Med Ethics Midterm --> Final Exam

Act Utilitarianism Definition

Argues that in all situations the utility of an action is based on an act that leads to the greatest good for the greatest number

Act Utilitarianism Example

Saving multiple lives by sacrificing one

Moral Rights

Claim is based on moral principles

Legal Rights

Claim is based on law

Positive Rights

Impose obligations on people to provide other people with goods or services

Negative Rights

Pertain to the obligations on the part of other people to refrain from interfering with our freedom of action

Kantian Deontologism

An act can be described as good and what ought to be done because it expresses certain characteristics; follow only those rules which you would will to be universal laws for everyone, including yourself

Ambiguity

Situations in which the clarity of the facts does not dictate the decision

The Tragic in Human Life

Consequences of human limitations in knowledge and resources leading to

1) The chance of being wrong despite the best knowledge and intentions

2) The need to make morally wrenching decisions in the face of incomplete information or with inadequate resources

Autonomy

You shall not treat a patient without the informed consent of the patient or his or her lawful surrogate, except in narrowly defined emergencies

Informed Consent

• Foundational

• Without this, principles of autonomy and dignity would be diminished

• Two required conditions:

  • Competency

  • Informed

• A process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a clinical trial

Competence

Capacity; ability to perform a certain task

Surrogate

People who are authorized by law or custom to make decisions when the patient is incompetent or doubtfully competent

Paternalism

Acting without consent or even overriding a person’s wishes, wants, or actions in order to benefit the patient or at least to prevent harm to the patient

Therapeutic Privilege

Privilege of withholding information from the patient when the physician believes that the disclosure will have an adverse effect on the patient’s condition or health

Emergency

• Exception to informed consent

• 3 conditions must be present

  • Patient must be incapable of giving consent and no lawful surrogate is available to give the consent

  • There is danger to life or danger of a serious impairment to health

  • Immediate treatment is necessary to avert dangers

Right to Refuse Treatment

Given autonomy a competent person, adult or emancipated minor, has the right to refuse treatment

Medical Indications Principle

Granted informed consent, the physician should do what is medically indicated, such that from a medical point of view, more good than evil will result

Proportionality

• Risk benefit consequential approach

• Good must outweigh evil

• Provided the action does not go directly against the dignity of the individual person (the intrinsic good), there must be a proportionate good to justify permitting or risking an evil effect

Double Effect

• The action must be good or morally indifferent in itself

• The agent must intend only the good effect and not the evil effect

• The evil effect cannot be a means to the good effect

• There must be a proportionality between the good and evil effects

3 Principles of Surrogate Decision Making

• Substituted judgement

• Rational choice

• Best interest

Wedge Principle

In defending a given position even a small concession will destroy that position

Logical Wedge Principle

Concerned with logical consistency and not with the actual effects

Empirical Wedge Principle

Does not worry about logical consistency, but about the actual consequences of the act or the exception to the rule

Conflict of Interest

When a health care provider subordinates the interest, including the financial interest. of the patient to the interests of the provider or a third party

Ordinary Patient’s Obligation

Produces more good than harm

Extraordinary Patient’s Obligation of Health Care

Produces more evil than good

Refusal of Care

Health care professionals and health care agencies do not have to accept all patients who present themselves for treatment

Legitimate Reasons:

• physician may lack skills to treat patient

• physician may lack the time because practice is already oversubscribed 

Minimum Adequate Humane Health Care

Basic level of health care every person should have access to; includes services necessary to prevent serious harm, maintain normal functioning, and treat urgent conditions

Health and Disease

Health- lack of disease

Disease- Any deficit in the physical form or physiological or psychological functioning of the individual in terms of what society wants or expects from that individual, or in terms of what the individual wants or expects from himself or herself

The Goals of Health Care

Prevention of disease and injury

Relief of unnecessary pain and suffering

Care and cure of the sick

Avoidance of premature death

Pursuit of a peaceful death

Ethical Distribution

Must provide for priorities and a system of allocating resources that at least regularizes expectations in the light of what is politically and economically possible

Mandatory Reporting

1) Statute law

2) Legal precedent

3) Unusual relationships

4) Proportionality - for the public good

Context Issues Related to Confidentiality and Health Care

Keeping secrets (knowledge that a person has a right or obligation to conceal)

Tarasoff Case

Court ruled that when a therapist knows a patient poses a serious danger to others, the duty to protect potential victims outweighs confidentiality- must inform third party and authorities

Issues Related to Appeals to Conscience

Wrong to do this vs wrong for me to do this

Due Process

1) Charge is clear and specific, described in non-evaluative terms

2) Evidence must be presented to support charge

3) Accused must be given opportunity to respond to charge

Harms From Breaking Professional Secrets

1) Patient- client

2) Profession

3) Society

Exceptions to Confidentiality

1) Statute law

2) Legal precedent

3) Unusual relationships

4) Proportionality - for the public good

Assisted Suicide

Someone helps but main action done by one killed

Active Suicide

Doing something

Passive Suicide

Omitting something

Physician-assisted Suicide

Active suicide of a patient with the intervention of a health care provider; patient asks provider for means to kill themselves and is given

Therapeutic Abortion

Curing the pregnant woman or saving her life

Non Therapeutic Abortion

Causes no personal ethical problems who do not grant the fetus a serious life to right (abortion of choice)

Serious Right to Life

Life can be taken under serious circumstances (save mother over child)

Absolute Right to Life

Life cannot be taken under any circumstances (must save mother and child no matter what)

Discard Problem

In pioneering days, fertilized eggs that were not put into the woman were discarded or used for experimental purposes. This questioned the right to the life of the conceptus.

False Negative

When the test comes back negative when in fact a patient is positive for the condition

• False sense of security

• Leave an illness untreated

False Positive

Result that says a condition is present when is it is not

• Torture patient worry concern

• Patient will be treated unnecessarily and even dangerous treatments

• Can be costly

Mass Screenings

Large numbers of apparently healthy people are tested in order to detect the few people who have what is sometimes a relatively rare condition (false positives)

Cost of individual test and cost of each case detected