Moral status Flashcards
What are the criteria for moral status?
Sentience Human Autonomy Personhood Potentiality Patient SHAPPP
All 6 apply to us because we are all one of those things, but for particular patient groups only certain ones of these will apply
You don’t have to have all of them but you just have to have one or more to have moral status
What is sentience?
Neurological intact state - ability to feel pain/pleasurable stimuli
If we can feel pain then we assume you dont want to feel pain - have moral status
What are the clinical applications of sentience?
Pain relief - moral duty to avoid pain
- also applies for unconscious patients in ITU because they may still feel pain
Esp. for foetus over 20 weeks gestation - need to make sure if you are carrying out any procedures that the foetus is anaesthetised - at this time the neurones are sufficiently mature for the foetus to feel pain but they won’t remember it
What comes under the human criteria for moral status?
Sanctity of human life - there is something special about being human, we are different to other animals
Religious and professional support
- most commonly religious - idea that you are created in an image of god and therefore there is something holy within us, therefore we shouldn’t do things that would deliberately end that life because it has a quality of god within it
- at the extreme end = never carry out terminations and never withdraw treatment
What are the clinical applications under the human criteria for moral status?
Prohibits abortion
Prohibits euthanasia
Prohibits withdrawal of treatments
Tend to not allow DNRs
What comes under autonomy for moral status?
Respect autonomous wishes - freedom of thought, will and action = mental state- we have to understand information and make decisions based upon it
Advanced concept- linking capacity and competency
Assume patient is autonomous unless there is evidence to say they are not
What are the clinical applications under autonomy?
Have to accept autonomous decisions but non-autonomous patients need others to decide for them on the grounds of best interest
Psychiatric patients and the young/elderly are the most confused and vulnerable
- most contentious of areas such as psychiatry because you can’t assume someone with a mental illness is not autonomous - may have varying levels of autonomy
- in demential patients they can have fluctuating levels of autonomy
What comes under personhood in terms of moral status?
This is different to being human it is a philosophical concept - it goes further than autonomy because for personhood you have to be able to envisage a future - make decisions based on the future
Being a person is not just a biological maters, it the ability to have certain continuous mental states like desires for the future, rational thoughts etc.
These provide the right to life
Mental states are no longer possible = patient may no longer be a person
What clinical applications come under personhood in terms of moral status?
Diagnose and treat patients who are no longer persons? - clinical states where we lose personhood - biologically existing but have no potential to become a person
What does it mean by potentiality in terms of moral status?
Although the patients present state lacks a criteria for moral concern, they are likely to develop in the future
- when you are asleep you are not an active person but we still treat you because you have a future life
What clinical applications come under potentiality in terms of moral status?
Provide reasons for not harming the foetus - pre-person that has a potential future
Provides justification for continuing with life-supportive therapies until clinical improvement or futility reached
- obligations to think about a potential foetus’ life which is why mothers prescriptions may differ during pregnancy
- need to consider what benefit the person will have from the intervention
What does it mean by patient in terms of moral status?
Drs have duties to all their patients, irrespective of the philosophical status of a patient
Grounded in professional duties and obligations
What clinical applications come under patient in terms of moral status?
Provides justification for continuing care when other grounds are missing - legal limit
- only treat a patient if it will confer benefit - impacts resources because trusts aren’t going to allow you to treat a patient with an intervention that is not going to confer any benefit, it would be a waste of scarce resources
When is a patient dead?
Moral concern (having rights, duties, obligations) changes when a patient dies
Conventionally, death declared when cardiopulmonary arrest is irreversible:
- have no heartbeat
- not breathing
- can’t be resuscitated
What two clinical states challenge the conventional method of diagnosing death?
persistent vegetative state PVS
brainstem death
