Explore Ebooks
Categories
Explore Audiobooks
Categories
Explore Magazines
Categories
Explore Documents
Categories
Bioethics I
Prepared and presented by Marc Imhotep Cray, M.D.
Basic Medical Sciences and Clinical Knowledge (CK) Teacher
What is Bioethics?
Study of ethical issues arising from biological and medical sciences
Varieties of Bioethics
Medical ethics
Physician-centered
Bioethics in general
Includes issues in genetics, reproductive technologies, experimentation, and distribution of life-saving resources
Origins of Bioethics
Represented the view that ethical problems in medicine and biological sciences can be solved by applying moral principles
(Source: Albert R. Jonsen, Journal of Medicine and Philosophy (1991), pp. 113-30)
New technologies
E.g., assisted reproduction, gene therapy, support and prolonging of life
Philosophers
Ethical dilemmas go beyond issues of legality. Philosophers can help doctors to make sound ethical decisions and to justify them to their patients and the public. If you need an analysis, send the urine to the biochemist, and the ethics to the philosopher.
MEDICAL ETHICS
Distinguish morality from law Distinguish moral philosophy from religious ethics and codes
Use reason and arguments Apply general moral principles Provide conceptual and analytical tools Justify or question moral practices
Normative Ethics
Developing principles that tell us which actions are right, and what we are morally required to do.
Normative Theories
Deontological theories
Associated with German philosopher Immanuel Kant.
Consequentialist theories
Most well-known theory is utilitarianism. Utilitarians seek to maximize general human happiness or well-being. Famous utilitarian philosophers include John Stuart Mill and Jeremy Bentham.
11
Deontological Theories
A type of action is right or wrong no matter what its consequences are. Moral agents have duties which oblige them to do certain types of action. Duties can be specified in the form of rules that must be universally applicable. Persons and their autonomy should be respected at all times.
12
Consequentialist Theories
What makes an action right or wrong are its consequences. The consequences of an action can always be measured by a common standard: what it contributes to the good of all who are affected by the action The right action is one that has the maximum beneficial results. The same unit of benefit to any person should be given equal weight.
13
Case-study approach
Methodology of casuistry (Jonsen & Toulmin)
16
Choice of ethical theory cannot be justified Real life is too messy and detailed Priority of principles cannot be resolved
E.g., principles of autonomy and beneficence can be in conflict.
17
Problem of bias
Intuitions need to be critically examined.
Too many mid-level principles in evaluating cases Theoretical issues cannot be avoided
E.g., euthanasia raises questions about the value of human life; allocation of resources raises questions of distributive justice.
18
Philosophers can help doctors to identify goals in medicine and to develop practical principles. Moral philosophy will impact on clinical practice by improving understanding and affecting the way in which ethical problems in medicine are described.
19
Medical ethics
Medical ethics is grounded in philosophical ethics, it concerns itself with the ethical questions and dilemmas in medicine. Medical ethics is not any special ethics but an ethics which deals with special cases from medical practice.
20
Doctor-patient relationship
Medical ethics has three centres: doctor, patient and society. Its centre is the doctor-patient relationship.
21
The duty The duty health The duty The duty The duty The duty The duty The duty
to help, cure to promote and protect the patients to to to to to to inform confidentiality protect the patients life respect the patients autonomy protect privacy respect the patients dignity
22
to to to to to to to
high quality medical service autonomous choice decide be informed privacy health education dignity
23
24
An obligation of nonmaleficence and an obligation of beneficence are both expressed in the Hippocratic oath: I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them.
25
The principle of nonmaleficence asserts an obligation not to inflict harm intentionally. Principles of beneficence potentially demand more than the principle of nonmaleficence, because agents must take positive steps to help others, not merely refrain from harmful acts.
26
Beneficence One ought to prevent evil or harm One ought to remove evil or harm One ought to do or promote good
27
The word autonomy is derived from the Greek autos (self) and nomos (rule, governance or law). It was first used to refer to the self-rule or selfgovernance of independent Hellenic city-states Autonomy has since been extended to individuals and has acquired meanings as diverse as self-governance, liberty rights, privacy, individual choice, freedom of the will, causing ones behaviour, and being ones own person.
28
Autonomous person
We analyze autonomous persons in tems of liberty (independence from controlling influences) agency (capacity for intentional action)
29
Autonomous action
We analyze autonomous action in terms of persons who act Intentionally With understanding Without controlling influences that determine their action
30
31
Through the account of autonomous choice. A person must do more than express agreement or comply with a proposal. He/she must authorize through an act of informed and voluntary consent. in terms of the social rules of consent in institutions that must obtain legally valid consent from patients or subjects before proceeding with therapeutic procedures or research.
32
Inability to express or communicate a preference or choice. Inability to understand ones situation and its consequences. Inability to understand relevant information. Inability to give a (rational) reason. Inability to give risk/benefit related reasons. Inability to reach a reasonable decision.
33
Paternalism
is the intentional overriding of one persons known preferences or actions by another person, where the person who overrides justifies the action by the goal of benefiting or avoiding harm to the person whose will is overriden.
34
Weak paternalism
In weak paternalism an agent intervenes on ground of beneficence or nonmaleficence only to prevent substantially nonvoluntary conduct, i.e. to protect persons against their own substantially nonautonomous actions.
35
Strong paternalism
Strong paternalism involves interventions intended to benefit a person despite the fact that the persons risky choices and actions are informed, voluntary and autonomous.
36
37
38
To each person an equal share (formal equity) To each person according to need To each person according to effort To each person according to contribution To each person according to merit To each person according to freemarket exchanges
39
Useful References
Tom Beauchamp & James Childress, Principles of Biomedical Ethics (Oxford University Press, 1994) Nancy Jecker, Albert Jonsen & Robert Pearlman (editors), Bioethics: An Introduction to the History, Methods, and Practice (Jones & Bartlett, 1997) Robert Veatch (editor), Medical Ethics (Jones & Bartlett, 1997)
40
41
42
43
44
45
46
47
48
ANSWERS TO QUESTIONS
1=A 2=A 3=A 4=D 5=C 6=C 7=F 8=C
Marc Imhotep Cray, M.D.
49
E-Textbook Medical Ethics Today: The BMAs handbook of ethics and law Books; 3 edition (January 30, 2012) Updates http://bma.org.uk/practical-support-at-work/ethics/medical-ethics-today Best Price $148.33 or Buy New $181.49