Medical Bioethics Summary

Page 1: Introduction to Bioethics

• Morality

  • Norms/Rules/Standards regarding right/good vs. wrong/bad

  • Types of Morality:

    • Normative: Prescriptive standards on how people should act universally.

    • Non-normative: Descriptive account of how people actually behave based on empirical observations.

• Ethics

  • Philosophical study of morality.

  • Types of Ethics:

    • Normative Ethics: Evaluates acceptability and justification of moral norms.

    • Practical (Applied) Ethics: Applies ethical theories to resolve real-world problems.

• Morality and Law

  • Morality and law do not always coincide.

  • Legal does not equate to moral (e.g., euthanasia may be legal in some places, but viewed as immoral by others).

• Contemporary Ethical Theories:

  1. Consequentialism

     • Evaluates morality based solely on the consequences or outcomes of actions.

     • Focuses on the importance of the outcome rather than the actions leading to it.

     • Responsibility split: Positive responsibility for actions; negative responsibility for omissions.

  2. Utilitarianism

     • A form of consequentialism emphasizing "greatest happiness for the greatest number" (Bentham, Mill, Sidgwick).

     • An act is morally right if it maximizes good outcomes for all.

  3. Nonconsequentialism (Deontological Theory)

     • Evaluates morality based on moral principles/rules/duties rather than consequences.

     • Focuses on how actions are determined rather than just outcomes.

Page 2: Key Concepts in Bioethics

• Virtue Ethics

  • Centers on the character of moral agents, emphasizing virtues such as compassion and integrity.

  • Morality of actions assessed based on the virtues of the agent.

• Bioethics

  • Application of ethics in the field of biomedicine.

  • Issues include life support and genetic testing.

  • Connection between bioethics and public policy.

• Principlism (Beauchamp & Childress)

  • Non-consequentialist theory with four principles of bioethics:

    1. Respect for Autonomy

    2. Nonmaleficence (do no harm)

    3. Beneficence (action for the welfare of patients)

    4. Justice (fair treatment).

• Virtues in Medicine

  • Essential virtues include compassion, discernment, trustworthiness, integrity, and conscientiousness.

• Medical Ethics

  • Addresses the moral standards governing doctor-patient relationships and the conduct expected of medical professionals.

  • Underpinned by codes of ethics in medicine and nursing.

• Professionalism

  • Encompasses personal, public policy, and professional obligations in healthcare delivery.

Page 3: Ethical Medical Decisions

• Core Ethical Questions

  • Ethical medical decisions should be derived from what a good doctor would do, rather than personal conscience or legality.

• Obligations of Doctors:

  1. Beneficence (acting for patient good)

  2. Truth-telling

  3. Confidentiality

  4. Respect for patient autonomy

  5. Clinical justice

• Conscientious Objection

  • Questions of whether doctors can refuse treatments (e.g. abortion) based on religious or moral grounds.

• Informed Consent

  • Defined as a patient’s autonomous authorization of medical intervention.

  • Includes two dimensions:

    1. Autonomous authorization

    2. Legally effective authorization.

Page 4: Capacity and Consent

• Criteria of Autonomy:

  1. Ability to adopt values and goals.

  2. Comprehension of the situation.

  3. Capacity to make choices that align with personal commitments.

  4. Ability to act upon decisions.

• Consent Importance:

  • Recognizes the moral and legal right of patients over their own medical decisions.

  • Right to bodily integrity is paramount.

• Types of Informed Consent:

  • Implicit: Derived from patient behavior.

  • Explicit: Either oral or written consent.

  • Presumed: Used in life or death situations (e.g., organ donation from deceased).

• Elements of Informed Consent:

  • Competence, Disclosure, Understanding, Voluntariness, Consent.

• Situations Where Consent Isn't Needed:

  • Emergencies and mandatory treatments (e.g., vaccinations).

• Advanced Directives (Living Wills):

  • Allows patients to state care preferences in case of future incapacity.

  • Contains values, preferences, and guidelines for surrogate decision-making.

Page 5: Surrogate Decision-Making

• Questions:

  • Should surrogates be treated like patients?

  • How should their decisions be valued by doctors?

  • Stroke considerations for assessing validity of surrogate decision-making.

• Standards of Surrogate Decision-Making:

  1. Advanced directives.

  2. Substituted judgment.

  3. Best interest standard.

• Types of Surrogate Decisions:

  1. Withholding treatment that promises poor outcomes.

  2. Decisions of uncertain consequential significance.

  3. Denying treatment where refusal leads to significant harm.

Page 6: Euthanasia and Assisted Suicide

• Euthanasia Definition:

  • Death facilitated without pain, termed "a good death."

  • Includes active (direct) and passive (withholding treatment) forms.

• Medically Assisted Suicide:

  • When a doctor provides the means for a patient to end their own life.

• Belgium 2014:

  • First country to legalize euthanasia for terminally ill minors under strict conditions.

• Moral Debates:

  • Tension between mercy killing vs. potential slippery slopes of euthanasia debates.

Page 7: Types and Morality of Euthanasia

• Types of Euthanasia:

  • Active: Causing death through action.

  • Passive: Causing death through inaction or omission.

  • Voluntary: At the request of the person affected.

  • Involuntary: Against the person's expressed wishes.

  • Non-voluntary: Without the person's consent or knowledge.

• Key Moral Considerations:

  • Focus on respect for autonomy in evaluating moral justifications.

  • Analyze moral implications of actions (killing) vs. omissions (letting die).

Page 8: Principle of Double Effect

• Principle of Double Effect:

  • A moral framework justifying actions that have both good and bad outcomes.

  1. Action must not be morally wrong.

  2. Bad effects should not be the means to the good.

  3. Bad effects must be unintended.

  4. Proportionate reason must justify the action despite potential bad effects.

• Legal Provisions:

  • Netherlands: Euthanasia legal since 2002 under strict conditions.

  • Belgium: Legalized in 2002 with a patient consent requirement.

  • Luxembourg: Legal since 2009 under similar strict conditions.

Page 9: U.S. Legal Provisions

• Oregon:

  • Implemented the Death with Dignity Act in 1997 allowing assisted suicide for competent terminal patients.

• Advanced Directives and Euthanasia:

  • Countries like Belgium and the Netherlands officially recognize the validity of advanced directives for patients who can no longer express their wishes.

Page 10: Abortion

• Definition and Ethical Issues:

  • Abortion: Spontaneous or induced termination of pregnancy.

  • Ethical dilemmas surrounding distinctions and definitions of embryo/fetus under various circumstances.

• Moral Positions:

  • Warren: Abortion is moral under any circumstances.

  • Marquis: Abortion is immoral without exception.

Page 11: Status and Criteria of Personhood

• Personhood Concept:

  • Biological and moral criteria defined for assessing the status of embryos and fetuses.

• Arguments Against Abortion:

  • Ethical implications of killing innocent human beings as moral actions.

  • Warren’s critique questions the moral community definition and challenges based on rationality.

Page 12: Future Like Ours Argument

• Don Marquis' Perspective:

  • Killing adults denies them a valuable future; embryos also have potential futures.

• Ethical Debate:

  • Is it morally permissible to terminate potential lives based on current states?

Page 13: Enhancement

• Definition of Enhancement:

  • Any action improving human capacities or creating new traits.

• Types of Enhancements:

  1. Physical

  2. Genetic

  3. Mood or emotional

  4. Cognitive

  5. Moral

  6. Longevity

  7. Enhancement of relationships.

Page 14: Genetic Selection

• IVF and Genetic Diagnostics:

  • IVF: In Vitro Fertilization principles and procedures.

  • PGD: Preimplantation Genetic Diagnosis and potential ethical dilemmas surrounding selection.

  • Principle of Procreative Beneficence:

  • Should aim for children with the best potential future.

Page 15: Eugenics and Related Cases

• Types of Eugenics:

  • Positive vs. negative, coercive vs. voluntary approaches.

  • Ethical concerns about the implications of selecting traits in offspring.

• Case Studies:

  • Examples of medical and ethical dilemmas such as savior siblings and wrongful life claims.

Page 16: Justice in Bioethics

• Justice Principles:

  • Fairness in treatment distribution and how it applies to medical ethics.

• Criteria for Justice:

  • Equal shares, need, contribution, age, and other dimensions based on societal standards.

Page 17: Theories of Justice in Medicine

• Libertarianism:

  • Individual responsibility for health; minimal state intervention.

• Utilitarianism:

  • Maximizing benefits for the largest number of people.

• Egalitarianism:

  • Equal access to basic healthcare regardless of personal circumstances.

Page 18: Right to Health Care

• Arguments for Health Care as a Right:

  • Collective social protection vs. individual responsibility narratives.

• Limits of Right to Health Care:

  • Equal access standards and determining criteria for care prioritization.

Page 19: Micro-Allocation Criteria

• Allocation Standards:

  • Criteria influencing decisions in healthcare rationing including age, social standing, and individual health needs.

Page 20: Utilitarianism During Pandemic

• Consequentialism:

  • Ethical considerations involving decisions during public health emergencies, like prioritizing interventions.

Page 21: Core Responsibilities of Medicine

• Trust Theory:

  • Basis of medical ethics rooted in trust.

• Fiduciary Responsibility:

  • Commitment to trustworthiness and ethical integrity.

Page 22: Proactive Beneficence

• Proactive Beneficence:

  • The obligation to act for the benefit of patients by understanding their preferences and needs.

Page 23: Moral Fictions in Medical Ethics

• Moral Fictions Defined:

  • Concept that influences ethical decisions regarding the withdrawal of life-sustaining care versus euthanasia.

Page 24: [Blank Page]

Page 25: Sample Questions

• Questions covering topics such as moral philosophy, principlism, and societal ethics, emphasizing the criteria for medical decisions.

Page 26: Further Questions

• Additional assessment questions focusing on ethical definitions and principles in practice.

Page 27: Evaluating Ethical Decisions

• Questions to evaluate understanding of critical ethical concepts like patient autonomy and compassionate care.

Page 28: Rights and Responsibilities

• Questions regarding the implications of conscientious objection and ethical responsibilities in medical practice.

Page 29: Ethical Complexities

• Explores complexities in defining rights in medical scenarios and their moral implications.

Page 30: Critical Thinking Questions

• Engages with arguments surrounding personhood, competence, and surrogate decision-making issues.

Page 31: Assessing Competence

• Analyzes criteria for autonomy and decision-making capabilities in medical contexts.