Biomedical Ethics Lecture and Exam Review
Biomedical Ethics Exam Structure
Section A Overview
This section is worth marks in total.
It consists of 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 marks in total.
It consists of 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 ( marks): Summarise the facts of the case that are relevant specifically to ethical considerations.
b. Principles Application ( marks): Explain and apply the four primary ethical principles: Autonomy, Justice, Beneficence, and Non-maleficence.
c. Ethical Rationale ( 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 ( marks): Summarise facts relevant to ethical considerations.
b. Concept Application ( marks): Explain and apply three specific ethical concepts: Non-maleficence, Killing and Letting Die, and the Rule of Double Effect.
c. Theory Selection ( 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 ( 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.