Day1 introduction to medical ethics delivered to the medical students at Tabuk Univesity, Saudi Arabia

1. Introduction to Medical Ethics
Overview; Definitions &Concepts of ethics &
bioethics; Western approach to ethics; Islamic
approach; Tools & Frameworks
Dr. Ghaiath M. A. Hussein
Asst. Prof., Dept. of Medical Ethics
King Fahad Medical City – Faculty of Medicine
King Saud Bin Abdul-Aziz University for Health Sciences
Tabuk FOM, medical students (March 1, 2011)
Email: ghaiathme@gmail.com; ghussein@kfmc.med.sa
Office: 01-2889999 Ext.7588, Mob.: 0566511653

2. What we will try to learn today?
• Section I: Definitions & Concepts
• What is ethics?
• What is bioethics?
• What is medical ethics?
• Development of medical ethics
• Section II: Western approaches to medical ethics
• Section III: Islamic approaches to medical ethics
• Section IV: Tools and Frameworks to resolve ethical
issues in healthcare

3. Section I: Overview of ethics &
bioethics
Why do we do what we do?

4. Which one would you drink?

5. Less embarrassing choices…
 I need to pass the exam..cheat or not?
 I need the organs of this dying patient... Let him
die fast?
 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?

6. What do you think?

7. Levels of moral response
 The expressive level (unanalyzed expressions or
feeling 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 provided)
Thomas J and Waluchow W, 1998

8. Ethics
Ghaiath
8
 explicit critical reflection on moral beliefs, practices
and problems
 philosophical study of morality
This is at the reflective level…
(contrast with “descriptive ethics”)

9. The Fact-Value Distinction
Ghaiath
9
• Fact: description of the way the world is; an actual
state of affairs (“is”)
• Value: judgment about the way things should be
(“ought”)
▫ no “ought” can be deduced from an “is”

10. Ethical reasoning
Values and ethical principles
• Value = something a person/community has
identified as important (e.g., autonomy/self-
determination)
• Values by themselves don't tell us what we ought to
do
• Key values in bioethics have corresponding ethical
principles meant to guide action (e.g., principle of
respect for autonomy)

11. Section II: Definitions &
Concepts
What is ethics?
What are the branches of ethics?
What is bioethics?
What is medical/clinical ethics?
What is an ethical issue?

12. 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)

13. 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.

14.  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?

15. Questions answered by Bioethics
 deciding what we should do (what
decisions are morally right or
acceptable);
 explaining why we should do it
(how do we justify our decision in moral
terms); and
 describing how we should do it
(the method or manner of our response
when we act on our decision).

16. What is clinical/medical ethics?
 Clinical ethics is a practical discipline that
provides a structured approach to assist
physicians in identifying, analyzing and resolving
ethical issues in clinical medicine.
 The practice of good clinical medicine requires
some working knowledge about ethical issues
such as informed consent, truth-telling,
confidentiality, end-of-life care, pain relief, and
patient rights

17. Ethics
Bioethics
Clinical Ethics
Research ethics
Resource
Allocation
ethics
Public Health
ethics
Nursing ethics
other
Business ethics
Environmental
ethics
Social ethics
Organizational
ethics
IT ethics
Other

18. 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

19. Domains of Ethics in Health Care
 Shared decision making with patients
 Ethical practices in end-of-life care
 Patient privacy and confidentiality
 Professionalism in patient care
 Ethical practices in resource allocation
 Ethical practices in management
 Ethical practices in research
 Ethical practices in the everyday workplace

20. What else could it be?
 Miscommunication stands for 70-80% of problems
in healthcare
◦ E.g. Doctors don’t know to tell medical info
 Management issue
◦ “when shall I get promoted? All my colleagues did. This is
not ethical!”
 Financial issue
◦ “I am underpaid for my workload. This is not ethical!”

21. Section III: Western approach to
ethics and ethical reasoning
How right and wrong are
distinguished?

22. Ethical justification
In ethics, the support/reasons ultimately come from
moral values, principles and theories:
• “I think we should do X because A and B are really
important values”
• “Y wouldn’t be appropriate because it violates
principles A and B”
• “X would be the right thing to do because of our
obligation to do A”
Jonathan Breslin, 2006

23. Ethical theories and principles
as lenses
23
“Doing bioethics well requires appeal to
the insights provided by multiple
theories…
the metaphor of lenses provides a more
accurate and a more productive
understanding of the role of theories in
bioethics…”
(Sherwin, The Politics of Women’s Health, 205).

24. 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 with knowing others
 To call for Allah on guidance ‫تعالى‬ ‫هللا‬ ‫إلى‬ ‫الدعوة‬

25. General characteristics of western
philosophies
 Secularism: people are free to practice their religion but
no particular religious guidance to right & wrong
 Individualism:It’s all about I, me and myself!
 The individual and nuclear family structure are the societal
builidng block.
 The indivdual’s interest is what should come first (vs. more
collective extended family ethics in our region)

26. Schools of thought in moral reasoning
 Utilitarianism: 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.
 Deontology: 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

27. Schools of thought in moral
reasoning (cont.)
 Feminist ethics (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.
 Casuistry: 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.

28. Schools of thought in moral
reasoning (cont.)
 Virtue ethics: It emphasizes the virtues, or
moral character
 A patient should not comply with a “don’t smoke”
advice from a smoking doctor!

29. Schools of thought in moral
reasoning (cont.)
 Principlism:
 Autonomy: respect humans'
ability to choose,
 Beneficence: Do Good for
others,
 Nonmaleficence (Do No
Harm), &
 Justice

30. Other philosophies...
 Taxonomy of ethics
Other philosophies Abrahamic
Philosophies
Oriental
philosophies
African, Asian, etc. Islamic Buddhist
Human Rights Jewish Conficious
Catholic Indian
Protestant Persian
Jehovah Witnesses

31. Section IV:
Islamic approach to ethical
analysis and decision making

32. Ethics in Islam… not a separate entity!

33. How should Muslims decide their acts?
 And I (Allâh) created not the jinn and mankind except that
they should worship Me (Alone). َ
‫س‬ْ‫ن‬ِ‫اإل‬ َ‫و‬ َّ‫ن‬ ِ‫ج‬ْ‫ال‬ ُ‫ت‬ْ‫ق‬َ‫ل‬َ‫خ‬ ‫ا‬َ‫م‬ َ‫و‬
‫ال‬ِ‫إ‬
ِ‫ُون‬‫د‬ُ‫ب‬ْ‫ع‬َ‫ي‬ِ‫ل‬
(
‫الذاريات‬
56
)
 Worship in Islam includes:
 To follow the orders of Allah and His Prophet Mohamed (PBUH)
 “And whosoever does not judge by what Allâh has revealed,
such are the Kâfirûn (i.e. disbelievers - of a lesser degree as
they do not act on Allâh’s Laws” (5: 44); “And whosoever does
not judge by that which Allâh has revealed, such are the
Zâlimûn (polytheists and wrong-doers - of a lesser degree)” (5:
45); “And whosoever does not judge by what Allâh has
revealed (then) such (people) are the Fâsiqûn [the rebellious
i.e. disobedient (of a lesser degree)” (5: 47)

34. 1)The Koran and 2) the Sunna,
 Ijmaa means a unanimous agreement among Muslim Scolars on any Shariah
ruling
 Qiyas refers to likening a new case in question without textual evidence to an
original ruling which is supported by explicit legal text which shares the same
cause.
 Maslahah means deciding a ruling based on the principle of general public
interest in issues which do not have clear and specific ruling from text of either
Al-Quran or Al-Sunnah.
 Istihsan refers to setting aside an established ruling backed by dalil
(evidence) on a matter in favor of an alternative ruling which is stronger and
more convincing than the first ruling, based on the support by dalil.
 Istishab refers to the presumption of continuity of the original ruling as long as
there is no other dalil to establish the contrary.10
 Sadd Zari`ah signifies an approach used to prevent any means to evil in order
to avoid from forbidden acts. It is regarded as an early preventive measure to
keep away a Muslim from committing actions prohibited by Allah SWT.
 `urf is defined as established norms and common to the majority of people in
a community either in the form of sayings or doings as long as it does not
contradict the Shariah ruling.

35.  The are to preserve
person’s:
1. Religion;
2. Soul;
3. Mind;
4. Wealth; &
5. Progeny.
All Islamic legislations came to achieve these
goals.

36.  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 )

37. • Clear and fixed sources
• Clear goals of morality (Maqasid
Alshariya)
• Its moral style endorses values of:
▫ Bringing hope (
‫تنفروا‬ ‫وال‬ ‫بشروا‬
)
▫ Softness (
‫لينا‬ ‫قوال‬ ‫له‬ ‫فقوال‬
)
▫ Kindness (
‫زانه‬ ‫اال‬ ‫شيء‬ ‫في‬ ‫الرفق‬ ‫كان‬ ‫ما‬
)
▫ Respect for vulnerable (
‫بالقوارير‬ ‫رفقا‬
( )
‫يوقر‬ ‫لم‬ ‫من‬ ‫منا‬ ‫ليس‬
‫صغيرنا‬ ‫ويرحم‬ ‫كبيرنا‬
)

38. 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

39. 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.

40. Section V: Tools & Frameworks

41. Consider each medical condition and its
proposed treatment. Ask the following
questions:
Does it fulfil any of the goals of medicine?
With what likelihood?
If not, is the proposed treatment futile?
Address the following:
What does the patient want?
Does the patient have the capacity to decide?
If not, who will decide for the patient?
Do the patient's wishes reflect a process that
is informed? understood? voluntary?
Describe the Patient's quality of life in the
patient's terms.
What is the patient's subjective
acceptance of likely quality of life?
What are the views of the care providers
about the quality of life?
Is quality of life "less than minimal?" (i.e.,
qualitative futility)
Social, legal, economic, and institutional
circumstances in the case that can:
influence the decision
be influenced by the decision
e.g., inability to pay for treatment;
inadequate social support

42. Box 1: Medical Indications
 Medical Indications are those facts about the
patient's physiological or psychological condition
that indicate which forms of diagnostic,
therapeutic, or educational interventions are
appropriate.
 Is the Problem Acute? Chronic? Critical? Reversible?
Emergent? Terminal?
 What Are the Goals of Treatment?
 InWhat Circumstances Are Medical Treatments Not
Indicated?
 What Are the Probabilities of Success of Various
Treatment Options?
 How Can This Patient Be Benefited by Medical and
Nursing Care, and How Can Harm Be Avoided?

43. Box 2: preferences of patients
 The choices that persons make when they are faced
with decisions about thier health and medical
treatment.
 Ethical issues included:1)respect for the
autonomy of the patient; (2) the legal, clinical,
and psychological significance of patient
preferences; (3) informed consent; (4) decisional
capacity; (5) truth telling; (6) cultural and religious
beliefs; (7) refusal of treatment; (8) advance
directives; (9) surrogate decisions; (10) the
challenging patient; and (11) alternative
medicine.

44. Box 3: Quality of life
 refers to that degree of satisfaction that people
experience and value about their lives as a whole,
and in its particular aspects, such as physical health.
 The main ethical principles involved are:
Beneficence & Autonomy

45. Box 3: Quality of life...cont’d
 Relevant ethical questions
 What are the prospects, with or without treatment, for a
return to normal life, and what physical, mental, and social
deficits might the patient experience even if treatment
succeeds?
 Are there biases that might prejudice the provider's
evaluation of the patient's quality of life?
 What ethical issues arise concerning improving or
enhancing a patient's quality of life?
 Do quality-of-life assessments raise any questions
regarding changes in treatment plans, such as forgoing
life-sustaining treatment?
 What are the plans and rationale to forgo life-sustaining
treatment?

46. Box 4: Contextual Features
 It addresses the ways in which professional,
familial, religious, financial, legal, and institutional
factors influence clinical decisions
 Involved ethical principles are: beneficence,
respect for autonomy and justice
 Justice refers to those moral and social theories
that attempt to distribute the benefits and
burdens of a social system in a fair and equitable
way among all participants in the system.

47. CASES Approach

48. The CASES Approach
 The CASES approach was developed by the
National Center for Ethics in Health Care
 Clarify the facts & requirements
 Assemble the relevant information
 Synthesize the information
 Explain the synthesis
 Support the ethical decision making process

49. Clarify the facts & requirements
 Characterize the type of problem
 Obtain information about the case
 Establish the goal from the ethical
analysis (consultation process)
 Formulate the ethics question
 Given [uncertainty or conflict about values], what
decisions or actions are ethically justifiable? or
 Given [uncertainty or conflict about values], is it ethically
justifiable to [decision or action]?

50. Assemble the Relevant Information
 Consider the types of information needed
(Medical facts, Patient’s preferences, QOL,
Contextual features)
 Identify the appropriate sources of information
 Gather information systematically from each
source
 Summarize the information and the ethics
question

51. Synthesize the Information
 Determine whether a formal meeting is needed
 Engage in ethical analysis
 Identify the ethically appropriate decision maker()
 Facilitate moral deliberation about ethically justifiable
options

52. Explain the Synthesis
 Communicate the synthesis to key participant
 Provide additional resources
 Document the consultation in the health record
 Document the consultation in consultation service
records

53. Support the Consultation Process
 Follow up with decisions taken
 Evaluate the outcome of the decision
 Adjust the consultation process
 Identify underlying systems issues

54. Islamic Approach to Resolving
Ethical Issues in Clinical
Practice

55. 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

56.  Is there a previous Fatwa on the issue?
 Is there a text on the issue from Koran and/or
Sunna, or secondary sources?
 What are the medical/scientific facts?
 What are the Sharia Goals involved?
 What are applicable fiqhi principles?
 Weighing of principles?
 Applying the relevant secondary sources (matching
the scripts to goals and principles)

57. Cases for discussion & Group
Work

58. The case of Dax Cowart
 Dax Cowart, was very badly burned and
sustained a long, painful treatment and
rehabilitation. He believed that his disabilities
caused by the explosion—blindness,
disfigurement, and crippling—would make his
life intolerable and not worth living.
 He refused treatment and wished to die.
 He personally assessed his future quality of life
as not worth living.

59. The case of Dax Cowart...cont’d
 Later, Dax revised his earlier assessment as he
gradually overcame depression.
 He learned to appreciate mental activities, to enjoy
social interaction, and to cope with his frustrations.
 He became a lecturer about his own story and an
advocate for patients' rights and personal autonomy.
 He graduated from law school, passed the bar, and
practiced law.
 Confronting death: Who chooses? Who decides? A dialogue between Dax Cowart
and Robert Burt. Hastings Cent Rep. 1998;28(1):14–28.

60. Exercise
 Analysize Mr. “Dax” Case according
to
 Group A: the 4 boxes model
 Group B: CASES approach
 Group C: Islamic Approach

61. Duties & Rights in
Clinical Practice
Dr. Ghaiath M. A. Hussein
Asst. Prof., Dept. of Medical Ethics
King Fahad Medical City – Faculty of Medicine
King Saud Bin Abdul-Aziz University for Health Sciences
Email: ghaiathme@gmail.com; ghussein@kfmc.med.sa
Office: 01-2889999 Ext.7588, Mob.: 0566511653

62. What will we try to learn today?
 Roles & duties of doctors (towards self & colleagues,
patients & community)
 Patients' rights
 Privacy, confidentiality and medical records
 Informed consent to treatment
 Discussions and cases

63. Before we start…where are we?
Patient
Doctor
Lab./X-
ray
Social
worker
Nurse
Manager
Educator
Doctors Are NOT the focus of the healthcare

64. Roles & duties of doctors (towards
self & colleagues, patients & community)

65. Islamic Values That Guide Duties/Rights
 The Sharia ordained treatment of diseases, and mentioned several
methods of treatment, among which are the following:
 To seek the proper medicine through a reliable doctor, well
qualified in this profession.
 "No disease Allah created, but that He created its treatment“; "There
is a remedy for every malady, and when the remedy is applied to the
disease it is cured with the permission of Allah, the Exalted and
Glorious".
 To take preventive measures (e.g. quarantine, and keeping away
from those carrying contagious diseases).
 "Plague was a punishment or torture which Allah sent on the children
of Israel or on some people before you. So If you hear of its spread
in a land, don't approach it, and if a plague should appear in a land
where you are present, then don't leave that land in order to run
away from it (i.e. plague)".
 "If you hear about it (an outbreak of plague) in a land, do not go to it,
but if a plague breaks out in a country where you are staying, do not
run away from it".

66. Muslim leading medical ethicists!
 Ishaq ibn ‘Ali Al-Rahawi (9th century CE) wrote a book entitled
Adab al-Tabib or ‘The Ethics of the Physician’ .
 Al-Tabari, the chief physician in 970 A.D., described also the
Islamic code of ethics in his book Fardous Al Hikma stated:
 “… The physician should be modest, virtuous and merciful… He
should wear clean clothes, be dignified, and have well- groomed hair
and beard…. He should select his company to be persons of good
reputation…. He should be careful of what he says and should not
hesitate to ask forgiveness if he has made an error….
 He should be forgiving and never seek revenge…. He should be
friendly and peacemaker…. He should avoid predicting whether a
patient will live or die, only Allah knows… He ought not loose his
temper when his patient keeps asking questions, but should answer
gently and compassionately… He should treat alike the rich and the
poor, the master and the servant ….
 He should be punctual and reliable… He should not wrangle about
his fees... He should not give drugs to a pregnant woman for an
abortion unless necessary for the mother's health. …. He should be
decent towards women and should not divulge the secrets of his
patients…He should speak no evil of reputable men of the
community or be critical of any one's religious belief … He should

67. Oath of Muslim doctor
“I swear by God ...The Great ..
 To regard God in carrying out my profession;
 To protect human life in all stages and under all circumstances,
doing my utmost to rescue it from death, malady, pain and
anxiety;
 To keep peoples' dignity, cover their privacies and lock up their
secrets ;
 To be, all the way, an instrument of God's mercy, extending my
medical care to near and far, virtuous and sinner and friend and
enemy;
 To strive in the pursuit of knowledge and. harnessing it for the
benefit but not the harm of Mankind;
 To revere my teacher, teach my junior, and be brother to
members of the Medical Profession;
 To live my Faith in private and in public, avoiding whatever
blemishes me in the eyes of God, His apostle and my fellow
Faithful… And may God be witness to this Oath.”

68. Doctors’ Duties
Towards patients, colleagues, & community

69. Muslim Doctors’ Duties Towards Patients
 Respect for Patient ‫المريض‬ ‫احترام‬
 Respect for Privacy ‫المريض‬ ‫خصوصية‬ ‫ضمان‬
 Comprehensive care ‫للمريض‬ ‫الشاملة‬ ‫الرعاية‬
 Respect for patient’s autonomy ‫المريض‬ ‫استقاللية‬ ‫احترام‬
 Inform the patient about his/her condition ‫تبصير‬
‫مرضه‬ ‫بطبيعة‬ ‫المريض‬
 Protect patient's interests ‫المريض‬ ‫مصلحة‬ ‫حماية‬
 Keep the patients’ secrets ‫المريض‬ ‫سر‬ ‫كتمان‬
Source: Islamic Code of Medical & Health Ethics

70. DUTIES OF PHYSICIANS IN GENERAL (WMA)
A PHYSICIAN SHALL
 Always exercise his/her independent professional
judgment and maintain the highest standards of
professional conduct.
 Respect a competent patient's right to accept or
refuse treatment.
 Not allow his/her judgment to be influenced by
personal profit or unfair discrimination.
 Be dedicated to providing competent medical service
in full professional and moral independence, with
compassion and respect for human dignity.

71. DUTIES OF PHYSICIANS IN GENERAL (WMA)
A PHYSICIAN SHALL
 Deal honestly with patients and colleagues, and
report to the appropriate authorities those physicians
who practice unethically or incompetently or who
engage in fraud or deception.
 Not receive any financial benefits or other incentives
solely for referring patients or prescribing specific
products.
 Respect the rights and preferences of patients,
colleagues, and other health professionals.

72. DUTIES OF PHYSICIANS IN GENERAL (WMA)
A PHYSICIAN SHALL
 Recognize his/her important role in educating the
public but should use due caution in divulging
discoveries or new techniques or treatment through
non-professional channels.
 Certify only that which he/she has personally
verified.
 Strive to use health care resources in the best way
to benefit patients and their community.
 Seek appropriate care and attention if he/she suffers
from mental or physical illness.
 Respect the local and national codes of ethics

73. DUTIES OF PHYSICIANS TO PATIENTS
A PHYSICIAN SHALL
 Always bear in mind the obligation to respect human
life.
 Act in the patient's best interest when providing
medical care.
 Owe his/her patients complete loyalty and all the
scientific resources available to him/her.
 Whenever an examination or treatment is beyond
the physician's capacity, he/she should consult with
or refer to another physician who has the necessary
ability.
 Respect a patient's right to confidentiality.

74. DUTIES OF PHYSICIANS TO PATIENTS
A PHYSICIAN SHALL
 Give emergency care as a humanitarian duty unless
he/she is assured that others are willing and able to
give such care.
 In situations when he/she is acting for a third party,
ensure that the patient has full knowledge of that
situation.
 Not enter into a sexual relationship with his/her
current patient or into any other abusive or
exploitative relationship.

75. The duties of a doctor (GMC)
To be a doctor that Patients are able to trust with
their lives and health, you must:
 Make the care of your patient your first concern
 Protect and promote the health of patients and the public
 Provide a good standard of practice and care
 - Keep your professional knowledge and skills up to date
 - Recognize and work within the limits of your competence
 - Work with colleagues in the ways that best serve patients’
interests
 Treat patients as individuals and respect their dignity
 - Treat patients politely and considerately
 - Respect patients’ right to confidentiality

76. The duties of a doctor (GMC)
 Work in partnership with patients
 Listen to patients and respond to their concerns and
preferences
 Give patients the information they want or need in a
way they can understand
 Respect patients’ right to reach decisions with you
about their treatment and care
 Support patients in caring for themselves to improve
and maintain their health

77. The duties of a doctor (GMC)
 Be honest and open and act with integrity
 Act without delay if you have good reason to believe
that you or a colleague
 may be putting patients at risk
 Never discriminate unfairly against patients or
colleagues
 Never abuse your patients’ trust in you or the public’s
trust in the profession.
 You are personally accountable for your
professional practice and must always be
prepared to justify your decisions and actions.

78. DUTIES OF PHYSICIANS TO COLLEAGUES
A PHYSICIAN SHALL
 behave towards colleagues as he/she would have
them behave towards him/her.
 NOT undermine the patient-physician relationship of
colleagues in order to attract patients.
 when medically necessary, communicate with
colleagues who are involved in the care of the same
patient. This communication should respect patient
confidentiality and be confined to necessary
information.

79. Physician's Duties towards his Colleagues
 To deal with, and act towards his colleagues in a good
manner and in the same way he would prefer to be
treated
 To avoid direct criticism to his colleague in front of
patients
 Not to indulge in defaming the honor of his colleagues
 To exert every possible effort to educate the colleagues
within his/her medical team, or those are under training
 Respect the differences with colleagues (sex, culture,
belief…).
 The physician should be prepared to conduct peer review
to the performance of his fellow colleagues and should
accept the same procedure on him
 S/he must report the incidence in which a colleague
could be dangerous to the authority concerned
 Treat colleagues (or their dependents) free of charges,
unless paid by a third party.
Source: Saudi Council for Health Specialties Manual of Ethics of the Medical Profession

80. Doctor’s duties towards his profession
 Respect the honour of the profession;
 Develop him/herself to develop the profession
through CME, research, and publications;
 Adhere to the standards of practice (GCP, EBM,
guidelines, etc.)
 Abstain from any behaviour/action that would
question his/her credibility, or establishing dishonest
affairs with patients or their families;
 Avoid the request of fame on the account of the
professional ethics and standards
 To provide role model for his colleagues & patients
Source: Islamic Code of Medical & Health Ethics

81. Doctor’s role towards community
 Positive interaction with the community’s affairs
 Protect the community by reporting
reportable/epidemic diseases
 Improve health in the community through advocacy
and health education, and involvement in community
health activities
 Rational use of the healthcare institutions’ resources
 Effective contribution to the development of policies
and health systems that respond to the community
needs and facilitates easier access to health care.
Source: Islamic Code of Medical & Health Ethics

82. Doctor’s rights...
The Doctor has the right to:
 Receive his/her complete right to respectful treatment
and civil rights, equal to other community members
 Chances to continuous education and training (through
libraries, conferences, workshops, symposia, etc.)
 A setup within which s/he can provide healthcare in
compliance with the international guidelines and
standards
 Not to be coerced by any means to do or abstain from
doing a work related to his/her profession, except within
the limits of law
 Not to be suspended or halted from practice, expect
within the limits of law & professional regulations
 Defend him/herself in any trial and professional
discipline, or/and to have the right to delegate lawyers (or
experts)

83. Thank You
To contact me:
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