Week 16: Basic Principle: Fulfilling duties towards self or other persons

Analysis of Bioethical issues = an ethics of duty or obligation

Pluralists = many duties/ W. D. Ross, duties of:
- Ethics- refers to the identification, study, and resolution or
- non-malificence: do not harm
mitigation of conflicts among competing values or goals.
- beneficence: do good, benefit
- The ethical question is, “What should we do, all things
- justice: treat equals equally
considered?” The “bio” puts the ethical question into a
particular context. - add autonomy: respect individuals
- Bioethics is commonly understood to refer to the ethical - fidelity: be faithful
implications and applications of the health-related life - reparation: return good for good
sciences. - gratitude
- self-improvement
Bioethics is concerned with questions about basic human
- Kant’s version: Reason reveals our duty
values such as the rights to life and health, and the rightness
- Categorical Imperative (required)
or wrongness of certain developments in healthcare
institutions, life technology, medicine, the health professions - Can the action be universalized?
and about society's responsibility for the life and health of its - Does the action treat people as ends, not just means?
members. - Ross’s Version: Common sense intuition reveals our
- BIOETHICAL ISSUES - Areas of health sciences that are the - prima facie duties (Clear)
subject for bioethical analysis - Duty of non-injury has priority
- Other duties: fidelity, reparation, gratitude, beneficence,
Bioethical Issues
justice, self-improvement
- Euthanasia/Mercy-killing– the practice of ending a life, on
- Ethical position claiming that the rightness or wrongness of
grounds of humane-mess, to relieve pain and suffering
actions depends on whether they correspond to our duty or
- Organ Transplants- Lawful / legal
not.
- “Natural law prohibits that a human cadaver be treated - Duty or obligation is binding even though a moral action
merely like a commodity or like an animals” (Pius XII - may be different or result in painful consequences
1956)
- Certitude of death is an important ethical question to be Strengths of Deontologism:
considered in transplants.  Emphasizes respect for every human.
- Abortion– an operation or other intervention to end a  Provides certainty
pregnancy by removing an embryo or fetus from the womb. Weaknesses of Deontologism:
 Hard to handle exceptions
Abortion under the law  Hard to solve conflicting rules
- Abortion is allowed only for medical reasons in very  Allows acts that create many bad consequences
exceptional circumstances
- WHO Chronicle of 1976 : Legalism
- A strict, literal, or excessive conformity to a religious or
- When mother is authorized to safeguard her physical
moral code.
and mental health
- The legalist tradition derives from the principle that the best
- When the pregnancy is the consequence of rape or
way to control human society is through written law rather
incest.
than through ritual, custom or ethics.
- When Chromosomal abnormalities are diagnosed
through amniocentesis Teleological Method
- When the parents are mentally deficient. - Teleology, from the Greek word telos, meaning “purpose”
or “end,” is the study of goals, ends, purposes, and
Family planning & Reproductive health
destinies–if they exist.
 the use of birth control methods to choose the number
- Humans and other organisms have purposes and goals that
and timing of children born into a family.
drive their behavior.
- Contraception - the voluntary prevention of conception
- An ethical theory that teaches an action if it is right or
by the positive use of artificial means.
wrong depending on the consequences or outcome of a
- Morality of Contraception:
situation.
- Church rejects any artificial intervention to conception
- any conjugal act must be open to the transmission of life Deontological Teleological
- Human life begins at the moment of conception. Rules-based view of ethics Consequences-based view
 Genetic Science & Bioengineering – the use of of ethics
engineering principles and techniques to solve medical Goodness or badness is Goods or badness is
problems determined by the action determined by the results
- e.g. in the design of artificial limbs or in organ or outcomes
replacement The only behaviour that Can justify the behaviour
can be considered ethical as ethical if it produces
Ethical Method is the one that has good greatest good for the
- draws upon ethical theory to apply, to evolve ethical codes will behind it greatest number
into useful and relevant guidelines to which the standards Utilitarianism theory
of validity, relevance, and comparability may be applied. - The doctrine that an action is right insofar as it promotes
Deontology happiness, and that the greatest happiness of the greatest
- Derived from the greek word “deon” meaning “duty” number should be the guiding principle of conduct.
- Deontology is a category of normative ethical theories that - The Utilitarian theory suggests that it is morally right to seek
encompasses any theory which is primarily concerned with the greatest good for the greatest number of people.
adherence to certain rules or duties. - John Stuart Mill
- Principle of Utility, also known as Greatest Happiness
Principle
- An action is right to the extent that it increases the total
happiness of the affected parties
- An action is wrong to the extent that it decreases the total
happiness of the affected parties
- Happiness may have many definitions such as: advantage,
benefit, good, or pleasure
Proportionalism
- is an ethical theory that lies between consequential theories
and deontological theories.
- Consequential theories, like utilitarianism, say that an
action is right or wrong, depending on the consequences it
produces, but deontological theories, such as Immanuel
Kant's categorical imperative, say that actions are either
intrinsically right or intrinsically wrong.
(Article)
The principle of Proportionality: An Ethical Approach to
Resource Allocation During the COVID-19 Pandemic
By Kate Jackson-Meyer, Ph.D.
Policy makers, hospitals, and health care professionals are
facing, or are likely to face, excruciating ethical decisions
about resource allocation and risk calculation due to the
COVID-19 pandemic and medical supply shortage.
Emphasizing the principle of proportionality in resource
allocation can help to correct for the shortcomings and
limits of the maximizing approach, which is the dominant
approach being put forward.
A limited number of life-saving ventilators means that
decisions will have to be made about who receives
ventilators and who does not. Due to limited availability of
masks and personal protective equipment, health care
workers take on risks of virus transmission when they treat
COVID-19 patients or suspected COVID-19 patients. As a
result, hospitals must decide how much risk is appropriate
for health workers to assume in the pursuit of saving lives.
And, a limited supply of face masks has led to conflicting
information and confusion about whether the public should
wear face masks.
I suggest that the principle of proportionality is an
important addition for decision-making in these kinds of
situations. The principles put forward by the institute of
Medicine’s Crisis Standard of Care- fairness, duty to care,
duty to steward resources, transparency, consistency,
proportionality, and accountability- and the principle of
bioethics- autonomy, beneficence, non-maleficence, and
justice- are important to include in ethics decisions, but
each one alone presents little guidance for how to weigh or
balance principles or how to account for harm.
Emotivism
is a meta-ethical view that claims that ethical sentences do
not express propositions but emotional attitudes.
- A moral theory that suggests that when we say something is
wrong, we are merely expressing an emotional reaction to a
certain set of events or facts.
- Emotivism is a theory that claims that moral language or
judgments:
1. are neither true or false;
2. express our emotions; and
3. try to influence others to agree with us. To better
understand emotivism, consider the following statements:
Prudential Personalism
- An ethical approach that recognizes that human nature is
embodied in each individual in a unique manner and, as
such, the role of free will and intelligence in decision making
is a personal right.
- Personalism is an intellectual stance that emphasizes the
importance of human persons. Various conceptualizations
have been explored, so personalism exists in many different
versions, and this makes it somewhat difficult to define as a
philosophical and theological movement. (Friedrich
Schleiermacher )
- Prudential personalism judges the rightness or wrongness
of an action in terms of:
- simply obeying the law.
- how it contributes in its context to the growth of
persons in community.
- the situation of the action.
Legal Positivism
- The belief in postulated code of conduct based upon social
facts, adopted by authorized institutions, and used as an
instrument of control for the people of a state.
- According to John Austin, legal positivism is defined as the
existence and content of law depends on social facts and
not on its merits.
- Positivism is from the Latin root positus, which means to
posit, postulate, or firmly affix the existence of something.
- Legal positivism is a school of jurisprudence whose
advocates believe that the only legitimate sources of law
are those written rules, regulations, and principles that have
been expressly enacted, adopted, or recognized by a
governmental entity or political institution, including
administrative, executive, legislative, and judicial bodies.
Values of Medical Technologist
- Inherent Personal Value - motivates a person to choose
what is good for oneself, and becomes the basis for one’s
interest in doing what’s right.
- Personal Values- developed from life experiences.
- A medical technologist is accountable to the patient, to the
attending physician and to the community, in general.
- The medical technologist has the responsibility to provide
accurate and reliable test results.
- Integrity in the laboratory management is needed in
providing quality assurance.
- The medical technologist reviews records in compliance
with clinical guidelines in specimen collection, diagnostic
essay and data collection.
- The obligation to protect the confidentiality of all laboratory
test results and patient information is a sign of respect to
the right of patient for privacy.
End of lecture / Summary
- Bioethics is commonly understood to refer to the ethical
implications and applications of the health-related life
sciences.
- BIOETHICAL ISSUES - Areas of health sciences that are the
subject for bioethical analysis
- Ethical Methods / Theories
- Values of Medical Technologist