Basics and ethics Flashcards
What is medical law?
body of laws concerning the rights and responsibilities of medical practitioners and their patients. - what should medical practitioners do?
development and hippocratic oath
Used to be conducted in secrecy, idea of benevolent paternalism (doctor knows best) and no empirical basis to the practice (no clinical trials to prove their roles)
self determination did not develop until eugenic policies were introduced during WWII - Nuremberg code
oath written by hippocrates - in modern society it is a code of practice not binding covenant - only heal, dont cause harm or kill - symblolic
ECHR
Article 2 - right to life - doctor may not intentionally kill a patient
Article 3: the right to protection from torture, inhuman or degrading treatment - doctor cannot leave a patient in a state that is inhuman or degrading e.g. trans person beign denied surgery
Article 8: the right to respect for private life - A patient has an absolute right to refuse treatment and donor conceived children and their rights to their donor name and address
Article 9: - Freedom of thought, conscience and religion - can refuse treatment even if it will kill you as doctors must respect religious beliefs
Article 14: the right not to be discriminated against - A doctor may not allocate healthcare resources based on age or sex
Ethics
system of principles or values that assist decision making - mason and mccall smith
Medical ethics is a branch of applied ethics which is concerned with how we go about resolving the dilemmas that we face in medical practice - historically been too narrow and paternalistic
didnt take social causes of illness into account e.g war, pollution, enviro, DV - Sherwin 1998
focused too much on consent and too little on patient’s perspective and resp to make good decisions
Bioethics
Newer discipline that concerns life sciences
wider remit - looking at social contexts which was absent in medical ethics
raises Qs e.g. new health technologies? what ethical issues arise?
Consequentialism
Teleological (judge rightness of an action based on consequences)
judge an action by its cons
central princip: Maximisation of human welfare, - choose what has best overall consequences for greatest number - utilitarian approach
Utilitarianism
quantifying approach to wellbeing - if killing one person will help the survival of five, is it what we should do?
QUALYs - Quality adjusted life years - cost effectiveness toll used in resource allocation
Criticisms:
Only keep promise/acts if this will generate best consequences
ignores intrinsic value of certain acts
Cannot uphold rights - as minority group is not being considered
Quantitative approach to welfare
Organ-donation - if someone had a good life then better chances of receiving an organ than someone who took drugs when they were younger
Solution: Rule Utilitarianism- for overall consequence - not always quantitative, also about the thinking of the context the decision is imbedded in
deontology
Immanuel kant - arg we will never know full cons of actions - perform actions we know are intrinsically good and avoid intrinsically bad actions
duty to act and do the right thing
Categorical imperatives:
universal princip: act only on that maxim whereby you can at the same time will that it should become a universal law
Humanity princip: never use a person as a means to an end e.g. conceive a child to save sick older sibling
Criticisms:
how do we know what is intrinsically good?
Exceptions/ - resource constraints where one persons treatment is so expensive leaves many others without treatment
Do rules respect autonomy? - deontology would arg against euthanasia
Virtue ethics
Aristotle - purpose of life is to act in virtuous way - concerned with nature of action and intention to act
rejects idea patient autonomy is an absolute overriding virtue
Virtues = traits necessary for ‘human flourishing’ - honesty, courage, compassion etc - expressed through actions and if constantly act virtuous you will become virtuous
Criticisms:
What are virtues? are there really virtuous ppl?
no straightforward answers
Principlism
Beauchamp and Childress
- autonomy - patient’s right to choose over his/her own life and the health professional’s duty to respect this autonomy
- Non-Maleficence: it is professional’s duty to cause no harm or damage to the patient - difficult in contexts of euthanasia
- beneficence: every medical action must promote the wellbeing and the participation of the other, requiring some balance between the benefits and possible damages of a certain action
- justice: we should treat like cases a like. For example, the duty to distribute health resources impartially
Casuistry
uses concrete cases and analogy (bottom up approach) - look how analogous probs were solved in past - no ethical prob is completely unprecedented
No ethical problem is completely novel and therefore it makes sense to look at how similar ones resolved in the past.
Criticisms:
exceptions exist
analogies are never perfect
Feminist ethics
gender inequality e.g. clinical drugs trials exclude women due to pregnancy so drugs arent safe for women
believes med ethics focus on dilemmas facing doctors but ignores carers, nurses and patients
women = disprop rep among patients with their reproductive capacity as principal carers for children, elderly and greater life expectancy
criticism - disempowers women by associating them with care
key princips
- Autonomy: Right to make decisions about your future (Are we fully autonomous?)
- Human dignity: vague concept (we do not bin human tissue or embryos)
- Sanctity of Life: human life is ‘sacred’ (what makes us superior than non-human animals? Eg a healthy animal vs brain dead person?)
- Playing God: (This argument assumes that God gives life and takes it away. Should we reject medicine? Should we let nature take its course?)
- Slippery Slope: This is a consequentialist argument –it is not about a particular technique but a fear about what that technique can lead to. (the future of uncontrollable consequences. But this can be regulated.)
- Precautionary Principle: If our actions may lead to morally unacceptable harm that is plausible but uncertain, we should avoid or diminish that harm.
