Professionalism and Ethics Handbook for Residents 232P; 14.8Cm × 21Cm ISBN: 978-603-90608-2-6 1-Medical Ethics 2-Professional Ethics I-Title 174.2 Dc 1436/2924 L.D
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Professor James Ware, MA, MB, FRCS, DMSc Director of Medical Education and Postgraduate Studies Department of Medical Education and Postgraduate Studies Saudi Commission for Health Specialties Riyadh, Saudi Arabia Dr. Abdulaziz Fahad Al Kaabba, MBBS, JMHPE, MHSc, DCH, ABFM Family Physician Consultant Associate Professor of Family Medicine & Bioethics College of Medicine Al-Imam Muhammad Ibn Saud Islamic University Riyadh, Saudi Arabia Dr. Ghaiath MA Hussein, MBBS, MHSc (Bioethics) Doctoral Researcher Ethics, Society & History (MESH) School of Health & Population Sciences University of Birmingham United Kingdom Professor Dr. Omar Hasan Kasule, Sr., MBChB (MUK), MPH & DrPH (Harvard) Head of Knowledge Exchange and International Collaboration Chairman, KFMC Ethics Committee and the Institutional Review Board (IRB) Faculty of Medicine King Fahad Medical City Riyadh, Saudi Arabia Ms. Vittoriana Crisera Journal Manager, Journal of Health Specialties Saudi Commission for Health Specialties Riyadh, Saudi Arabia © Saudi Commission for Health Specialties, 2015 King Fahd National Library Cataloging-in-Publication Data Saudi Commission for Health Specialties, Riyadh - 2015 Professionalism and Ethics Handbook for Residents 232p; 14.8cm × 21cm ISBN: 978-603-90608-2-6 1-Medical ethics 2-Professional ethics I-Title 174.2 dc 1436/2924 L.D. no. 1436/2924 ISBN: 978-603-90608-2-6 © 2015 by the Saudi Commission for Health Specialties All rights are reserved. You must have prior written permission for any reproduction, storage in a retrieval system, or transmission, in any form or by any means. Requests for permission should be directed to The Saudi Commission for Health Specialties (SCHS), Diplomatic Quarter, next to the Egyptian Embassy, PO Box: 94656, Postal Code: 11614. It is also possible to contact SCHS through the Consolidated Communication Centre (from within KSA): 920019393, and through International Contact Call +966114179900. This Manual is a publication of the Department of Medical Education and Postgraduate Studies, The Saudi Commission for Health Specialties (SCHS). It was written and edited by a group of experts in the field of medical education and medical ethics. Its contents do not necessarily reflect the policies of the SCHS, except where this is clearly and explicitly indicated. Production and Concept The Saudi Commission for Health Specialties, KSA. For further information and suggestions, please contact Ms. Laila Al-Yousef, [email protected] Disclaimer: Every effort has been made in preparing this Handbook to provide accurate and up-to-date information that is in accord with accepted standards and practice. Nevertheless, the editors and authors can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The editors and authors therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Although many of the case studies contained in this Handbook are drawn from actual events, every effort has been made to mask the identities and the organizations involved. Citation: Hussein GM, Alkabba AF, Kasule OH. Professionalism and Ethics Handbook for Residents (PEHR): A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh, Saudi Arabia: Saudi Commission for Health Specialties, 2015. FOREWORD XVI ACKNOWLEDGMENTS XVII MODULE 1 - INTRODUCTION TO MEDICAL ETHICS 1 1.1 Objectives of the Module 3 1.2 Case (Ethical Scenario) 3 1.3 What is the PEHR of Health Care Ethics? 3 1.4 Why is the PEHR Needed? 4 1.5 How is the PEHR Structured? 5 1.6 How to use the PEHR in Practice 5 1.7 Definitions of Terminology and Concepts 6 Ethics 6 Bioethics 7 Clinical (medical) ethics 7 Research ethics 7 Public health ethics 7 Islamic bioethics 7 Why is it important to know about bioethics? 8 1.8 Case Discussion 8 1.9 Conclusion and Summary 8 1.10 References and Suggested Readings 9 MODULE 2 - PRINCIPLES OF WESTERN & ISLAMIC APPROACHES TO BIOETHICS 11 2.1 Objectives of the Module 13 2.2 Case (Ethical Scenario) 13 2.3 Introduction 13 The global/Western approach to bioethics 13 The Islamic approach to bioethics and how it differs from Western approaches 15 How do Muslims tell right from wrong? 15 The purpose of Islamic laws and rulings 16 The major principles that guide Islamic judgment on ethical issues and their sub-principles 17 2.4 Ethical, Fiqhi, Legal, and Policy Implications of Bioethics in Health care 19 2.5 How to Improve Your Practice by Knowing About Western and Islamic Ethics 20 2.6 Case Discussion 20 2.7 Conclusion and Summary 22 2.8 References and Suggested Readings 22 MODULE 3 - DOCTORS‟ PROFESSIONAL RELATIONSHIPS AND DUTIES 25 3.1 Objectives of the Module 27 3.2 Case (Ethical Scenario) 27 3.3 Why is Knowing About Doctors‟ Duties and Relationships Important? 27 3.4 Where Are You? What Do You Do? 28 3.5 Interprofessional Relationships and Duties 31 Duties of a doctor and his/her profession 32 v Duties towards patients and their families 33 Duties towards colleagues 35 Duties towards community 36 3.6 Ethical, Legal, and Policy Implications 37 3.7 Islamic Rulings and Fatwas on the Topic 37 3.8 How to Improve Your Practice by Using Consideration and Empathy 39 3.9 Case Discussion 40 3.10 Conclusion and Summary 40 3.11 References and Suggested Readings 41 MODULE 4 - TRUTH TELLING AND BREAKING BAD NEWS 43 4.1 Objectives of the Module 45 4.2 Case (Ethical Scenario) 45 4.3 Introduction 45 The ethical issues related to truth telling 45 Disclosing unfavorable information 47 How to break bad news to patients? 48 4.4 Are there Ethically Acceptable Conditions that Allow Us Not to Tell Our Patients the Truth About their Conditions? 50 4.5 Why is Truth Telling and Breaking Bad News Important to Your Practice 51 4.6 Ethical, Legal, and Policy Implications of Truth Telling and Breaking Bad News 52 4.7 Case Discussion 52 4.8 Conclusion and Summary 53 4.9 References and Suggested Readings 54 MODULE 5 - PATIENTS‟ RIGHTS AND RESPONSIBILITIES 55 5.1 Objectives of the Module 57 5.2 Case (Ethical Scenarios) 57 Case scenario 1 57 Case scenario 2 57 5.3 Introduction 57 5.4 Why are Patients‟ Rights Important? 58 5.5 Ethical, Legal, and Policy Issues 59 5.6 Patients‟ Responsibilities: 60 5.7 Rulings and Fatwas on the Topic: 60 5.8 How to Improve Your Practice by Knowing About Patients‟ Rights 61 5.9 Case Discussion 61 Case 1 61 Case 2 62 5.9 Conclusion and Summary 62 5.10 References and Suggested Readings 62 MODULE 6 - MEDICAL MALPRACTICE AND MEDICAL ERRORS 65 6.1 Objectives of the Module 67 6.2 Cases (Ethical Scenarios) 67 Case scenario 1 67 Case scenario 2 67 vi 6.3 Introduction 67 6.4 Why is this Subject Important? 68 6.5 Ethical Issues Related to Malpractice 69 6.6 Islamic Issues Related to Medical Errors and Malpractice 69 6.7 How to Improve our Practice by Knowing About Medical Negligence 70 6.8 Case Discussion 71 Case 1 71 Case 2 71 6.9 Conclusion and Summary 71 6.10 References and Suggested Readings 72 MODULE 7 - PATIENT AUTONOMY AND CONSENT TO TREATMENT 73 7.1 Objectives of the Module 75 7.2 Case (Ethical Scenarios) 75 Case scenario 1: Autonomy as the basis of informed consent 75 Case scenario 2: Scope and limitations of consent 75 Case scenario 3: Consent and protection of the patient 75 Case scenario 4: Consent and the protection of the physician 76 Case scenario 5: The process of informed consent 76 Case scenario 6: Capacity/competence to consent 76 Case scenario 7: Proxy consent/substitute decision maker 76 Case scenario 8: Prospective consent/advance directives 77 Case scenario 9: Consent for children 77 Case scenario 10: Consent for the mentally impaired 77 Case scenario 11: Consent for the unconscious 77 7.3 Introduction: Terminology and Concepts 77 7.4 Why is it Important To Know About Autonomy and Consent? 79 7.5 Ethical, Legal, and Policy Issues 79 Autonomy as the basis of informed consent 79 Scope and limitations of consent 79 Consent and protection of the patient 80 Consent and the protection of the physician 80 The process of informed consent 80 Capacity/competence to consent 81 Proxy consent and substitute decision maker 81 Prospective consent and advance directives 81 Consent for children 82 Consent for the mentally impaired 82 Consent for the unconscious 83 7.6 How to Improve Your Practice 83 7.7 Case Discussion 83 Case 1: Autonomy as the basis of informed consent 83 Case 2: Scope and limitations of consent 83 Case 3: Consent and protection of the patient 83 Case 4: Consent and the protection of the physician 84 Case 5: The process of informed consent 84 Case 6: Capacity and competence to consent 84 vii Case 7: Proxy consent and substitute decision maker 84 Case 8: Prospective consent and advance directives 84 Case 9: Consent for children 84 Case 10: Consent for the mentally impaired 84 Case 11: Consent for the unconscious 84 7.8 Conclusion and Summary 84 7.9 References and Suggested Readings 85 MODULE 8 - PRIVACY AND CONFIDENTIALITY 87 8.1 Objectives of the Module 89 8.2 Case (Ethical Scenario) 89 8.3 Introduction 90 How privacy and confidentiality differ 90 Measures to protect patients‟ privacy 90 Measures to protect the confidentiality of your patients‟ information 91 Conditions to disclose identifiable medical information 92 8.4 Why is Learning About Privacy and Confidentiality Important? 93 8.5 Ethical, Legal, and Policy Implications of Privacy and Confidentiality 94 8.6 Rulings and Fatwas on the Topic 94 8.7 How to use Privacy and Confidentiality in Your Practice 96 8.8 Case Discussion 96 8.9 Conclusion and Summary 97 8.10 References and Suggested Readings 98 MODULE 9 - TERMINALLY INCURABLE DISEASES AND END-OF-LIFE DECISIONS 99 9.1 Objectives of the Module 101 9.2 Case (Ethical Scenarios) 101 Case scenario 1: Palliative vs.