Applied vs. Normative Ethics in Medicine

Applied Ethics vs. Normative Ethics

• Applied ethics focuses on how to act in specific situations, creating rules like those used by kinesiologists.
• Normative ethics provides theories that define how people should behave, creating general rules like those of utilitarianism or Kantianism.

Medical Ethics

• Principlism is the primary medical approach, using principles of autonomy, beneficence, non-maleficence, and justice.
• Case-based reasoning, or modern casuistry, identifies similar cases to resolve current conflicts. This method is considered unavoidable.
• Casuistry is a bottom-up approach, examining specific cases for guiding principles.

Ethical Considerations Case Study

• Erskine, a 14-year-old with metastatic neuroblastoma, is in PICU.
• His parents want "everything" done.
• Erskine wants no breathing machine.
• Benefience: The machine may prolong life but increase suffering.
• Non-maleficence: The machine's potential harm is unclear.
• Autonomy: Erskine has the right to refuse treatment.
• Justice: Resource allocation is a possible consideration in similar cases.
• Dignity: Respecting Erskine's wishes maintains his dignity.
• Truthfulness and honesty: All parties should honestly discuss prognosis and treatment.
• Moral diagnosis: The conflict highlights the tension between beneficence/non-maleficence and autonomy. Erskine's decision as a competent individual should take priority.

Possible Courses of Action

• Honor Erskine's wishes: Stop the machine and focus on palliative care.
• Engage further discussion: Facilitate open dialogue among family (parents) and medical team to reach consensus.

Justification

• Honoring Erskine's wishes respects autonomy.
• Further discussion cannot be coercive and must prioritize Erskine's wishes.

Principlism Continued

• Key concepts in bureaucracy
• Bureaucratic rationality: institutions use rationality to achieve objectives.
• Formal rationality: Using logic and reason to determine an action's importance.
• Substantive rationality: Considering the value of an action.
• Bureaucracy cost: loss of autonomy, freedom, individuality.
• Benefits of bureaucracy: Written rules, promotions, specialization.
• McDonaldization: society adopting characteristics of fast-food restaurants. Finding efficiency can detract from other values.

Explore the differences between applied ethics and normative ethics, particularly in the context of medical ethics. This quiz examines principlism, case-based reasoning, and a real-world case study involving a 14-year-old patient. Learn about the ethical principles that influence decision-making in healthcare.