MEDICAL ETHICS
BASIC PRINCIPLES
Ass. Prof. DR. NAWAR S. KHALIL
Definition
Ethics is derived from the Greek word “Etho”, Its
mean the manner and habits of man or of animal.’
Philosophy of morality.
“The science dealing with morality, its origin
and development, the rules and norms of
conduct of people, their duties towards
society and towards each other”.
The term Morality emerged of Latin word “Mor”
or “Mores”, that originally had the same meaning
as Greek word “Etho”
Ethics are …
Ethics is the discipline, which studies the mind of life and
the idea of good life
Moral Principles
What is good and bad
What is right and wrong
Ethical norms are not universal – depends on the sub
culture of the society
Ethics are not …
Ethics is not the same as feelings
Ethics is not religion
Ethics is not following the law
Ethics refers to standards of behavior that
tell us how human beings ought to act in the
many situations in which they find
themselves
as friends, parents, children, citizens,
businesspeople, teachers, professionals, and
so on.
Medical Ethics
“Is branch of Ethics that is concerned with
Philosophy and theory underlying the principles
and norms of right professional conduct in
Medicine”
It implies”
Obligations of physician towards the healthy and
sick man.
Obligation towards other physicians and health
professionals,
Obligations towards society.
These are not laws, but standards of conduct which define
the essentials of honorable behavior for the physician
Historical Background
Ethics as the focus of philosophical mind has
emerged during the “Golden Century” of the
Hellenistic culture (IV-V centuries BC).
It was present in the ideology of Sophistic School,
Socrates, as well as Plato’s books, and “Nicomacus
Ethics” of Aristotle.
Medical ethics may be traced to guidelines on the
duty of physicians such as the Hippocratic oath
The oldest code of medical ethics: Hippocratic Oath (4th Century
BC)
Several parts of the oath have been revised over the
years, e.g. -
“To consider dear to me, as my parents, him who
taught me this art; to live in common with him and,
if necessary, to share my goods with him…”
“Nor will I give a woman a pessary to procure
abortion;”
“I will not cut for stone, even for patients in whom
the disease is manifest; I will leave this operation to
be performed by practitioners, specialists in his art.”
Basic Principles of Medical Ethics
Autonomy “Respect for Patient Autonomy”
Beneficence
Non maleficience
Justice
Autonomy
Autonomy literally means ‘self-rule’ or ‘self-governance’.
An individual’s capacity to make decisions about their health
care needs and to consent to or refuse treatment depends on
their ability to think, decide and act, freely, on the basis of
such thought and decision.
Patient has freedom of thought, intention and action when
making decisions regarding health care procedures
For a patient to make a fully informed decision, she/he must
understand all risks and benefits of the procedure and the
likelihood of success.
Always respect the autonomy of the patient - then
the particular patient is free to choose.
“A person with diminished autonomy, by contrast, is in
some respect controlled by others or incapable of
deliberating or acting on the basis of his or her
desires and plans”, (Beauchamp & Childress (2001))
Those with diminished autonomy e.g. prisoners,
learning disabled persons, patient with dementia.
Respect for patient autonomy requires doctors (+
family) to help patients make their own decisions
and to respect those decisions (irrespective of
whether one believes those decisions to be wrong).
The patient must be informed clearly the consequences of
his action that may affect him adversely.
Desiring to "benefit" the patient, the physician may
strongly want to intervene believing it to be a clear
"medical benefit." The physician has a duty to respect the
autonomous choice of the patient, as well as a duty to avoid
harm and to provide a medical benefit.
But the physician should give greater priority to the
respect for patient autonomy than to the other duties.
However, at times this can be difficult because it can
conflict with the paternalistic attitude of many health care
professionals.
In the case of a child, the principle of avoiding the harm of
death, and the principle of providing a medical benefit that
can restore the child to health and life, would be given
precedence over the autonomy of the child's parents as
surrogate decision makers.
Beneficence
The practitioner should act in “the best interest” of
the patient - the procedure be provided with the
intent of doing good to the patient
This needs health care provider to,
Develop and maintain skills and knowledge by
continually updating training.
Consider individual circumstances of all patients.
“The obligation to do good / promote what is best for
the patient”.
Sometimes conflict may arise between doctor's
judgement of what is in the patient’s best interests
and his desire to respect the patient’s different but
autonomous decision.
Must be balanced with the principles of respect for
autonomy, non-maleficence and justice.
Non maleficence
“Above all, do no harm,“ – Make sure that the
procedure does not harm the patient or others in
society.
When interventions undertaken by physicians
create a positive outcome while also potentially
doing harm it is known as the "double effect."
E.g.: the use of morphine in the dying patient. eases
pain and suffering while hastening the demise
through suppression of the respiratory drive
Physicians are obligated not prescribe medications
they know to be harmful.
It is an extremely important principle to avoid
harming others, but cannot take priority and be
expressed as an absolute principle.
Must be considered in the context of the
obligation in medicine of the principle to do good
for our patients (beneficence), e.g. cancer surgery.
Justice
The distribution of scarce health resources, and
the decision of who gets what treatment “fairness
and equality”
The burdens and benefits of new or experimental
treatments must be distributed equally among all
groups in society
THANK YOU
