Lesson 6 Ethical

Dilemmas
Working through an ethical dilemma in professional practice.

What is a dilemma?
https://www.youtube.com/watch?v=-mEq4W26i9Y
The role of professional and lay ethics committee volunteers
who provide ethics support

Practical Bioethics in the Time of

COVID-19
ETHICAL
DILEMMAS
▪ looks at ethical issues that arise in virtue of our biological
nature, in virtue of the fact that we are embodied and not just
minds
▪ Clinical research studies
▪ Violations of autonomy
▪ Paternalism & Benevolence? Beneficence
▪ Chemotherapy vs Quality of Life – not only medical
knowledge but human values. Quantity or Quality
▪ Biotechnology
▪ Paternalism vs Consumerism
Bioethics as part of 6

applied ethics A quite frequent definition

of bioethics as applied
ethics.
Applied ethics
Bioethics applies moral
philosophical reasoning
Bioethics to the ethical problems
arising in the diverse
Modern field of the lifesciences.
medical ethics
The term, bioethics was
coined in 1971, with the
foundation of an institute in
Washington DC. >>
The Kennedy Institute for
the Study of Human
Reproduction and Bioethics
 7

The pluralism in bioethical

approaches
▪Legal context of the problem
▪Empirical evidences in approaching an
ethical problem
▪Social sciences approaches
▪Religious approaches
▪ A nurse can move toward flourishing moral ground
by traveling along a path of intellectual & moral
virtues.
▪ If nurses remain open to learning through being
sensitive to how life stories evolve, are
constructed and can be changed, a narrative view
of life can provide
insight into the
nature of reality and how to become
practically wise.
Bioethics is, after all, very wide ranging - it
encompasses just about every ethical issue
involving medicine and biology.
Without some basic and
unifying principles, it would be
difficult to imagine considering this a single
field of study at all.
Hippocrates,
an early Greek
What we should learn from these
physician ancient writings is that the first
and most important principle of
all bioethics is to help other
humans. Actions taken must
always have that goal in mind -
not profit, personal fame, or
anything else that is self-serving.
The patient's interests
must always come first
▪Ethics is commitment to
highest order of moral values
and an ability to distinguish
right from wrong.
Some current issues
▪Malpractice, negligence, unethical advertisement
▪Irrational use of drugs
▪Use of unnecessary procedures –Caesarian
▪Sex selection procedures leading to female
foeticide
▪Care of terminally ill
▪Equitable distribution – reaching the unreached
▪Commercialization of healthcare
Class discussion
▪Should the elderly be provided the
same level healthcare as provided for
children?

▪Must a healthcare provider who is HIV

positive inform patients?

▪Is there morality to mercy killing?

▪Who should live when not all can live?

ETHICAL DILEMMAS
IMPORTANT

In the realm of health care it is difficult to hold rules

or principles that are absolute. This is due to the
many variables that exist in the context of clinical
cases as well as the fact that in health care there
are several principles that seem to be applicable in
many situations. Even though they are not
considered absolute, these rules and principles
serve as powerful action guides.
Gene Therapy & Genetic
Engineering
▪Gene therapy seeks to alter
genes to correct genetic defects and
thus prevent or cure genetic diseases.
▪Genetic engineering aims to
modify the genes to enhance the
capabilities of the organism beyond
what is normal.
Arguments against
https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/gene-therapy
▪ Do not know enough about how
gene therapy works and what
could go wrong…clinical study
reported many
deaths…technically too
dangerous!
▪ The objection sees gene
therapy as a form of
discrimination against impaired
people and persons with
disabilities. It discriminates or
invites discrimination against
persons with disabilities.
▪ Can be superseded by in-vitro
fertilization and selection of
embryos.
▪ Genetic engineering is against the
natural or supernatural order.
▪ Genetic engineering is
dehumanizing because it will
create nonhuman, alienated
creatures. Genetically engineered
people will be alienated from
themselves, or feel a confused
identify, or no longer feel human,
or the human race will feel
alienated from itself.
▪ Genetic engineered creatures will
suffer from obsolescence.
Computers become obsolete
quickly as newer models are
introduced
▪ Critics of genetic engineering see
it as an attempt at eugenics
through technology.
 Many social, moral, and ethical
Human Cloning arguments have been raised in
opposition to copying a person.
For more details see AMA's 1999
▪ Artificial Life (often CEJA Report: The Ethics of
abbreviated ALife or A-Life) is Cloning (PDF, 41KB).
a field of study wherein
researchers examine systems
related to natural life, its
processes, and its evolution,
through the use of simulations
with computer models,
robotics, and biochemistry.
“What we can do does not always mean we should.”

In spite of recent technological advances, animal cloning

remains extremely inefficient. For every 100 experiments
only one, two, or if lucky, perhaps three appear to
produce a viable offspring in surrogate mothers.
Scientific explanations for these failures remain to be
defined.

Screening tools, do they

exist?
Principle of Stewardship
IMPORTANT

Four Topic Method for Analysis

of Clinical Ethics Cases
Jonsen, Seigler & Winslade
Four Topic Method for Analysis of Clinical Ethics Cases
Jonsen, Seigler & Winslade

• Medical • Patient
Indications Preferences

Principle of Principle of
Beneficence & Respect for
Nonmaleficence Autonomy

Principle of
Beneficence, Principle of
Nonmaleficence Loyalty &
& Respect for Fairness
Autonmy
• Quality of • Contextual
Life Features
I. Medical Indications
Principle of Beneficence & Nonmaleficence
1. What is the patient’s medical problem? History?
Diagnosis? Prognosis?
2. Is the problem acute? Chronic? Critical? Emergent?
Reversible?
3. What are the goals of the treatment?
4. What are the probabilities of success?
5. What are the plans in the case of therapeutic failure?
6. In sum, how can this patient be benefited
by medical/nursing care, and how can
harm be avoided?
 II. Patient Preferences
Principle of Respect for Autonomy
1. Is the patient mentally capable and legally competent? Is
there evidence of incapacity?
2. If competent, what does the patient state about preference
for treatment?
3. Has the patient been informed of the risks & benefits? Has
the patient given informed consent?
4. If incapacitated, who is the appropriate surrogate? Is the
surrogate using standards for decision making?
5. Has the patient expressed prior preferences? Advance
Directives?
6. Is the patient unwilling or unable to cooperate with the
medical treatment?
7. In sum, is the patient’s right to choose being
respected to the extent possible in ethics & law?
III. Quality of Life
Principle of Beneficence & Non-maleficence and
Respect for Autonomy
1. What are the prospects, with or without treatment, for
a return to normal life?
2. What physical, mental and social deficits is the patient
likely to experience if treatment succeeds?
3. Are there biases that might prejudice the provider’s
evaluation of the patient’s quality of life?
4. Is the patient’s present or future condition such that
his or her continued life might be judged undesirable?
5. Is there any plan and rationale to forgo treatment?
6. Are there plans for comfort and palliative care?
 IV. Contextual Features
Principle of Loyalty and Fairness
1. Are there family issues that might influence treatment
decisions?
2. Are there provider (physicians or nurses) issues that
might influence treatment decisions?
3. Are there financial and economic factors?
4. Are there religious and cultural factors?
5. Are there limits on confidentiality?
6. Are there problems of allocation of resources?
7. How does the law affect treatment decisions?
8. Is clinical research of teaching involved?
9. Is there any conflict of interest on the part of the
providers of the institution?
Individual SEATWORK
Write a draft as a possible argument response to the
following cases presenting an ethical dilemma.
Does the Principle of Distributive
Justice apply here?
DILEMMA #1
Take a stand and defend it with
your argument.
What is the basis of your stand?
Principle of Informed Consent
DILEMMA #2
Will you allow or not allow?
Request by the husband?
Request by the parent?
Why? What is the basis?
Intravenous hydration and a feeding tube
are ordered for a terminally ill patient with
Alzheimer’s dementia who is no longer
able to make his own decisions. The
healthcare proxy (eldest son) states, “no
artificial nutrition and hydration,” yet the
his elderly wife insists that a feeding tube
be inserted.
DILEMMA #3
Analyze the following scenario
and give your recommendation
based on all the concepts and
principles learned in class.
Each breakout group divide into 2
sides:
Members for each side come up w/
strong supportive arguments to be
presented in the plenary session.
Breakout Group
Breakout discussion
Dilemma 1
Group #allornothing
Group #oneofeach

Plenary session
Breakout discussion
Dilemma 2
Group #okwhynot
Group #donot!

Plenary session
Breakout discussion
Dilemma 3
Group #legalproxy
Group #dearwife

Plenary session
END.