Health ethics

MEDICAL
ETHICS
Dr. Abdalnasir Moh. Almagzop
MBBS / M.Sc (PH) / M.Sc (TROP. MED.) / MD (COMM. MED.)

• “And if anyone saved a life, it
would be as if he saved the life
of the whole people.” (Al Quran
5:32)
• “No soul can die except by
Allah's permission.” (Al Quran
3:185)

MEDICAL ETHICS
• Medical ethics is primarily a
field of applied ethics, the study
of moral values and judgments
as they apply to medicine.
•‫آداب‬‫مهنة‬‫الطب‬‫هو‬‫في‬‫المقام‬‫األول‬‫مجال‬
‫األخالقيات‬،‫التطبيقية‬‫ودراسة‬‫القيم‬‫األخالقية‬‫واألحكام‬
‫التي‬‫تنطبق‬‫على‬‫الطب‬.

A NOBLE PROFESSION
• Medical profession is the guardian
of human life and is responsible for
defending living beings from the
miseries and death from disease.
•‫مهنة‬‫الطب‬‫هو‬‫الوصي‬‫على‬‫حياة‬،‫اإلنسان‬‫وهي‬
‫مسؤولة‬‫عن‬‫الدفاع‬‫عن‬‫حياة‬‫االنسان‬‫من‬‫مآسي‬
‫المرض‬‫والموت‬.

•Medical ethics is a code of
conduct of practicing doctors/
dental surgeons evolved over
centuries nationally and
internationally that is based
on the most admirable human
values and principles.
•‫آداب‬‫مهنة‬‫الطب‬‫هي‬‫مدونة‬‫لقواعد‬
‫السلوك‬‫في‬‫ممارسة‬‫األطباء‬/‫أطب‬‫اء‬
‫األسنان‬‫تطورت‬‫على‬‫مدى‬‫قرون‬
‫دوليا‬‫وعالميا‬‫والتي‬‫تقوم‬‫على‬‫ا‬‫لقيم‬
‫اإلنسانية‬‫والمبادئ‬‫األكثر‬‫انتش‬‫ارا‬‫و‬
‫اتفاقا‬‫عليها‬.

Greek healers in the 4th Century B.C.,
drafted the Hippocratic Oath and pledged
to :
“prescribe regimens for the good of my
patients according to my ability and my
judgment and never do harm to anyone”.
‫صاغ‬‫المعالج‬‫و‬‫ن‬‫اليوناني‬‫ون‬‫في‬‫القرن‬‫الراب‬‫ع‬
‫قبل‬‫الميالد‬‫قسم‬‫أبقراط‬‫و‬‫الذي‬‫فيه‬‫المعالج‬‫ي‬‫تعهد‬
‫ب‬...:”‫اصف‬‫ال‬‫نظم‬‫العالجية‬‫لصالح‬‫مرضاي‬
‫وفقا‬‫لقدرتي‬‫وحكمي‬‫وأبدا‬‫ال‬‫ا‬‫ضر‬‫باي‬‫أحدا‬".

Muslim physicians:
Ishaq bin Ali Rahawi
(who wrote the Conduct of a Physician,
the first book dedicated to medical ethics)
Muhammad ibn Zakariya ar-Razi
(known as Rhazes in the West)

Muslim physicians
Ishaq bin Ali Rahawi:
Who wrote the Adab al-Tabib
(Conduct of a Physician), the first
paper dedicated to medical ethics.
He regarded physicians as
"guardians of souls and bodies", and
wrote twenty chapters on various
topics related to medical ethics.

PRINCIPLES OF
MEDICAL ETHICS
‫الطبية‬ ‫األخالق‬ ‫مبادئ‬

There are main four principles of
Medical Ethics:
1. Patient Autonomy;
2. Beneficence;
3. Do No Harm (or Non-malificence);
4. Justice.

• In addition to the four ethical principles
the following ethical principles have
been included:
Principles of confidentiality
‫مبادئ‬‫السرية‬
Protection of the vulnerable
‫الضعفاء‬ ‫حماية‬
Collegiality
‫الزمالة‬

1.Autonomy :
‫االستقاللية‬
•Respect the
autonomy of the
patient.
•The patient has the
right to refuse or
choose their
treatment.

2. Beneficence:
‫االحسان‬
•promoting what is
best for the patient .
•A practitioner should
act in the best interest
of the patient.

• Beneficence implies consideration of
the patient's pain; their physical and
mental suffering; the risk of disability
and death; and their quality of life. At
times, beneficence can imply not
intervening, if the benefit of therapy
would be minimal.
•‫اإلحسان‬‫يعني‬‫النظر‬‫في‬‫آالم‬‫المريض؛‬‫المعاناة‬
‫الجسدية‬‫والعقلية؛‬‫مخاطر‬‫العجز‬،‫والوفاة‬‫ونوعية‬
‫حياتهم‬.‫في‬‫بعض‬،‫األحيان‬‫يمكن‬‫االحسان‬‫يعني‬‫عدم‬
،‫التدخل‬‫إذا‬‫كانت‬‫الفائدة‬‫من‬‫العالج‬‫ضئيلة‬‫للغا‬‫ية‬.

3. Non-maleficence:
‫االيذاء‬ ‫عدم‬
•first, do no harm.
•We have been given
the gift of life, for
goodness sakes,
Protect it!!!
Respect it!!!

4. Justice: ‫العدالة‬
•Resources are limited;
you cannot cure everybody
and so priorities must be
set (hence the notion of
triage).
•‫عالج‬ ‫يمكنك‬ ‫ال‬ ،‫محدودة‬ ‫الموارد‬
‫األولوي‬ ‫تحديد‬ ‫يجب‬ ‫ولذا‬ ‫الجميع‬‫ات‬
(‫الفرز‬ ‫فكرة‬ ‫هنا‬ ‫ومن‬).

Principles of confidentiality
• Non-disclosure / disclosure of patients’
details and medical records.
• To respect the privacy and preserve the
dignity of each patient.
•‫عدم‬‫الكشف‬/‫الكشف‬‫عن‬‫تفاصيل‬‫المريض‬
‫والسجالت‬‫الصحية‬.
•‫على‬ ‫والحفاظ‬ ‫الخصوصية‬ ‫احترام‬‫كرامة‬‫مريض‬ ‫كل‬.

Dignity:
• The patient and the
doctor have the right to
dignity.
•The spirit of humanity,
respecting the worth of each
person
•Each person we encounter
in our working day deserves
our respect—patients,
visitors, co-workers
‫والطبيب‬ ‫المريض‬ ‫من‬ ‫لكل‬ ‫حق‬ ‫الكرامة‬
‫العمل‬ ‫اثناء‬ ‫نواجهه‬ ‫شخص‬ ‫كل‬
‫احترامنا‬ ‫يستحق‬(‫زو‬ ، ‫مرضى‬‫ار‬
‫العمل‬ ‫وزمالء‬)
‫واالحترام‬ ،‫اإلنسانية‬ ‫روح‬ ‫يستحق‬ ‫شخص‬ ‫كل‬

Confidentiality:
•is commonly applied to
conversations between
doctors and patients. This
concept is commonly
known as patient-
physician privilege.
•‫تعني‬‫الحفاظ‬‫على‬‫سرية‬‫المريض‬‫من‬‫ج‬‫هة‬
،‫الطبيب‬‫وهذه‬‫تسمى‬‫ميزة‬‫العالقة‬‫بين‬
‫المريض‬‫والطبيب‬
•Legal protections prevent
physicians from revealing
their discussions with
patients, even under oath
in court.
•‫الحماية‬‫القانونية‬‫تمنع‬‫األطباء‬‫من‬‫الك‬‫شف‬
‫عن‬‫مناقشاتهم‬‫مع‬،‫المرضى‬‫حتى‬‫تحت‬
‫القسم‬‫في‬‫المحكمة‬.

• Confidentiality forms a cornerstone of the doctor-patient
relationship, but it is increasingly hard to maintain with the
growth of electronic data.
•‫ا‬‫لسرية‬‫تشكل‬‫حجر‬‫االساس‬‫في‬‫العالقة‬‫بين‬‫الطبيب‬،‫والمريض‬‫ولكن‬‫من‬‫الص‬‫عب‬
‫ا‬‫لحفاظ‬‫على‬‫ذلك‬‫ل‬‫تزايد‬‫النمو‬‫في‬‫تناقل‬‫البيانات‬‫اإللكترونية‬.
• In order to protect the trust between doctor and patient, the
physician should not release personal medical information
without the patient's consent.
•‫من‬‫أجل‬‫حماية‬‫الثقة‬‫بين‬‫الطبيب‬‫والمريض‬‫ينبغي‬‫على‬‫الطبيب‬‫عدم‬‫التصري‬‫ح‬
‫ب‬‫المعلومات‬‫الطبية‬‫الشخصية‬‫للمريض‬‫دون‬‫موافق‬‫تة‬‫المريض‬.
• Like other ethical duties, however, confidentiality is not
absolute. It can be necessary to override privacy in the
interests of public health. However, this should always be
done in a way that minimizes harm to the patient.
•‫مثل‬‫الواجبات‬‫األخالقية‬،‫األخرى‬‫السرية‬‫ليست‬‫مطلقة‬.‫يمكن‬‫أن‬‫ي‬‫كون‬‫من‬‫ال‬‫ض‬‫رور‬‫ي‬
‫تجاوز‬‫الخصوصية‬‫من‬‫اجل‬‫مصالح‬‫الصحة‬‫العامة‬،‫بشرط‬‫ان‬‫يتم‬‫ذلك‬‫بطريقة‬‫تقلل‬
‫الضرر‬‫على‬‫المريض‬.

Discussion topic:
A patient's relative gives you information on
the patient but asks you not to reveal where
the information came from. Do you have to
keep this secret?

Disclosure:
•the doctor must disclose
information that is
materially relevant to the
patient's understanding of
his condition, his
treatment options and
likely outcomes.
• This would include, for
example, information on
medical errors made in
their care.
• Errors do not necessarily
constitute improper,
negligent, or unethical
behavior, but failure to
disclose them may.

•‫يجب‬‫على‬‫الطبيب‬‫الكشف‬‫عن‬‫المعلومات‬‫للمريض‬
‫لفهم‬‫حالته‬،‫الصحية‬‫وخيارات‬،‫العالج‬‫والنتائج‬
‫المحتملة‬.
•‫ويشمل‬،‫ذلك‬‫على‬‫سبيل‬،‫المثال‬‫معلومات‬‫عن‬‫األخ‬‫طاء‬
‫الطبية‬‫المرتكبة‬‫اثناء‬‫تقديم‬‫الخدمة‬‫الطبية‬.
•‫األخطاء‬‫الطبية‬‫ال‬‫تشكل‬‫بالضرورة‬‫سلوك‬‫غير‬
،‫الئق‬،‫إهمال‬‫أو‬‫فعل‬‫غير‬،‫أخالقي‬‫بقدر‬‫ماهو‬‫عليه‬
‫في‬‫عدم‬‫الكشف‬‫عنها‬.

Discussion topic:
A teenage patient requests an abortion but
asks you not to tell her parents. How do you
balance protection of the patient's
confidentiality against the rights of her
parents?

Protection of the vulnerable
‫الضعفاء‬ ‫حماية‬
• Standing up for the rights of those who
may be unable to speak or act for
themselves. e.g.. Children, the frail
elderly, and patients who are unable to
make decisions for themselves.
•‫الوقوف‬‫على‬‫حقوق‬‫أولئك‬‫الذين‬‫قد‬‫يكونون‬‫غير‬‫قادرين‬‫على‬‫الكالم‬
‫أو‬‫العمل‬‫ألنفسهم‬.‫على‬‫سبيل‬‫المثال‬.‫األطفال‬‫والمسنين‬‫الضعف‬،‫اء‬
‫والمرضى‬‫الذين‬‫ال‬‫يستطيعون‬‫اتخاذ‬‫قراراتهم‬‫بأنفسهم‬.

Collegiality ‫الزمالة‬:
• Calls for support of colleagues and
fellow practitioners and
professionals.
• Mutual respect & understanding
for fellow optometrists, for other
professionals and for their
respective roles in the health care
team.

•‫في‬ ‫الممارسين‬ ‫الزمالء‬ ‫من‬ ‫الدعم‬ ‫طلب‬ ‫يجب‬
‫ذلك‬ ‫تطلب‬ ‫اذا‬ ‫الطبي‬ ‫لبحقل‬..
•‫للزمال‬ ‫والتفاهم‬ ‫المتبادل‬ ‫االحترام‬ ‫توفر‬ ‫يجب‬‫ء‬
‫كل‬ ‫ودور‬ ‫المهنيين‬ ‫من‬ ‫غيرهم‬ ‫عن‬ ‫خبرة‬ ‫االكثر‬
‫الصحية‬ ‫الرعاية‬ ‫فريق‬ ‫في‬ ‫منهما‬.

Doctor-Patient Relationship:
All doctors know that it is
unethical, at a minimum,
to have a bad relationship
with patients.

Truthfulness.
‫الثقة‬
Honesty.
‫والصدق‬ ‫الشرف‬
Informed consent.
‫والمعتم‬ ‫الرسمية‬ ‫الموافقة‬ ‫طلب‬‫دة‬
The Physician's moral
integrity and virtuous
character.
‫والشخصية‬ ‫األخالقية‬ ‫النزاهة‬
‫للطبيب‬ ‫الفاضلة‬.

‫قال‬‫رسول‬‫هللا‬‫صلى‬‫هللا‬‫عليه‬‫وسلم‬:”‫ان‬‫أ‬‫زعمي‬
‫بيت‬‫ب‬‫يف‬‫بض‬‫ر‬،‫نة‬‫جل‬‫ا‬‫ملن‬‫ترك‬‫اء‬‫ر‬‫امل‬‫ن‬‫ا‬‫و‬‫اكن‬‫حم‬،‫قا‬‫بيت‬‫ب‬‫و‬
‫يف‬‫وسط‬،‫نة‬‫جل‬‫ا‬‫ملن‬‫ترك‬‫الكذب‬‫ن‬‫ا‬‫و‬‫اكن‬،‫مازحا‬‫ب‬‫و‬‫بيت‬
‫يف‬‫عىل‬‫أ‬،‫نة‬‫جل‬‫ا‬‫ملن‬‫سن‬‫ح‬‫خلقه‬“.
‫رواه‬‫أبو‬‫داود‬‫والطبراني‬‫في‬‫معاجمه‬،‫وغيرهما‬‫وحسنه‬
‫األلباني‬‫في‬‫صحيح‬‫سنن‬‫أبي‬‫داود‬.

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