bioethics

theories

Descriptive ethics

what people believe about morality

Prescriptive ethics

determines what actions are right or wrong and how people should act

Meta-ethics

philosophy branch - what does good or right even mean

Ethical absolutism - meta-ethics belief

Just one supreme value that will help you decide what’s good or bad

Ethical relativism/pluralism - meta-ethics belief

Multiple principles - relativism = derived from cultures, pluralism = natural facts

Ethical nihilism - meta-ethics belief

ethical values are empty, there is no right or wrong

Jonathan Haidt Spectrums of Morality

Care/harm, fairness/cheating, loyalty/betrayal, authority/subversion, purity/sanctity

Deontology

Relating to binding duty

Deontology Categorical imperative - Kant

act according to the an underlying rule whereby you can at the same time will that is should become a universal law

Consequentialism

Moral worth of an act is determined by the value of its consequences

Utilitarianism

Right course of action maximizes utility & reduces sufferings/costs

Theory of Well-being - Hedonism

everything that promotes pleasure & diminishes pain is good

Theory of Well-being - Preference-satisfaction

everything that promotes your preference is good & what doesn’t is bad

Theory of Well-being - Objective List

what does a human need to flourish - meaningful relationships, autonomy, freedom

Virtue ethics

looks at character rather than the act - moral agent is central

Belmont Report

respect for persons, beneficence, justice

Principle Approach Origin

based on common morality - set of universal features shared by all persons committed to morality

Four principles of Biomedical Ethics

respect for autonomy, non-maleficence, beneficence, justice

Quality of Life

Hedonism + eudaimonia dimensions

Respect for autonomy principle

to act intentionally, with understanding, without controlling influences

Substanially autonomous

Fully autonomous

Non-maleficence principle

not inflict harm/evil

Beneficence principle

prevent harm from occurring to others + protect/defend rights of others

Justice principle

equal share, according to: need, effort, contribution, merit, free-market exchanges

Reflective Equilibrium for Principles

Core moral conviction → principle → test in practice → adjust + refine → make coherent + consistent → repeat

Care ethics

moral theory emphasizing relationships & dependencies in human life

Care ethics aim

sustain relationships, promote well-being of caregivers & care-receivers

Critiques of care ethics

slave morality, essentialism, ambiguity

Tronto definition of care

activity that includes everything to do with maintaining, containing + repairing our world to live as well as possible

Five phases of care

Caring-about (attentiveness): recognize needs

Taking care of (responsibility): assume responsibility

Care-giving (competence): direct meeting of needs

Care-receiving (responsiveness): feedback

Caring with (solidarity) - distribution of care

Individual autonomy

self-determination, self-rule based on negative freedom

Negative freedom - free from autonomy

absence of obstacles - external or internal

Relational autonomy

develop autonomy through social interaction

Positive freedom - free to autonomy

realize one’s existential goals through social surroundings & interdependence

Shared decision-making

individual, family + healthcare team, respecting individual’s values to make informed decisions

3-talk model

team talk = describes choices, offers support + ask about goals

option talk = different options laid out with pros + cons

decision talk = make sure individual’s preferences driving decision

Intuitionist - non-consequentialism

we have moral duties that are immediate, uninferred knowledge

Prime facie duty

an obligation that is binding "at first glance” - always to be acted upon unless it conflicts on a particular occasion with another duty

Actual duty

determined by an examination of the respective weights of competing prima facie duties in

particular situations

Principle-based theory

standard of conduct on which many other moral claims & judgements depend

Non-maleficence vs. autonomy

Non-maleficence triumphs

Non-maleficence vs. beneficence

Context determins which outweight

Principle vs. rule

principle = the most general and comprehensive norms

rule = precise and practical guides to action that depend on the more general principles

Paternalistic Relationship Model Interaction

Patients receive the interventions that best promote their healthy & wellbeing → physician identifies needed treatment

Paternalistic Relationship Model Autonomy

the patient’s assent - more emphasis on well-being than autonomy

Paternalistic Relationship Model Use

emergency - when time taken to obtain consent may cause irreversible harm

Informative Relationship Model Interaction

physicians (technician) provide patient with all relevant info → patient selects the medical intervention they want & physician executes

Informative Relationship Model Autonomy

patient’s control over medical decision-making

Informative Relationship Model Use

best for short-term, small procedures

Interpretive Relationship Model Interaction

elucidate patient’s values & what they went → help patient select available intervention that realizes these values - physician (counselor) informs + assist value articulation

Interpretive Relationship Model Autonomy

strive for autonomy, but patient needs help to learn what their values are

Interpretive Relationship Model Use

patient has clear conflicting values

Deliberative Relationship Model Interaction

physician (friend) help patient determine best health-related values that can be realized in clinical situation

Deliberative Relationship Model Autonomy

patient’s moral self-development

Paternalistic Relationship Model Objections

physician can authoritatively inform patient when an intervention will be initiated

Informative Relationship Model Objections

lacks understanding patient’s values

Interpretive Relationship Model Objections

physician may impose own values - unintended paternalism

Deliberative Relationship Model Objections

physician’s recommendation in deliberation + prioritizing health-related values will be based on their own values - unintended paternalism