Mohsen George

General Surgery Consultant

Member of scientific council of General Surgery of EFB
Member of Surgery Scientific Council of ABHS

mohsen george August 2018

 Medical ethics is a system of moral
principles that apply values and judgments to
the practice of medicine.

‫األخالقيات الطبية هي نظام من المبادئ األخالقية التي‬

.‫تطبق القيم واألحكام فى ممارسة مهنة الطب‬

mohsen george August 2018

 Code of Medical Ethics
• Hippocratic Oath 400 B.C.
• Translated from Greek by Francis
Adams to English 1849
• I consider for the benefit of my patients
• Abstain from whatever is deleterious &
mischievous
• I will give no deadly medicine to
anyone if asked
• I will not give a woman a pessary to
produce abortion
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Medical Ethics is not assigned a major
role in medical school curriculum ….
Why?
• As long as the physician is a knowledgeable and
skillful clinician, ethics doesn’t matter.
• Ethics is learned in the family, not in medical school.
• Medical ethics is learned by observing how senior
physicians act, not from books or lectures.
• Ethics is important, but our curriculum is already
too crowded and there is no room for ethics
teaching.
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Four basic Principles of Medical Ethics

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Four basic Principles of Medical Ethics
• Autonomy: The right to choose or refuse treatment
• Non Maleficence: do no harm to patients - Physicians
must refrain from providing ineffective treatments or
acting with malice toward patients
• 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
• Justice: The distribution of scarce health resources, and
the decision of who gets what treatment “fairness
(equity) and equality”
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 Autonomy

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 Autonomy
• 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.

mohsen george August 2018

 Autonomy
• Always respect the autonomy
• Such respect is not simply a matter of
attitude, but a way of acting so as to
recognize and even promote the
autonomous actions of the patient.
• The autonomous person may freely choose
loyalties or systems of religious belief that
may adversely affect him. The patient must be
informed clearly the consequences of his action
that may affect him adversely.
mohsen george August 2018
 Autonomy
• 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’
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 Autonomy

• 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.

mohsen george August 2018

 Consent to Treatment
Consent to treatment is the principle that a person
must give their permission before they receive any type
of medical treatment or examination. This must be
done on the basis of a preliminary explanation by a
clinician.

Consent is required from a patient regardless of the

intervention – from a physical examination to organ
donation.

It is part of Medical Ethics & the International Human

Rights Law
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Consent can be given:
• Verbally – for example, to have an X-ray.
• In writing – for example, by signing a consent form
for surgery.
• Patients may Passively allow intervention to be
taken– for example, by holding out an arm to show
they are happy to have a blood test.

mohsen george August 2018

For consent to be valid: it must be voluntary and
informed, and the person consenting must have the capacity to
make the decision. These terms are explained below:

• Voluntary – the decision to either consent or not to consent to

treatment must be made by the person themselves, and must not be
influenced by pressure from medical staff, friends or family.
• Informed – the person must be given all of the information in
terms of what the treatment involves, including the benefits and risks,
whether there are reasonable alternative treatments and what will
happen if treatment does not go ahead.
• Capacity – the person must be capable of giving consent,
which means they understand the information given to them, and they
can use it to make an informed decision.
mohsen george August 2018
If an adult has the capacity to make a voluntary and
informed decision to consent to or refuse a particular
treatment, their decision must be respected. This still
stands even if refusing treatment would result in their
death, or the death of their unborn child.
If a person does not have the capacity to make a decision
about their treatment, the healthcare professionals treating
them can go ahead and give treatment if they believe it is
in the person’s best interests. However, the clinicians must
take reasonable steps to seek advice from the patient’s
friends or relatives before making these decisions.

mohsen george August 2018

When consent is not necessary
There are a few exceptions when treatment can go ahead without
consent. For example, it may not be necessary to obtain consent if:
• Treatment is needed in an emergency, and the person is unable to
give consent because they lack the capacity to do so.
• When, during an operation, it becomes obvious that the person
immediately requires an additional procedure to treat a life-
threatening problem that was not included in their original
consent.
• A person with a severe mental health condition – such as
schizophrenia, bipolar disorder or dementia – lacks the capacity to
consent to the treatment of their mental health. However, in these
cases, treatment for unrelated physical conditions still requires
consent, which the patient may be able to provide, despite their
mental illness.
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 Non-Maleficence

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 Non Maleficence

• “Above all, Do No Harm

• Make sure that the procedure does
not harm the patient or others in
society

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• Physicians are obligated not prescribe
medications they know to be harmful.
• Some interpret this value to exclude the
practice of euthanasia
• Violation of non-maleficence is the
subject of medical malpractice litigation

mohsen george August 2018

 Patient Safety Terms

Medical Error
Is the failure of a planned action to be
completed as intended, or the use of the wrong
plan to achieve an aim.
(IOM)

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 Medical malpractice

An act or omission by a health care

provider that deviates from accepted
standards of practice in the medical
community which causes injury to
the patient.

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 Patient Safety Terms
Sentinel Event
An unexpected occurrence involving death or serious physical or
psychological injury.

Adverse Event
An untoward, undesirable, and usually unanticipated event, such
as death of a patient, in a health care organization.

Near Miss
could have resulted in loss, injury or illness, but did not because
the error was caught.

No Harm Event
as near miss but absence of injury is owed to chance.
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 Patient Safety Terms

Incident Report:
The documentation for any unusual
problem, incident, or other situation
that is likely to lead to undesirable
effects or that varies from established
policies and procedures or practices.

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mohsen george August 2018
Before
Induction of
Anesthesia

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Before
Skin
Incision

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Before
Patient
Leaves OR

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 2009

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 2010

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 Beneficence

mohsen george August 2018

 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

mohsen george August 2018

 Beneficence
This needs health care provider to:
1. Develop and maintain skills and
knowledge by continually updating
training
2. Consider individual circumstances
of all patients

mohsen george August 2018

 Justice

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 Justice / Equity

The distribution of scarce health resources,

and the decision of who gets what treatment
“fairness (equity) and equality”

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The four main areas that Health care
provider must consider when evaluating
justice:
1. Fair distribution of scarce resources
2. Competing needs
3. Rights and obligations
4. Potential conflicts with established
legislations
mohsen george August 2018
mohsen george August 2018
 Thank you

mohsen george August 2018