Bioethics Final

Ethics

The study of morality using the tools and methods of philosophy

Normative ethics

The search for, and justification of, moral standards, or norms

Metaethics

The study of the meaning and justification of basic moral beliefs.

Applied ethics

The use of moral norms and concepts to resolve practical moral issues

Bioethics

Applied ethics focused on health care, medical research, and medical technology

Moral Norms

normative dominance

universality

impartiality

reasonableness

Moral obligations

concern our duty—our actions

Moral values

concern things we judge to be morally good, bad, praiseworthy, or blameworthy - character or motives

Actions are morally

right or wrong

Persons are morally

good or bad

absolute principle

applies without exceptions

prima facie principle

applies in all cases unless an exception is warranted

Moral Principles (pillars of Bioethics)

Autonomy

Nonmaleficence

Beneficence

Utility

Justice

Moral Objectivism

The view that there are moral norms or principles that are valid or true for everyone

Ethical Relativism

The view that moral standards are not objective but are relative to what individuals or cultures believe

Subjective Relativism

The view that right actions are those sanctioned by a person

Cultural Relativism

The view that right actions are those sanctioned by one’s culture

Argument

At least one statement (premise) providing support for another statement (conclusion)

Deductive argument

An argument intended to give logically conclusive support to its conclusion

Inductive argument

An argument intended to give probable support to its conclusion

Good arguments have

solid logical structure (valid or cogent)

true premises

moral argument

one whose conclusion is a moral statement

has at least one moral premise and at least one nonmoral premise

Modus Ponens

Affirming the Antecedent

If p, then q

p, therefore q

Modus Tollens

Denying the Consequent

if p, then q

not p, therefore not q

straw man fallacy

misrepresentation of a person’s views so they can be more easily attacked or dismissed

Appeal to the person fallacy

rejecting of a statement on the grounds that it comes from a particular person, not because the statement, or claim, itself is false or dubious

appeal to ignorance fallacy

tries to prove something by appealing to what we don’t know

begging the question fallacy

trying to prove a conclusion by using that very same conclusion as support

it is arguing in a circle

fallacy of slippery slope

arguing erroneously that a particular action should not be taken because it will lead inevitably to other actions resulting in some dire outcome

moral theory

explanation of why an action is right or wrong or why a person or a person’s character is good or bad

Tells us what it is about an action that makes it right

Consequentialist theory

Asserts that the rightness of actions depends solely on their consequences

Deontological theory

Asserts that the rightness of actions is determined partly or entirely by their intrinsic value

Utilitarianism

Right actions are those that result in the most beneficial balance of good over bad consequences for everyone involved

Act-utilitarianism

The rightness of actions depends solely on the relative good produced by individual actions

Rule-utilitarianism

A right action is one that conforms to a rule that, if followed consistently, would create for everyone involved the most beneficial balance of good over bad

Kant’s Categorical Imperative

Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as if they are an end

Principlism

The theory that right actions are not necessarily those sanctioned by single-rule theories such as utilitarianism, but rather by reference to multiple moral principles that must be weighed and balanced against each other

Natural Law Theory

The view that right actions are those that conform to moral standards discerned in nature through human reason

Virtue Ethics

A moral theory that focuses on the development of virtuous character

Aristotle

Contractarianism

Moral or political theories based on the idea of a social contract or agreement among individuals for mutual advantage

Feminist Ethics

An approach to morality aimed at rethinking or revamping traditional ethics to eliminate aspects that devalue or ignore the moral experience of women

Generally downplays the role of moral principles and traditional ethical concepts

Moral reflection must take into account the social realities (social practices, relationships, institutions, power arrangements)

Casuistry

A method of moral reasoning that emphasizes cases and analogy rather than universal principles and theories

Moral judgments are arrived at not by applying theories, rights, and rules, but by paying careful attention to specific cases and circumstances

Judgments about new cases are made by analogy with similar or paradigm cases

Autonomy

A person’s rational capacity for self-governance or self-determination

Autonomy principle

Autonomous persons should be allowed to exercise their capacity for self-determination

Paternalism

The overriding of a person’s actions or decision-making for his or her own good

Weak paternalism

Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished

Strong paternalism

The overriding of a person’s actions or choices although he or she is substantially autonomous

_____________ have established the principle that a competent patient has a right to reject recommended treatments, even life-saving ones

courts

Physician Autonomy

The freedom of doctors to determine the conditions they work in and the care they give to patients

Pressures on physicians

Penalties for low productivity

Pharmaceutical companies that encourage use of expensive treatments of marginal efficacy

Patterns of physician reimbursement that encourage procedure-oriented interventions and minimize counseling

Advance Directive

A legal document that speaks for you if you are incapacitated

Utilitarianism _____________ the possibility of paternalism

allows for

In general, Kantian ethics ______ paternalism

rejects

Natural law theory is ________ paternalistic than Kantian ethics

more

Moral Conflicts in Nursing

The traditional notion of a nurse as subordinate to physicians vs. the idea of nurse as patient advocate

The nurse’s obligation to follow doctor’s orders vs. the nurse’s duty of beneficence toward patients

What is the nurse’s duty to physicians when their orders seem clearly to be in error, likely to harm patients, or obviously in violation of patients’ autonomy?

Helga Wanglie

elderly woman placed on a ventilator

deals with futility

Elizabeth Bouvia

woman who wanted to starve herself

deals with autonomy

Confidentiality

An obligation or pledge of physicians, nurses, and others to keep secret the personal health information of patients unless they consent to disclosure

Right to privacy

The authority of persons to control who may possess and use information about themselves

therapeutic privilege

the withholding of relevant information from a patient when the physician believes disclosure would likely do harm

Tarasoff v. Regents of the University of California

court held that duties of patient-psychotherapist confidentiality can be overridden when “a patient poses a serious danger of violence to others.”

Duty to Warn

Many believe that exceptions to confidentiality are justified when confidentiality must be weighed against other duties, such as the duty to prevent serious harm to the patient and others

Arguments for Confidentiality

Without respect for confidentiality, physicians would have a difficult time fulfilling their duty of beneficence

Without respect for confidentiality, trust between physician and patient would break down

Disclosure of confidential medical information could harm patients

Persons have a right to privacy

Carlos R

HIV

deals with confidentiality

Informed Consent

The action of an autonomous, informed person agreeing to submit to medical treatment or experimentation

informed consent is a ________________ and _______________

ethical ideal

legal requirement

Salgo v. Leland Stanford Jr. University Board of Trustees (1957)

coined the term informed consent

Decision-Making Capacity

Assessing for “decision-making capacity” involves determining whether a patient or subject is psychologically or legally capable of adequate decision-making

Conditions of Informed Consent

The patient is competent to decide

She gets an adequate disclosure of information

She understands the information

She decides about the treatment voluntarily

She consents to the treatment

Courts and legislatures have mandated the disclosure of

The nature of the procedure

The risks of the procedure

The alternatives to the proposed procedure, including the option of no treatment

The expected benefits of the proposed treatment

Kantian ethics and informed consent

requirement of informed consent can be derived directly from Kantian ethics

Clinical trial

A scientific study designed to systematically test a medical intervention in humans

Blinding

A procedure for ensuring that subjects and researchers do not know which interventions the subjects receive (standard treatment, new treatment, or placebo)

Placebo

An inactive or sham treatment

Randomization

The assigning of subjects randomly to both experimental and control groups

phases of clinical studies

Phase I trial—Tests the drug in a few people for safety and adverse reactions and ascertains safe and unsafe doses (nontherapeutic).

Phase II trial—Investigators give the drug to larger groups of subjects to get a preliminary indication of its effectiveness and to do more assessments of safety.

Phase III trial—Researchers determine whether the drug is effective, how it compares with other proven treatments, and how to use it in the safest way

Ethical Requirements for Clinical Trials

Subjects must give their informed voluntary consent to participate

The study must be designed to minimize risks to subjects and offer an acceptable balance of risks and benefits

Subjects must be selected fairly to avoid exploiting or unjustly excluding them

The subjects’ privacy should be protected, and the confidentiality of research data must be preserved

Before the research is conducted, it must be reviewed and approved by an independent panel

Moral Principles That Apply to Human Research

autonomy, beneficence, justice

Therapeutic trials

usually justified by the potential good to the subjects and to future patients or society

Nontherapeutic trials

justified by significant potential good to society

Researchers do not try to evaluate the drug’s efficacy

Declaration of Helsinki

embraced by the World Medical Association (WMA) in 1964

nuremberg code

came out of the atrocities of WWII

Belmont Report

1979

formulated by the congressionally established National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research

tuskegee syphilis study

1932-1972

Abortion

The ending of a pregnancy

Induced abortion

The intentional termination of a pregnancy through drugs or surgery

Quickening

A pregnant woman’s experience of fetal movement inside her (at about 16-20 weeks)

Spontaneous abortion (miscarriage)

An abortion resulting from natural causes such as a birth defect or maternal injury

Therapeutic abortion

Abortion performed to preserve the life or health of the mother

Viability

The development stage at which the fetus can survive outside the uterus

Judith Jarvis Thomson

argues that even if the unborn is a person from the moment of conception, abortion may still be morally justified in some cases

embryo

the early developmental stage of an animal, including humans, from fertilization to the point where major body structures are formed

fetus

an offspring of a human or other mammal in the stages of prenatal development that follow the embryo stage (in humans taken as beginning eight weeks after conception)

Genesis 1:27

So God created mankind in his own image, in the image of God he created them; male and female he created them

Exodus 21:22

If people are fighting and hit a pregnant woman and she gives birth prematurely[a] but there is no serious injury, the offender must be fined whatever the woman’s husband demands and the court allows

Psalm 139:13

For you created my inmost being; you knit me together in my mother’s womb

Jeremiah 1:5

Before I formed you in the womb I knew[a] you, before you were born I set you apart; I appointed you as a prophet to the nations.

Luke 1:44

As soon as the sound of your greeting reached my ears, the baby in my womb leaped for joy

In vitro fertilization (IVF)

The uniting of sperm and egg in a laboratory dish instead of inside a woman’s body

Gamete intrafallopian transfer (GIFT)

Ovarian stimulation and egg retrieval proceed as they do in IVF, but then the eggs and sperm (gametes) are transferred together to a fallopian tube to fertilize