Tripoli university

Medical technology collage

Health Laws and Ethics (I)
Introduction
Dr Hanan Abuabaid
Ethics and Morality
Ethics is a set of moral principles and a code for behavior that govern
an individual’s actions with other individuals and within society.
Morality is what people believe to be right and good, while ethics is a
critical reflection about morality.
Law
Laws are brought about by tension, agitation, and conflict in dramatic
situations.
Laws are societal rules or regulations that are obligatory to observe.
Bioethics refers to the moral issues and problems that have arisen as a
result of modern medicine and medical research.
Bioethics
Ethical and bioethical principles can be personal, organizational,
institutional, or worldwide
Issues in bioethics are usually life-and-death issues!
Law, ethics, and bioethics are different but related concepts.
Comparing Law and Ethics
Laws are mandatory to which all citizens must adhere or risk civil or
criminal liability.
Ethics relate to morals and help us organize complex information and
competing values and interests to formulate consistent and coherent
decisions.
Law is an obligation on the part of society imposed by the competent
authority, and noncompliance may lead to punishment in the form of
monetary (fine) or imprisonment or both. There are two kinds of laws
mainly, statutory law and judgment law.
“Ethics” is concerned with studying and/or building up a coherent set
of “rules” or principles by which people ought to live. It is the social
value which binds the society by uniform opinion/consideration and
enables the society to decide what is wrong and what is right. It is the
science of morale concerning principle of human duty in the society.
Ethics in Medicine
Medical ethics describes the moral principles by which a doctor must
conduct themselves. You need to understand the concept of medical

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 ethics when you’re applying for Medical School, but you aren’t
expected to be an expert.
It’s worth being aware that medical ethics is a changing ideal.
Something that might have been considered ethical 30 years ago may
not be today – and what we think is ethical right now may change in
the future.
Why Is Medical Ethics Important?
Medical professionals frequently find themselves facing moral questions
and ethical dilemmas in their line of work. Medical ethics provide a
framework to help them make judgement calls which are morally sound
and right for the patient in question.
It’s essential for aspiring Doctors to have a good moral compass and a solid
grasp of medical ethics so they can consistently do what is best for their
patients.
Ethical Principles
1-Veracity
2-Autonomy
3- Autonomy/Freedom
4- Privacy/Confidentiality
5- Beneficence/Nonmaleficence
6- Fidelity
7- Justice
The right to participate in and decide on a course of action without undue
influence.
Autonomy
Self-Determination: which is the freedom to act independently. Individual
actions are directed toward goals that are exclusively one’s own.
Veracity: The duty to tell the truth Truth-telling, honesty.

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Privacy/Confidentiality
Respecting the “self” of others and respecting privileged knowledge.
Beneficence/Nonmaleficence
The principle and obligation of doing good and avoiding harm.
These principal counsels a provider to relate to clients in a way that will
always be in the best interest of the client, rather than the provider.
Strict observance of promises or duties.
This principle, as well as other principles, should be honored by both
provider and client.
Fidelity
Strict observance of promises or duties.
The principle that deals with fairness, equity and equality and provides for
an individual to claim that to which they are entitled.
Justice
The principle that deals with fairness, equity and equality and provides for
an individual to claim that to which they are entitled.
Comparative Justice: Making a decision based on criteria and outcomes. ie:
How to determine who qualifies for one available kidney. 55-year-old male
with three children versus a 13 old girl.
Noncomparative Justice: ie: a method of distributing needed kidneys using
a lottery system.
The Healthcare arena, in common with every other segment of society has
found it necessary to find ways to create understanding and agreement.
Respect for the Individual
In our pluralistic society individuals often misunderstand each other.
Even when they do understand each other, it is possible for them to
disagree.
The Healthcare arena, in common with every other segment of society has
found it necessary to find ways to create understanding and agreement.

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Introduction to Bioethics
Bioethics is the application of ethics to the field if medicine and
healthcare.
It is the way of understanding and examining what is right and what is
wrong in biomedical research and practice.
Bio ethics was first coined in 1971 by Van Rensselaer potter of Wisconsin
university.
History of Bioethics
Started as concerns regarding research ethics Nuremberg Doctors’ Trial --
23 German physicians who either participated in the Nazi program to
euthanize persons deemed "unworthy of life “or who conducted
experiments on concentration camp prisoners without their consent were
tried. The trial lasted 140 days. 85 witnesses testified and almost 1,500
documents were introduced. 16 of the doctors charged were found guilty.
7 were executed.
Consent
It is an act of voluntary agreement between two parties; in medical care, it
is the patient and the doctor. The consent is of two types.
Implied consent
The consent is not written when a patient submits to health care agencies
for medical examination or treatment. Patients attending the OPD of the
hospital for consultation and treatment do not require written consent
unless some complicated procedures are performed.
Informed consent
It may be oral or written, mostly written for future reference. Informed
means that the patient or his/her attendant understands the mode of
treatment or procedure, and only after understanding it fully, the patient
or attendant has signed. All consent should be taken from the partner.
In simple terms, informed consent can be defined as an instrument of
mutual communication between doctor and patient, with an expression of

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authorization/permission/choice by the latter for the doctor to act in a
particular way.
Consent not Required
When the patient is unconscious, no attendant is there to give consent and
delay can be dangerous for the patient.
What We're Founding Bioethicists Studying?
• Normative ethics – formulation and defense of basic principles, values,
virtues, and ideals governing moral behavior
• Descriptive ethics – factual descriptions of moral behavior and belief
systems
• Analytic approach – discerning meanings of life, concepts of
rights/justice/fairness, etc.
• Balancing ethical principles: Shift from the greatest good to individual
rights.
Principles of Bioethics:
• Respect for persons
• autonomy- informed voluntary consent
• protection of vulnerable persons
• Beneficence/non-Maleficence
• protection of rights
• Investigator – study design
• wellbeing of subjects
• more benefits than risks
• Justice/non-exploitation
• fairness
Equitable recruitment of participants
caring of vulnerable group Principles of Bioethics:

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 ❏ Respect for persons
• autonomy- informed voluntary consent
• protection of vulnerable persons
❏ Beneficence/Non-Maleficence
• protection of rights
• Investigator – study design
• wellbeing of subjects
• more benefits than risks
❏ Justice/Non-Exploitation
• fairness
• equitable recruitment of participants
• caring of vulnerable group
Systematic Approach in Resolving Dilemmas
.Define and identify the ethical dilemma
• Clarify the facts – what’s known and what’s not?
– Medical indications- patient profile.
– Patient/Resident/Family (PRF) preferences.
– Quality of life-subjective evaluation of his or her situation
– Contextual Factors-Social contexts, family situation,
cultural/religious values, financial situation, etc.
– Analyze and balance the values involved
– Make a recommendations shared decision making
– Follow up and evaluation
• ensures accountability, consistency, and transparency, thereby
promoting trust and integrity recommendations.
What Should the Clinicians Do?

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 Moral Considerations Factual Considerations
• Non-Maleficence Medical Indication
• Beneficence PF Preference
• Autonomy Improving the quality of Life
• Justice Contextual Factors
• Care
• Confidentiality
• Loyalty
• Truthfulness

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Abortion Defined:
Abortion is defined as the medical process of ending a human pregnancy
so it doesn’t culminate in the birth of a baby. Pregnancy can be terminated
by taking medications or having a surgical procedure.
An abortion is legal after 24 weeks if the woman’s life is at risk due to the
pregnancy, the child will be born with a severe disability or there is a risk
of grave physical and mental injury to the woman – although this is
generally safer if carried out earlier in the pregnancy.

The Legal Debate

There is significant legal debate surrounding abortion, which centers
around the point in time at which abortion is allowed.
This debate centers around beliefs about when the fetus becomes a living
organism, and thus when abortion becomes murder. Some people believe
that abortion at any point in the pregnancy is murder. At the other end of
the spectrum, others argue that abortion is acceptable at any point during
the pregnancy as, until the child is born, they do not consider it to be alive.
The Abortion Regulations 2020 – came into effect on 31st March 2020.
Under the new regulations, termination of pregnancy is allowed:

1- Unconditionally prior to 12 weeks.

2- Up to 24 weeks when continuing the pregnancy would risk mental
or physical injury to the woman or girl that is greater than the risk of
terminating the pregnancy.
3- After 24 weeks when there is substantial impairment to the fetus,
including when death is likely before, during, or shortly after birth.
4- Termination must only be carried out by registered medical
professionals – however, those using abortion pills purchased online
will not be prosecuted, and health professionals are no longer under
any duty to report their patients’ use of abortion pills.
Ethics: Pro-Life

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 It’s important to understand the arguments held by people who
oppose abortion, and are described as pro-life. Some people may believe
that:
 Human life begins at the point of conception. Therefore, abortion is
tantamount to murder as it is the destruction of a human life.
 Instead of carrying out an abortion and taking an innocent human
life, the child can be adopted if the parents are not able to cope
with looking after them.
 Some women may be pregnant as a result of rape or incest. The
unborn child is innocent and should not be punished for this crime
through an abortion.
 An abortion can cause psychological distress for the woman.
 All children have great potential and a woman could decide to abort
a fetus that may have been extremely important to society or the
world.
Ethics: Pro-Choice
The alternative opinion is called pro-choice and describes those who
support abortion. People with this ethical stance may believe that:

 Almost all abortions are carried out in the first three months of the
pregnancy, at which time the fetus cannot exist independently
outside of the mother’s womb. Therefore, it cannot be regarded as a
living organism, and abortion is arguably not murder.
 Fertilized eggs that are used for in vitro fertilization (IVF) are often
thrown away or destroyed if not implanted and some would argue
that these fertilized eggs are human lives – but destroying them is
not considered murder.
 In the case of rape or incest, forcing a woman to have the child is
likely to be more psychologically damaging to her than having an
abortion.
 Keeping abortion legal will prevent deaths and complications from
unsafe backstreet abortions that are carried out in secrecy.
 An abortion may be necessary to save the woman’s life in certain
cases and thus this option should be taken where necessary, rather
than risking the mother’s life.

Euthanasia, sometimes known as ‘mercy killing’, refers to

ending a patient’s life who is suffering from an incurable
and/or painful disease, or is in an irreversible coma.

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 Two types of euthanasia you should know about are:
Active euthanasia: When the acting person deliberately
intervenes to end someone’s life. For example – a doctor
injecting a patient who has terminal cancer with an
overdose of muscle relaxants to end their life would be
considered active euthanasia.
Passive euthanasia: Where a person causes death by
withholding or withdrawing treatment that is necessary
to maintain life. For example – withholding antibiotics
from someone who has bacterial pneumonia.

Also categorize euthanasia as:

Voluntary euthanasia: Where euthanasia is carried out at

the request of the person who dies.
Involuntary euthanasia: When the patient who dies
wants to live but is killed anyway (normally called
manslaughter or murder).
Assisted suicide: The only difference between this and
euthanasia is the person who actually performs the final
act. In assisted suicide, the physician intentionally gives the
patients the means to take the lethal medication
themselves. For active euthanasia, the physician is the one
who commits the act that directly causes death i.e. by
injecting lethal drugs.
Assisted dying: This is a sub-term of assisted suicide but
is only used in the context of when a patient who is already
dying, i.e. terminally ill, asks for help to die. Assisted dying
is not usually used in the context of bringing about the
deaths of patients who are not already dying (for example,
paralyzed patients or those who have found out that they
have developed a condition in the future i.e. Huntington’s
Disease).
It is important to understand the different types of
euthanasia so that you don’t confuse assisted dying with
the related debate of euthanasia.

Euthanasia is a type of suicide and this is a sin- “ O ye who

believe.. Do not kill yourselves for truly Allah hath been to
you most merciful..” Qur'an 4:29l

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“ Whoever jumps off a mountain and kills himself will
forever keep falling down in the depths of hell”Prophet
Muhammad
2. All life comes from Allah and is sacred- no person can
take life away. We do not own our bodies- Allah does.
3. Allah creates life and life is a Divine Mystery- only Allah
then can take life an only when he has decided it should
end
“ To Allah belongs the kingdom of the heavens and earth …
when the time comes…they cannot tarry for a single hour
nor can they go ahead Patience and endurance are highly
valued- in fact, through physical suffering, a person has the
opportunity to make up for past sins and loose them-
making them able to go straight to heaven (Paradise)
“ When the believer is afflicted with pain…God forgives his
sins and his wrongdoings are discarded as a tree sheds off
its leaves” Muhammad , the Hadith.
4. The Islamic Code of Medical Ethics endorsed the First
International Conference on Islam Medicine at Kuwait in
1981 when it stated “Mercy killing(euthanasia) finds no
support. the claim of killing for painful hopeless illness is
also refuted, for there is no human pain that cannot be
largely conquered by medicine or surgery.” and Muhammad
himself said “Seek treatment subjects of God, for every
illness God has made a cure.”

who decides what is ethical?

Over the centuries the medical profession has developed its
standards of behavior for its members, which are expressed
in
codes of ethics and related policy documents. At the global
level, the
WMA (World Medical Association) has set forth a broad
range of ethical statements that specify the behavior
required of physicians no matter where they live and
practice.
, countries’ medical associations have
been responsible for developing and enforcing the
applicable ethical
standards. Depending on the country’s approach to medical
law, these
standards may have legal status

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DOES MEDICAL ETHICS CHANGE?
There can be little doubt that some aspects of medical
ethics have
changed over the years. Until recently physicians had the
right and
the duty to decide how patients should be treated and there
was
no obligation to obtain the patient’s informed consent.

THE ROLE OF THE WMA

As the only international organization that seeks to
represent all physicians, regardless of nationality or
specialty, the WMA has undertaken the role of establishing
general standards in medical ethics that are applicable
worldwide
There can be little doubt that some aspects of medical
ethics have changed over the years. Until recently
physicians had the right and the duty to decide how
patients should be treated and there was no obligation to
obtain the patient’s informed consent.

THE ROLE OF THE WMA

As the only international organization that seeks to
represent all physicians, regardless of nationality or
specialty, the WMA has undertaken the role of establishing
general standards in medical ethics that are applicable
worldwide.
the WMA has
adopted policy statements on more than 100 specific
issues, the majority of which are ethical in nature while
others deal with socio-medical topics, including medical
education and health systems.
Each year the WMA The General Assembly revises some
existing policies and/or adopts new ones.
The WMA ensures that its ethical policy statements reflect a
consensus by requiring a 75% vote in favor of any new or
revised policy at its annual Assembly.
There are different ways of approaching ethical issues such
as the ones in the cases at the beginning of this Manual.
These can be divided roughly into two categories: non-
rational and rational. It is important to note that non-

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rational does not mean irrational but simply that it is to be
distinguished from the systematic, reflective use of reason
in decision-making.
Obedience is a common way of making ethical decisions,
especially by children and those who work within
authoritarian structures.
Imitation is similar to obedience in that it subordinates one’
judgment about right and wrong to that of another person,
in this case, a role model.
Intuition is an immediate perception of the right way to act
in a situation.
Habit is a very efficient method of moral decision-making
since there is no need to repeat a systematic decision-
making process each time a moral issue arises similar to
one that has been dealt with previously
Ethics Committees
Found in most health care facility’s
Usually, twelve to fifteen members Multidisciplinary
members A representative from the Board of Trustees
The facility administrator
The facility’s director of Nursing
A staff nurses
A physician
An area clergy
A Social Worker
An Attorney
An Ethic is (Usually a philosophy or theology professor)
Lay persons from the community
Functions of the Committee
Education
To committee members themselves
Continuing education and in service to facility’s staff
To the community
Development and review of laws, standards of care,
institutional policies and guidelines
About withdrawing and withholding nutrition and hydration
Do Not Resuscitate
Utilization of facility’s/communities' resources
Case Consultation with:
Family members
Patients
Health care providers

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Staff
And their own clergy
Case Consultation May:
Provides information about ethical principles relevant to the
case under discussion
Help clarify what options are open
Provide information about relevant policies of the facility
Make a recommendation that is advisory in nature

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