Bioethics Flashcards
The development of bioethics (5 points)
- Hippocratic Oath
o Modern doctors see it as a promise to uphold the art of medicine and act in patients’ best interests - Early paternalistic medicine
o Doctors knew best
o WW2 experimentation on Jewish people – against Hippocratic oath - Nuremberg Code 1947
o Self-determination - Voluntary consent of the human subject is absolutely essential - Declaration of Helsinki 1964
o First significant effort of the medical community to regulate research itself through ethical codes - Key Rights in ECHR
Key rights and legal principle in the ECHR (as incorporated by the HRA 1998)
Article 2 - right to life
- Legal principle: A doctor may not intentionally kill a patient
Article 3 - right to protection from torture, inhuman or degrading treatment
- Legal principle: A doctor must not, where possible, leave a patient in a state that is inhuman or degrading
Article 8 - the right to respect for private life and the right to family life
- Legal principle: A patient has an absolute right to refuse treatment
- Legal principle: A doctor should consult with parents, where possible, before providing treatment to children (unless the child is sufficiently mature to make his or her own decision)
Article 9 - freedom of thought, conscience and religion e.g. Jehovah’s Witness refuse blood transfusions – doctors must respect this
- Legal principle: A patient has an absolute right to refuse treatment
Article 14 - the right not to be discriminated against e.g. during Covid, people in care homes refused PPE and not vaccinated as were old so not prioritised
- Legal principle: A doctor may not allocate healthcare resources based on age or sex
Tensions between articles
Article 2 and 3
People want to die due to medical conditions they are in – some argue patients have a right to due as it would be torture otherwise
They cannot have the ability to kill themselves and doctors are not allowed to administer drugs to do it for them in the UK as euthanasia is illegal so they are left to suffer
Charlie Guard case (plus academic)
Terminally ill baby – needed artificial ventilation, but doctors at GOSH did not think it was in best interests
Doctors applied to High Court for confirmation that removing ventilation would be lawful – contested by parents
Experimental treatment being offered in US – however never been used on patients like Charlie, not seen Charlie or read his notes, doctor had financial interest in providing the treatment
High Court ruled in favour of GOSH – confirmed in Supreme Court and ECtHR
Charlie moved to hospice, ventilator removed and died
Art 8 – doctor should consult with parents unless child sufficiently mature to make his own decision – Charlie only baby so unable to make his own decision (could not exercise own autonomy)
Hippocratic oath – doctors must act in patient’s best interests so should prioritise the patient over the parents wishes (principlism)
Role of courts – should base judgment off medical advice and patient’s best interests rather than parents wishes. Important to consider parent’s wishes but this is not determinative factor, should be best interests of child
Brassington – situation was not unjust – ‘Charlie Guard was a very unfortunate child, but not every misfortune indicates an injustice’
Amendments to HFEA 1990 passing through parliament (plus academic)
Clause 14(4)(9) - people or embryos known to have a gene, chromosome, or mitochondrion abnormality that confers a significant risk of serious physical or mental disability, serious illness, or other serious medical condition must not be preferred over those not known to have an abnormality.
Emery et al – this is discriminatory: ‘wording implies that deaf people are less valuable than “hearing” people, and likewise for their embryos. This contradicts attempts by the UK government to recognise the equal status of deaf people in policy (through recognising British sign language) and in law (through equal rights for deaf people). Deaf people wish to have equal rights when making decisions about reproduction, even when genetic technology is involved’
Making ethical decisions - yuk factor? (2 academics)
o George Orwell – moral nose: can you simply sniff a situation and detect wickedness?
o John Harris – criticises the notion that people have ‘gut feelings’ about what is right and wrong as it is unreliable – we need to identify reasons that justify our position
Making ethical decisions - the trolley problem (explanation and 2 academics)
o Would you pull a lever to divert the train tracks to one man standing on the tracks and kill him, rather than letting the train continue on the original track which 5 people were standing on?
o Would you push a fat man off the bridge to stop the train which would save 5 people?
o Most people would pull the lever but very few would push the fat man off the bridge
o Foot
Distinction between killing and letting die.
Killing is active while letting die is passive – pulling the lever is saving the life of five workers and letting one person die whereas pushing the fat man over the side is an intentional act of killing
o Truog et al
Covid-19 In India oxygen shortages – proposed triaging ventilator allocation by independent triage committee which would lift moral burden from treating physicians and keep physician out of loop while advising patient and their relatives of the decision
Religious perspectives
o Sanctity of life, treating all humans equally, distinguishing right and wrong
Consequentialism/utilitarianism
o Teleological reasoning – judge the rightness or wrongness of an action in terms of its consequences
o Choose the path which has the best overall consequences for the greatest number
o UTILITARIANISM
Places the concepts of ‘good and bad’ before the ideas of ‘right and wrong’ – aims to achieve greatest happiness for the greatest number
Quantitative approach to wellbeing – if killing one person will help the survival of five, it would have the best consequence
Critiques of utilitarianism (4)
- Only keep promises/acts if this will generate best consequences –
o this means intrinsic value of certain acts are ignored (e.g. doctor-patient confidentiality)
o also cannot uphold rights (e.g. may be denied expensive treatment as allocating resources to save a greater number of people, but surely the individual still has a right to treatment) - Quantitative approach to welfare –
o E.g. organ donation – killing one to save five – this is problematic
o Potential solution: rule utilitarianism – would not ask on case by case basis which action will maximise welfare, but rather which general rules will on the whole lead to best consequences - How do you know what is a good consequences?
- How do you rank consequences/interests?
Deontology
o Kant – we can never know the full consequences of our actions, so we should perform actions we know to be intrinsically good and let the consequences unfold
o Perform intrinsically good actions and avoid intrinsically bad actions
o Universal principle: Act only on that maxim whereby you can at the same time will that it should become a universal law
o Humanity principle: Act as to treat humanity, whether in your own person or in that of any other, never solely as a means but always also as an end (not a means to an end) – e.g. saviour siblings would be wrong
Critiques of deontology (4)
- How do we know what is intrinsically right or wrong?
- Only tells us what not to do – what should we do?
- Are there exceptions? – e.g. resource constraints
- What of the patient? – do rules respect autonomy?
Virtue ethics
o Purpose of life is to act in a virtuous way – concerned with both nature of the action and intention to act
o Rejects idea that patient autonomy is an absolute or overriding virtue
Critiques of virtue ethics (2)
- What are virtues? Are there really virtuous people?
- Wanting to do the right thing – a doctor who withholds diagnosis of terminal cancer from patient may be doing it from compassion but this would still be the wrong thing to do
Principlism
o Beauchamp and Childress four principles:
1. Autonomy – patient’s right to choose his/her own life and health professional’s duty to respect this autonomy
2. Non-Maleficence – professional’s duty to cause no harm or damage to the patient (similar to virtue ethics)
3. Beneficence – every medical action must promote the wellbeing and participation of the other, requiring balance between the benefits and possible damages of a certain action (similar to consequentialism)
4. Justice – we should treat like cases a like e.g. duty to distribute health resources impartially (similar to deontology)
o Potential 5th – Common Good – we should do sacrifices for the common good e.g. public health, protection of environment
