Ethics in psychiatry Flashcards
First book on medical ethics
- Ishaq bin Ali Rahawi
- book called Adab al-Tabib (conduct of a physician) from 9th century
Hammurabi code
- first attempt in history to codify medical competence and legal liabiity for negligence
- not a code of ethics
Charaka
- ancient Indian physician
- earliest medical ethics relevant to modern medicine
- 4 ethical principles
1. friendship
2. sympathy
3. interest
4. no attachment to the patient after their recovery - always strive to acquire knowledge
Higher order principles
Deontology and teleology are two alternative higher-order ethical principles regarding medical practice
Deontology
- Deon is greek for duty
- Rules govern medical practice
- rights and duties determine action and so it is absolutism
- -according to Ross, some duties are right because of their very nature e.g telling the truth- these are prima facie duties
- other duties are right in particular circumstances- duty proper
e. g GMC good medical practice
Teleology
- teleon is greek for ‘purpose’
- -people have interests, whether these are concerns, desires or needs
- accordingly a broad judgement of benefits and harm determine medical practice
- the right action is the one that has the best foreseeable consequences
- also known as consequentialism or utilitarianism
Utilitarianism
- right action for best foreseeable consequences
- act utilitarianism: deals with a specific act only
- rule utilitarianism: deals with general practices for which rules can be established
Prima Facie principles
- Beaucheamp and Childress, Gillon
1. autonomy
2. beneficence
3. non-maleficence
4. justice
Paternalistic model
-doctor knows best
Informative model
- doctor is seen as a dispenser of information
- choice is left to patient
Interpretative model
- doctor might have treated the patient for a long time and know them well and so understands them
- shared decision making
Deliberative model
- doctor may act as friend and counselor
- gives information and advises on course of action
- used in lifestyle modification
Direct ethics
-to determine the ethical behaviour we should assess the act -what has to be done
Indirect ethics
-about the character of the moral agent choosing these actions
Pragmatic ethics
emphasis on achieving success and reaching a goal with little concern on how this is achieved