23-09-21 - Moral Theory and Principle of Medical Ethics

Question 1

What are the 3 common moral theories in medical ethics?

What is an example of each?

Answer 1

• Basis of theory: An action is right if, and only if:
• Consequentialism – It promotes the best consequences. Most common form is utilitarianism (the best outcome for the most people)
• Deontology – It is in accord with a moral rule or principle. Duties and rights-based morality. Moral rule or principle can be decided on universality e.g., telling the truth.
• Virtue ethics – It is what a virtuous agent would do in the circumstances. A virtue is a character trait a human being needs to flourish. e.g., a good doctor is one who is caring, disciplined, skilful, trustworthy

Question 2

What are shortcomings with each of the 3 common moral theories?

Answer 2

• Consequentialism
• Which good?
• How do we quantify good?
• Is it practical to make moral decisions with a calculator?
• Inadequate protection for individual rights
• Deontology
• Consequences matter
• How do we decided on duties?
• How do we decide on duty hierarchy?
• What about situation where we seem to be morally required to break a rule (e.g lying to protect someone from physical harm)
• Virtue ethics
• How do you decide on virtues?
• May be culturally specific

Question 3

What are 3 other theories of medical ethics?

Answer 3

• Moral relativism – There is no objective way to establish that a particular morality is the correct morality and concludes there is no reason to believe in a single true morality.
• Cultural relativism – beliefs, customs and morality exist in relation to the culture from which they originate and are not absolute.
• Principlism – emphasises four principles of medical ethics and blends these with virtues and practical wisdom

Question 4

What are the 4 principles of medical ethics?

Answer 4

• Justice – fairness in the provision of care
• Beneficence – Doing good
• Non-maleficence – Avoiding doing harm
• Autonomy – Respecting the patient’s wishes.

Question 5

What is Justice?

Answer 5

• Fairness in all decisions regarding a patient’s treatment
• Patients will receive equal access to resources and treatments
• Scarce resources will be distributed as evenly as possible.
• Healthcare professionals will respect the patients’ rights and morally acceptable laws.

Question 6

What is Beneficence?

Answer 6

• Healthcare professionals will make decisions to achieve the best patient outcome possible.
• They will acknowledge that what is the best course of treatment for the patient won’t be the best course for another.
• Doctors will keep their professional skills up to date and act competently to uphold beneficence

Question 7

What is non-maleficence?

What must be considered?

Answer 7

• Do not cause harm to patients or the community
• Ties in with beneficence
• Sometimes harm is unavoidable during certain treatments
• Doctrine of double effect must be considered

Question 8

What is autonomy?

Answer 8

• Allows for competent informed patients to make decisions regarding their own course of treatment (informed consent) and respecting those decisions
• This is true whether the decision has a positive or negative effect (such as blood transfusion for a Jehovah’s witness)
• Patients can only reject treatment; they can’t ask for treatment that was not offered.
• Also respecting a patient’s right to confidentiality.

Question 9

What is the doctrine of double effect DDE?

Answer 9

• Moral distinction between intending harm and foreseeing harm
• It is not permissible to deliberately cause harm
• It is permissible to cause some harm through a beneficial effect (sometimes this is described as harm being a foreseen but unintended side effect of the beneficial effect)

Question 10

What are the four criteria of the doctrine of double effect? What is an example where the DDE is used?

Answer 10

• The action must be good, independent of its consequences
• Although the bad effect can be foreseen, the agent must intend only the good effect
• The bad effect must not be a means to the good effect (e.g., giving a high dose of pain medication so the patient dies)
• The good effect must outweigh, or compensate for, the bad effect
• It is morally permissible to give a high dose of a drug (let’s say morphine) to ease a patient’s pain – even when the doctor can foresee that this will hasten the patient’s death
• It is NOT morally permissible however to give the drug to cause death