Chapters and Articles

Medical Ethics, the Law, and Cultural Competency

Yasmin Al-Atrache, ... Naja Wilson, in The Emergency Department Technician Handbook, 2024
Introduction
Medical ethics encompass the obligations health care professionals have to ensure patients’
overall well-being and to respect their fundamental human rights. Medical ethics applies to every
healthcare provider and is a dynamic concept that varies among different societies, religious
groups, and cultures. Implementing the basic principles of medical ethics is an essential
component of patient care. There are four main pillars of medical ethics:
■
Autonomy: Allow an individual freedom to make their own decisions.
■
Justice: Treat all patients fairly and with equality.
■
Beneficence: Do good on behalf of the patients and society as a whole.
■
Nonmaleficence: Do no harm or protect from harm.
The four main pillars of medical ethics serve as a general guide in patient care and are adaptable
to specific situations. There are inherent limitations to each of these principles. For example,
autonomy may not be appropriate for a patient who lacks decision-making capacity due to severe
dementia or intoxication.
These concepts not only dictate standards of care but also help us evaluate our own personal
biases and behavior toward patients, their families, and our colleagues. Consider the concept of
cultural sensitivity and how that fits into the pillars of medical ethics. In the ED, we often
encounter patients of varied religious, cultural, and social backgrounds. Respect,
professionalism, and consideration of such differences are imperative in implementing patient-
oriented care in hopes of improving patient outcomes.
Everyone on the medical team should ensure that the patient’s well-being is a priority during the
ED visit and has an obligation to speak up with concerns or questions. Technicians are especially
important in this process because they often have more frequent interactions with patients and
their families and can provide an invaluable perspective.
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Medical Ethics, Use of Empirical Evidence in
P. Borry, in Encyclopedia of Applied Ethics (Second Edition), 2012
Historical reasons
Medical ethics has developed into an autonomous research field during the past several decades.
The following events partly explain why medical ethics received increasing attention and why
medical ethics as a discipline was begun: the atomic bombing of Hiroshima and Nagasaki;
unethical medical experimentation during World War II; the exponential proliferation of
technological innovations in biotechnology, molecular biochemistry, and pharmacology, which
challenged traditional medical knowledge and practice; debates on equal access to health
services and equitable distribution of limited economic resources; and the development of patient
rights. Initially, people from many different disciplines, such as medicine, law, theology,
biological sciences, social sciences, philosophy, and the humanities, entered into the dialogue.
However, in a process of professionalization and institutionalization, the bioethical discussions
quickly became anchored in the fields of theology and philosophy.
Mainstream medical ethics evolved toward becoming a philosophical undertaking, with the aim
of finding solutions for moral problems in an impartial, unprejudiced, and nonculturally biased
way. Ethical practice evolved as a consideration of advantages and disadvantages in the search to
justify one particular ethical option. The objective of this type of argumentation was not to find
an absolute and definitive answer for moral problems but, rather, a coherent and rational way of
problem-solving. Medical ethics often focused on the application of ethical principles to concrete
moral questions. It was patterned after the field of philosophy (with the aim of logical reasoning,
conceptual clarity, coherence, and rational justification) to produce a rational and
decontextualized discourse. Ethicists often depicted sociological studies as being irrelevant to
their discipline because they feared being influenced too strongly by historical and sociological
contextualization, which could bog them down in cultural and ethical relativism.
The hegemony of the philosophical tradition in bioethics since the inception of the discipline has
led to a situation in which the social sciences are considered to be an epiphenomenon, peripheral
to medical ethics. A fundamental meta-ethical reason stands at the base of this fear.
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Ethical Challenges and the Role of Palliative Care in Kidney
Disease
Michael J. Germain MD,, Lewis M. Cohen MD, in Chronic Kidney Disease, Dialysis, and
Transplantation (Fourth Edition), 2019
Ethical Principles
Medical ethics derive from the basic concept of human ethics. The word ethics is derived from
the Greek word ethos, meaning “custom.” Accordingly, medical ethics are a set of changeable
principles for what is considered “good, right or wrong behavior”.1a
Ethics addresses the fundamental question, “How should I live my life?”
Ethics are based on accepted standards of behavior. For example, in virtually all societies and
cultures, it is wrong to kill or steal property from someone. These standards have developed over
time and have been memorialized in religious, philosophical, and legal thought.
Moral standards are based on emotions and reason and lead to altruism. Altruism is likely a
genetically based drive developed through evolution. For example, when a hunter/gatherer kills
or gathers a large amount of food, that person will share it with the group rather than waste the
food. Over time there was an evolutionary advantage to this behavior. 2
Bioethics speak to how we, as medical personnel, treat our patients. In Western (and increasingly
global) society, the accepted principles are autonomy, justice, beneficence, and nonmaleficence
(Boxes 20.1 and 20.2).
Autonomy, especially in the United States, is a core value. But even this principle is strained
when the question of euthanasia or physician-assisted suicide/dying is discussed. Interestingly,
preservation of life at all costs is not a principle of medical ethics, so there are no medical ethical
issues raised by these death-hastening practices. Withholding or withdrawing dialysis can
similarly be viewed in this context.
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Ethical and Legal Issues in Neurology
Robert M. Taylor, in Handbook of Clinical Neurology, 2013
Conclusion
Medical ethics is the effort to determine what clinicians should do in complex clinical and
research situations. It is not a hypothetic exercise, because physicians and other healthcare
providers must act to provide care for patients. Although usually what we should do is obvious,
situations invariably arise in which what we should do is not immediately self-evident. Some
understanding of the bases for ethical analysis is essential if we are to act correctly in most
situations.
As a starting point, it is helpful to understand the basic ethical theories of deontology,
consequentialism, and virtue theory and the advantages and disadvantages of each. Beyond that,
it is important to have a basic understanding of principlism, the most widely accepted approach
to ethical analysis in modern medicine. Finally, it is helpful to understand some of the alternative
approaches to medical ethics, as they each provide unique insights into ethical dilemmas and also
highlight the limitations of principlism.
Neurology is fraught with potential ethical challenges and dilemmas. The modern neurologist
will benefit from an effort to understand better the nature of these challenges and dilemmas and
constructive approaches to addressing and resolving them.
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Ethics in intensive care
Raymond F Raper, Malcolm M Fisher, in Oh's Intensive Care Manual (Seventh Edition), 2014
Ethical framework
Medical ethics are usually discussed in the context of principles. These principles inform ethical
behaviour and can be summarised as:
1.
Autonomy: the principle of individual self-determination in respect of medical care
2.
Beneficence: the principle of ‘doing good’, an obligation always to act in the best
interests of patients with respect to saving lives, curing illness and alleviating pain and
suffering
3.
Non-maleficence: the principle of doing no harm
4.
Fidelity: faithfulness to duties and obligations, a principle underlying confidentiality,
telling the truth, keeping up with medical knowledge (i.e. continuing professional
development) and not neglecting patient care
5.
Social justice: the principle of equitable access of all citizens to medical care according to
medical need
6.
Utility: the principle of doing most good for the most number of people – that is,
achieving maximum benefits for society without wasting health resources.
Utility is a consequentialist concept, where the right or wrong of an action is determined by the
outcome rather than by an a priori principle. The ‘correct’ action may thus vary with the
particular circumstances. This is sometimes seen as an entirely different framework from the
rights or principles-based system. The utility principle is more applicable to systems
development in medical practice and may create conflict with responsibility for individual
patients. It is important that intensivists participate in the public debate that determines how
much of society's goods are to be allocated to medicine and how much of the health budget is to
be allocated to intensive care without, at the same time, surrendering responsibility for the
interests of individual patients. Moving between these collective and individual spheres of
functioning can be challenging, but is essential to good medical practice.
Ethical conflict is most often encountered where there is a clash of values. Rationing, for
instance, involves a clash between the values of individual rights and collective rights.
Euthanasia usually involves a clash between the values of sanctity of life and autonomy.
Resolution of ethical conflict depends on recognition both of the values that are in dispute and of
the principles that are operative. Absolutist terms such as ‘futility’ tend to mask the values-in-
clash and are thus unhelpful in resolution of ethical conflict. Consideration of the various
interests involved is also helpful in foregrounding the real issues behind an ethical conflict.
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Ethical Considerations
Michael E. Groher, in Dysphagia (Second Edition), 2016
Take Home Notes
Medical ethics is a subspecialty of medical care that brings together patients, caregivers, and
nonmedical and medical professionals in an effort to make the best decision on a health care
issue. It is driven by a congressional mandate called the Patient Self-Determination Act.
1.
An AD is a statement made by a patient that provides guidance to health care
professionals regarding the patient's wishes for treatment or no treatment in certain
medical circumstances.
2.
The two broad categories of nonoral feeding include enteral and parenteral.
3.
The major enteral feeding routes are nasogastric, gastrostomy, and jejunostomy.
4.
Feeding tubes do not necessarily reduce the risk of aspiration pneumonia or prolong life.
5.
Aspiration pneumonia does not develop in all patients who aspirate. Some clinical factors
are more predictive than others in identifying aspirators in whom pneumonia will
develop.
6.
Ethical dilemmas regarding the use and acceptance of tube feeding may result in conflicts
between the patient and the medical care team. Most of these dilemmas can be resolved
with a review of the patient's wishes and a detailed review of the course of medical care.
7.
Professional ethics can be threatened if a patient refuses to follow medical advice. Asking
another professional to assume the care of the patient is within a practitioner's right.
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Ethics in Pediatric Intensive Care
Joel E. Frader, Kelly Michelson, in Pediatric Critical Care (Fourth Edition), 2011
Moral Theory
Medical ethics does not constitute a completely independent field. Most persons think of medical
ethics as an applied discipline of the wider branch of philosophy that is ethics. Like most other
intellectual pursuits, ethics has developed according to several theoretical traditions. In Western
ethics, two particular ways of thinking have dominated for some time. Because these approaches
may yield rather different perspectives on some questions, they deserve mention.
Consequentialism
One tradition, known as consequentialism, examines the correctness of an action according to
what effects the act will likely have on the real world. Good actions produce the most favorable
ratio of happiness, pleasure, or some similar value to unhappiness or a similarly disvalued result.
The utilitarian philosophers Bentham and Mill enjoined us to seek the greatest happiness for the
greatest number of individuals possible. These theories emphasize the social nature of human
moral action, requiring calculation of the consequences of an act. Only after determining the
impact of an action for those directly and remotely involved can a person pronounce ethical
judgment.
Deontology
The other main approach to moral theory proceeds from different premises. Deontology (from
the Greek word for duty) holds that some actions have intrinsic moral worth. Many religious
moral rules conform to this view. Hence the Ten Commandments pronounce that we should not
kill. Other approaches, such as Kant’s categorical imperative, also proclaim universal truths and
rules that persons should honor irrespective of the consequences.
A consequentialist might claim that removal of organs from persons in a persistent vegetative
state does not harm the individuals because they can no longer experience meaningful life, or
even hunger or thirst. The consequentialist also might assert that harvesting the organs best
serves the class of patients in a persistent vegetative state because, overall, transplantation fosters
the well-being (and by implication, happiness) of humans who can actually benefit from
continued treatment. Some deontologists, however, surely would argue that the killing that
necessarily results from the removal of vital organs, no matter what the intent, undermines
human dignity and is morally impermissible.
Prevailing Principles
Despite the “opposing” traditions of ethics, most persons in medical ethics agree on a small
number of important principles that should guide medical behavior. The reader should note,
however, that narrow adherence to these notions encourages an oversimplified approach.
Medical ethics neither begins with nor ends with the principles named here. A more nuanced
view includes many more considerations and a clear sense of how different ideas interact,
especially how some moral duties conflict with others. Nevertheless, a few guideposts may
help intensivists understand that medical ethics, like clinical medicine, uses formal logic and has
a recognizable structure.
Beneficence
The first principle, beneficence, demands that physicians provide care that benefits the patient.
This principle may seem self-evident until you remember that many potential conflicts of interest
can influence medical decisions. For example, parents of children may face tragic choices about
the support of a sick child whose survival could endanger the economic or psychological
integrity of the rest of their family. Other conflicts may involve doctors, especially those in a fee-
for-service system, who benefit financially from providing services that promise only marginal,
if any, additional benefit.
Nonmaleficence
Beneficence contrasts with nonmaleficence. According to this notion, doctors have a duty to
avoid harming patients. Again, the idea may seem obvious, but the practical application involves
considerable complexity. For example, when deciding whether to use extracorporeal membrane
oxygenation for a desperately ill infant with a diaphragmatic hernia, you must consider the
possibility that the technology will extend the life of the baby only by several days but may
cause discomfort to implement and maintain; that is, no long-term benefit will accrue to balance
the burden of the procedure. Similar reasoning might apply to cases of malignancy for which
chemotherapy and other treatments have no or little likelihood of producing a cure or substantial
life prolongation, whereas the treatments impose burdens, such as nausea, itching, extreme
fatigue, and high risk of infection. The principle of nonmaleficence reminds us to take potential
pain and suffering seriously before recommending no-holds-barred medical intervention.
Autonomy
When considering which medical treatments will best help a patient and what harms to avoid, a
natural question arises: whose perspective should we use? The principle of autonomy suggests
that we must respect individual human differences. To the extent possible, persons should decide
for themselves what is in their own best interests. In pediatrics, respecting autonomy can present
difficult questions about when children develop the capacity and independence to accept or
refuse recommended treatment. The autonomy principle reminds us that individuals or their
families often have different values and goals from those of their physicians. Medical decisions
usually should be in accordance with the patient’s or family’s perspective.
Justice
The fourth principle, justice, provides some of the most pressing and challenging dilemmas for
modern medical care. Put simply, this principle exhorts us to use our services fairly, that is, to
avoid decisions that accept or reject candidates for treatment based on factors that are irrelevant
to their medical situation, such as poverty. The application of the justice principle runs into two
major obstacles today. First, members of our society seem to have a great deal of difficulty
agreeing on what constitutes just or fair allocation of medical resources. Second, we have not yet
decided exactly how considerations of justice should affect the medical care system.
Medical goods can be distributed, assuming not everyone can have everything, according to a
number of different schemes: based on the likelihood of success; by some definition of need
(urgency, desperation); as a reward (for past achievement, for waiting the longest, for future
contribution); by equal shares; by random assignment until the goods run out; or, as we often do
in our society, by ability to pay. Different philosophical and political traditions support each of
these approaches, and we seem far from agreeing on which is best.
With respect to the second issue, some persons urge physicians to ignore financial constraints to
do everything “medically indicated” for patients, regardless of the economic consequences. 1 The
argument is that, at least for decisions about individual patients, physicians discharge their
fiduciary responsibility only by advocating the best, even if most expensive, care.
Macroeconomic concerns, regional and institutional issues, and microeconomics challenge this
view.
From a macroeconomic perspective, our society resists increasing medical spending as an ever-
increasing proportion of total social expenditure (such as percent of gross domestic product).
Most Western industrial countries spend on average 9% of gross domestic product on health
care. Does the United States get incrementally better outcomes for its 15% or larger outlay? 2 By
many measures of public health (e.g., infant mortality and longevity), the well-being of the U.S.
population does not reflect our high medical expenses.2 Similarly, does the way we spend our
health care dollar make the most sense? Should we spend great sums of money on expensive
intensive care at the end of life for patients with little likelihood of benefit? In pediatrics, we
have reason to believe that preventive measures (e.g., immunization and accident prevention)
reduce morbidity and mortality rates3-5 and, in some cases, save money.3,4
Regional and institutional economic questions involve matters such as consolidation of care to
increase economic efficiency and medical efficacy. However, political and psychosocial
factors often lead to duplication of services and diffusion of experience. Certain programs may
even create conflicts of interest. For instance, a hospital could offer a particularly scarce and
expensive service (e.g., extracorporeal membrane oxygenation or pediatric organ
transplantation). The costs of the service might be so high that just a few patients treated “free,”
that is, without charge to the family, might threaten the economic stability of the enterprise. Such
fiscal concerns surely help shape what services institutions offer and the way those services
become available (are “marketed”) to those in need.
With respect to microallocation, intensivists frequently engage in decisions about the distribution
of specific services to particular patients, sometimes with clear awareness that competition exists
under conditions of scarcity. With a nearly full ICU and a large demand for postoperative care
for the cases on the next day’s operating room schedule, intensivists often must negotiate and
juggle, trying to meet varying claims about who should occupy scarce beds and receive nursing
attention. Even the decision to use one vasoactive drug or antibiotic instead of a far more or less
expensive agent requires an attempt to balance expected benefit against drains on resources. It
seems inappropriate to demand that physicians ignore such actual conflicts. Intensivists, like
other practitioners, rarely enjoy the luxury of having a single duty to a single patient with an
unlimited ability to pay for services. Although doctors might prefer to leave economic
considerations to policymakers and the marketplace, justice issues do find their way into ICU
routines.
The challenge for the pediatric intensivist involves applying the various ethical principles and
perspectives to individual cases and to policies that affect how the unit operates. The following
sections focus on a few topics where ethical concerns arise frequently.
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Veterinary Ethics
B.E. Rollin, in Encyclopedia of Applied Ethics (Second Edition), 2012
Abstract
Veterinary medical ethics developed as a field in the latter quarter of the twentieth century. As a
branch of professional ethics, it must accord with societal ethics or risk loss of autonomy.
Veterinarians face possible conflicts between obligations to clients, society, peers, animals,
employees, and themselves. Some of these conflicts can be resolved by appeal to ethical
principles and theories. The fundamental question of veterinary ethics concerns the primacy of
veterinarian obligation to owner or animal, according to the model of veterinarian as analogous
to pediatrician or garage mechanic. Society is moving toward a new ethic for animals that helps
resolve this issue.
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Ethical Issues and Artificial Intelligence Technologies in
Behavioral and Mental Health Care
David D. Luxton, ... Michael Anderson, in Artificial Intelligence in Behavioral and Mental
Health Care, 2016
Background
Modern medical ethics are concerned with the application of fundamental values and general
ethical principles to medical practice and research. In general, medical ethics are intended to help
guide the behavior of healthcare professionals and organizations towards the benefit and
protection of patients and others who may be affected by their behavior. Thus they protect not
only patients but also care providers and their institutions by setting standards of conduct that
ultimately promote the trust of patients, professional colleagues, and the general public.
The four cornerstones of medical ethics are respect for autonomy, beneficence, nonmaleficence,
and justice. Respect for autonomy affirms patients’ right to think freely and decide and act on
their own free will. This includes patients’ rights to self-determination and full disclosure of
information so that patients can make informed decisions and choices regarding their
care. Beneficence means that healthcare providers will promote patients’ general
wellbeing. Nonmaleficence requires that the actions of care providers do not harm the patient
involved or others in society. This includes providing treatments known to be effective and
assuring competence of care. Justice refers to the principle that holds that patients in similar
situations should have access to the same care, and that in allocating resources to one group we
should assess the impact of this choice on others. These are considered prima facie principles
because each principle is considered binding unless it conflicts with another principle, and if it
does, it requires us to choose between them (Gillon, 1994).
Medical ethics are formalized and communicated by established codes and oaths, the origins of
which can be traced back thousands of years (e.g., Babylonian Code of Hammurabi, Oath of
Hippocrates). The first formal ethical code of a medical professional organization was published
in 1847 by the American Medical Association (AMA Code of Medical Ethics). The British
Medical Association followed suit by publishing its first code of Medical Conduct of Physicians
in 1858. After the Second World War, the World Medical Association was established as a
forum where national medical associations could discuss the ethical concerns presented by
modern medicine. The World Health Organization (WHO) issued the International Code of
Medical Ethics, the first worldwide medical ethical code, in 1949. The code was based on the
Declaration of Geneva, which was adopted by the General Assembly of the World Medical
Association in 1948 in response to the medical crimes of Nazi Germany.
The American Psychiatric Association (APA), American Psychological Association (APA), and
the American Counseling Association (ACA) are examples of several of the largest mental
healthcare professional organizations in the United States that have published ethical codes and
guidelines for their respective professions (see ACA, 2014; APA, 2002, 2013). The American
Psychological Association organizes its guidelines by standards, which range in topic areas
including the resolution of ethical issues, competence, psychological assessment, and those
specific to therapy. The American Psychological Association’s Ethics Code preamble and
general principles are aspirational in intent, whereas its ethical standards are enforceable rules of
conduct. That is, the code’s preamble and general principles describe the goals to which
psychologists aspire, whereas the code’s ethical standards describe the rules by which
psychologists must abide. Violators of ethical standards may thus be subject to sanctions such as
expulsion from the professional organization. The overarching intent of codes and guidelines,
such as those of the American Psychological Association are thus to provide mental
healthcare professionals with direction to help guide their behavior and justify their decisions
and courses of action including the resolution of ethical dilemmas that they encounter.
It is important to note that ethics and legal principles differ in that ethics are guiding principles
whereas laws, while sometimes based on ethical or moral principles, are enforceable rules and
regulations that have penalties if violated. Sometimes, however, the law may be in conflict with
ethical principles. Many medical organizations, such as the American Medical Association,
specify that when the professional believes a law is unethical, they should work to change the
law (AMA, 1994). Ethical principles also differ from societal values or moral values, the latter
two being dependent on personal or societal standards of what is important and thus could be in
conflict with ethical principles or with the law.
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Health Technology Assessment
R.E. Ashcroft, in Encyclopedia of Applied Ethics (Second Edition), 2012
Ethics in Health Care
Traditional medical ethics concentrated on the relationships between a doctor and each of his or
her individual patients, and between a doctor and his or her fellow medical professionals.
However, this has for many years been regarded as insufficiently narrow. No adequate health
care ethics can think only of the ‘sacred dyad’ of ‘one doctor, one patient.’ Every doctor has
many patients, and most doctors practice within a health care system or institution. Doctors are
by no means the only professionals responsible for patients, or involved in their care; these
diverse relationships and responsibilities involve their own ethical issues.
An adequate ethics for health care must also take into account the ‘population perspective’
of public health medicine and the impact of collective funding of health care (through insurance
or state-financed health care). Also, health care is now practiced under a new constraint: Once
what could be done for a patient was constrained by what was known, where now it is often the
case that what we can afford is more of a constraint than what we know. Technological change in
medicine is occurring at a very rapid rate, and there is a seemingly constant growth in the
number of options for treatment and care in all areas of medicine. These issues have
made justice in health care a primary moral problem.
A final contrast, much remarked upon in the general medical ethics literature in the developed
world, is the way the balance between beneficence and autonomy has shifted away from the
primacy of beneficence (so-called ‘paternalism’) toward the primacy of autonomy. This trend
has been linked by several commentators to two social trends in capitalist societies: a putative
moral and cultural fragmentation of society, such that we have become ‘moral strangers’ to each
other, unable to identify each other’s best interests, and the rise of consumer society. It could be
argued that informed consent began by being understood as a negative right to refuse certain
things being done to you, but has become a positive right to demand that certain things be done
for you.
In consequence of these factors, medical ethics seems now to require that technical choices are
framed not only by the need to be beneficent efficiently and effectively, but also by the need to
optimize social welfare (which may restrict some options) and to satisfy aggregate private
welfare (arguably not the same thing, and arguably in tension with social welfare). Thus, the
meaning of health technology assessment varies with the degree of emphasis placed on social
solidarity or individual liberty in the society where HTA is done.
Analysis of the fundamental understanding of medical ethics and its applications
in healthcare encompasses a multifaceted exploration of principles, dilemmas,
and moral responsibilities inherent to the medical profession. Central to this
understanding is the recognition of the intricate balance between beneficence,
non-maleficence, autonomy, and justice.
Firstly, the principle of beneficence underscores the obligation of healthcare
practitioners to act in the best interest of their patients, striving to promote their
well-being and alleviate suffering. This principle guides medical decision-making,
emphasizing the importance of maximizing benefits while minimizing harms.
Linked closely to beneficence is the principle of non-maleficence, which mandates
the avoidance of harm to patients. This involves not only refraining from actions
that may cause harm but also preventing potential harm and addressing existing
risks. Ethical dilemmas often arise when the pursuit of beneficence conflicts with
the imperative of non-maleficence, requiring careful consideration and ethical
deliberation.
Autonomy, another cornerstone of medical ethics, emphasizes the right of
patients to make informed decisions about their own healthcare. Respect for
autonomy requires healthcare providers to engage patients in shared decision-
making, ensuring that they have the necessary information, comprehension, and
capacity to participate in choices about their treatment and care.
Moreover, the principle of justice necessitates the fair and equitable distribution
of healthcare resources, as well as the provision of healthcare services without
discrimination. Healthcare disparities, resource allocation dilemmas, and issues of
access underscore the importance of addressing systemic injustices within
healthcare systems.
In the practical realm of healthcare, the application of these ethical principles
manifests in various contexts, including but not limited to end-of-life care,
reproductive health, organ transplantation, and research involving human
subjects. Ethical frameworks, such as informed consent, confidentiality, and
patient confidentiality, serve as guiding principles in navigating complex moral
terrain.
Furthermore, the evolving landscape of medical technology, advances in genetics,
and emerging medical challenges continually pose new ethical considerations for
healthcare professionals. Ethical reflection, ongoing education, and
interdisciplinary collaboration are essential for navigating these complexities and
upholding the highest standards of ethical conduct in healthcare delivery.
In conclusion, the analysis of medical ethics and its applications in healthcare
underscores the importance of a nuanced understanding of ethical principles and
their practical implications. By integrating ethical considerations into clinical
practice, healthcare providers can uphold the core values of beneficence, non-
maleficence, autonomy, and justice, thereby promoting the well-being of patients
and fostering trust in the healthcare profession.

‫استكشاف المفاهيم األساسية مثل السلوك الطبي المهني والتوجيه األخالقي في الطب‬

Exploring fundamental concepts such as professional medical conduct and ethical

guidance in medicine delves into the core values and standards that define the
practice of medicine. These concepts serve as guiding principles, shaping the
behaviors, decisions, and responsibilities of healthcare professionals in their
interactions with patients, colleagues, and society at large.
Professional medical conduct encompasses a set of ethical norms and standards
that govern the behavior and actions of healthcare practitioners. At its essence, it
involves upholding the integrity, competence, and accountability expected of
individuals entrusted with the care of patients. Professionalism in medicine
extends beyond clinical expertise to encompass attributes such as compassion,
empathy, honesty, and respect for patient autonomy.
Ethical guidance in medicine provides a framework for navigating the complex
moral terrain inherent in healthcare delivery. This guidance is often grounded in
foundational ethical principles, including beneficence, non-maleficence,
autonomy, and justice. Healthcare professionals are called upon to apply these
principles in their daily practice, balancing the needs and interests of patients
with broader societal considerations.
 Central to ethical guidance in medicine is the principle of beneficence, which
emphasizes the obligation to act in the best interest of patients and promote their
well-being. This principle guides healthcare practitioners in making decisions that
maximize benefits and minimize harms, striving to improve patient outcomes
while respecting their values and preferences.
Linked closely to beneficence is the principle of non-maleficence, which
underscores the imperative to avoid causing harm to patients. Healthcare
professionals are tasked with identifying and mitigating potential risks and harms
associated with medical interventions, prioritizing patient safety and well-being
above all else.
Respect for patient autonomy is another foundational principle that plays a
pivotal role in ethical guidance in medicine. This principle recognizes patients'
rights to make informed decisions about their own healthcare, free from coercion
or undue influence. Healthcare providers are tasked with facilitating shared
decision-making and ensuring that patients have the information,
comprehension, and capacity to participate in choices about their treatment and
care.
Furthermore, ethical guidance in medicine emphasizes the importance of justice
in healthcare delivery, advocating for the fair and equitable distribution of
resources and access to care. Healthcare professionals are called upon to address
healthcare disparities, advocate for vulnerable populations, and uphold principles
of fairness and equity in their practice.
In navigating the complexities of medical practice, ethical guidance provides
healthcare professionals with a moral compass, helping them navigate ethical
dilemmas, conflicts of interest, and challenging situations. By adhering to
principles of professional medical conduct and ethical guidance, healthcare
practitioners can uphold the highest standards of integrity, compassion, and
professionalism, thereby promoting trust, dignity, and well-being in patient care.

‫المبادئ والقيم االساسية في االخالقيات الطبية‬:

These principles and values provide a foundation for ethical practice in medicine,
guiding healthcare professionals in their interactions with patients, colleagues,
and society. By upholding these principles, healthcare providers can ensure the
delivery of compassionate, respectful, and patient-centered care while promoting
the well-being and dignity of their patients.

‫ والتكافل الصحي‬،‫ والتوازن بين المصالح‬،‫ والسرية‬،‫تحليل المبادئ األساسية مثل العدالة‬
‫استكشاف كيفية تطبيق القيم األخالقية األساسية في مواقف مختلفة داخل مجال الرعاية الصحية‬
‫دراسة تأثير الثقافة والتقاليد والديانات على تحديد المبادئ والقيم األخالقية في مجال الطب‬
‫احترام حقوق المرضى وكرامتهم‬

.‫الصدق والنزاهة في تقديم المعلومات الطبية واتخاذ القرارات‬

.‫التوازن بين مصلحة المريض والمصلحة العامة‬
.‫الحفاظ على سرية المعلومات الطبية للمرضى‬
.‫احترام مبادئ العدالة والمساواة في تقديم الرعاية الصحية‬
‫دراسة التحديات األخالقية الحديثة التي تواجه مقدمي الرعاية الصحية في ظل التطورات التكنولوجية‬
‫واالجتماعية‬
‫تقييم تأثير العوامل البيئية والسياسية واالقتصادية على الممارسة األخالقية في الطب‬
‫استكشاف التحديات األخالقية المرتبطة بالتواصل مع المرضى وتقديم الرعاية للمجتمعات المهمشة‬

The importance of medical ethics cannot be overstated, as it serves as the moral

foundation that guides the practice of medicine and the delivery of healthcare.
Several key reasons underscore the significance of medical ethics:
1. Patient Welfare: Medical ethics prioritizes the well-being of patients above
all else. It ensures that healthcare decisions and actions are made with the
best interests of patients in mind, striving to promote their health, alleviate
suffering, and respect their autonomy and dignity.
2. Trust and Professionalism: Upholding ethical principles fosters trust
between healthcare professionals and patients, as well as within the
healthcare system as a whole. Patients rely on healthcare providers to act
with integrity, competence, and honesty, and adherence to ethical
standards strengthens the credibility and professionalism of the medical
profession.
3. Informed Decision-Making: Ethical principles, such as respect for patient
autonomy and the provision of informed consent, empower patients to
participate in their own healthcare decisions. By ensuring that patients
have the necessary information and understanding to make choices about
their treatment and care, medical ethics promotes shared decision-making
and respects individual values and preferences.
4. Prevention of Harm: Ethical guidelines, such as the principles of
beneficence and non-maleficence, help mitigate the risks of harm
associated with medical interventions. Healthcare professionals are
obligated to minimize potential harms to patients and prevent medical
errors, adverse events, and unnecessary suffering through adherence to
ethical standards and best practices.
5. Equity and Justice: Medical ethics underscores the importance of fairness,
equity, and justice in healthcare delivery. It calls attention to disparities in
access to care, resource allocation, and the provision of healthcare services,
advocating for equitable distribution of resources and the elimination of
discrimination and biases in healthcare practice.
6. Professional Accountability: Ethical principles hold healthcare
professionals accountable for their actions and decisions. By adhering to
ethical guidelines and standards of conduct, healthcare providers
demonstrate their commitment to ethical practice and accept responsibility
for the consequences of their actions.
7. Public Policy and Regulation: Medical ethics informs public policy,
legislation, and regulatory frameworks governing healthcare delivery.
Ethical considerations influence debates on healthcare reform, medical
research ethics, end-of-life care, and other areas of healthcare policy,
 shaping laws and regulations that safeguard patient rights and promote
ethical practice.
In summary, medical ethics plays a vital role in ensuring the integrity, compassion,
and professionalism of healthcare practice. By upholding ethical principles,
healthcare professionals uphold the trust of patients, promote patient welfare,
and contribute to a healthcare system grounded in values of respect, justice, and
accountability.
https://www.intechopen.com/chapters/74571

The term 'bioethics' emerged in 1970, signifying a significant development in the field of
healthcare ethics. Initially introduced by Potter and institutionalized by Hellegers,
bioethics originated from two distinct perspectives: one emphasizing moral conflicts in
medicine and the other embracing a broader analysis of life's equilibrium and quality.
Over time, bioethics became predominantly associated with medical ethics, focusing on
ethical issues related to healthcare, particularly at the beginning and end of life.

Despite its evolution into a primarily medical discipline, bioethics originally

encompassed a wider range of ethical considerations across various domains. It
emphasized sustainable development and advocated for a reverence for all forms of life,
reflecting a new mindset towards respecting life and nature.

Bioethics now encompasses different branches, including ecological, biological, and

medical bioethics, each addressing specific ethical concerns. The concept of 'Global
Bioethics' proposed by Potter reflects the comprehensive nature of bioethics, spanning
diverse areas such as medical ethics and ecological ethics.

In summary, bioethics represents a broader civil ethics for contemporary societies,

transcending professional ethics to encompass a comprehensive approach to analyzing
ethical problems across different fields.

‫دراسة تطور المفاهيم األخالقية في مجال الطب منذ العصور القديمة حتى الوقت الحاضر‬
‫استكشاف التحوالت التاريخية في تطبيقات األخالقيات في مجال الطب وأسبابها‬
- ‫تحليل األحداث والشخصيات التاريخية الرئيسية التي أثرت في تطور األخالقيات الطبية‬.
The Covid-19 pandemic, which struck the world in 2020, brought about numerous
ethical challenges for healthcare professionals and managers, exacerbating
existing issues and introducing new complexities.
One major dilemma was the strain on healthcare quality due to the overwhelming
demand. Hospitals faced a surge in patients, leading to shortages of beds and
healthcare workers. Despite their dedication, fatigue and stress among staff likely
affected the quality of care, compromising the principles of beneficence and
justice.
Intensive care resources became severely limited, requiring healthcare workers to
make difficult decisions about treatment allocation. Triage protocols had to
prioritize patients with a higher likelihood of survival, often resulting in the
exclusion of elderly or frail individuals, raising ethical concerns about
discrimination based on age or health status.
Additionally, the pandemic disrupted traditional patient care practices, with many
patients dying at home while awaiting medical assistance. Hospital restrictions
meant patients faced death alone, devoid of familial or spiritual support,
representing a departure from holistic care approaches.
The crisis also disrupted routine healthcare services, leading to delays in
preventive screenings and check-ups for chronic conditions like cancer and heart
disease. This compromised the principles of beneficence and non-maleficence, as
patients missed crucial opportunities for early diagnosis and intervention,
potentially leading to increased mortality rates for these conditions.
 ‫يستكشف هذا البحث األساسيات الفنية لألخالقيات الطبية وتطبيقاتها في ممارسة الرعاية‬
‫الصحية‪ ،‬مع التركيز على المبادئ مثل النفعية‪ ،‬عدم التضرر‪ ،‬الحرية‪ ،‬والعدالة‪ .‬ويقوم بتتبع‬
‫التطور التاريخي لألخالقيات الطبية من الحضارات القديمة إلى األخالقيات الحديثة‪ ،‬ويسلط‬
‫الضوء على األحداث الهامة التي شكلت ممارسة الطب‪ .‬كما يفحص البحث التحديات األخالقية‬
‫التي تفاقمت بفعل جائحة كوفيد‪ ،19-‬بما في ذلك مشكالت توزيع الموارد وانقطاع الرعاية‬
‫الصحية وتكامل التكنولوجيا مع االعتبارات األخالقية‪ .‬وفي الختام‪ ،‬يؤكد البحث على أهمية‬
‫التعليم األخالقي‪ ،‬وإنشاء اللجان األخالقية‪ ،‬وتعزيز الرعاية المركزة على المريض‪ ،‬وتوزيع‬
‫الموارد بشكل عادل‪ ،‬وااللتزام بأخالقيات البحث‪ ،‬والمشاركة المجتمعية كتوصيات لتعزيز‬
‫السلوك األخالقي وتحسين نتائج رعاية المرضى في أنظمة الرعاية الصحية‪ .‬من خالل هذه‬
‫التدابير‪ ،‬يمكن لمنظمات الرعاية الصحية تعزيز أسسها األخالقية والتنقل بفعالية في المشهد‬
‫‪.‬األخالقي المعقد في مجال الرعاية الصحية‬
‫‪:‬المقدمة (المفهوم األساسي لألخالقيات الطبية)‬
‫األخالقيات الطبية هي حجر االساس للرعاية الصحية‪ ،‬حيث تضم مبادئ وقيم توجه سلوك‬
‫العاملين في الرعاية الصحية في تعامالتهم مع المرضى والزمالء والمجتمع‪ .‬وتركز‬
‫األخالقيات الطبية على أهمية النفعية‪ ،‬مع التركيز على صحة المرضى‪ ،‬وتشجيع الحرية‪،‬‬
‫وضمان العدالة في تقديم جميع اشكال الرعاية الصحية‪ .‬وتتعدى مفهوم األخالقيات الطبية‬
‫الرعاية الفردية للمريض لتشمل االعتبارات المجتمعية األوسع‪ ،‬بما في ذلك اآلثار األخالقية‬
‫للبحث الطبي وسياسات الرعاية الصحية ومسؤوليات المؤسسات الطبية‪ .‬في النهاية‪ ،‬تعمل‬
‫األخالقيات الطبية كبوصلة أخالقية توجه عملية اتخاذ القرارات األخالقية وتعزز الثقة‬
‫‪.‬والنزاهة واالحترافية داخل مجتمع الرعاية الصحية‬
‫‪:‬مبادئ األخالقيات الطبية‬
‫األخالقيات الطبية هي الركيزة األساسية للسلوك األخالقي في الرعاية الصحية‪ ،‬حيث تشكل‬
‫كيفية تفاعل العاملين في الرعاية الصحية مع المرضى والزمالء والمجتمع‪ .‬وفي هذا السياق‪،‬‬
‫‪.‬تكمن التوازن المعقد بين النفعية وعدم التضرر والحرية والعدالة‬
‫الحرية الذاتية ‪ :‬احترام حرية المريض الذاتية أمر أساسي في األخالقيات الطبية‪ ،‬حيث ‪1.‬‬
‫تبرز حقوق المرضى في اتخاذ قرارات مستنيرة حول رعايتهم الصحية بناًء على قيمهم‬
‫وتفضيالتهم وفهمهم لحالتهم الطبية‪ .‬ويوفر العاملون في الرعاية الصحية المعلومات‬
‫‪.‬الضرورية والدعم للمرضى التخاذ الخيارات‪ ،‬حتى إذا كانت تخالف آراءهم‬
 ‫النفعية‪ :‬يلتزم العاملون في الرعاية الصحية بمبدأ النفعية بالعمل في مصلحة مرضاهم‪2. ،‬‬
‫وتعزيز رفاهيتهم وتحسين جودة حياتهم‪ .‬ويتضمن ذلك تحقيق الفوائد‪ ،‬ومنع األذى‪،‬‬
‫‪.‬واعتبار تفضيالت المرضى وقيمهم في التدخالت الطبية‬
‫عدم التضرر‪ :‬يقتضي مبدأ عدم التضرر على العاملين في الرعاية الصحية تجنب ‪3.‬‬
‫إلحاق الضرر بالمرضى‪ ،‬وتقليل المخاطر المرتبطة بالتدخالت الطبية‪ ،‬ومنع األخطاء‪،‬‬
‫وإعطاء األولوية لسالمة المرضى‪ .‬ويعد السعي لعدم إلحاق الضرر بالمرضى أمًر ا‬
‫‪.‬أساسًيا في الممارسة الطبية‬
‫العدالة‪ :‬تؤكد العدالة في األخالقيات الطبية على العدالة والمساواة والتوزيع العادل ‪4.‬‬
‫للموارد الصحية‪ .‬ويجب على العاملين في الرعاية الصحية معاملة جميع المرضى‬
‫بشكل عادل‪ ،‬دون تحيز أو تمييز‪ ،‬وتخصيص الموارد إلعطاء األولوية الحتياجات‬
‫‪.‬الفئات الضعيفة‪ ،‬وضمان الوصول المتساوي لخدمات الرعاية الصحية‬
‫الصدق‪ :‬يعتبر التصدق قيمة أساسية في األخالقيات الطبية‪ ،‬حيث يتطلب من العاملين ‪5.‬‬
‫في الرعاية الصحية التواصل بصدق مع المرضى حول حالتهم الطبية وخيارات العالج‬
‫والتوقعات‪ .‬ويتضمن ذلك تقديم معلومات دقيقة‪ ،‬واحترام سرية المريض‪ ،‬وتجنب‬
‫‪.‬الخداع أو البيانات المضللة‬
‫السرية‪ :‬يعتبر احترام سرية المريض أمًر ا أساسًيا‪ ،‬حيث يقوم العاملون في الرعاية ‪6.‬‬
‫الصحية بحماية خصوصية معلومات المريض وضمان حمايتها من الكشف غير‬
‫المصرح به‪ .‬ويتطلب األمر الحصول على موافقة مستنيرة للكشف عن المعلومات‬
‫‪.‬والحفاظ على السرية في جميع تفاعالت المريض‬
‫تاريخ األخالقيات الطبية‬
‫عبر الستين عاًم ا الماضية‪ ،‬شكلت األخالقيات الطبية الحديثة ممارسة الطب بشكل كبير‪: ،‬‬
‫وغالًبا ما ال يدرك األطباء كيف أن األخالقيات شكلت عملهم‪ ،‬ولكن في نهاية المطاف بشكل‬
‫أفضل‪ .‬في فترة الثالثينات‪ ،‬كان الطب يعمل تحت نموذج ولي األمر حيث يقدم األطباء‬
‫النصيحة‪ ،‬وكان من المتوقع أن يلتزم المرضى دون الحصول على الكثير من الحقوق‪.‬‬
‫للدهشة‪ ،‬يمكن أن يتم تسجيل المرضى حتى دون علمهم في التجارب‪ ،‬مما كان مقبواًل على‬
‫نطاق واسع في ذلك الوقت‪ .‬ومع ذلك‪ ،‬ألقت ما بعد الحرب العالمية الثانية ضوًءا على الجرائم‬
‫التي ارتكبها األطباء األلمان في معسكرات االعتقال‪ ،‬مما دفع إلى محاوالت لمعالجة هذه‬
‫الظلمات ‪ .‬وقاد هذا إلى إنشاء األخالقيات الطبية الحديثة‪ ،‬كما يتجلى في ميثاق نورمبرغ‪ .‬على‬
‫الرغم من هذه المحاوالت األولى‪ ،‬استغرق األمر عدة عقود حتى أصبحت هذه المبادئ مقبولة‬
 ‫على نطاق واسع‪ .‬وفضيحة توسكيجي في عام ‪ ،1972‬حيث تم تسليم المشاركين األفارقة‬
‫األمريكان للزهري دون معرفة وحرمانهم من العالج السليم‪ ،‬أكدت الحاجة إلى التغيير‪.‬‬
‫واستجابة لفضائح مثل توسكيجي‪ ،‬بدأت المجتمع الطبي في التركيز على حرية المريض‬
‫والشفافية‪ .‬أدى الشك في السلطة في الستينات والسبعينات إلى تحول نحو ضمان أن يكون‬
‫للمرضى دور في رعايتهم الطبية‪ .‬وهذا أدى إلى معيار أخالقي جديد يعطي األولوية للتواصل‬
‫‪.‬الصريح مع المرضى‪ ،‬حتى لو كانت األخبار صعبة السماع‬
‫أهمية األخالقيات الطبية‬
‫تحمل األخالقيات الطبية أهمية كبيرة في مجال الطب لعدة أسباب مقنعة‪ .‬فهم هذه األسباب ‪:‬‬
‫‪:‬يسلط الضوء على الدور الحيوي لألخالقيات في الرعاية الصحية‬
‫حل النزاعات‪ :‬نظًر ا لتنوع التفاعالت البشرية المشاركة في عالجات الطبية‪ ،‬قد تنشأ ‪1.‬‬
‫صراعات بين العائالت والمرضى والعاملين في الرعاية الصحية‪ .‬يزود التدريب‬
‫األخالقي األطباء باألدوات الالزمة للتعامل مع هذه النزاعات بفعالية‪ ،‬مما يضمن نتائج‬
‫‪.‬عادلة وعادلة‬
‫المسؤولية األخالقية‪ :‬بمراعاة حياة المرضى في خطر‪ ،‬يتحمل األطباء مسؤولية عميقة ‪2.‬‬
‫في اتخاذ قرارات مدروسة تولي اهتمامات المرضى األولوية‪ .‬يعتبر التدريب األخالقي‬
‫‪.‬بمثابة مصباح يوجه األطباء للحفاظ على أعلى معايير الرعاية والنزاهة‬
‫التعلم المستمر‪ :‬يمكن للتعليم األخالقي تمكين العاملين في مجال الرعاية الصحية من ‪3.‬‬
‫تعميق فهمهم ومعرفتهم‪ ،‬مما يمكنهم من التنقل في مواجهة المواقف األخالقية المعقدة‬
‫‪.‬بثقة وكفاءة‬
‫الحفاظ على الثقة‪ :‬يحمي التدريب األخالقي الثقة والعالقة بين المرضى ومقدمي ‪4.‬‬
‫الرعاية الصحية‪ .‬من خالل االلتزام بالمبادئ األخالقية‪ ،‬يحافظ األطباء على نزاهة‬
‫‪.‬العالقة بين الطبيب والمريض‪ ،‬مما يعزز االحترام المتبادل والثقة‬
‫التعاون والدعم‪ :‬تمتد اإلرشادات األخالقية بعيًد ا عن الرعاية الصحية الفردية لتشمل ‪5.‬‬
‫التفاعالت مع الزمالء وطاقم المستشفى‪ .‬يعزز الحفاظ على بيئة مهنية إيجابية ومحترمة‬
‫‪.‬التعاون ويعزز نتائج رعاية المرضى‬
‫تعزيز الكفاءة‪ :‬المعايير األخالقية الواضحة تبسط عمليات اتخاذ القرار وتسهل حل ‪6.‬‬
‫النزاعات بسرعة‪ ،‬مما يحافظ على الكفاءة العامة لتقديم الرعاية الصحية‪ .‬يمكن أن‬
‫‪.‬يؤدي إهمال المبادئ األخالقية إلى اضطرابات وتهديد جودة رعاية المرضى‬
 ‫تحديات في األخالقيات الطبية‪ :‬جلبت جائحة كوفيد‪ ،19-‬التي ضربت العالم في عام ‪،2020‬‬
‫تحديات أخالقية عديدة للمهنيين والمديرين الصحيين‪ ،‬مما يزيد من القضايا القائمة ويقدم‬
‫تعقيدات جديدة‪ .‬كان أحد التحديات الرئيسية هو الضغط على جودة الرعاية الصحية بسبب‬
‫الطلب الهائل‪ .‬واجهت المستشفيات زيادة في عدد المرضى‪ ،‬مما أدى إلى نقص في األسرة‬
‫والعاملين في الرعاية الصحية‪ .‬على الرغم من التفاني‪ ،‬من المحتمل أن يؤثر التعب واإلجهاد‬
‫على العاملين في المجال الطبي على جودة الرعاية‪ ،‬مما يعرض مبادئ النفعية والعدالة‬
‫للخطر‪ .‬أصبحت الموارد الطبية الحرجة محدودة بشكل كبير‪ ،‬مما استدعى من العاملين في‬
‫الرعاية الصحية اتخاذ قرارات صعبة بشأن توزيع العالج‪ .‬اضطرت بروتوكوالت التقييم إلى‬
‫إعطاء األولوية للمرضى ذوي الفرص األعلى للبقاء على قيد الحياة‪ ،‬مما يؤدي في كثير من‬
‫األحيان إلى استبعاد األشخاص المسنين أو الضعفاء‪ ،‬مما يثير مخاوف أخالقية بشأن التمييز‬
‫بناًء على العمر أو الحالة الصحية‪ .‬باإلضافة إلى ذلك‪ ،‬أدت الجائحة إلى انقطاع ممارسات‬
‫الرعاية الصحية التقليدية‪ ،‬حيث توفي العديد من المرضى في المنزل أثناء انتظار المساعدة‬
‫الطبية‪ .‬فترات االنقطاع في المستشفيات أدت إلى وجود المرضى يواجهون الموت بمفردهم‪،‬‬
‫بال دعم عائلي أو روحي‪ ،‬ممثلة تحواًل عن نهج الرعاية الشاملة‪ .‬عالوة على ذلك‪ ،‬أدت األزمة‬
‫إلى تعطيل الخدمات الصحية الروتينية‪ ،‬مما أدى إلى تأخير في الفحوصات الوقائية‬
‫والفحوصات الدورية للحاالت المزمنة مثل السرطان وأمراض القلب‪ .‬وقد أدى هذا إلى‬
‫المساس بمبادئ النفعية وعدم التضرر‪ ،‬حيث فات الفرص الحاسمة للتشخيص المبكر والتدخل‪،‬‬
‫‪.‬مما قد يؤدي إلى زيادة معدالت الوفيات لهذه الحاالت‬
‫الختام‪ :‬في الختام‪ ،‬تلعب األخالقيات الطبية دوًر ا حيوًيا في توجيه المهنيين في الرعاية الصحية‬
‫من خالل المناظر المعقدة لرعاية المرضى والبحث واتخاذ القرارات التنظيمية‪ .‬تعتبر مبادئ‬
‫النفعية وعدم التضرر والحرية والعدالة أركاًن ا على أساسها يتم بناء السلوك األخالقي في‬
‫الطب‪ .‬على مر السنين‪ ،‬شكل تطور األخالقيات الطبية بفضل اإلرهاصات الهامة‪ ،‬بدًءا من‬
‫الجرائم في فترة ما بعد الحرب العالمية الثانية إلى إنشاء الرعاية المركزة على المريض في‬
‫الرعاية الصحية الحديثة‪ .‬يمنح التدريب األخالقي العاملين في مجال الرعاية الصحية األدوات‬
‫الالزمة للتنقل في المواقف األخالقية‪ ،‬وحل النزاعات‪ ،‬والحفاظ على الثقة والنزاهة في العالقة‬
‫بين الطبيب والمريض‪ .‬وفي مواجهة جائحة كوفيد‪ ،19-‬واجه العاملون في مجال الرعاية‬
‫الصحية تحديات أخالقية جديدة‪ ،‬مثل توزيع الموارد واالنقطاع عن الرعاية الصحية والتواصل‬
‫التكنولوجي‪ .‬ومع ذلك‪ ،‬يمكن تجاوز هذه التحديات من خالل التزام المجتمع الطبي بالمبادئ‬
‫األخالقية والتركيز على الرعاية المركزة على المريض وتوزيع الموارد بشكل عادل وااللتزام‬
‫بأخالقيات البحث والتفاعل المجتمعي‪ .‬من خالل هذه الجهود‪ ،‬يمكن للمنظمات الصحية تعزيز‬
‫‪.‬أسسها األخالقية والمناورة بفعالية في المشهد األخالقي المعقد لرعاية المرضى‬
 ‫في ضوء التحديات األخالقية التي أبرزتها جائحة كوفيد‪ 19-‬والقضايا األوسع التي تواجه أنظمة الرعاية الصحية‪ ،‬يمكن‬
‫‪:‬تقديم عدة توصيات لتعزيز السلوك األخالقي وتحسين رعاية المرضى‬

‫‪ .١‬االستثمار في التعليم األخالقي ‪ :‬يجب على المهنيين في مجال الرعاية الصحية الحصول على تدريب شامل في‬
‫األخالقيات الطبية طوال مسيرتهم المهنية‪ ،‬مع التركيز على أهمية النفعية‪ ،‬عدم التسبب باألذى‪ ،‬الحرية الذاتية‪ ،‬والعدالة‪.‬‬
‫‪.‬يجب أن يتضمن هذا التعليم سيناريوهات عملية ودراسات حالة لتجهيز المهنيين للمواجهة الواقعية للمشاكل األخالقية‬

‫‪ .٢‬لجان األخالق‪ :‬ينبغي على المؤسسات الصحية إنشاء لجان أخالقية تتألف من أصحاب مصلحة متنوعين‪ ،‬بما في ذلك‬
‫المهنيين في الرعاية الصحية‪ ،‬واألخصائيين في األخالق‪ ،‬والمرضى‪ ،‬وممثلي المجتمع‪ .‬يمكن لهذه اللجان تقديم اإلرشادات‬
‫‪.‬حول القضايا األخالقية‪ ،‬واستعراض السياسات واإلجراءات‪ ،‬وتقديم الدعم للموظفين الذين يواجهون تحديات أخالقية‬

‫‪ .٣‬تعزيز الرعاية المركزة على المريض‪ :‬يجب على أنظمة الرعاية الصحية أن تعطي األولوية للرعاية المركزة على‬
‫المريض‪ ،‬مع ضمان مشاركة األخيرين بنشاط في عمليات اتخاذ القرار بشأن رعايتهم الصحية‪ .‬يشمل ذلك احترام حرية‬
‫‪.‬الشخص وتوفير التواصل الشفاف والشراكة مع المرضى في تخطيط الرعاية ووضع األهداف‬

‫‪ .٤‬توزيع الموارد بشكل عادل ‪ :‬يجب على المؤسسات الصحية وضع بروتوكوالت عادلة وشفافة لتوزيع الموارد خالل‬
‫فترات األزمات مثل الجائحات‪ .‬ينبغي أن تولي هذه البروتوكوالت اهتماًما خاًص ا بحاجات الفئات الضعيفة‪ ،‬وتقليل التمييز‪،‬‬
‫‪.‬وضمان توزيع الموارد استناًدا إلى الحاجة السريرية بدًال من الوضع االجتماعي أو العوامل األخرى‬

‫‪ .٥‬أخالقيات البحث‪ :‬يعتبر الرقابة األخالقية لألبحاث الطبية أمًر ا حاسًم ا لحماية حقوق ورفاهية المشاركين في البحوث‪.‬‬
‫يجب على المؤسسات الصحية االلتزام بمعايير أخالقية صارمة عند إجراء البحوث‪ ،‬بما في ذلك الحصول على موافقة‬
‫‪.‬مسبقة مستنيرة‪ ،‬وتقليل المخاطر على المشاركين‪ ،‬وضمان نزاهة وشفافية الممارسات البحثية‬

‫‪ .٦‬مشاركة المجتمع ‪ :‬يجب على المؤسسات الصحية التفاعل بنشاط مع المجتمعات التي تخدمها لفهم قيمهم وتفضيالتهم‬
‫واحتياجاتهم‪ .‬يمكن أن تسهم هذه المشاركة في عمليات اتخاذ القرارات األخالقية‪ ،‬وتحسين الثقة والتعاون بين مقدمي‬
‫‪.‬الرعاية الصحية والمرضى‪ ،‬وتعزيز العدالة الصحية واالجتماعية‬

‫من خالل تنفيذ هذه التوصيات‪ ،‬يمكن ألنظمة الرعاية الصحية تعزيز أسسها األخالقية‪ ،‬وتحسين نتائج رعاية المرضى‪،‬‬
‫‪ ..‬والتعامل بشكل أفضل مع التحديات األخالقية المعقدة التي تواجه صناعة الرعاية الصحية‬