Bioethics Flashcards
Non-Hippocratic Codes
Codes were Hippocratic until the 1970s, were written by not medical ppl but came about by liberal politics
Nuremberg Code (1946 after WW2)
Informed consent came about from the Nuremberg trials
Universal Declaration on Bioethics and Human Rights
International standard for ethics (2005)
Moral Standing
Is the moral status of a being, can have “full standing” (humans) or “limited standing” (corpses, egg/sperm, fetuses, non-human animals)
Cardiac-Oriented View of Death
Individual dies when there is irreversible cessation of circulatory/resp function
Whole-Brain View of Death
Individual dies when there is irreversible cessation of all functions of the entire brain (including brain stem)
- this is current law except in Japan, NJ and NY
Higher-Brain View of Death
Individual dies when there is an irreversible loss of “higher” brain function; consciousness usually considered critical
Abortion 3 Views
- acceptable until capacity for higher brain function exists (~ 24wks)
- acceptable until capacity for any brain function exists (~ 8-12wks)
- acceptable until capacity for cardiac function exists (conception)
Capacity
Actual ability to carry out function
Potential
Genetic program to develop the capacity to carry out the critical function
Non-Human Animals
Western thought: sharp division btwn humans and other animals
Eastern thought: connections closer btwn humans and animals
Speciesism
Belief that membership in a species per se is relevant to moral standing
Principle
General characteristic of actions that makes them morally right
Virtue
Character trait of a person
Beneficence
Do good
Nonmaleficence
Don’t do harm
Utility
Measure of net good by taking into account both benefits (beneficence) and harms (nonmaleficence)
Objective vs. Subjective Judgments
Hippocratic: clinician subjective judgment of facts/therapy
Modern: strives for objectiv judgment of facts, medical science can tell which therapy is best
Postmodern/contemp: pt’s values should take precedence
Medical vs. Other Benefits
- if health is goal, pt math want to trade health off for other goods
- if total welfare is goal, physician’s skills are inadequate
Conflicting Medical Goals
- Save life
- Cure dz
- Relieve suffering
- Promote health
Conflicts over Relating Benefits to Harms
Hippocratic formula (arithmetic or geometric combining), Primum non nocere (“first of all, do no harm”)
Fidelity (respect for persons)
Duty of loyalty
Confidentiality: hippocratic principle justifies breaking confidence to benefit pt
- fidelity supports duty to keep promises of confidence EVEN IF pt would benefit from breaking it
Autonomy (respect for persons)
- Informed consent
- negative rights: liberty rights (right to be left alone)
- positive rights: entitlement rights (right to some good or service)
Veracity (respect for persons)
Truth-telling and lying
Avoidance of killing (respect for persons)
euthanasia
British Medical Association
Abandoned hippocratic paternalistic exception for breach of confidence and replaced with:
- exception of pt agrees, or formal public policy
- 1971
American Medical Association
Abandoned hippocratic paternalistic exception for breach of confidence and replaced with:
- exception of threat of serious bodily harm, or applicable statute/ordinance
- 1980
Therapeutic Privilege
Clinician’ privilege of withholding info that he/she believes will be harmful to the pt
(re: autonomy)
Professional Standard (for informing)
What competent physician similarly situated would disclose
Reasonable Person/pt Standard (for informing)
What reasonable pt would want to know or would find important in decision making
Subjective standard (for informing)
What specific pt would want to know
Consent
Autonomy requires the use of the reasonable person standard modified by what the clinician knows or should be expected to know about the pt’s unique subjective interests
Veracity (for informing)
From 60s to 80s there was radical change from non-disclosure to disclosure of the dx
(Veracity - truth-telling and lying)
Active Killing vs. Letting Die
- consequences of active killing may be worse (wrong ppl may die)
- autonomy can require clinician not to treat but does not require physician to actively kill
- active killing is simply inherently wrong
Stopping vs. Not Starting Tx
Feels diff to clinicians but they are ethically equivalent actions
Direct vs. Indirect Killing
Direct = intended (active or passive) Indirect = unintended (active - anesthesia; passive - forgoing life support)
Ordinary vs. Extraordinary Means
Ordinary = proportionally beneficial Extraordinary = benefits do not exceed burdens (turning an old woman over to prevent decubitus ulcer but it breaks her bones, etc.)
Formerly Competent Pt
Have expressed wishes about terminal care while competent
- moral: “autonomy extended”
- legal: substituted judgment
Never-competent Pt (w/o fam)
No one w/ standing to speak for the pt
- “best interest” standard is the legal principle, and usually best option
Never-competent Pt (w/ fam)
Fam given standing to speak for pt (normally next-of-kin, until proven malicious, unreasonable, or unwilling)
*limited familial autonomy: fam has autonomy w/in reason
Principle of Social Utility
for allocating scarce resources
Action is justified if it produces as much net good in aggregate as possible considering all who are affected
- problems: quantification and inequity (mainly equity)
Principle of Justice
for allocating scarce resources
Action is justified if it strives for an “end-state pattern” of the distribution of the good (may not do as much good as principle of social utility)
- modern “end-state pattern”: effort or need
Clinician’s Role in Allocating Resources
- let clinicians abandon their pt’s @ the margin
- give clinicians exemption from principles of social ethics
Duty proper
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Prima facie
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Duty proper
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Prima facie
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