Setting the Stage

Question 1

Personal Morals

Answer 1

Define one’s personal character

The fabric of who you are

Question 2

Professional Ethics

Answer 2

Social System in which morals are applied
Standards or codes of behavior expected by a group to which one belongs
Rules or principles/ways of thinking that guide actions

Question 3

What are the first four goals of medicine?

Answer 3

Promotion of health/disease prevention
Maintenance/improvement of quality of life
Cure of disease
Prevention of untimely death

Question 4

What are the second four goals of medicine?

Answer 4

Improvement of functional status/maintenance of compromised status
Education/counseling regarding condition/prognosis
Avoidance of harm to patient in course of care
Providing relief and support near time of death

Question 5

Classify these as either Medical, Ethical, or Legal questions: Should we? Do we have to? Can we? Are we prohibited from?

Answer 5

Should we? (Ethical)
Do we have to? (Legal)
Can we? (Medical)
Are we prohibited from? (Legal)

Question 6

Codes of Ethics

Answer 6

Professional Organizations

Summarize principles and behavior expected by all members of a discipline

Question 7

Osteopathic Pledge of Commitment

Answer 7

I pledge to:
Provide compassionate, quality care to my patients;
Partner with them to promote health;
Display integrity and professionalism throughout my career;
Advance the philosophy, practice and science of osteopathic medicine;
Continue life-long learning;
Support my profession with loyalty in action, word and deed;
Live each day as an example of what an osteopathic physician should be.

Question 8

AMA Physician Charter: Fundamental Principles

Answer 8

Primacy of patient welfare
Patient autonomy
Social justice

Question 9

AMA Physician Charter: Professional Responsibilities/Commitment to

Answer 9

Professional competence
Honesty with patients
Maintaining appropriate relations with patients
Improving quality of care
Improving access to care
Just distribution of finite resources
Scientific knowledge
Maintaining trust by managing conflicts of interest
Professional responsibilities

Question 10

What are the main sources of Ethical Conflict?

Answer 10

Different:

Facts, Values, Emotions, Reasoning, Loyalties, Perceptions

Question 11

Different Reasoning examples

Answer 11

Consequences

Liability

Question 12

Different Loyalties examples

Answer 12

Patient
Institution
Society

Question 13

Different Values examples

Answer 13

Culture

Religion

Question 14

Virtue Ethics

Answer 14

Oldest/most durable theory of ethics (~4000 years old)
Moral norms govern right action
Emphasizes the agent who performs the action

Question 15

Virtue

Answer 15

Character trait which disposes habitually to excellence in intent and performance
“Don’t even have to think about it”

Question 16

What is the current ethical trend?

Answer 16

To link Virtue Theory with Four Principles

Question 17

What are the 8 Virtues?

Answer 17

Prudence-Wisdom
Justice
Fortitude
Temperance
Fidelity to Trust
Compassion
Integrity
Effacement of self-interest

Question 18

Cardinal Virtues

Answer 18

Prudence-Wisdom
Justice
Fortitude
Temperance

Cardinals “Just Play during Freezing Temperatures”

Question 19

Prudence-Wisdom

Answer 19

Practical wisdom
Aritstotle, “Possessing moral insight”
Capacity to make the right decision, at the right time, for the right reasons
BOTH AND rather than EITHER OR

Question 20

Justice

Answer 20

Only one that is both a Virtue and Principle
Strict habit of rendering what is due others
Challenge for clinicians, as emphasis is not on individual patient
Focus on pattern of distribution of the good

Question 21

Fortitude

Answer 21

Sustained moral courage
Resisting temptation to diminish patient good through self-fear/social or bureaucratic pressure
Being an advocate for patients

Question 22

“Never practice medicine out of fear” (Which virtue)

Answer 22

Fortitude quote

Question 23

Temperance

Answer 23

Is a victory over desire
Greatest temptations in society are excesses of all sorts
Plato, “Doing good in one’s business or affairs”

Question 24

Fidelity to Trust

Answer 24

Finding out who patient is and how they want to meet challenges of illness, disability, and death
Most serious outcome of erosion of trust is emergence of an ethic of distrust

Question 25

Compassion

Answer 25

Cognitive aspect of healing to fit the UNIQUE predicament of patient
Idea of CO-SUFFERING
Most widespread criticism of medicine

Question 26

Integrity

Answer 26

Integration of all the virtues into a whole and prudentially judge the relative importance in each situation of principles, rules, guidelines, precepts, and the other virtues in reaching a decision to act

Question 27

Intellectual Integrity

Answer 27

Know what you know and admit what you do not know

Question 28

Effacement of Self-Interest

Answer 28

One of the least popular virtues in medicine

Tremendous narcissism of our age makes it difficult for many to put the needs of others first

Question 29

What are the two basic approaches to solving ethical problems?

Answer 29

1. Ethics of Care (Virtue Ethics)

2. Principle-Based Ethics

Question 30

Ethics of Care (Virtue Ethics)

Answer 30

Applications of the Virtues
Clinicians hold THEMSELVES ACCOUNTABLE for well-being of patient
Emphasis is on QUALITY CARE as a moral obligation

Question 31

Principle-Based Ethics

Answer 31

1. Beneficence (positive actions; need not always be followed; “healing, make whole again, benefit patient”)
2. Nonmaleficence (negative prohibitions of actions; MUST be followed; avoid harm)
3. Autonomy (self-determination; informed consent; patient empowerment to make decision)
4. Justice (Obligation to be fair)

Question 32

Principle-based Drive Analysis

Answer 32

Rational, analytic, problem-solving focus
No general conception of the good on individuals
Focus on ACTION
Central Question: “What am I Obligated to do?”
Reduces ethics to QUANDARIES or DILEMMAS
More LEGALISTIC FRAMEWORK

Question 33

Four ways to evaluate Ethical Problems

Answer 33

1. Medical Indications (good ethic decisions always begin with good information)
2. Patient preferences
3. Quality of Life
4. Contextual features