Medical Ethics

Ethics

A branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong behavior. AND moral principles that govern a person’s behavior

Normative ethics

Ethical theories

Applied ethics

applying various theories to decide on correct action

What affects ethical decision making?

Religious belief, upbringing, conscience, justice, societal rules, etc.

Utilitarian/consequentialist ethics

what action results in the most good for the most people?

Rules/Kantian ethics

There is a set list of rules that you must follow to be a good person no matter the consequences.

Natural Law Ethics

Divine Command Theory

Four Disciplines of Medical Bioethics

Philosophy, law, religion, and medicineC

Common ethical principles

seek the good and do no harm

Eugenics

theory and practice that aims to improve the genetic quality of human kind through selective breeding

Eugenics methods

• prevent breeding

• allow to die

• euthanasia

• prevent birth

Tuskegee Syphilis Experiment

syphilis was studied in African American men for 40 years and they went untreated even when treatment was developed

Nuremberg Trials

20 Nazi physicians performed brutal human experiments at Auschwitz

Nuremberg Code

Result of the Nuremberg trials, laid out rules and requirements for medical research/studies

Belmont Report

Created as a result of the Tuskegee experiment, guidelines for medical research that ensures the rights and autonomy of the subjects are protected

3 Basic Ethical Principles

Respect for persons/Autonomy

Beneficence

Justice

Buck vs Bell

Supreme Court decision that upheld the states ability to sterilize “unfit” individuals.

Seattle God Squad

Committee that reviewed candidates for the few dialysis machines and decided who got priority.

4 Instruments of Autonomy

• Informed Consent

• Advanced Directive

• Substituted Judgement

• Best Interests

Dax Cowart

Suffered serious burns and begged to be allowed to die instead of going through treatment, but was still put through months of painful treatment.

Karen Quinlan

Fell into a vegetative state, family went to court trying to get her off of life support and when she was finally taken off, she lived for 9 more years before passing.

Nancy Cruzan

Left on a feeding tube for years while her parents begged for her to be taken off, her friends advocated and said she had stated before she would not have wanted to live like that and she died soon after being taken off.

Paternalism

The doctor can act against a patients wishes if its what they believe is best for the patient.

Advanced Directive

Legal document that lets you state your choices for medical care ahead of time in cse you are not concious.

Autonomy

Liberty, capacity, understanding

Beneficence

Rule of rescue, paternalism, Ideal vs Obligatory

Nonmaleficence

killing vs letting someone die, withholding vs withdrawing, principle of double effect

Justice

Utilitarian, Libertarian, Egalitarian, Communitarian

Libertarian

Stresses equal access to rights and individual freedom, the governments role is to protect rights but not guarantee access.

Utilitarian

Also called consequentialism, what actions result in the best outcome for the most people.

Communitarian

Opposes extreme individualism, takes into our account our interdependence as a society and emphasizes the connection between individuals and their community.

Egalitarian

All must be treated equal

Veil of ignorance

If you were born not knowing what ethnicity, class, gender, etc. you’d be born, how would you arrange the world’s rules?

Just distribution

1. each person gets an equal share

2. each person gets what their individual needs require

3. each person gets something based on the effort they put into society

4. each person gets something based on their societal contribution

5. each person gets what their merit deserves

4 considerations of beneficence

Partial adherence (respecting patient autonomy while achieving clinical beneficence)

Limited specific (not enough resources)

Ideal vs. obligatory (whats realistically expected of a person)

Utility (balancing risks and benefits)

Obligatory rules

1. protect and defend the rights of others

2. prevent harm from coming to others

3. remove conditions that will cause harm to others

4. help persons with disabilities

5. rescue persons in danger

Nonmaleficence

Not harming, ALWAYS obligatory

Principle of Double Effect

• nature of the act must be good

• must intend only the good effect

• bad effect cannot be the means to the good effect

• good must outweigh the bad effect

Four instruments of autonomy

• informed consent

• advanced directive

• substituted judgement

• best interests

Capacity

• ability to understand the information, appreciate the situation, use reason to make a decision, communicate their choice

Deontology

Rule based, non-consequentialist, or Kantian ethics. You must follow a set of rules to be the best possible person.

Casuistry

1. Describe case in detail

2. Identify maxims

3. Identify paradigm cases/prior opinions

4. Reflective equilibrium leading to resolution

Natural Law Theory

Right and wrong are rooted in human nature and can be discovered through human reason rather than man made rules.

Divine Command Theory

Morality is dependent upon God and moral obligation consists in obedience to God’s commands.