Bioethics schools.pptx

Bioethics schools Moral conscience But first Moral conscience is a judgment of reason by which the human person recognizes the moral quality of a concrete act that he intends to do, is doing or has done.  The man who seeks the good must faithfully follow what he perceives as just and right acco...

Bioethics schools Moral conscience But first Moral conscience is a judgment of reason by which the human person recognizes the moral quality of a concrete act that he intends to do, is doing or has done.  The man who seeks the good must faithfully follow what he perceives as just and right according to the dictates of his conscience (right reason). There must be a correspondence between the subjective ethical judgment and the objectivity of the act. = true conscience. If this does not coincide = erroneous conscience. Securities of the conscience:  Certainty  Doubtful  Perplexed Principalist bioethics Principlist bioethics developed historically in the North American context from the book Principles of Biomedical Ethics, by Beauchamp and Childress, who tried to establish, from what they called a universalizable "common morality", an ethics based on this set of principles. This proposal is in turn based on the Belmont Report of 1978. Four principles: 1. Beneficence: the commitment to seek the good of the patient (Where can we find this principle?) 2. Non-maleficence 3. Autonomy: two conditions -> a) Freedom; b) capacity for the action. (Where can we find this principle?) 4. Justice Advantages:  Widely accepted throughout the Western world. It is simple and useful. It has a basic framework on which to confront the various ethical problems. Common language. The principle of respect for autonomy provides the basis for considerations on such important issues as informed consent or refusal of medical treatment. Difficulties: Clousert and Gert published an article criticizing principalism. The school did not offer a hierarchical and convincing table of principle -> if any principle conflicted with another, which one is chosen? Lack of a unitary theoretical system of interpretation of these principles. Example of conflict between principles? The pragmatic-utilitarian model It proposes a pragmatic morality: the morality of calculating evaluable utility, of the relationship between cost and benefit. Currently is associated with Peter Singer. Advantages:  The calculation of utility, the sustainability of the means used and the concern for an objective cost-benefit analysis are issues that must be taken into account in all ethical models. It helps to ensure the economic sustainability of treatments and healthcare institutions. Difficulties:  The pragmatic moral principle of cost-benefit cannot weight the goods.  Money costs are confronted with the value of a human life.  The criterion of utility can never be the ultimate criterion in bioethics.  The end of our actions is ultimately determined by the dignity of the sick person, over and above other types of utility criteria. The contractual model Contractualism is based on the criterion of an inter-subjective agreement stipulated by an ethical community, that is, by all those who have the capacity and power to decide. Referential author: Engelhardt Consequences: 1. The social consensus justifies the undervaluation of all those who are not yet part of the community whose rights would therefore depend on adults and who, in the final analysis, are not considered as persons. 2. Those who have not achieved social insertion are also undervalued, as is the case, for example, with the sick who have lost all social relations or the unrecoverable insane. Therefore Not all human beings are persons. Engelhardt establishes four principles for bioethics-contractualism: 1. Permission principle: "Do not do to others what they would not do to themselves and do for them what you have undertaken to do" 2. Principle of doing the good that the patient understands as good for him/her. 3. Principle of ownership: People own themselves, they own what they do, and society and other people only have moral rights over them if the person has ceded this right. 4. The principle of political authority: Political authority receives its principal moral justification by virtue of the three preceding principles. Disadvantages:  The only source of authority is consensus. This model reduces the conception of the human person to a sociological concept. These vulnerable subjects are left defenseless. It does not offer criteria that can solve ethical difficulties in a universal way, nor guidelines to morally oppose a community. Strength:  It offers a context of great "comfort" and "security" for the case of the health agent who follows the guidelines of his environment, because he will always be covered by the rules agreed upon in that particular community.  Minimum agreement based on an ethical contract of the parties that are shared by all in an ethical community. Particularly advantageous for healthcare personnel. Other schools not so popular: 1. Narrative ethics: this ethics makes a synthesis between the collective principles received and the particularities of each person. it does not have an anthropological and ethical foundation, it is relativistic and subjective. 2. Casuistic bioethics: it is based on deciding in each situation. it is purely subjective. It does not provide concrete practical criteria. 21/01/2024 The personalist model It is a synthesis between classical realist philosophy and some elements of contemporary personalist phenomenology.  The personalist model places the dignity of the human person as the fundamental criterion for the theoretical study and practical discernment of ethical issues. The person always as an end, never as a mean. It is this dignity that demands the utmost respect and effective protection for each person, from the moment of conception to the moment of natural death. What is human dignity? The dignity of man is based on the fact that "he is a person", on his personal being: understanding and will, self-awareness, self-determination and self-realization, free and conscious action. Dignity is that which must be treated with "respect", that is, with "care", because of its intrinsic value. We established that: Material body and spiritual soul form the unity of the human person. The dignity of the human person comes from this all men have the same dignity, even if they have not yet developed all their faculties or even if they no longer have the possibility of manifesting them due to various circumstances. The person is someone and not something. Values and principles to be applied: a) The principle of the defense of human life and its inviolability: defend of the physical life and spiritual dimension. b) The principle of freedom and responsibility: The greater the freedom, the greater the responsibility. -The consequences of the free acts we perform are also ours. -This supposes the obligation to use freedom taking into account the effects of our acts. The use of freedom for good is a good use of freedom, the use of freedom for evil means a bad use of our freedom. - Responsibility implies the obligation to weigh the action we are doing or want to do, to become aware of its moral value. -It also implies being accountable for our actions. Since we are the owners of an action, and since it cannot exist without our consent, we are the ones who must answer for it: in front of… - The principle of freedom-responsibility of the patient is delimited by the principle of defense of physical life - which is a preceding and superior value to freedom and which appeals to primary responsibility. - It should always be kept in mind that life and health are entrusted primarily to the patient's responsibility. If the physician considers the patient's claims or wishes to be ethically unacceptable, he can - and sometimes must - make use of his own responsibility, inviting the patient to reflect, refusing to participate in certain actions, or inviting him to go to another hospital or another physician. - This principle also implies the principle of truthfulness and integrity in our work and actions. Truthfulness obliges us to tell the truth and therefore not to lie or deceive the patient. c) Principle of Totality or therapeutic principle: therapeutics indicates that in order to do good to the person as a whole, the use of medical or surgical therapies that harm a part of the organism may be licit and even obligatory, as long as this action benefits the person as a whole.  The principle of the inviolability of life, which we have presented as primary and fundamental, is not contradicted, but is properly applied when, in order to save the whole and the very life of the subject, it is necessary to intervene even by mutilating a part of the organism. Therapeutic principle requires certain conditions to be applied: 1) it is an intervention on the diseased part or the part that is the direct cause of the disease, in order to save the healthy organism; 2) that there are no other ways or means to avoid the disease; 3) that there is a good, proportionally high, chance of success; 4) and that the patient's consent is given. Rule of "proportionality of therapies”: This rule implies that the application of a therapy or treatment must be evaluated in the context of the whole person, and an adequate proportion must be required between the risks and harms it entails and the benefits it procures. Applying disproportionate care may represent a demonstration of aggressiveness or therapeutic overkill, for example, when dealing with the care of the terminally ill incurable patient. d) The principles of Sociability and Subsidiarity: Sociability is an intrinsic characteristic of the nature of the human person, who is essentially a social being. By sociability we understand the characteristic of the person that makes the person essentially open to relationships with others and to life in society. The principle of sociability commits each and every person to seek his or her own fulfillment by also participating in the fulfillment of the good of his or her fellow human beings. For this reason, in the case of the promotion of life and health, every person must look after his or her own life and that of others as not only a personal but also a social good, and commits the community to promote the life and health of each and every one, to foster the common good by promoting the good of each and every one. Subsidiarity: In terms of social justice, the principle obliges the community to guarantee to each and everyone the means to access the necessary care, even at the cost of the sacrifice of those who have an affluent social position. The principle of subsidiarity consists of a double obligation that involves the social community as such, as well as each of its members, but especially its authorities. Subsidiarity is to attend to the needs of others without substituting them in their capacity to decide and act; it implies that the higher levels of society - governments, institutions, international organizations - should not supplant, but rather help, the lower levels: individuals, families, associations, etc. Knowing to cure, not to manipulate