BE - Exam Study Guide

Biomedical Ethics Exam Structure

  • Section A Overview

    • This section is worth 2020 marks in total.
    • It consists of 44 short answer questions.
    • Questions are based entirely on the guest lectures provided in the course.
    • Each question specifies the number of marks allocated, which serves as a guide for the required depth of the response.
    • Focus areas: Definitions, core concepts, examples, and practical applications.

  • Section B Overview

    • This section is worth 3030 marks in total.
    • It consists of 22 case studies.
    • Students must apply ethical principles and theories rather than personal opinions.
    • Responses require structured reasoning and justification.
    • Each case study follows one of two specific exemplar formats.

  • Exemplar 1 Assignment Structure

    • a. Situation Outline (22 marks): Summarise the facts of the case that are relevant specifically to ethical considerations.
    • b. Principles Application (88 marks): Explain and apply the four primary ethical principles: Autonomy, Justice, Beneficence, and Non-maleficence.
    • c. Ethical Rationale (55 marks): Determine if the person is acting ethically. Provide a rationale based on the prior application of the four principles.

  • Exemplar 2 Assignment Structure

    • a. Situation Outline (22 marks): Summarise facts relevant to ethical considerations.
    • b. Concept Application (66 marks): Explain and apply three specific ethical concepts: Non-maleficence, Killing and Letting Die, and the Rule of Double Effect.
    • c. Theory Selection (22 marks): Select the theory of distributive justice (Utilitarian, Libertarian, Egalitarian, or Communitarian) that most closely applies to the case and provide a rationale.
    • d. Final Rationale (55 marks): Provide a rationale for whether the person is acting ethically based on previous answers.

The Four Ethical Principles

  • 1. Autonomy

    • Definition: The right of competent individuals to make informed decisions about their own lives and healthcare.
    • Requirements for Autonomy:
      • The person must have decision-making capacity.
      • The person must receive adequate information.
      • The person must understand the information provided.
      • The person must be free from coercion.
    • Examples of Respecting Autonomy:
      • A patient refuses chemotherapy after fully understanding the risks and benefits.
      • A patient chooses to undergo a specific surgery.
    • Examples of Violating Autonomy:
      • Performing medical treatment without obtaining consent.
      • Withholding important information from the patient.
      • Pressuring a patient into making a specific decision.
    • Questions to Ask in Case Studies:
      • Was informed consent obtained?
      • Did the patient understand the situation?
      • Was the decision voluntary?
      • Were the patient\'s wishes respected?

  • 2. Beneficence

    • Definition: The obligation to act in ways that promote the wellbeing of others.
    • Key Idea: "Do good."
    • Healthcare Examples:
      • Providing effective treatment.
      • Relieving pain and suffering.
      • Preventing disease.
      • Promoting patient welfare.
    • Questions to Ask in Case Studies:
      • Does this action benefit the patient?
      • Will it improve health outcomes?
      • Does it promote wellbeing?

  • 3. Non-Maleficence

    • Definition: The obligation to avoid causing harm.
    • Key Idea: "First, do no harm."
    • Types of Harm:
      • Physical harm.
      • Psychological harm.
      • Social harm.
      • Financial harm.
    • Examples:
      • Avoiding unnecessary surgery.
      • Preventing medication errors.
      • Minimising treatment side effects.
    • Questions to Ask in Case Studies:
      • Could this action cause harm?
      • Is the harm avoidable?
      • Do the benefits outweigh the risks?

  • 4. Justice

    • Definition: The fair distribution of benefits, risks, costs, and resources.
    • Examples:
      • Equal access to healthcare services.
      • Fair allocation of organs for transplantation.
      • Fair use of limited hospital resources.
    • Questions to Ask in Case Studies:
      • Is everyone treated fairly?
      • Are resources distributed equitably?
      • Is there evidence of discrimination or bias?

Applying Ethical Principles in Practice

  • Step-by-Step Analysis for Case Studies:
    • Step 1: Identify the ethical issue.
    • Step 2: Discuss each principle (Autonomy, Beneficence, Non-Maleficence, Justice) separately.
    • Step 3: Conclude whether the action is ethical based on the analysis.

Killing vs. Letting Die

  • Killing

    • Definition: Directly causing a person’s death through an intentional action.
    • Examples: Administering a lethal injection or intentionally giving a fatal overdose.

  • Letting Die

    • Definition: Allowing death to occur by withholding or withdrawing treatment.
    • Examples: Turning off life support or respecting a patient\'s refusal of treatment.

  • Ethical Debate:

    • Position 1: Some ethicists argue there is a major moral difference between the two.
    • Position 2: Others argue the outcome is identical, meaning there may be little moral difference.

  • Questions to Ask:

    • Was death caused directly?
    • Was treatment withdrawn?
    • Was death intended?
    • Was patient choice respected?

Rule of Double Effect

  • Definition: An action that has a good intended effect but also a harmful, unintended side effect may be ethically permissible under specific conditions.

  • The Four Essential Conditions:

    • 1. The action itself must be morally good or neutral (e.g., giving pain relief).
    • 2. The good effect must be the intended effect (e.g., relieving suffering).
    • 3. The bad effect must not be the means to the good effect (e.g., death is not the method used to achieve pain relief).
    • 4. Benefits must outweigh harms (e.g., relieving severe suffering outweighs the risk of shortening life).

  • Classic Example:

    • A terminal cancer patient receives high-dose morphine.
    • Intended effect: Pain relief.
    • Possible side effect: Respiratory depression that may shorten life.
    • Ethical Reasoning: Since pain relief was intended and death was not, it may satisfy the Rule of Double Effect.

Theories of Distributive Justice

  • 1. Utilitarian Theory

    • Core Idea: Maximise overall benefit for the greatest number of people.
    • Focus: Outcomes and consequences.
    • Key Phrase: "The greatest good for the greatest number."
    • Healthcare Example: Allocating scarce resources to patients who will generate the highest overall benefit.

  • 2. Libertarian Theory

    • Core Idea: Individual freedom and personal responsibility.
    • Focus: Minimal government interference.
    • Key Phrase: "People should be free to choose."
    • Healthcare Example: Individuals purchasing healthcare based on their own choices and available resources.

  • 3. Egalitarian Theory

    • Core Idea: Equality.
    • Focus: Equal access and equal opportunity.
    • Key Phrase: "Everyone should be treated equally."
    • Healthcare Example: Universal healthcare access for all, regardless of income.

  • 4. Communitarian Theory

    • Core Idea: Promoting the welfare and values of the community.
    • Focus: Society’s interests over individual preferences when necessary.
    • Key Phrase: "The common good."
    • Healthcare Example: Mandatory vaccination policies.

Framework for Final Ethical Judgments

  • Structuring the Rationale:

    • 1. State Position: e.g., "Overall, the healthcare professional is acting ethically."
    • 2. Support with Principles: Address Autonomy (informed choice), Beneficence (wellbeing), Non-maleficence (minimised harm), and Justice (fair allocation).
    • 3. Address Conflicts: Acknowledge when principles clash (e.g., "Although there is some risk of harm, the expected benefits outweigh these risks.").
    • 4. Conclude: Summarize based on the integrated application of all principles.

  • Quick Revision Matrix:

    • Autonomy: Was the patient\'s choice respected?
    • Beneficence: Does it help the patient?
    • Non-maleficence: Could it cause harm?
    • Justice: Is it fair?
    • Killing: Was death directly caused?
    • Letting Die: Was treatment withheld/withdrawn?
    • Double Effect: Was harm unintended but foreseeable?
    • Utilitarian: Greatest good for greatest number?
    • Libertarian: Individual freedom?
    • Egalitarian: Equality for all?
    • Communitarian: Best for society/community?

  • Final Exam Tip:

    • Use the following structured order for every case study: Facts → Ethical Principles/Concepts → Application to Case → Ethical Judgement → Conclusion. This mirrors the marking criteria and helps maximise marks.