Philosophical basis and medical ethics 10.10.22 Flashcards
What is the pond report?
Lead to changes in medical ethics, and recognised the need to teach formally in the curriculum
Mid Staffordshire
Proof organisations can get it wrong and ethics can be ignored
Noel Conwey
Had motor neuron disease. Wanted to be able to say goodbye to family in a fit state and not when he was zombie like. Any doctor that tried to help him die would face 14 years in prison.
What is ethics?
The philosophical study of right and wrong actions or ways or living.
“Attempt to arrive at an understanding of the nature of human values, of how we ought to live, and of what constitutes right conduct” Richard Norman: The mora, philosophers (1998)
This definition tells us:
- Ethics is not certain
- It involves our value claims
- It can involve two very different perspectives
What is meta-ethics?
Explored fundamental questions (can things be right or wrong, what is the good life, are ethical statements just feelings?)
Facts vs values
Ethics is about values. But…
-ethical decisions cannot be made without knowing facts
-some ethical theories require calculations based on fact
-ethics can also inform our knowledge of facts
What is naturalistic fallacy?
False claim that what is natural is good
What are the possible rivals to ethical arguments?
-laws
-codes of ethics
-religious and/or cultural beliefs
-personal conscience
Law and ethics
- Laws are necessary for doctors in an increasingly litigious and legally governed society
- Law is often made, raising concerns as to how easily political, societal forces can change laws
- rapid medical advances may leave the law catching up
- ethics often informs law as jurisprudence
- laws cannot cover every eventuality
Law, religion and belief
Many people hold beliefs that inform their decisions.
Relativism - accepts any claim is valid since views are subjective - would mean that intentional agreement was never possible.
Personal conscience similarity problematic did to relativistic claim ( but professionally allowed)
Non-western ethics
Many other beliefs systems due to geographical location and other religious beliefs e.g. Dharma
Work deductively
Medical problem. Apply one specific ethical theory consistently to each problem. Traditional
Work inductively
Use medical problems to generate theory of guides to medical practice e.g. casuistry
Work with intuitions and feelings
Consider theory that best fits own considered beliefs and then apply it
Ethical analogies
‘Should a surgeon ever agree to remove a healthy limb of a patient with BDD (body dysmorphic disorder)’. This is questioned ethically but something like breast enhancement isn’t
Could be risky if others question the analogous act
E.g. using cannabis for medical reasons
Ethical fallacies
Sometimes it is easiest to spot the bad argument
Ad hominem
Shifting claim to an irrelevant aspect of person making the argument “Jones is wrong, but he votes conservative!’
Authority claims
arguing a claim is correct simply because someone in authority has said it
Question begging
Including conclusion in premise e.g. ‘abortion is non justified killing and is murder. Murder is illegal. Abortion should be illegal’
Dissenters
identifying those who disagree with an argument does not in itself show the argument is not valid - see authority claim
Motherhoods
inserting soft statements to disguise contentious one
Confusing necessary and sufficient
assuming something is the only requirement for an outcome, when it is but one aspect
Who does ethics apply to?
Understanding medical ethics means being aware of who and what is subject to ethical decisions and whose values and views should be respected.
Ethics in practice: Decision - making model
- Recognise ethical situation
- Break down dilemma into parts
- seek info from patients and others
- identify relevant legal and professional guidance
- if not solution found, apply critical ethical analysis
- break down dilemma into parts
- justify decisions with sound arguments
What are some doctors’ ethical problems?
- Treating patients with impaired or uncertain decision-making
- Disagreement among care givers
- Patient disagreement due to beliefs or religion
- Conflict with policies or laws
- request for doctor- assisted suicide or euthanasia
What is morality?
Concern with the distinction between good and evil or right and wrong
What is Meta ethics?
- abstract
- nature of goodness and badness, right or wrong
What is normative ethics?
The focus is on acts
- Agent: person performing the act
- The act itself
- Consequences of the act
- Virtue, deontological and consequentialist
- applied ethics
What is consequentialsm?
Evaluating an action in terms of its’ outcome
What is utilitarianism?
Maximising good - wellbeing/welfare; most happiness for the largest number of people
Preference utilitarianism - utility increases as preference/desire is satisfied
Hedonism/Hedonistic utilitarianism - Maximise pleasure vs pain, simple sensory vs higher cognitive
Act vs omission
Is harm by omission (not doing anything) more wrong than harm by action.
What is the doctrine of double effect?
- The nature of the act itself is good or morally neutral
- Intention is the good effect
- The good effect outweighs the bad effect in circumstances sufficiently grave to justify causing the bad effect (minimising harm)
What are the challenges of consequentialism/ utilitarian?
- Treat minorities unfairly to promote the happiness of majority
- Carry out ethically questionable research to maximise welfare of society
- What is good/bad
What is deontology?
Features of the act themselves determine worthiness (uses rules to decide what is right and wrong)
E.g. kantianism (just duty rather than emotions) virtue
what is a categorical imperitive?
Act that the maximum of your action can become a universal law for all rational beings. Don’t expect anything back
What are the challenges of a deontologist?
- Key concern is about duties and rights and not about consequences of actions but acts that have intrinsic worthiness
- Can duties conflict
What are virtue ethics?
- Focus is on the character of the agent
- Integrates reason and emotion
- a virtue is a trait of character manifested in habitual action, that is good for a person to have
- a moral virtue is a socially and morally valuable trait of character
Definition of arête
excellence or virtue- disposition rather than a tendency
Definition of phronesis
practical or moral wisdom
Definition of eudaemonia
usually translated as happiness or flourishing
What are the limitations of virtue ethics?
- Assessment of virtue is culture- specific
- The notion of virtue is too broad and non-specific to allow for practical application
- An emphasis on the moral character of individuals ignores social and communal dimensions
- Honesty points to telling the hurtful truth, kindness and compassion to remaining silent or even lying.
What are the applications of virtue ethics?
- Fitness to practice issues can be failures of virtue
- Understanding your patient’s coping strategies with regard to bad news or illness
What is care ethics?
- Human dependency and the need to be cared for.
- The need to be cared for takes over all other actions
What are the four principles of ethics?
- Autonomy
- Beneficience
- Non-maleficience
- Justice
What is autonomy
- Be able to make a decision (capacity)
- Be able to freely make a decision
- It is self determined by a patient
What is beneficience?
- Provide benefit to others
- Do good
What is non-maleficience?
- Do no harm
- Prevent/reduce harm
What is Justice?
- Need vs benefit
- Utility, QALYs
- How we spend or give out tax payers money (NHS)
How does utilitarian apply to healthcare?
acts valued by their consequences – RA, triage,
How does Deontology apply to healthcare?
conflicting duties as a parent or HP; confidentiality
