Medical Ethics : Medical Ethics Marc Imhotep Cray MD
Medical ethics : Medical ethics Medical ethics is grounded in philosophical ethics, it concerns itself with the ethical questions and dilemmas in medicine.
Medical ethics is not any special ethics but an ethics which deals with special cases from medical practice.
Doctor-patient relationship : Doctor-patient relationship Medical ethics has three centres: doctor, patient and society.
Its centre is the doctor-patient relationship.
The moral duties of the doctor : The moral duties of the doctor The duty to help, cure
The duty to promote and protect the patient’s health
The duty to inform
The duty to confidentiality
The duty to protect the patient’s life
The duty to respect the patient’s autonomy
The duty to protect privacy
The duty to respect the patient’s dignity
The moral rights of the patient : The moral rights of the patient The right to high quality medical service
The right to autonomous choice
The right to decide
The right to be informed
The right to privacy
The right to health education
The right to dignity
Principles of biomedical ethics : Principles of biomedical ethics Nonmaleficence
Beneficence
Respect for autonomy
Justice
Hippocratic oath5-4 centuries B.C. : Hippocratic oath5-4 centuries B.C. An obligation of nonmaleficence and an obligation of beneficence are both expressed in the Hippocratic oath:
“I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them.”
Nonmaleficence and beneficence : Nonmaleficence and beneficence The principle of nonmaleficence asserts an obligation not to inflict harm intentionally. Principles of beneficence potentially demand more than the principle of nonmaleficence, because agents must take positive steps to help others, not merely refrain from harmful acts.
The differerence of two principles : The differerence of two principles Nonmaleficence
One ought not to inflict evil or harm Beneficence
One ought to prevent evil or harm
One ought to remove evil or harm
One ought to do or promote good
The concept of autonomy : The concept of autonomy The word “autonomy” is derived from the Greek “autos” (self) and “nomos” (rule, governance or law). It was first used to refer to the self-rule or self-governance of independent Hellenic city-states. Autonomy has since been extended to individuals and has acquired meanings as diverse as self-governance, liberty rights, privacy, individual choice, freedom of the will, causing one’s behaviour, and being one’s own person.
Autonomous person : Autonomous person We analyze autonomous persons in tems of
liberty (independence from controlling influences)
agency (capacity for intentional action)
Autonomous action : Autonomous action We analyze autonomous action in terms of persons who act
Intentionally
With understanding
Without controlling influences that determine their action
To respect an autonomous agent : To respect an autonomous agent is to acknowledge that person’s right to hold views, to make choices, and to take actions based on personal values and beliefs. Such respect involves respectful action, not merely a respectful attitude. Respect involves treating persons to enable them to act autonomously, whereas disrespect for autonomy involves attitudes and actions that ignore, insult, or demean others’ autonomy and thus deny a minimal equity to persons.
Informed consent is analyzable : Informed consent is analyzable through the account of autonomous choice. A person must do more than express agreement or comply with a proposal. He/she must authorize through an act of informed and voluntary consent.
in terms of the social rules of consent in institutions that must obtain legally valid consent from patients or subjects before proceeding with therapeutic procedures or research.
The standards used to determine the incompetence : The standards used to determine the incompetence Inability to express or communicate a preference or choice.
Inability to understand one’s situation and its consequences.
Inability to understand relevant information.
Inability to give a (rational) reason.
Inability to give risk/benefit related reasons.
Inability to reach a reasonable decision.
Paternalism : Paternalism is the intentional overriding of one person’s known preferences or actions by another person, where the person who overrides justifies the action by the goal of benefiting or avoiding harm to the person whose will is overriden.
Weak paternalism : Weak paternalism In weak paternalism an agent intervenes on ground of beneficence or nonmaleficence only to prevent substantially nonvoluntary conduct, i.e. to protect persons against their own substantially nonautonomous actions.
Strong paternalism : Strong paternalism Strong paternalism involves interventions intended to benefit a person despite the fact that the person’s risky choices and actions are informed, voluntary and autonomous.
A central problem in biomedical ethics : A central problem in biomedical ethics Whether respect for autonomy of patients should have priority over professional beneficence.
The concept of justice : The concept of justice The terms fairness, desert (what is deserved), and entitlement (that to which one is entitled) have been used by various philosophers in attempts to explicate justice. These accounts all interpret justice as fair, equitable, and appropriate treatment in light of what is due or owed to person.
Principles of distributive justice : Principles of distributive justice To each person an equal share (formal equity)
To each person according to need
To each person according to effort
To each person according to contribution
To each person according to merit
To each person according to free-market exchanges