Medical Ethics: An In-Depth Exploration of Ethical Issues & Theoretical Frameworks

As providers, do we need to address or get involved with ethical dilemmas?

Yes

What are consequence-oriented theories?

Judge right and wrong based on outcomes or predicted outcomes

- Utilitarianism is the most common form

What is utilitarianism?

most common form of consequence-oriented theories

Greatest good for the greatest number of people

Good for weighing up all possible outcomes of action AND providing goal of greatest happiness

Steps to Utilitarianism:

1. Examine the consequences (short and long term)

2. Compare

- How many helped and what degree? How many harmed and what degree?

3. Select course that maximizes pleasure/benefit

4. Decision that has greatest amount of benefit for most or least amount of harm for most is best

Criticisms of Utilitarianism:

- Calculation of all possible outcomes is impossible

- Could infringe on the happiness/harm of another individual or group

- Not give enough respect to persons

What are duty-oriented theories?

Believe that basic rightness or wrongness of an act depends on its intrinsic nature rather than on the situation or the consequences.

An act would be either right or wrong, not both.

Consequences of an action were essentially irrelevant.

Morality derived from rationality.

In duty-oriented theories, an action would be known to be right when it was in accordance with these imperatives:

- Universal application

- Unconditionality

- Demanding an action

In duty-oriented theories, an action is judged as right or wrong by

determining its relationship to an imperative even without knowledge of circumstances

What are the criticism of duty-oriented theory?

When situationally applied (ex. from slides, your Jewish friend is hiding from Nazi regime.. do you lie or tell the truth?)

it is difficult to know what duty triumphs based on the theory

How does the duty-oriented theory apply to the sanctity of life?

Modern medicine must save every living individual from death.

- Regardless of cost, suffering, or inability to restore life in a meaningful sense

How does the consequence-oriented theory apply to the sanctity of life?

Could allow the handicapped to be euthanized on basis of that their removal served the best interest of society

What is virtue ethics?

Heart of the moral agent making the decision

- Not the reasoning to a right action

Belief that someone who has appropriate moral virtues like courage, temperance, wisdom, and justice will naturally act in certain ways

Emphasis placed on what we can do to produce the sort of character that instinctively does the right thing

virtue ethics main takeaway

Make the choice which will make you be a better person

Whichever you decide will be the moral choice based on your education and development

- Lying decided by person-by-case basis;

- Factors of personal benefit, group benefit, and intentions are there but do not matter

What are some criticisms of virtue ethics?

- No specific direction in decision making

- Virtues not defined

- No definition of a "virtuous" person

- Not all circumstances will have an exact "virtuous" action

- Doesn't respond to change in time or society

What does the biomedical decision making include?

- Action/Duty

- Consequences

- Principles

What is principlism?

uses key ethical principles of beneficence, nonmaleficence, autonomy, and justice in resolution of ethical conflicts or dilemmas

Is the dominant approach to bioethics

What are some criticisms of principlism?

Except for nonmaleficence, the principles are not true action guides.

- They function as checklists, do not provide useful guidance.

- They give more of an abstract or general approach.

ethical theories conclusion

Consequentialist/Utilitarian: Outcome

Duty-Oriented Theory: Action

Virtue Theory: Agent

Principlism: Principles

How are values or beliefs applied to ethical issues?

- Not subject to scientific analysis

- Can't be quantified

- Deeply felt, rarely won

What are moral rules?

standards of right behavior

Standards or principles derived from a code of conduct from a particular philosophy, religion, culture

Principles of a particular tradition, group, or individual

What are some examples of common moral rules?

- Do not kill

- Do not cause pain (including mental suffering)

- Do not disable (loss of physical or mental abilities)

- Do not deprive of freedom

- Do not deprive of pleasure

- Do not deceive

- Keep your promises

- Do not cheat

- Do your duty

- Obey the law

What is an example of conflicting morals?

Doing one's duty may require causing pain.

- A PA performs a painful procedure in order to prevent more serious pain or death.

- By refusing to do the necessary painful procedure would be a violation of one's duty as health professional

Needs some justification which must be impartial - must be able to be applied universally.

Moral rules are not absolute.

Example of morals and personal beliefs applied to a particular case

Ex. Physician claims that deception about a diagnosis (Huntington's disease in a young adult) to avoid causing a specified degree of anxiety and other mental suffering is justified

Is it morally justifiable to withhold bad news from a patient?

Not justifiable because:

- Patient is deprived of the opportunity to make decisions based on the facts

- No informed consent

- If he does find out, he will have less faith in statements made by physicians

- Increasing the amount of anxiety and suffering

How else does withholding bad news affect any other or specific value?

Trust is lost