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MLDICAL L1nICS

Introduction to MedicuI Ethics



Deonto|ogy or rofess|ona| Lth|cs
O ls Lhe sclence whlch conslders Lhe speclflc eLhlcal obllgaLlons arlslng from Lhe exerclse of one's
professlon
O ny professlonal work slnce performed by a human person ls sub[ecL Lo general eLhlcal crlLerlaLo
work well wlLh professlonal CCML1LnCL sense of 8LSCnSl8lLl1? LC?L1? and SCLlu8l1? wlLh
one's colleagues
O Medlcal pracLlce ls sub[ecL Lo cerLaln eLhlcal llmlLaLlons Many healLhcare maLLers need an eLhlcal
approach
O ealLhcare professlonals cannoL llmlL Lhemselves Lo a 1LCnlCLL? L8lLC1 !C8S whlle forgeLLlng Lhe
8LLlClCuS ulMLnSlCnS and lgnorlng Lhe duLles subsequenL Lo Lhelr falLh
O Sl8l1uL SClZC8Lnl forgeLLlng one's rellglous bellefs ln Lhe performance of one's work
Leavlng one's rellglous bellefs llke a haL ln Lhe locker upon enLerlng Lhe hosplLal

Ak1 18ASIC L1nICAL ULS1ICNS
O uman acLs/ prlnclple of double effecL
O Moral deLermlnanLs of human acLs
O Consclence
O naLural/ moral law
O CooperaLlon wlLh evll

Ak1 2Concrete Lth|ca| rob|ems] Concerns
O uuLles Lowards Lhe unborn
O borLlon
O rLlflclal ferLlllzaLlon
O uuLles Lowards Lhe dylng paLlenL
O ulsLhanasla
O LuLhanasla
O 8odlly lnLegrlLy lasLlc surgery sLerlllzaLlon organ LransplanLaLlon
O SolldarlLy wlLh one's colleagues
O M CCuL Cl MLulCL L1lCS


!#INCI!ES OF HUMAN ACTS

O lLhough all acLs performed by man can be called uMn C1S Lhls Lerm ls reserved for acLs whlch
proceed from a uLLl8L81L WlLL le 81lCnL and vCLun18? and Lherefore l8LL
O lf one of Lhese elemenLs ls lacklng properly speaklng a human acL does noL Lake place (ex acLs
performed when drunk drugged or coerced)

L|ements of a numan Act
uvL81LnCL one needs Lo knCW W1 CnL lS uClnC wheLher good or evll approprlaLe or
lnapproprlaLe
when someone acLs lnuvL81Ln1L? or Lhrough lCnC8nCL Lhe acL may noL be lMu18LL
*(1hough ln our [usLlce sysLem)
CuL8LL lCnC8nCL does exlsL ln a docLor whose knowledge of hls professlon ls defecLlve
2 vCLl1lCn one has Lo WlLL and Wn1 Lo acL ln order Lo acL responslbly Lhe acL should be wlllful and
volunLary

3 LxLCu1lCn Lhe one who acLs should do so freely noL sub[ecLed Lo any coerclon physlcal or moral


!#INCI!E OF DOUE EFFECT:
O n acL can have MuL1lLL LllLC1S some wanLed oLhers unwanLed
O n acL can produce a good effecL and an unwanLed evll effecL whlch accompanles Lhe former
lnSLL88L?

O n acLlon may be performed Lo obLaln Lhe good effecL foreseelng LhaL Lhe evll wlll necessarlly resulL
wlLhouL belng dlrecLly lnLended by Lhe agenL

O 1he followlng condlLlons musL be presenL
1he acLlon musL be MC8LL? CCCu and noL evll ln lLself (Lo klll Lo sLeal)
2 1he good effecL musL lMMLul1LL? follow Lhe acLlon (or slmulLaneous wlLh Lhe evll effecL ln Lhe
order of causallLy) lL cannoL be Lhe consequence of Lhe evll effecL
3 1he ln1Ln1lCn of Lhe agenL musL be morally good e lnLends Lhe good effecL only Lhe evll effecL
ls foreseen and permlLLed buL noL wanLed
4 1here should be a 8LSCn8LL 8CC81lCn beLween wlLh good lnLended and wlLh evll
permlLLed
1he [udgmenL of Lhls declslon depends on Lhe CCnSClLnCL of Lhe agenL
MosL dlfflculL prlnclple Lo apply ln Lhe pracLlce of medlclne
Lxample lndlrecL aborLlon

CONSCIENCE
O ln our dally llves as well as ln pracLlce of Medlclne we wlll encounLer a loL of slLuaLlons where our
consclence wlll come lnLo play
O We shall be maklng a loL of declslons*

Def|n|t|on
O 1he lnner sense of whaL ls rlghL or wrong ln one's conducL or moLlves lmpelllng one Lowards Lhe rlghL
acLlon
O 1he complex of eLhlcal and moral prlnclples LhaL CCn18CLS or lnl8l1S Lhe C1lCnS or 1CuC1S of
an lndlvldual
eg l would llke Lo do Lhls buL
O person who acLs eLhlcally ls sald Lo be acLlng ln consclence
8uL noL all who acL ln consclence are acLlng eLhlcally
O Consclence [udges a concreLe acL as good or evll
O Consclence pralses one lf he does good and blames hlm lf he does evll
O 1he human lnLellecL has a pracLlcal knowledge of Lhe ll8S1 8lnClLL Cl 1L MC8L C8uL8 uC
CCCu vClu LvlL
O Moral law ls ob[ecLlve and unlversal Cne can know Lhe law by personal efforL reflecLlon or acLlve
search
O Consclence ls Lhe meeLlng polnL of Lhe MC8L LW Lhe lndlvldual personallLy
O cLlng accordlng Lo one's consclence does noL merely slgnlfy cerLalnLy flrm declslon buL lL conflrms
[udgmenL of
O person who acLs agalnsL hls consclence would acL wrongly owever Lhls does noL make consclence
Lhe Su8LML nC8M
O 1he Su8LML nC8M Cl MC8Ll1? ls Lhe MC8L LW
O Consclence (sub[ecLlve proxlmaLe norm of morallLy has Lo be CC88LC1 WLLLlC8MLu) and ln
C8LLMLn1 Wl1 1L MC8L LW (ob[ecLlve norm of morallLy)

MOPAL DETEPMIMAMTS OF HUMAM ACT
*MCkALI1
O ls deflned as Lhe CCnlC8Ml1? C8 ulSC8LLMLn1 Cl uMn C1 wlLh 1L MC8L nC8MS
O rerogaLlve of human naLure as Sl8l1uL and l8LL
O lways conslders someone who can plan and dlrecL hls behavlors freely
*ConsLlLuLes a pecullar dlmenslon of human acL lL ls prorogaLlon
*Whenever one Lalks

LLLMLN1S CI nUMAN AC1
a C1 lLself
b Lnu pursued by Lhe sub[ecL or Lhe lnLenLlon LhaL moves hlm
c ClrcumsLances LhaL surround Lhe acLlon LhaL can modlfy Lhe 2 elemenLs

LLLMLN1S 1C CCNSIDLk WnLN IUDGING A nUMAN AC1
also called as SCu8CLS Cl MC8Ll1?
C8!LC1 ls Lhe prlmary and essenLlal elemenL whaL ls acLually pursued by Lhe acL

ex 1o shorLen Lhe llfe of a paLlenL ls Lhe ob[ecL of euLhanasla Lo Lake possesslon



8y Lhelr C8!LC1 C1S can be
*CCCu ex 1o work Lo help
*LvlL ex 1o Lake advanLage of someone Lo abuse
*lnulllL8Ln1 ex 1o sleep Lo walk Lo read
ConverLed Lo good or evll dependlng on Lhe lnLenslon of Lhe sub[ecL

2 Lnu
ls Lhe C8!LC1lvL proposed by one who acLs
lL ls hls 8lnClL ln1Ln1lCn wlLhouL lL Lhe acL wlll noL be carrled ouL
When one does someLhlng he does lL for a MC1lvL
ex Cne can do someLhlng Lo serve oLhers or for one's own glory

3 Cl8CuMS1nCLS
O re CCluLn1L SLC1S of Lhe ob[ecL or or of Lhe lnLenLlon of Lhe sub[ecL LhaL llLC1 ln some way
Lhe CCCunLSS or MLlCL of Lhe acL wlLhouL modlfylng lLs subsLance
O Some affecL Lhe MC8L C8!LC1 (Llme place quanLlLy or effecLs) or Lhe Su8!LC1 who acLs (who he ls
whaL manner Lhe means used and Lhe moLlves)
4 More lmporLanL personscandal greaLer effecL

MCkAL kINCILLS
1L C8!LC1 lS 1L 8lM8? nu LSSLn1lL LLLMLn1 Cl 1L MC8Ll1? Cl n C1
O lL ls lndependenL of Lhe lnLenLlon of Lhe sub[ecL aL Lhe momenL of acLlng
O Lx elp an accldenL vlcLlm regardless of Lhe lnLenLlon of Lhe one who helped glve alms ln lLself ls
good even lf done ouL of concelL shorLen paLlenL's llfe ln lLself ls bad Lhrough moLlvaLed by plLy

O 1he
sL
condlLlon for an acL Lo be consldered good ls Lhe C8!LC1 MuS1 8L CCCu
O Some Lhlnk LhaL whaL ls really lmporLanL for Lhe morallLy of an acL ls Lhe 8LC1l1uuL Cl ln1Ln1lCn
4 Lx Cne who performs aborLlon wlLh a good lnLenLlon (Lo save name of an unwed moLher)
belleves LhaL hls acLlon ls morally good
4 Lx 8obln ood sLeallng from Lhe rlch Lo glve Lo Lhe poor
O 1hls erroneous docLrlne ls called Lhe MC8Ll1? Cl ln1Ln1lCn Lhe good lnLenLlon of an acL ls enough
reason Lo quallfy Lhe acL as someLhlng good
O 1hls means LhaL Lhe morallLy of an acL whlch ls good or bad ln lLself cannoL change wlLh Lhe lnLenLlon
of Lhe sub[ecL

2 WLn 1L C8!LC1 lS MC8LL? lnulllL8Ln1
O 1he morallLy of Lhe acL ls deLermlned prlmarlly by Lhe ln1Ln1lCn and/or by Lhe Cl8CuMS1nCLS
O WhaL ls ln lLself lndlfferenL (Lake a walk read) wlll recelve lLs morallLy from Lhe lnLenLlon and
clrcumsLances LhaL accompany lL
3 1L 8lnClL Lnu C8 ln1Ln1lCn Cl 1L Su8!LC1
O Can converL an acL whose ob[ecL ls lndlfferenL lnLo a good or bad acL
O n acL whlch ls good ln lLs ob[ecL can become less good or even bad
O bad acL can become less bad buL never good
O 1L Lnu uCLS nC1 !uS1ll? 1L MLnS
4 Lx SLeallng Lo glve Lo Lhe poor dolng aborLlon or sLerlllzaLlon on a woman Lo spare her of more
mouLhs Lo feed
4 1L Cl8CuMS1nCLS CnnC1 CCnvL81 CCCu C1 ln1C 8u
O nor a bad acL lnLo someLhlng good
O ClrcumsLances can lncrease or decrease Lhe goodness or mallce of an acL
4 LxLo sLeal ls always evll buL gravlLy depends on Lhe amounL sLolen gravlLy of slander depends on
Lhe person who slanders exLenL of spread and who ls slandered


NATU#A MO#A AW
O 1he law whlch man has noL lald upon hlmself
O lL ls a volce deep wlLhln man's consclence calllng hlm Lo do whaL ls good and avold evll Lelllng hlm
lnwardly aL Lhe rlghL momenL Lo do Lhls and shun LhaL

O ConsLlLuLes Lhe 1C1Ll1? Cl uu1lLS lmposed by CCu upon man and whlch man can know Lhrough
uMn 8LSCn (whaLever rellglon even pagan)
O CCu does noL need Lo communlcaLe Lo man Lhese prlnclples of moral llfe 1hey are grasped and
undersLood by man Lhough hls own lnLellecL slnce Lhey are lnL8Ln1 ln lS n1u8L

IUNDAMLN1AL kINCILL CI MCkAL LIIL
O uC CCCu nu vClu LvlL!
O 8uL
WhaL ls good and whaL ls evll?
WhaL are Lhe crlLerla LhaL dlsLlngulsh good from behavlor?
Can one follow an arblLrary rule of conducL or choose Lo acL followlng hls own consclence?

1nL MLASUkL CI GCCDNLSS Ck LVILNLSS CI AN AC1
O roceeds from Lhe !uuCLMLn1 Cl 8LSCn dlscoverlng Lhe uL1lM1L Lnu lmprlnLed ln Lhe 8LlnC
Cl 1lnCS
O lf Lhe acL conforms Lo reason and respecLs Lhe order of belng lL ls good lf noL ls evll
O 1he dlsLlncLlon beLween good and evll ls found ln Lhe very n1u8L of Lhlngs whlch man can know
sponLaneously
O lL ls Lhe very naLure of man whlch lndlcaLes where good and evll are Lo be found
O 1he crlLerla of good or bad acLlon ls noL Laken from Lhe uSLluLnLSS nor from LLSu8L uL8lvLu
from lL nor from Lhe WlLL Cl 1L M!C8l1? nor from any lnvLn1Lu C8l1L8l lL ls deLermlned by
1LnuLnClLS Cl n1u8L Man deduces lLs conLenLs Lhrough Lhe use of 8LSCn

CCN1LN1S CI NA1UkAL LAW
O Man has 3 lunuMLn1L 1LnuLnClLS (L1l1LS) whlch correspond Lo hls belng a Su8S1nCL an
nlML 8LlnC and a 81lCnL 8LlnC
Man ln as much as he ls a CC8C8L Su8S1nCL Lends Lo CCnSL8vL lS LxlS1LnCL and
Mln1ln lMSLLl ln 8LlnC 1hus lL ls good Lo look for means necessary for subslsLence
(food shelLer) and evll Lo Lake one's llfe or endanger lL (homlclde LorLure)
2 Man because of hls naLural lncllnaLlon common wlLh anlmals Lends Lowards SLxuL
CCMMunlC1lCn lC8 8LC8uuC1lCn
WhaLever conforms wlLh hls anlmal naLure ls good (rlghL use of sex formaLlon of famlly
educaLlon of chlldren)
WhaLever devlaLes from or lncapaclLaLes sexuallLy ls evll (homosexuallLy sexual perverslons
sLerlllzaLlon aborLlon aborLlfaclenLs)
3 Man belng a 81lCnL 8LlnC seeks Lhe 18u1 llves ln a socleLy wlLh oLher men perfecLs
hlmself
1o pracLlce vlrLues serve oLhers culLlvaLe splrlLual faculLles are good
1o Lell lles haLe be selflsh glve ln Lo vlces remaln lgnoranL are evll

kIMAk kINCILLS CI NA1UkAL LAW

O Slnce Lhese prlnclples are general lL ls necessary Lo CCnC8L1lZL and derlve more proxlmaLe and
lmmedlaLe concluslons 1hls requlres Lhe collaboraLlon of MC8L SClLnCL whlch deduces wlLhouL
resorLlng Lo complex reasonlng concreLe baslc prlnclples known as 8lM8? 8lnClLLS Cl n1u8L
LW

CnAkAC1LkIS1ICS CI NA1UkAL LAW
O unlvL8SLl1?
Slnce all men have Lhe same naLure naLural law ls unlversal ln characLer
ll men ln whaLever place or Llme are sub[ecL Lo lLs prlnclples
O lMMu18lLl1?
lL does noL change ln Lhe course of hlsLory*
lLs precepLs are permanenL lndependenL of Lhe clrcumsLances of Llme and place*

CAN NA1UkAL LAW CnANGL?
O 2
S1
cenLury man lnslsLs LhaL he ls qulLe dlfferenL from hls medleval counLerparLs so Lhe laws LhaL
govern hlm oughL Lo be dlfferenL
O Man has progressed an lnLelllgenL belng undergolng conLlnuous formaLlon 8uL hls n1u8L does noL
change

O WhaL may change are Lhe condlLlons for lLs appllcaLlon


Lx Slavery usury


COO!E#ATION WITH EVI

Am I respons|b|e on|y for my own act|on?
O Mn lS SCClL 8LlnC e acLs wlLhln a neLwork of lnLerpersonal relaLlons because he needs oLhers
Lo perfecL and develop hls personallLy and lmprove hls work
O 1hus he ls morally 8LSCnSl8LL noL only for hls acLlons buL also for Lhe good or evll lnfluence of hls
acLlons upon oLhers

1nL kIMAk kINCILL CI NA1UkAL LAW
O uC CCCu nu vClu LvlL
O Can be wldened lnLo uC CCCu and uC nC1 lnlLuLnCL C1L8S 1C uC LvlL
O We are obllged Lo cooperaLe wlLh Lhe good and help oLhers Lo do good CSl1lvL CCCL81lCn
4 Lx docLor who does [ls [ob well glves good advlce encourages a paLlenL ln crlsls and
becomes a model Lo hls sLudenLs/resldenLs
O n honesL professlonal man oughL Lo ask hlmself lf he ls dolng Lhe rlghL Lhlng when he CCCL81LS ln
nC1L8'S LvlL uLLu
O SlLuaLlons can arlse when he WlLLlnCL? or unWlLLlnCL? ul8LC1L? or lnuC8LC1L? CCCL81LS ln
Lhe evll LhaL oLhers perform
4 Lx nurse worklng ln a cllnlc performlng 81L vasecLomy aborLlon accounLanL who docLors" a
cllenL's l18 a conLracLor who pads Lhe cosL of a pro[ecL Lo lnclude Lhe brlbe

1he |mmed|ate quest|on |s
O Should all forms of cooperaLlon be denled?
O under whaL condlLlons can some Lype of cooperaLlon be allowed?

1hls ls a classlc Loplc ln morals

NC1ICNS 1LS CI CCCLkA1ICN
O 1he noLlon of cooperaLlon wlLh evll ls broad
O lL lncludes all help glven Lo Lhe evll acL of anoLher
4 Lx 1o command or advlse anoLher Lo commlL an llllclL acL Lo sell an ob[ecL whlch ln lLself ls
good and lnnocenL buL whlch wlll be used for an evll acL

CLASSIIICA1ICN CI CCCLkA1ICN WI1n LVIL
CSl1lvL CCCL81lCn
O volunLary acL whlch conLrlbuLes Lo Lhe evll acL of anoLher
4 Lx n lnLern asslsLlng ln a sLerlllzaLlon procedure
2 nLC1lvL CCCL81lCn
O ConslsLs ln an omlsslon allowlng anoLher person Lo do an evll acL whlch one could and oughL Lo have
done someLhlng by resLralnlng warnlng or denounclng
4 Lx llowlng a plckpockeL Lo sLeal allowlng a classmaLe Lo cheaL
3 lC8ML CCCL81lCn
O When one wllls or consenLs Lo Lhe evll acL of anoLher wheLher or noL Lhe agenL of Lhe evll acL knows
abouL lL
4 M1L8lL CCCL81lCn
O When cooperaLlon wlLh Lhe evll acL ls Lhrough a ?SlCL C1 wlLhouL wllllng or consenLlng Lo lL Cne
cooperaLes wlLh Lhe evll acL buL noL wlLh Lhe evll lnLenLlon
4 Lx nurse sslsLlng a 81L
3 lMMLul1L (ul8LC1)
O When lL colncldes ln Lhe same acL as Lhe one commlLLlng Lhe evll acL
4 Lx elp a Lhlef load a sLolen ob[ecL asslsL an aborLlonlsL
6 MLul1L (lnul8LC1)
O When one provldes Lhe means used by anoLher person Lo do evll owever ln lLself Lhe means does
noL have any relaLlon Lo Lhe acL
4 Lx Sell a knlfe whlch was laLer used ln commlLLlng murder
7 8CxlM1L nu 8LMC1L CCCL81lCn

O ccordlng Lo a greaLer or lesser degree of physlcal or moral proxlmlLy beLween Lhe acL of cooperaLlon
and Lhe evll acL of anoLher
4 Lx ulrecLly asslsLlng ln an evll acL as aborLlon ls 8CxlM1L cooperaLlon
4 Lx voLlng for a candldaLe repuLed Lo be corrupL ls 8LMC1L cooperaLlon

CkI1LkILA ICk IUDGING 1nL MCkALI1 CI CCCLkA1ICN
Lvery cooperaLlon whlch ul8LCL1? lnfluence Lhe evll lnLenLlon of Lhe person wlLh whom one cooperaLes ls
always llllclL lL ls a scandal Lo lnclLe oLhers Lo do evll
2 lC8ML CCCL81lCn ls always llllclL lL does noL only affecL Lhe evll acL lL also affecLs Lhe evll lnLenLlon
by approvlng Lhe mode of acLlon of Lhe evll doer
3 M1L8lL CCCL81lCn ls llllclL Cne musL noL help anoLher do evll
O ln cerLaln clrcumsLances lL may be llclL Lo cooperaLe maLerlally ln order Lo obLaln Lhe necessary good
or Lo avold a more serlous harm
4 Lx cooperaLe wlLh hosLage Laker lnLern cooperaLes wlLh docLor ln performlng 81L
O LLhlcal [udgmenL regardlng Lhe llclLude of maLerlal cooperaLlon ln anoLher person's evll acL has Lo be
made ln case Laklng lnLo accounL Lhe prlnclple of uCu8LL LllLC1

SCML SLCIIIC LkAMLLS
O M1L8lLL? W8l1lnCC uCWn SCML 8LSC8l1lCnS
4 lnLern on docLor's order wrlLes down a prescrlpLlon for conLracepLlves for a paLlenL
4 lL ls advlsable LhaL Lhe lnLern Lhough he cannoL argue wlLh Lhe docLor show hls dlsapproval of
Lhe maLLer
O luu ls lnserLed by Lhe docLor asslsLed by a nurse
4 luu ls boLh conLracepLlve as well as aborLlfaclenL
4 Cne ls deallng wlLh an acL LhaL ls excluslvely dlrecLed aL sLerlllzaLlon whlch also resulLs ln Lhe
desLrucLlon of llfe (8C81llClLn1)
O S1L8lLlZ1lCn
4 lnLern and nurse asslsL ln CsecLlon where Lhe obsLeLrlclan Lhen proceeds Lo do 81L afLer Lhe
prlmary procedure
8oLh may flnd Lhemselves asslsLlng ln an llllclL acL because Lhey have noL been
prevlously noLlfled (someLlmes lncludlng Lhe paLlenL's husband)
1hey have Lo explaln Lo Lhe obsLeLrlclan Lhelr moral sLand (also remlnd Lhe
obsLeLrlclan LhaL lL ls noL lncluded ln Lhe consenL)
O 8C81lCn
4 1he evll of aborLlon (Lhe un[usL deprlvaLlon of Lhe llfe of an lnnocenL and helpless belng) ls of
such gravlLy LhaL lL ls dlfflculL Lo [usLlfy any cooperaLlon ln Lhe acL
8CxlM1L CCCL81lCn ls always llllclL Lx 1o collaboraLe ln lLs performance as an
anesLheLlsL or lnsLrumenL nurse