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ETHICS
Dr.Waseem Ahmed Abujamea, MD
ED CONSULTUNT,SBEM,AbEM
PROGRAM DIRECTOR KSMC
DEPUTY CHAIRMAN EMERGENY
DEPARTMENT
KSMC
 Ethics … . Its importance
 Medical ethics . Its Importance.
 Medical ethics and the law
 Facts and rules**
ETHICS
Definitions:
 Ethics (n):
 The philosophical study of moral values and rules
 ‫الدراسة الفلسفية للقيم والقواعد األخالقية‬
 A system of principles governing morality and acceptable
conduct
 ‫نظام من المبادئ اللي تحكم االخالق والسلوك المقبول‬
 Morality (n):
 Is the value dimension of human decision making and
behavior.
 The language of morality includes:

Nouns: such as
‘rights’,
‘responsibilities’
and ‘virtues’

Adjectives: such as ‘good’
and ‘bad’ (or ‘evil’), ‘right’
and ‘wrong’, ‘just’ and
‘unjust’.‫عادل او ظالم‬
According to these definitions:

Ethics is primarily
a matter of knowing.

 Morality is
a matter of doing.
The close relationship between ethics and
morality consists in the concern of ethics to
provide rational criteria for people to decide or
behave in some ways rather than others i.e.:
morally
 For the perfect human relationship they are ought
to think right “ethically” and act right “morally”.
MEDICAL ETHICS
Definition:
 Medical ethics:
The branch of ethics that deals with moral issues in
medical practice.
 Medical ethics is pertaining to the Physician and
Health care Providers behavior and decision-making.
 Medical ethics: Does not deal with the scientific or
technical questions such as:
 How to treat diabetic ketoacidosis, acute respiratory
failure, manage hypertensive patient
 How to perform cholecystectomy, or how to do
intubation or insert a central line..,
 Medical ethics deal with the Questions about values,
rights and responsibilities.
 All physicians / health care providers face ethical
questions just as often as scientific and technical ones.
Why medical ethics?
i.e. Importance of medical ethics
 Medical ethics prepares the physicians/ health care
providers to recognize difficult situations and to deal
with them in a rational and principled manner.
 Ethics is also important in physicians’ interactions
with society and their colleagues and for the conduct
of medical research.
Ethical questions in medicine are not all equally
challenging.
Easy Ethical questions: because
there is a well-developed
consensus on the right way to
act in the situation:
 Physician should always
ask for a patient’s consent
for elective procedures and
to serve as a research
subject .
Difficult Ethical questions :
 Those for which no consensus
has developed or
 Those where all the alternatives
have drawbacks :
 Rationing of scarce healthcare
resources ,
 Patients triage ,
 DNAR decision
 Withholding / Withdrawing of
life sustaining measures
 Medical ethics and the law is closely related but they are
NOT identical
 Laws differ significantly from one country to another while
medical ethics is applicable across national boundaries.
 Medical Ethics prescribes higher standards of behavior than
does the law, and occasionally ethics requires that
physicians disobey laws that demand unethical behavior.
“physicians are expected to follow medical ethics rather
than law”.
 To be always considered in medical practice.
The Ethical Principles
(1978, Beauchamp and Childress )
The principles to organize physicians’ thinking about the
ethical practice of medicine:
 (1) Beneficence, the physicians’ duty to help patients
 (2) Nonmaleficence, the obligation to avoid harm.
 (3) Respect for autonomy, the patients’ right to self-
determination.
 (4) Justice, to treat every one equally and the fair allocation of
medical resources.
Justice situates patients and physicians within the larger
society and acknowledges the importance of treating similar
patients in similar ways.
 (5) Veracity: Truth telling: Obligation to full and honest
disclosure.
Rule #1**
 Always remember the Ethical principles in every case
you discuss.





(1) Beneficence,
(2) Nonmaleficence,
(3) Respect for autonomy,
(4) Justice, and
(5) Veracity.
Rule #2**
 The patient-physician relationship **.
 The patient-physician relationship is the cornerstone
of medical practice and medical ethics.
 A unique “professional’ relationship which facilitates
an exchange of scientific knowledge and care within
a framework of ethics and trust.
Rule # 3**
 Patients come to physicians for help with their most
pressing needs –
 Patients allow physicians to see, touch and manipulate
almost every part of their bodies.
 Why?
 Because Patients trust their physicians to act in their
best interests**.
Rule # 4**
 To meet the expectations of the patients, it is
important that physicians know and represent the
core values of medicine :
 Compassion,
 Competence and
 Autonomy.
The ‘centrality’ of the patient in any discussion
on medical ethics**
 Most medical associations acknowledge in their
foundational policies that ethically, the best
interests of the individual patient should be the first
consideration in any decision on care.
Rule # 5**
 What does this mean?
 The physicians need to know how to navigate
through the many ethical challenges faced in daily
practice and find effective ways TO PUT THEIR
PATIENTS FIRST**
Rule # 6**
 Current Health Care: since 1940s
 Advanced diagnostic and therapeutic tools.
 Hospital population:
Older / Sicker
Multiple comorbidities
Complicated procedures / Treatment
 Expectations are high / unrealistic. Patients/ Families
want it all, want it now.
Rule# 6**
 Goals of medical treatment:
 To Preserve life ,
 To Restore health and well-being
 To Prevent / minimize disability and
 To relief pain and suffering.
Rule # 7 **
“The task of medicine is to cure
sometimes, to relieve often, and
to comfort always.”
Ambrose Paré (1510-1590)
Rule # 8**
 Types of patients:
 1. Patients are certain to survive the current illness
(floor patients)
 2. Patients are certain to die due to current illness (should
receive the most appropriate terminal care under palliative
care service.)
 3. Patients between these two groups, have various degree of
uncertainty (should receive maximum effort but be seriously
evaluated in a daily basis;
Dr. Loeb’s Laws:
 1. If what you are doing is working, keep doing it.
 2. If what you are doing is not working, stop doing it.
 3. If you do not know what to do, do nothing.
 4. Never make the treatment worse than the disease.
“If at all possible, keep your patient out of the
operating room.” OR “never give your patient to a
surgeon”
Matz R: Principles of medicine .NY State J med 77:99-101, 1977
Rule # 9**
 Always remember Dr. Loeb's laws
Dr. Robert Loeb
Rule # 10**
"I treated the patients and God healed
them."
Ambrose Paré (1510-1590)
Rule# 11**
Ways of dealing with any problem
1)- To Spectate (or) (watch)
2)- To Run Away
3)- To Commit
Thank You