Week 3 Flashcards
What is dignity?
Human dignity is the basic value of human beings entitling them to respect
Who is Josef Mengele?
- Assigned to Auschwitz
- performed research protocols using twins as test subjects throughout the
1930s. - performed a broad range of agonizing and often lethal experiments
mostly with children twins
What was the outcome of world wars?
The human being needs to be protected.
Explain dignity fully.
A state, quality or manner worthy of esteem and respect; and (by extension) self-respect
* Dignity in care means the kind of care that supports and promotes, and does not undermine, a
person’s self-respect regardless of any difference
* “being treated like I am somebody”
This includes:
* Respect
* Privacy
* Autonomy
* Self-worth
What are the principles of dignity?
- Dignity in care is inseparable from the wider context of dignity as a
whole - Dignity is about treating people as individuals
- Dignity is not just about physical care
- Dignity thrives in the context of equal power relationships
When is human dignity at risk?
- In sickness
- Decline /towards death
- Childhood
- Elderly
- In prison
- People with disabilities
- People lacking capacity
Why does dignity become at risk?
When individuals become more vulnerable and their rights get compromised.
What is the aim of The Universal Declaration of Human Rights?
Aims to militate against oppression of people (especially minorities)
What do human rights do?
place a duty on the state & healthcare providers to
comply with minimum standards.
* Rights impose moral and legal constraints on collective social goals
(Savulescu et al, 2020)
* Claims for state provisions; Healthcare as major ethical duty
What is the aim of medical ethics?
- Focus on doctor-patient relationship
- Doctor’s duties of care
What are legal rights?
Human rights in national legal frameworks.
What is civil law?
Civil law concerns dealings between private individuals or groups
What is criminal law?
concerns matters serious enough to be considered
offences against the whole community
What is the entitlement of the patient?
- The Doctor treats a Patient
- A Patient is a Person
- Each Person is entitled to enjoy all HUMAN RIGHTS
- Respect and give recognition - HUMAN DIGNITY
- In one word-BENEFICENCE meaning to do the good for his or her patient
Examples of patient rights being compromised.
- Leaving a patient in soiled sheets
- Leaving trays of food when the patient needs help to eat
- Using excessive force to restrain someone in care
Summary
Summary part 2
What are the 4 principles of healthcare ethics?
- autonomy,
- beneficence,
- non-maleficence,
- and justice.
What is the framework of principles?
- principles are general norms that leave
considerable room for judgement in many
cases - Not precise action guides
What is respect for autonomy?
- self-rule, self-determination
- ability to think, to decide and to act on the basis of such
thought and decision, freely and independently - a medical practitioner cannot impose treatment on an
individual for whatever reason - Respect for autonomy requires health professionals to
help patients come to their own decisions and to respect
and follow those decisions
What does patient autonomy depend on?
-capacity
-necessity
-risk to others
What is beneficence?
- refers to the moral importance of
doing good to others (patients) - performing deeds of “mercy,
kindness, friendship, charity and the
like” - people take actions to benefit and
promote the welfare of other people. - process of ranking the available treatment options
What are the rules of beneficence?
❑ Protect and defend
the rights of others
❑ Prevent harm from
occurring to others
❑ Remove conditions
that will cause harm
to others
❑ Help persons with
disabilities
❑ Rescue persons in
danger
Autonomy vs Beneficence?
- Who should be the judge of what is best for the patient?
- Assessment of health professional vs patient’s own views
- Divergence between medical interest/medical benefit
and patient’s best interests/wishes/preferences - Medical interests; treatment and prevention of disease
- Best interests; broader concept to
physical, mental and social well-being - Include patient perspective
What is non-maleficence?
- It states that health professionals should avoid harm on
patients - Most medical treatments have some chance of doing harm. It
does not follow that such treatment should always be avoided - The potential benefits and harms and their probabilities need
to be weighed up to decide what is overall in the patient’s best
interests
Non-maleficence vs. Beneficence
What is justice?
- Health professionals have to make decisions about
distribution of time, money, clinical resources - The principle of justice emphasizes two points:
- Patients in similar situations should have access to the
same healthcare - In determining what level of care should be available for
one set of patients, we must take into account the effect
of such use of resources on other patients - fair distribution of resources (distributive justice)
- Benefits and burdens should be distributed fairly
among members of a society and with respect for
people’s needs/rights (social justice/rights based
justice)
What are the two principles of John Rawl’s theory of justice?
(1) everyone should
be given equal liberty regardless of their adversities
(2) differences among people should be recognised
by making sure the least-advantaged people are given
opportunities for improvement.
(Equal access to healthcare services)
How do the 4 principles interact with eachother?
- The four principles are non-hierarchical.
- For ethical clinical reasoning, one may be required to take
all principles into account when they are applicable to the
clinical case under consideration. - Yet, when two or more principles apply, we may find that
they are in conflict
What is the contribution of the 4 principles approach?
- Identifies key principles for ethical clinical practice
- “common morality”
- Draws attention to the values/rights/norms underlying moral
dilemmas - Reflects doctor’s duties
- Allows for multiple moral considerations
What are the criticisms for the 4 principles approach?
- Strictly adhering to the same principles/guidelines for different
situations can be problematic - the principles are nonspecific, appearing to simply remind the
decision maker of considerations that should be taken into account - there is no agreed upon method for resolving conflicts when two
different principles conflict about what ought to be done
*The four principles should not be treated as a general moral theory,
but rather, they assist in reflecting on moral problems and in
moving to an ethical resolution.
What is the structured case analysis model?
- Summarise the case
- State the moral dilemma(s)
- State the assumptions being made or to be made
- Analyse the case with reference to
- ethical principles
- consequences
- Professional codes / virtuous healthcare practitioner
- the law
- Acknowledge justifiable ethical solutions and those that
are not justifiable - State preferred approach with explanation
What steps do ethical analysis compromise?
- Determine whether the issue at hand is an ethical one.
- Consult authoritative sources (medical association codes of
ethics and policies, respected colleagues etc). - Consider alternative solutions in light of the
principles/duties/values/likely consequences - Discuss your proposed solution with those whom it will affect.
- Make your decision and act on it, with sensitivity to others
affected. - Evaluate your decision.
What is the clinical ethics committee?
- Multidisciplinary and independent groups
- Membership includes;
= Different health professionals (majority members); Members of
hospital management/administration; Legal member; Medical ethics
academic; Religious representatives; Lay members - aim to provide support for decision-making on ethical issues
arising from several aspects of patient care.
= provide discussion and/or advice about complex or controversial cases
= not take over responsibility for a clinical decision; this responsibility
remains with the doctor/the clinical team
What is the function of clinical ethics committees?
Their primary functions are
-case consultation
Urgent and non-urgent cases
-ethics education
-policy development and review
interpretation of national guidelines
What are the frequent issues for consultation with CEC?
- Withholding to withdrawing life sustaining treatment
- consent and capacity
- refusal of treatment and restraint issues
- pandemic response
