Ethics Exam 2

Metaethics

Dealing with the knowledge and source of ethics

Normative Ethics

Discussion of broad, basic norma of ethical behavior and character

Rules and Rights

Applying the “code of ethics” to a case

Cases

Applying other similar cases to a current case

Special Revelation

God’s communication to his people of his nature, character, and particular plan for redemption of mankind - the Bible is God’s means of this

General Revelation 

Moral knowledge obtained through reason and observation of the natural order - related to intuition, conscience, and common sense

The Twin Pillars of Natural Law

Moral norms arise from the natural order of the universe and the nature of human beings

The ability to recognize moral norms is available to all people (not just religious people)

Hypothetical Imperatives

To achieve outcome A, preform deed B (prudence)

Categorical Imperatives

Preform deed C, no matter what (maxims, absolute duties)

The Universalizability Principle 

Act only according to maxims that you would want to be a universal law without any contradictions

Steps in Moral Reasoning

1. What maxim should I operate under?

2. Can I universalize that maxim?

3. Do not act according to any maxim that creates contradiction.

Categorial Imperative - Humanity

Persons should be ends in and of themselves, never as a mere means to another person’s ends

Categorical Imperative - Autonomy

The will of every person is a universally legislating (self-governing) will

Divine Comand Theory

Morality is dependent upon commands from a deity (or deities), and man’s moral obligation is full obedience to these commands

Principle of Utility

We should pursue the most happiness for the most people as possible

Act Utilitarianism 

Choose the act that produces the greatest happiness for the greatest number - tends to look at immediate consequences 

Rule Utilitarianism

Live by rules that are more likely to produce the greatest happiness for the greatest number - attempts to look at long-term consequences

Legalist

Follow the law (duties) at all costs

Situational

Apply the golden rule to determine what is right

Antinomian 

Make moral decisions based on preference without regard for duty

Pragmatism

Concerned with real life situations

Relativism

Right and wrong related to the situation we are in

Positivism 

Moral judgements are decisions 

Personalism

Love is experienced by people

Fletchers Six Fundamental Propositions

1. Only one thing is intrinsically good; namely love alone

2. The ruling norm of Christian decision is love alone

3. Love and justice are the same, for justice is love distributed, nothing else

4. Love seeks our neighbor’s good, whether we like him or not

5. Only the end justifies the means, nothing else

6. Love’s decisions are made situationally, not perspectively

Virtue 

Always doing the right thing at the right time in the right way in the right amount toward the right people E

Eudaimonia

A “good life,” or a life well-lived

Beneficence

The quality or state of doing or producing good, namely the best interests of others

Non-Maleficence

First, do no harm

Distributive Justice

Fair and equitable treatment of patients and distribution of the benefits of healthcare

Autonomy

The right of competent patients to make informed decisions about their own medical care

Competence

Legal determination, made by a judge - requires a court order and a designation of a gaurdian

Decision-making Capacity

A clinical determination, made by a physician

Informed Consent

Contractual agreement - healthcare provider explains, patient agrees

Process of Informed Consent

1. Provision of information (disclosure) 

2. Assessment of understanding (comprehension)

3. Assessment of decisional capacity 

4. Assurance that consent is voluntary 

Patient Consent

Informed consent by a patient with decision-making capacity

Substituted Judgement 

A surrogate makes decisions when patient lacks capacity - applies to adults with mental disabilities, minors, comatose patients, demented, or otherwise incapacitated patients

Best Interests Standard

Basis for implied consent - logical outworking of beneficence

Empirical Functionalism

Defined by functions or abilities - a person is a collection of parts and specific functions

Ontological Personalism 

Defined by virtue of membership in the human race - a person is a substance 

Clinical Practice

Interventions that are designed solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success

Research

An activity designed to test a hypothesis, permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge

The Belmont Report - Respect for Persons 

Every person has the right to make decisions on their care and participation in research

The Belmont Report - Beneficence

The best interests of the patient must be considered - implies non-maleficence

The Belmont Report - Justice

Clinical research should be inclusive and allow for full participation by all segments of society - benefits of research should help the population 

Clinical Equipoise

The assumption that there is not one “better” intervention present (for either the control or experimental group) during the design of a randomized controlled trial

Vulnerable Subjects (IRB)

Pregnant women, fetuses, children, prisoners, and those with physical and mental disabilities

Ethical Principles of Research Involving Animals

Justification of research, ethical review and approval, care and housing, qualified personnel, regulatory compliance 

Professional Community Standard

Provide information in line with what a provider with appropriate training and experience would tell a patient and family

Objective, Reasonable Person Standard

Provide all information that a reasonable person in the patient’s condition would need and want to know

Individual Standard 

Provide all information that the individual patient would find pertinent to their decision 

Primary Duties of Provision of Information

1. Disclosing information

2. Obtaining authorization before. the intervention

Advance Directives

A legal document stipulating a person’s choices about medical treatment at the end of life

Provider Order for Life-Sustaining Treatment (POLST)

A medical order recording the patient’s preferences regarding end-of-life care

Medical Futility

Further treatment will not lead to improvement in patient health, well-being, comfort, or prognosis

Quality of Life (QOL)

Well-being as subjectively experienced together with the objective conditions that make it possible 

Shared Decision Making

A process for medical decision-making that includes exploring and comparing benefits, burdens, and harms of treatments through a meaningful dialog about what matters most to the patient

Veracity

devotion to the truth - “habitual truthfulness”

Deception

Violates autonomy by leading people to make decisions on partial or incomplete premises

Non-Disclosure 

Withholding information about a diagnosis or prognosis 

Privacy

Right of the patient to have one’s personal information kept secret

Confidentiality

Duty of a healthcare professional to see that patient information is kept private

Conscience

Inner sense of what is good, right, just, and fair - near universal 

Conscientious Objection

The grounds for healthcare professionals to abstain from participating in care due to moral or religious values - claims should be honored but one’s values should not prevent another from doing the same