Bioethics 2024 B PDF

Bioethics M.T.O. Tenchavez “I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of...

Bioethics M.T.O. Tenchavez “I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” What is the nature of ethics? ›an age-old attempt by human beings to determine how they should act ›a branch of philosophical study What is the nature of ethics? ›derived from the Greek word “ethos” which translates to “disposition” or “spirit of the community” ›the first formal ethical theories belong to Greek philosophers, such as Socrates, Plato, and Aristotle › Ethical theories attempted to establish standards of human conduct based on rational arguments rather than faith, superstition, consensus, or convention. ›An important distinction in the study of ethics is the difference between facts and values. What are facts? › they attempt to describe the way things are › ideas that are generally agreed upon (e.g. The leaf is green.) › Even though you may know that the leaf is not consistently green, no one is going to attack you when you make the statement that it is because the leaf is perceptibly green. What are facts? ›descriptive ideas in contrast to values which are prescriptive ideas ›Other examples of facts: Traffic is heavy; I am hungry; female Philippine eagles are usually larger than males. What are values? ›ideas about the way you want things to be or the way you think things should be ›attempt to evaluate or determine worth ›reflect the desires, opinions, and feelings of those who hold them What are values? ›are often heated topics and debate and not easily agreed upon ›Examples : People shouldn’t chew with their mouths open; desiring money is wrong; Ramon Magsaysay was the best President; there is only one God In conclusion… ›Facts are value-neutral. ›Facts describe and do not attempt to evaluate. ›Since ethics is interested in prescriptive ideas, then it is interested in values. What then is bioethics in health and medicine? ›an activity; it is a shared, reflective examination of ethical issues in health care, health science, and health policy What then is bioethics in health and medicine? ›a discussion; it takes place in the media, in the academy, in classrooms, and in labs, offices, and hospital wards. It involves not just doctors, but patients, not just scientists and politicians but the general public. What forms of ethics are considered in health and medicine? › consequentialism › utilitarianism › divine command ethics › deontological ethics › the ethics of care › one’s rights › virtue ethics › casuistry › principlism Consequentialism ›It claims that an action is right or wrong depending on the consequences that it brings rather than the type of action it is. ›The end justifies the means. Examples › Lying to save a life: Consequentialism says that lying is wrong, but that it's the right thing to do if telling a lie would help save a person's life. › Killing an innocent person to save others: A consequentialist would say that killing an innocent person is justified if it saves the lives of more innocent people. Problems of Consequentialism › Time-consuming and complicated in practice › In the ideal case, all consequences are identified and accounted. However, in almost all real decisions this is not possible.  Problems of Consequentialism › Itis observer or agent limited; the ideal case involves a completely unbiased ethical agent weighing all possible consequences with equity and neutrality towards all affected parties. This godlike position is not attainable. In real world cases, observers are supposed to inform themselves as much as possible about the consequences to make the best judgment possible dealing with actual and expected consequences. Problems of Consequentialism › Itis problematic to evaluate the morality of decision based on actual consequences as well as probable consequences. If an observer scales the weight of consequences based only on probability, some poor decisions can be made. A highly undesirable consequence may appear to be the result of a morally wrong decision. Utilitarianism ›Actions are “right in proportion as they tend to promote happiness; wrong as they tend to produce the reverse of happiness” and that what is desirable is “pleasure and the freedom from pain”. Utilitarianism ›Utilitarians consider happiness (pleasure or well-being) to be the only thing that is good in and of itself – the only thing that has intrinsic value. ›Utilitarians strive to follow the greatest happiness principle: act so as to produce the greatest overall happiness. Problems of Utilitarianism › Inorder to calculate the sum of pleasures and pains resulting from a given action, interpersonal comparisons must be made. Impartiality may not be possible. › Predicting the future is an uncertain business. Problems of Utilitarianism › It sets an unreasonably high standard for behavior. › It is easy to construct situations in which utilitarian reasoning leads to conclusions but these may conflict with our moral intuitions. Think It Over › Consider: Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetized, she asks you: “Doctor, will I be okay?” What will you tell her? Why? Think It Over › Consider: A hospital has limited capacity to deal with Covid-19 patients and has to decide between admitting a 20 year old patient, who is fit and well, and a 75 year old patient, who has a history of heart disease, for their last available ventilator. Who will you give the ventilator to? Why? Think It Over ›Consider: A wealthy person needs an organ transplant. If the wealthy person offers to donate a large sum of money to a charity to help thousands in exchange for being at the top of the list for an organ transplant, should the wealthy person be prioritized. Why?  Think It Over › Harsh Punishments: A consequentialist may support harsh punishments for contravening laws because the consequence of the punishment acts as a deterrent. Some people will be punished perhaps unfairly, but in total, less people will break the law, so the harshness of the punishment is justified.  Think It Over › Animal Testing: Animal testing is used by scientists to test the safety and effectiveness of new products and medicines. Even though it can cause harm to animals, it is often justified based on its potential benefits for humankind as a whole.  Think It Over › FactoryFarming: Factory farming is a method of raising livestock commercially on a large scale. Despite its potential environmental impacts and animal welfare issues, it remains popular due to its efficiency in producing food for mass consumption at a low cost.  Think It Over › Vaccination: Vaccines have been proven effective at reducing infectious diseases, thus making them an example of consequentialism because their positive outcome outweighs any potential risks.  Think It Over › Genetic Modification: Genetic modification has become increasingly popular due to its potential applications in medicine and agriculture. While ethical concerns are associated with this technology, proponents point out that its benefits may far outweigh any drawbacks in certain cases where a particular gene could cure a life- threatening illness or improve crop yields significantly in areas facing famine or drought conditions.  Think It Over › Stem Cell Research: Stem cell research has the potential to unlock treatments for diseases that were previously considered incurable. Even though there are moral implications associated with using embryonic stem cells, many believe that the positive outcomes outweigh any potential risks or objections based on morality alone. Divine Command Ethics › there are certain kinds of actions that are simply wrong › consults the revealed word of God and applies the appropriate injunction to the case under consideration › claims that an action is morally wrong if God forbids it; similarly, an action is right if God does not forbid it, and obligatory if God commands it Examples › Following the Ten Commandments: Many people who adhere to Abrahamic religions see actions like murder, adultery, and lying as morally wrong because they are explicitly forbidden in the Ten Commandments, which are believed to be divine commands  Examples › Religious dietary restrictions: Individuals following certain religions might avoid eating specific foods like pork because their religious text considers it "unclean" or forbidden by God. › Observing Sabbath: Some religions observe a specific day of the week as a day of rest and prayer, considering it a divine command to refrain from certain activities on that day.  Objections to the Divine Command Ethics › only useful to those who believe in God. When there is an atheist or agnostic involved in a discussion about the Divine Command Theory, the debate quickly turns to the question of God’s existence. › the theory is incomplete because it does not supply a procedure for discerning the will of God; How is one to decide which religion promulgates God’s true commands? Objections to the Divine Command Ethics › implies that the list of prohibited actions is arbitrary › This last objection was famously explored in Plato’s dialog Euthyphro. In this work, Socrates poses a question to Euthyphro equivalent to the following: Are actions wrong because God forbids them, or, does God forbid them because they are wrong? Think It Over › Euthanasia: Euthanasia is often considered immoral by some religious believers because it goes against the idea that only God has power over life and death. › Capital Punishment: Opponents of capital punishment reject this practice because they believe that taking someone’s life in retribution for a crime violates God’s commandment ‘Thou shalt not kill.’  Think It Over › Purityand Chastity: The divine command theory may consider any impure or sexually promiscuous behavior sinful as holy books ordain abstinence until marriage – thus encouraging chastity. › Environmentalism: Many religions endorse environmental stewardship, urging their followers towards conservation-based activities and sustainability. For example, Judaism’s Shabbat and Biblical teachings support eco- leadership as a divine commandment to respect the earth’s cycles and resources. Deontological Ethics › agrees with the Divine Command Theory › actions are forbidden or required not by the commands of God, but by the dictates of reason › It places value on the intentions of the individual rather than the outcomes of any action and focuses on rules, obligations, and duties. Deontological Ethics › most prominent theologian : Immanuel Kant › Kant argued that the only thing that is good without qualification is good will. › Good will signifies the motivation to do the right thing simply because it is the right thing – to act from a sense of duty. Deontological Ethics › Kant’s emphasis on reason, duty, and motives has influenced the development of bioethics. › His idea of human beings as ends- in-themselves, for example, has had a strong influence on standards for the use of humans as research subjects. Examples › Informed consent: A doctor must always explain all treatment options, risks, and benefits to a patient before proceeding with any medical intervention, even if it means the patient chooses a less optimal treatment based on their personal values. Examples › Respecting patient refusal: A patient has the right to refuse treatment even if it could potentially worsen their condition, as long as they are deemed competent to make that decision. Examples › Confidentiality:A healthcare provider must not disclose any personal information about a patient without their consent, even if it means not sharing details with family members. Examples › Not using a patient as a means to an end: A doctor should never perform a procedure on a patient solely for the benefit of research or another patient, even if it could lead to a significant advancement in medical knowledge. Objection against Deontological Ethics › One of the key criticisms in healthcare is that applying a strictly deontological approach to healthcare can lead to conflicts of interest between equally entitled individuals which can be difficult or even seemingly impossible to resolve.  Think It Over › Integrity:Being honest and consistent in your behavior and beliefs. It would be wrong to act one way with your friends and another way when you are around strangers. › Respect: Showing respect to others by honoring their wishes and beliefs, even if you disagree with them. If a friend asks you not to talk about a specific subject, it would be wrong to disregard this wish.  Think It Over › Responsibility: Taking responsibility for your actions and accepting the consequences, no matter how unfavorable. For instance, if you damage someone’s property, it would be wrong to try and hide the deed or blame someone else for your mistake.  Think It Over › Fairness: Making sure everyone is treated fairly, regardless of their race, religion, or gender. If a company is hiring new employees, it would be wrong to discriminate against any particular group of people. In a hospital, it would be wrong not to admit clients simply because they are poorer than others.  Think It Over › Humility: Showing modesty and not taking credit for something you didn’t do. It would be wrong to take credit when your team produces a great result. › Moderation: Acting in moderation and not overindulging, even if it’s something you enjoy. So, if you like a cake, it would be wrong to overeat it and make yourself sick. Rights of Persons › The idea that human beings have rights can be traced back to Roman law. › Roman legislators established legal procedures for Roman citizens to make claims to the protection of their personal interests. › In the Declaration of Independence, Thomas Jefferson declares that humans are “endowed, by their Creator, with certain unalienable Rights.” Rights of Persons › Locke argued that people are entitled to certain protections and benefits, not because their government grants them, but because God ordains them. Therefore, Locke concludes, natural rights cannot be taken away by a government. › also related to duty-based ethics Rights of Persons › Many modern thinkers contend that human rights go well beyond protection against lies or invasions of privacy. › In addition to these negative rights, they argue that there are positive rights - entitlements to the necessities of life. Nota Bene for Rights of Persons › Thedistinction between negative and positive rights can be easily understood by noting that for every right there is a corresponding duty. Health is a fundamental human right › “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” (from the 1947 Constitution of the World Health Organization) Health is a fundamental human right ›access to health services without suffering financial hardship ›access to safe drinking water and sanitation, nutritious foods, adequate housing, education and safe working conditions Health is a fundamental human right ›everyone should be entitled to control their own health and body, including having access to sexual and reproductive information and services, free from violence and discrimination Health is a fundamental human right ›rightto privacy and to be treated with respect and dignity ›Nobody should be subjected to medical experimentation, forced medical examination, or given treatment without informed consent. Core components of health as a right ›Availability ›Accessibility ›Acceptability ›Quality Examples of rights ethics ›A patient with a terminal illness refusing life-sustaining treatment: The doctor must respect the patient's decision to forgo treatment and focus on comfort care. Examples of rights ethics ›A patient asking to not be informed about a serious diagnosis: The doctor must respect the patient's wishes if they are mentally competent to make that decision. Examples of rights ethics ›A patient requesting access to their medical records: The healthcare provider must provide the patient with a copy of their medical information upon request. Virtue Ethics ›The right action is defined in terms of the behavior of the virtuous. ›Actions are to be judged based on whether or not they were characteristic of the men who exemplify these “skills.” Virtue Ethics › Development of the “skills” could be accomplished by practicing the intellectual virtue of wisdom and the moral virtues of courage, temperance, and justice. These admirable human qualities entail behavioral dispositions that represent a balance or “golden mean” that fosters the good life. Virtue Ethics › The inclination to look toward the wise, the mature, the virtuous, comes naturally to many. Children, separated from their parents and faced with an emergency may ask, “What would Mom and Dad do?” › The virtuous characteristics of healthcare professionals are highly valued. Codes of conduct and guidance are developed by professional regulators who emphasize the character of a registrant as one who can be relied upon to do the right thing in each situation. Objections against Virtue Ethics ›With no universally accepted definition of human flourishing, how are we to establish a list of virtues and procedures for developing positive character traits and habits? Objections against Virtue Ethics › What do we do when virtue ethicists disagree? With no principles to turn to, how can disputes be resolved? And, isn’t there something a little circular about defining right action in terms of the behavior of the virtuous while identifying the virtuous as those whose actions promote the good life? Does virtue really come first? Think It Over › People who are suffering from serious renal failure can be saved by kidney transplantation. Most of the kidneys are donated by relatives of the people who died, but their body organs can be used for transplantation. In some cases, kidneys are also donated by the living individuals generally the family or close relatives of the patient. Think It Over › The supply of the kidneys is very small, and most of the patients who are suffering from renal failure eventually die after waiting for the kidney donor for a long time. Due to this serious shortage of kidneys for transplantation, some people argue to permit the volunteer selling of the kidneys to meet the demand of kidney shortage, but these arguments raise the question that is it really ethical to permit the selling of kidneys? Think It Over › What is the situation of the person who wishes to sell his/her kidney? › To whom does the person want to sell the kidney? › Are proper tests conducted to check the health of both the donor and the recipient before and after the transplantation? › How much is the person charging for selling the kidney? Think It Over › Why is the donor willing to sell the kidney? › Is the donor psychologically stable and medically fit? › Is the donor under any constraints for selling his/her kidney? › Consider the virtues of justice, compassion, and discernment. Examples of Virtue Ethics › Honesty: A doctor openly discussing all potential risks and side effects of a treatment with a patient, even if it might lead to anxiety or hesitation. › Courage: A surgeon making a difficult decision to perform a high-risk surgery when it is the best option for the patient's long-term health. Examples of Virtue Ethics › Prudence: A physician carefully considering all available options before recommending a treatment plan, taking into account the patient's individual circumstances. › Empathy: A nurse actively listening to a patient's concerns and trying to understand their emotional state, even when dealing with a large caseload. Casuistry › Intentions, aggravating circumstances, and consequences must be considered. › Analysis is done with relatively clear, paradigmatic cases and then moved on to complicated situations. This case-based method of moral analysis came to be known as casuistry. Casuistry ›involves collecting all relevant details concerning a case, and then placing the case in the context of other cases ›Moral meaning and certainty are to be found in experience.  Objections against Casuistry › it requires a uniformity of views that is not present in contemporary pluralistic society › it cannot achieve consensus on controversial issues › it is unable to examine critically intuitions about cases › it yields different conclusions about cases when alternative paradigms are chosen  Think It Over ›Topics in clinical ethics include (1) medical indications, (2) patient preferences, (3) quality of life, and (4) contextual features, such as costs of care and allocation of resources, if casuistry is applied  Think It Over ›Consider: The problematic case of a pregnant, near-term Jehovah's Witness woman who developed abruptio placentae (premature separation of the placenta from the uterus), requiring a cesarean section to protect both mother and infant. She agreed to the cesarean section, but with no blood transfusion.  Think It Over › Complex situation: The case presents a clear conflict between the patient's religious beliefs and the doctor's obligation to provide life-saving treatment. › Analysing precedent cases: The doctor would consider past cases involving Jehovah's Witness patients and their refusal of blood transfusions to understand how similar situations were handled in the past.  Think It Over ›Applying ethical principles: The doctor would weigh the patient's right to autonomy against the principle of beneficence, considering the potential harm that could occur if the transfusion is not administered.  Other Examples ›Withholding life-sustaining treatment from a terminally ill patient: Deciding when to withdraw life support based on the patient's condition, their wishes, and similar cases where the quality of life was deemed too poor to justify continued treatment.  Other Examples › Sharing patient information with family members without explicit consent: Deciding whether to disclose sensitive medical information to a close family member in a situation where the patient is unable to communicate due to a medical crisis. › Performing a risky experimental treatment on a patient with a very aggressive disease: Evaluating whether the potential benefits of a new, unproven treatment outweigh the risks for a patient with limited options. The Ethics of Care ›When debating an ethical issue, men tend to emphasize justice, duties, rights, and principles. Their analysis is abstract and intellectual. For many women, however, this semi-legalistic approach ignores important values such as trust, cooperation, and care. The Ethics of Care ›moral decisions should grow from particular characteristics of the caring relationships between the people involved. Objections against Ethics of Care › It is not a complete theory of ethics. It gives us little guidance when interacting with those beyond our circle of friends and relations. › It does not tell us how to resolve conflicts when partners in a caring relationship advocate different courses of action. Think It Over › Consider: There’s a flaming car wreck involving your sister and a Nobel Prize–winning medical scientist, and you have the strength to rescue only one of the two. Who should you save? A strict utilitarian—someone believing we should always act to bring the greatest good to the greatest number—will go for the scientist. Saving him will likely produce future medical breakthroughs in turn saving many others, which means the greater good will be served by dragging him out. But how many of us would actually do that? Wouldn’t you go for your own sister before some scientist you’ve never met? Think It Over › Consider: Most parents trot out the idea of treating all their children identically—they all get their first car at the same age and so on—but if a sibling has special problems at one stage of their development, they’ll normally get special treatment in the name of preserving the family unit. The other brothers and sisters probably complain, but if they’re old enough they understand that protecting those who are vulnerable is one of the first imperatives of caring for each other as a group. Other Examples ›A doctor taking extra time to explain a complex diagnosis to an anxious patient, addressing their emotional needs alongside the medical information. › A nurse providing comfort and emotional support to a patient nearing end-of-life, prioritizing their well-being over purely clinical interventions. › A healthcare team considering a patient's family dynamics and cultural background when making treatment decisions. Other Examples ›A physician actively listening to a patient's concerns about a new medication, addressing their fears and validating their experience. › A nurse coordinating care between different specialists to ensure a patient receives comprehensive and coordinated treatment, considering their overall needs. › A doctor providing culturally sensitive care to a patient from a different background, taking the time to understand their beliefs and practices. Principlism › Beauchamp and Childress argued that all morally serious people share a common morality based on a set of pre-theoretical, common sense, non- absolute (prima facie) principles. › These four principles are autonomy, beneficence, non-maleficence, and justice. Principlism › Itblends these principles with virtues and practical wisdom. This is an attempt to bring together the best elements of ethical theories which are compatible with most societal, individual or religious belief systems. Autonomy › It is usually expressed as the right of competent adults to make informed decisions about their own medical care. › It demands that the individual is sovereign over his own mind and body. Autonomy › The principle underlies the requirement to seek the consent or informed agreement of the patient before any investigation or treatment takes place. Autonomy › Patientsshould be provided with the information necessary to make medical decisions and should be allowed to do so without coercion from medical professionals or family members. › Autonomy concerns have led to such practices as informed consent, confidentiality, and truth-telling. Informed Consent › shorthand for informed, voluntary, and decisionally-capacitated consent › Considered fully informed when a capacitated or “competent” patient or research subject to whom full disclosures have been made and who understands fully all that has been disclosed, voluntarily consents to treatment or participation on this basis Informed Consent › legitimate requirements for medical intervention › funding for research usually requires review of informed consent procedures, and the constitutional right to privacy binds government to honor patients' refusal of care Elements of a Fully Informed Consent › the nature of the decision/procedure › reasonable alternatives to the proposed intervention › the relevant risks, benefits, and uncertainties related to each alternative › assessment of patient understanding › the acceptance of the intervention by the patient › “An adult patient who…suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment… This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.”  Consider this scenario A 32-year-old pregnant woman came for vaginal delivery. She had two previous babies with emergency ceasarean section. The second baby was born just a year back. Because of this, doctors wanted Mrs. X to avoid any risk and to get her baby delivered through c-section. The staff members tried to convince Mrs. X and her husband to follow their recommendation, but to no avail. Finally, the patient was sent home for trail of normal labor. Two weeks later, she was admitted and experience intense pains. During delivery though, her uterus ruptured. The baby was delivered normally, whereas the mother was transferred to the intensive care unit for close observation. Unfortunately, a few weeks later she died.” Reflect upon the case again. Consider this question, “Could medical paternalism have saved the patient’s life?” Paternalism › paternalism is a type of medical decision making in which health care professionals exercise unilateral authority over patients › It is an action performed with the intent of promoting another’s good but occurring against the other’s will or without the other’s consent. In medicine, it refers to acts of authority by the physician in directing care and distribution of resources to patients. Paternalism › acts of authority by the physician in directing care and distribution of resources to patients › inherent in the physician role and, thus, in the decision-making process › a balance to other values and an ethical obligation to neither withhold guidance nor abdicate professional responsibility to patients Given that there is a strong obligation to respect the decisions of autonomous adults, how should we proceed when the conditions for autonomous decision- making are not met? Moral problem… › Should someone suffering from severe anorexia be forcibly fed? › Why should an adult woman of ordinary intelligence who refuses food not have her decision respected? Answer: › Anorexia has undermined her ability to make an autonomous decision. The decision to refuse food is not authentically hers; it springs from the mental disorder that has her in its grip. Force feeding could be described as a paternalistic intervention. Autonomy › most forcible when patients exercise this by refusing life- sustaining treatment › requires two conditions: The individual has to have the relevant internal capacities for self- government, and, has to be free from external constraints Remember… › If someone is being coerced into making a decision then it cannot be said to be theirs and should not be respected. › If there are concerns about coercion, good practice would involve spending some time alone with the patient in order to confirm that the decision is genuinely theirs. Remember… › Where patients lack the capacity to make a decision it follows necessarily that decisions must be made on their behalf. › Very young children ordinarily have the majority of decisions made by parents and carers. › Decisions relating to incapacitated adults are closely regulated by law. The Alternative… › Shared decision making is an active dialogue between physician and patient with the goal of arriving at mutual understanding and agreement on a treatment plan. › a shifting balance between physician expertise (paternalism) and respect for patient autonomy Shared Decision Making › linked with increased patient involvement to improved treatment adherence, disease coping, and quality of life › In contrast, lack of patient involvement correlates with lower adherence to treatment, patient satisfaction, and health outcomes But… › may only prove successful under ideal circumstances › less effective with patients who are in denial, or lack health literacy and do not understand disease processes and treatment implications Non-maleficence › Another principle with which most people can agree concerns the ancient injunction against doing harm. Medical school graduates still take the “Oath of Hippocrates” in which they promise to “abstain from whatever is deleterious and mischievous.” › Physicians must refrain from providing ineffective treatments or acting with malice toward patients. Non-maleficence › Thisprinciple offers little useful guidance to physicians since many beneficial therapies also have serious risks. The pertinent ethical issue is whether the benefits outweigh the burdens. › The principle of non-maleficence supports the establishment and enforcement of standards for physician competence and the prohibition of the use of human subjects in nontherapeutic experiments. Beneficence › While non-maleficence prohibits harmful acts, beneficence requires helpful acts. Most agree that health professionals have an obligation to act for the benefit of others. › Beneficent actions can be taken to help prevent, to remove harms, or to simply improve the situation of others. Beneficence › Ideal beneficence comprises extreme acts of generosity or attempts to benefit others on all possible occasions. › Doctors do have an obligation to: 1) prevent and remove harms, and, 2) weigh and balance possible benefits against possible risks of an action. Justice ›The principle of justice can also be found in the previously discussed theories of morality; the notion that equals must be treated equally. ›It could be described as the moral obligation to act on the basis of fair adjudication between competing claims. Justice › itis linked to fairness, entitlement and equality. › In health care ethics, this can be subdivided into three categories: fair distribution of scarce resources (distributive justice), respect for people’s rights (rights based justice), and respect for morally acceptable laws (legal justice). Relevance of bioethics in health and medicine › Bioethics has brought about significant changes in standards for the treatment of the sick and for the conduct of research. Every health care professional now understands that patients have a right to know what is being done to them, and to refuse. Every researcher now understands that participants in their studies have the same rights, and review boards to evaluate proposed research on those grounds are almost universal. The Case of David Cleaver The Case of David Cleaver › Bill (son #1): Dad’s heart is beating; he is still alive! We have no right to approve any action that could result in his death. › Jake (son #2): Bill, the doctor said that Dad has no chance of recovery. The MRI showed no activity in critical areas of his brain. Without the respirator his heart would stop. There is more to be considered here than simply keeping Dad’s heart beating. The Case of David Cleaver › Monica (wife): We need to think about David’s wishes. He was always in control of his life, always a part of every medical decision. His advance directive is very clear. He does not want his life to be artificially extended. We need to tell Dr. Alderfer to turn off the respirator. The Case of David Cleaver › Amy (sister #2): Just pull the plug? Can Dr. Alderfer do that? I can’t believe that someone can be killed just because the right areas don’t light up on a brain scan. I want to hear about how other patients have been treated, why some are left on a respirator while others are removed. There must be some guidelines as to how to proceed in cases like this. The Case of David Cleaver › Ben (brother): I think we need to meet with Dr. Alderfer. Amy’s point is well taken. We haven’t been in this situation before; we need some guidance. Before the meeting, however, I want us all to think about what the Cleavers have stood for, we want our actions to reflect the kind of people we are. We must come through this with our respect for one another intact. We need to be open, honest, caring, and considerate of each other’s views. What forms of ethics did the Cleavers believe? Examples of Medical Ethics Cases › Albert Kligman's dermatology experiments › Doctors’Trial. On December 9, 1946, an American military tribunal opened criminal proceedings against 23 leading German physicians and administrators for their willing participation in war crimes and crimes against humanity. › Henrietta Lacks › Yanomami blood sample collection › Roe vs. Wade How was bioethics applied in the course of the CoVid- 19 pandemic? Case Studies