NSCI 301: clinical neuroethics

metaethics

• Truth value: is it really right or wrong

• knowledge: why do we think smth is right or wrong

what is clinical neuroethics

• metaethics

• normative ethics

• practical or applied ethics

normative ethics

• what makes a good life or a life worth living?

• big 3: deontology, consequentialism, virtue ethics

• what you ought to do instead of the way things are

deontology

• rules-based approach

• never lie or kill

consequentialism

• outcome of the situation?

• is the benefit > consequences?

virtue ethics

• integrity, honesty

• putting patients 1st

• doing the right thing

practical or applied ethics

• what is the right thing to do

• what should i do

• which values should be prioritized

approaches to healthcare ethics

• principles of biomedical ethics conflict a lot so not preferred

• ethics of care/relational ethics

• narrative ethics

• rights based

ethics of care/relational ethics

• best use in conjunction with smth else

• moral dimension comes from relationships - what solution will support the relationship?

• bottom up; address specific context; emotional knowledge

• risk of moral relativism - how can we agree on specific values

• puts a lot of demands on healthcare professionals

narrative ethics

• narratives aid with clinical and moral decision-making

  • history of individual?

  • what’s their story?

• co-construction of a path that is less disruptive of the narrative - the person’s identity

rights based

• basic human rights

• derived from deontological approaches

respect for autonomy

• support a person’s right to self-govern so that their views, decisions, and actions are based on personal values, beliefs and ways of being

• authenticity

• independence - independent of other types of influence on decision-making

relational autonomy

relationships and social environments contribute to sense of self, capacities, values, life plans

criteria for assessing capacity - process approach to consent

1. understanding the info

2. reasoning abt the info

3. communicating a choice

4. appreciating how it applied to one’s own life

capacity assessments limitations

• diff assessment tools

• varied training and experience in capacity assessment

• challenging

• time-consuming

• evidence of disparities: diff racial groups have more capacity assessments over others

important notes on capacity

• decision/task specific: may have some capacity for some decisions and not others

• can fluctuate - patient may regain capacity, time-specific (taking medication that makes you drowsy)

• even if incapable, efforts must always be made to:

  • uphold wishes and preferences

  • maximally include patient in decision-making

factors on their own = not incapable

• refusing care

• living at risk - behaviour leading to negative outcomes

• immutable traits: race, sex, how they behave, diagnoses

encumbered capacity

decrease in capacity for a reversible reason:

• mental health condition

• emotional state

• undue influence

• lack of info

legal incapability does not = encumbered capacity

principle of precendent autonomy

• ability to articulate one’s preferences for future decisions in the case that one no longer has the capacity to make these decisions

• advance directives: legal doc where u can say “if i’m no longer able to…, then i do not want any medical intervention”

  • if not specific enough = problematic

living at risk

• engaging in behaviour that may result in negative consequences for the person or others in physical, emotional or psychological ways

• e.g.:

  • eating when at risk of aspiration

  • living at home without adequate support

  • going on unsupervised outings

  • smoking around o2 supplies

  • refusing to use a walker needed to prevent falls

moral distress

• being unable to translate moral choice into moral action due to internal or external constraints

• ik what i want to do but can’t

• idk what to do

• i cannot do 2 mutually exclusive things

GUIDE

• ethical decision-making framework

• Gather info and learn:

  • what’s the ethical issue

  • what’s their path

• Understand and prioritize values

  • is it autonomy and beneficence?

• Identify and weigh options

• Decide, implement and communicate

  • always put patient first

• Evaluate and revisit decision

procedural considerations

• how do we make decisions tgt and work collaboratively?

• e.g.:

  • inclusiveness: shared decision-making including patient and their families

  • contestability: review panel - provides a chance for the patient to speak up and say they disagree

  • treating like cases alike: triage protocols

substantive considerations

• what goals or ends should we pursue and how should the values be weighed against one another?

• e.g.:

  • beneficence: sufficient patient control

  • non-maleficence: avoiding unnecessary restraints

  • autonomy: respecting capable refusal