Lecture 3 - Methodologies Flashcards
Paternalism
Interfering with someone’s liberty for their own good.
Utilitarian view on paternalism.
Unencumbered persons known their own interests best. People are meddlesome by nature. So, since interference with unencumbered persons will produce more harm than good, it’s best to have a rigid rule against paternalistic interference with the unencumbered.
Ethical decision making involves identifying these 3 things…
- An ethical problem.
- The courses of action that are available.
- The course of action that has the weightiest reasons in its favour and acting on those reasons.
If the non-moral facts are clear and the principles point to the same course of action there is….
no ethical problem
How to identify if there is a moral problem (5 steps).
- Ask “are the non-moral facts clear and do the moral principles all agree on an action?”
- If answer is yes, there is no moral problem.
- If answer is no, then:
3a) Are there unclear or disputed non-moral facts?
3b) Do the moral principles conflict or is anything unclear? - If yes to 3, explain and assess.
- Ask “What is the course of action with the weightiest reasons and why?”
Disadvantages of strong paternalism.
Interferes with autonomy and encourages meddling.
Advantages of strong paternalism
Prevents some tragedies.
Disadvantages of weak paternalism
Permits preventable tragedies.
Strong paternalism in biomedical ethics.
Interfering with someone for their own good whether or not they are encumbered.
Prima facie
Based on the first impression; accepted as correct until proved otherwise.
Are principles of biomedical ethics prima facie principles or absolute principles?
Prima facie principles
Weak paternalism in biomedical ethics
Interfering with persons in their own interest only if they are encumbered, or they would be at risk to themselves, or we can intervene without causing more harm than is prevented, and the least intrusive means are used, and our action is not discriminatory.
Kantian ethics
What is right is to treat people as ends never merely as means (respect absolute value by respecting their autonomy).
What are the four topics?
Clinical issues, quality of life/death, preferences, and contextual features.
If the non-moral facts are unclear or the principles conflict or there is uncertainty about their meaning/application, there is a….
ethical problem
Kant’s argument for weak paternalism.
We cannot override a person’s autonomous choices, because that treats them merely as a means.
Method for making ethical decisions in clinical care (4 steps)
- Identify relevant facts using the Four Topics
- Identify the relevant moral principles and explain their relevance.
- Identify if there is a moral problem(s), and what it is.
- Resolve the moral problem by identifying evidence favouring one action over others.
What information should one include under “quality of life/death”?
What the quality of life/death of the patient would be with and without available treatments.
Fidelity
Living up to trust relationships with others; being faithful to institutional and professional roles.
Advantages of weak paternalism
Minimizes unwarranted interference. Respects dignity.
What are examples of clinical issues?
Diagnosis/prognosis, risk/benefits of treatment, goals/values of patient, and best clinical judgement.
What information should one include under “preferences”?
What the patient wants. If the patient is competent or not. If the patient is incompetent, do they have a surrogate? Is there informed, voluntary consent? What the HCP wants.
“The Four Topics” consist of which category of facts?
Non-moral facts.
