Medical Ethics Flashcards
What was (mainly) said in the Universal Declaration of Human Rights?
Universal Declaration of Human Rights (1948): Everyone has the right to life, liberty and security of person
What is the moral status of an embryo according to substance ontology ethics?
Substance ontology theories of embryological development:
Fertilisation > implantation > individuation >‘publication’ *> interaction >legal limit of abortion > start of life-supporting treatment > birth
Moral status is binary
*Publication is ~12 weeks, when the risk of miscarriage decreases drastically and most people announce they are pregnant
What is the moral status of an embryo according to continuity theories?
Continuity theories: Moral status is gradual [“we must not expect more precision than the subject matter admits” Aristotle]
What was the first example of medical ethics?
The oath of Hippocrates
What are the remarkable parts of the oath of Hippocrates?
“I will never divulge, holding such things to be holy secrets”. This means “I won’t talk about what I hear from my patients” and refers to the duty of confidentiality.
Do no harm/non-maleficence or primum, non noscere. This is more difficult then you think, because ether/anesthesia was only introduced in 1840 and the idea of germs causing (post-surgery) infections is from 1860. Before that time surgery could do more harm than good. In modern times, this can e.g. refer to cancer treatment. Don’t treat if that will cause extra harm to the patient
Why is confidentiality important according to consequentialism?
Confidentiality is important according to consequentialism because a relationship of trust is needed for a patient to give the doctor all the information they need.
Why is confidentiality important according to deontology?
Confidentiality is important according to deontology because of the right of privacy
What were the most important principles from the Nuremberg Code?
The most important principles from the Nuremberg Code (1946):
- “The voluntary consent of the human subject is absolutely essential” (article 1)
- Minimization of harms and suffering
- Balance of risks and societal benefits
What is the declaration of Helsinki?
The declaration of Helsinki (1964): raised standards for doctors participating in trials. It built on the Nuremberg Code and has been revised 7 times.
What are the most important principles of the Helsinki declaration?
The most important principles of the Helsinki declaration:
- The protocol must be evaluated by a research ethics review committee
- Proxy consent can be given by legal guardians of those unable to consent
- Vulnerable populations require special protections
- Subjects should not be withheld standard of care. You can’t withhold effective treatment and give them placebo
- Post-trial access arrangement. If the drug works, the drug has to be provided to participants until it becomes freely available on the market
- The interests of the subject “take precedence over the interests of science and society”
Who is Henry Beecher?
In 1966 Henry Beecher published a list of experiments that are ethically flawed. All of this research was “normal” government-funded, university-based research. Some of these experiments also happened after the 1940s. It wasn’t considered illegitimate or morally wrong until Beecher pointed it out.
What are some experiments on Henry Beecher’s list?
- -Lower blood pressure in sick patients to see if the heart or brain stops working first. Is this proportional? How do we benefit from this knowledge?
- Inject mentally disabled children with Hepatitis C to study the natural course of the disease
- Use mentally disabled to see if cancer could be transferred from one person to the other. (Inject tumor cells in healthy patient –> Do they get cancer? Yes.). This is how metastasis was discovered.
All of this research was “normal” government-funded, university-based research. Some of these experiments also happened after the 1940s. It wasn’t considered illegitimate or morally wrong until Beecher pointed it out.
What happened with the Tuskegee syphilis experiment (1932-1972)?
In this study, they wanted to follow the natural course of syphilis in African-American men. The participants were promised (and got) free feed, healthcare and funeral if they participated, but weren’t told what the research was about. They just got injections every once in a while. Researchers implied they were treating them, but didn’t and did not tell them that syphilis could be spread via sex. –> almost the whole community got infected. Researchers did not give the participants penicillin when that became available (and could cure syphilis). There was an outrage after journalists exposed the research. After the outrage, the research was stopped.
What are the four principles of biomedical ethics from Beauchamp and Childress?
“Principles of Biomedical Ethics” by Beauchamps and Childress (1985):
- Beneficence (benefit health patients)
- Non-maleficence
- Respect for autonomy
- Justice (treat similar people similarly. Distribute resources equally (but what is equal?))
What is an example of non-maleficence?
William Halsted’s radical masectomy (1890s-1980s). Breast, muscles and lymph nodes were removed regardless of cancer stage, which impaired upper body function. Women were either undertreated or overtreated.
