Medical Ethics 1

Definition – Values, Morals, and Ethics 1.Values - Fundamental beliefs that define difference between right and wrong, good and bad, justice and injustice. Examples: honesty, integrity, compassion, duty, courage, honour, responsibility, patriotism, respect, fairness INCLUDES utilitarian practical values – excellence, quality, service, safety. 2.Morals are the VALUES such as above that we attach to a system of beliefs. May be religious, political, green etc 3.Ethics How we make decisions and act out our morals. 2

Christian Values based on 1.Ten Commandments 2.Sermon on the Mount 3.The story of the Good Samaritan 4.Commandment to “Love your neighbour as yourself” 5. Jesus teaching of the Sheep and Goats Medical Ethics 3

Factors that limit individual ethical practice 1.The Law of the Land 2.Regulation a.By employers b.Professional bodies c.Clinical Practice guide lines – NICE d.Financial restraint Medical Ethics 4

12C Byzantine manuscript of Hippocratic oath Medical Ethics 5

Engraving of Hippocrates – Peter Paul Rubens 1638 Summary of Hippocratic oath 1.Share his art with teachers and disciples 2.Follow a regime that he thinks will benefit his patients 3.Abstain from anything deleterious or mischevious 4.Give no deadly medicine nor give a pessary to procure an abortion 5.Practise his art with purity and holiness 6. Go to houses for the benefit of the sick and abstain from mischief and corruption 7. Refrain from seduction of females and slaves 8. Will not divulge what is told in connection with his professional service Medical Ethics 6

History 1.First Code of Ethics - Formula comitis achiatrorum – 5C AD 2.First book - “The Conduct of a Physician” by Ishaq bin al-Ruhawi 3. Jewish thinker Maimonades and Theologian Thomas Aquinas wrote about medical ethics Thomas Percival - First modern code of medical ethics. Medical Ethics 7

Ethical Principles 1.Autonomy and Rights 2.Beneficence - Do good 3.Non-maleficence – Do no harm 4.Justice Medical Ethics 8

Christian perspective on Ethics 1.Autonomy and rights Dignity and respect, Consent, Confidentiality, Honesty and truthfulness; Patients make their own decisions. Conflicts of Consent 1.Wrong decisions, 2.Patient /doctor disagreement, 3. Patient /other party disagreement Medical Ethics 9

2. Beneficence (Do good) Most up to date and effective procedures, Wish of the patient respected, Act with kindness, compassion & respect Well trained staff Good equipment Suitable environment Safe implants Safe and reputable drugs Medical Ethics 10

Beneficience - Conflicts Trying to do good may cause harm Pain killers, Radiotherapy, Adverse reactions to drugs Surgery may be fatal Striving officiously to save life Over treatment Medical Ethics 11

3. Nonmaleficence (Do no harm) Positive steps to prevent harm Staff recruitment & training Audit Equipment Decisions about when and when not to treat Decisions to cease treatment > death Passive Removal of support Euthanasia Medical Ethics 12

Euthanasia Problem of consent (depression, may feel pressurised) law of the land, Religious principles - life is sacred Reduces confidence in Doctors Alternative - generous pain relief, Hospice care Medical Ethics 13

Medical Ethics Nonmaleficence (Do no harm) Positive steps to prevent harm Staff recruitment & training Audit Equipment Decisions about when and when not to treat Decisions to cease treatment > death Passive Removal of support Euthanasia Patient/Doctor relationship

4. Justice a. For the individual Emergency, non emergency Treatment of the elderly b. For people in general use of national resources Medical Ethics 15

Medical Ethics Christian perspective 1. God created us in his own image and gave us life for a purpose - so we must respect it 2. Jesus was very definite about caring for the sick 3. We should know how to behave through love 4. Clinicians should be permitted to practise according to their professional training and faith 5. They should be regulated by their peers 16