necessity (Dharuraat) legalizes the prohibited 5. The principle of - Custom or precedent (Urf):  Custom is recognized as a source of law on which legal rulings are based unless contradicted specifically by text from the main legislative sources, i.e. Koran and Sunna.
  • 28. Give example of an ethical issue/problem you faced or witnessed, mentioning the following:  What was the situation?  What was your feeling towards it?  What did you do?  Do you think you did the best thing? why?  What you think you need to know more to be able to handle similar situations in the future?
  • 29. Thank You To contact Dr. Ghaiath Hussein: Office: (+966)-(1)-2889999 Ext. 7588 Email: ghussein@kfmc.med.sa Personal: 00966566511653 – email: ghaiathme@gmail.com More Resources: http://med-ethics.com/ http://omarkasule.tripod.com/ http://www.islamset.com/ethics/index.html