Medical Ethics and Good Clinical Practices PDF

MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO ETHICAL THEORIES coworkers to be in, and then make it so...

MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO ETHICAL THEORIES coworkers to be in, and then make it so for yourself.  Represent the grand ideas on which guiding principles are based. Jeremy Bentham (1748-1832)  They attempt to be coherent and  Bentham's ethics began with the systematic, striving to answer the proposition that nature has placed fundamental practical ethical questions: human beings under two masters: - What ought I do? pleasure and pain. - How ought I live?  Anything that seems good must be either directly pleasurable or thought to The Rule Theory be a means to pleasure or to the avoidance of pain. THE WORLD  Conversely, anything that seems bad must be either directly painful or HOW TO UNDERSTAND IT HOW TO CHANGE IT thought to be a means to pain or to the deprivation of pleasure. Descriptive theory Action The “is” Ethical theory The “ought”  From this Bentham argued that the words right and wrong can be meaningful only if they are used in accordance with the utilitarian principle, I. UTILITARIANISM so that whatever increases the net surplus of pleasure over pain is right and  This is a theory of morality, which whatever decreases it is wrong. advocates actions that foster happiness or pleasure and opposes actions that John Stuart Mills (1806-73) cause unhappiness or harm.  Bentham's successor as the leader of the  When directed toward making social, Utilitarians economic, or political decisions, a  Although his position was based on the utilitarian philosophy would aim for the maximization of happiness (and this is betterment of society as a whole. said to consist of pleasure and the  Utilitarianism would say that an action is absence of pain), he distinguished right if it results in the happiness of the between pleasures that are higher and greatest number of people in a society or those that are lower in quality a group.  Mill sought to show that utilitarianism is compatible with moral rules and "The greatest good for the greatest number" principles relating to justice, honesty, is a maxim of utilitarianism. and truthfulness by arguing that utilitarians should not attempt to Jeremy Bentham and John Stuart Mills calculate before each action whether  An action is right if it tends to promote that particular action will maximize happiness and wrong if it tends to utility. produce sadness, or the reverse of  Instead, they should be guided by the happiness-not just the happiness of the fact that an action falls under a general actor but that of everyone affected by it principle (such as the principle that  At work, you display utilitarianism when people should keep their promises), and you take actions to ensure that the office adherence to that general principle is a positive environment for your tends to increase happiness. MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO  Only under special circumstances is it Business Ethics necessary to consider whether an  The theory asserts that there are two exception may have to be made. types of utilitarian ethics practiced in the business world, "rule" utilitarianism and ESSENTIAL FEATURE OF UTILITARIANISM "act" utilitarianism. 4 Conditions must be satisfied:  Rule utilitarianism helps the largest 1) The Principle of Utility: "Maximize the Good" number of people using the fairest  First, actors are obliged to maximize the methods possible. good: We ought always to produce the  Act utilitarianism makes the most ethical greatest possible balance of value over actions possible for the benefit of the disvalue people.  But what is good or valuable? Rule Utilitarianism 2) A Theory of Value: "The Standard of Ex: Goodness" Only pleasure or happiness can be Tiered pricing for a product or service for intrinsically good (Bentham & Mills) different types of customers.  The satisfaction of desires or wants is  In the airline industry, many planes offer seen as the goal of our moral actions first-, business-, and economy-class  To maximize an individual's utility is to seats. Customers who fly in first or maximize what he or she has chosen or business class pay a much higher rate would choose from the available than those in economy seats, but they alternatives also get more amenities -simultaneously, people who cannot afford upper-class 3) Consequentialism seats benefit from the economy rates.  Is the position that actions are morally This practice produces the highest good right or wrong according to their for the greatest number of people. consequences, rather than by virtue of  And the airline benefits, too. The more any intrinsic moral features they may expensive upper-class seats help to ease have the financial burden that the airline  A utilitarian demands that we only take created by making room for economy- account of what can be reasonable, class seats. expected to produce the greatest balance of good or least balance of harm Act Utilitarianism Ex: Pharmaceutical companies release drugs 4) Impartiality (Universalism) that have been governmentally approved,  The consequences affecting all parties but with known minor side effects because must receive equal and impartial the drug is able to help more people than are consideration bothered by the side effects.  This theory instructs adherents to work  Act utilitarianism often demonstrates for those outcomes that will give the the concept that "the end justifies the most advantage to the majority of those means"-or it's worth it. affected in the most impartial way possible. Limitations of Utilitarianism  It is often advocated as the basis for  It tends to create a black-and-white broad social policies. construct of morality. In utilitarian ethics, there are no shades of gray-either something is wrong or it is right. MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO  Utilitarianism also cannot predict with principle, rule, maxim or duty that is certainty whether the consequences of derived from an underlying moral our actions will be good or bad-the principle results of our actions happen in the  It stresses the intrinsic value of all future. individual persons: dignity, respect,  Utilitarianism also has trouble autonomy accounting for values like justice and  Kant believed that an act is morally individual rights. praiseworthy only if done neither for Example, say a hospital has four people self-interest reasons nor as a result of a whose lives depend upon receiving organ natural disposition, but rather from duty transplants: a heart, lungs, a kidney, and a  That is, the person's motive for acting liver. If a healthy person wanders into the must be a recognition of the act as hospital, his organ could be harvested to resting on duty save four lives at the expense of his one life.  If one merely performs the morally This would arguably produce the greater correct action, because one perform good for the greatest number. But few would one's duty for self-interest reasons, have consider it an acceptable course of action, let nothing to do with morality alone an ethical one. Example: If an employer discloses a health hazard How Does UTILITARIANISM affect the Society? to an employee only because he or she  Bases the authority of government and fears a lawsuit, and not because of a the sanctity of individual rights upon belief in the importance of truth telling, their utility, thus providing an alternative then this employer rightly but deserves to theories of natural law, natural rights, no moral credit for the action or social contract. An action has a moral worth only when II. DEONTOLOGY THEORY (KANTIAN THEORIES) performed by an agent who possesses a good  The term deontology is derived from the will, and a person has a good will only if moral Greek deon, "duty," and logos, "science." duty, based on universally valid rule is the motive  In deontological ethics an action is for the action considered morally good because of  Moral Law- Kant's supreme principle some characteristic of the action itself,  This Kantian principle has often been not because the product of the action is compared to the golden rule good.  Deontological ethics holds that at least A. Categorical Imperative some acts are morally obligatory  It is categorical because it admits of no regardless of their consequences for exceptions and is absolutely binding human welfare.  It is imperative because it gives Descriptive of such ethics are such instructions about how one should act expressions as "Duty for duty's sake," Ex: -Help others in distress Immanuel Kant (1724-1804) -Do not commit suicide  A theory that some features of actions -Work to develop your abilities other than or in addition to consequences make actions obligatory  Judgment is based on whether an act is in keeping with some moral standard: MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO B. Hypothetical Imperative the situation. Maybe that person has killed  Tell us what we must do, provided that another one in self-defense. we already have certain desires, interests, or goals 2. Do Not Steal  These imperatives are not commanded Stealing is also considered as a legal crime. We for their own sake but Commanded as a are taught not to steal anything or take means to an end that has already been anybody's thing without asking them. will or accepted  These imperatives are not moral in 3. Religious Belief Kant's philosophy because moral Every person of the particular religion has to imperatives tells us what must be done follow the rules and regulation of his religion. For to independently of our goals or desires example, if you're a Hindu you might believe that it's wrong to eat beef; this rule would be part of RULES AS UNIVERSAL LAW our deontology because we think it is wrong to Applies to everyone → no exception eat beef. Example: - Lying → the universality of rules that 4. Keeping Promises allow lying would entitle everyone to lie If you have made a promise, you must keep it. For to you, just as you would be entitle to lie example, you might borrow money on the to them promise to pay it back, but you don't intend to pay it back. So, making false promises is Never Treat Persons as Means considered wrong.  One must act to treat every person as an end and never as a means only 5. Cheating  One must treat persons as having their If someone cheats on us, we imagine that person own autonomously established goals as very wrong and untrustful because we think of  To treat persons merely as means, is to cheating as wrong. disregard their personhood by exploiting Ex: or otherwise using them without regards - Suppose you're a software engineer to their own thoughts, interest and and learn that a nuclear missile İs about needs to launch that might start a war. You can  It involves a failure to acknowledge that hack the network and cancel the launch, every person has a worth and dignity but it's against your professional code of equal to that of every other person and ethics to break into any software system that this worth and dignity cannot be without permission. And, it’s a form of compromised for utilitarian or any other lying and cheating. However, in letting reason the missile launch, thousands of people will die. 1. Do Not Kill We all see killing or murdering as an erroneous 6. Do not Lie human deed because we are taught since our "Do not lie" is the most taught ethics by our childhood that killing anybody including an parents, teachers, and everyone around. Lying is animal in a wrong act. For instance, if we found a considered wrong, even if it is to benefit or bring killer in our society, we all will hate him and about better consequences. consider him wrong because he/she has killed somebody. But we don’t know the detail behind 7. Respect the Elders Elders have to be respected. Respecting them is considered Right. If someone is found MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO disrespecting them, (may have a genuine reason Ex. Right to life, not to be harmed, to behind the disrespect) is considered as a bad human dignity and freedom of choice, to person. healthcare, to reproduce, to justice, to a good name, to die with dignity Advantages  Specific moral norms and responsibilities Virtue Ethics are easy to state  Virtue is neither a feeling nor an innate  They provide direction and predictable capacity, but rather a disposition bred answers useful for justifications and from an innate capacity properly trained criticism and exercised Limitations  Has a practical value in that a morally  Understanding, interpretation and good person with right desires or implementation may be selective motives is more likely to understand depending on who describes them and what should be done, to perform there are difficulties in applying them to required acts, and to form moral ideals the complexities and subtleties of a than is a morally bad or indifferent particular moral situation person  More than one duty may be applicable in  Principles of basic obligations a specific dilemma and some duties are waived, lost, or over-ridden Ethics of Care  Focuses on a set of character traits that Duty-based: Laws, Principles & Rights people all deeply value closely personal A. Laws are rules of conduct, ordinances or relationships: sympathy, compassion, impositions for the common good of a fidelity, love, friendship, and the like community, promulgated by the legitimate  Frames responsibilities in terms of authority and under obligations of obedience by meeting the health as well as other the subjects human needs of patients and their Examples: families, role commitments, concerns Divine law about causing harm, protecting positive - Bible and tradition, Ten family relationship and the like Commandments Natural law Casuistry - What reason and experience  Focuses on decision making using tells about what it requires to be particular cases, where the judgments a human person reached rely on judgments reached in Legal law prior cases - State  Casuists also have rightly pointed out B. Codes are systematic collection of Laws that generalizations are often best Ex: Hippocratic code (Physician's learned, accommodated and professional responsibilities and implemented by using cases, case privileges) discussions and case methods  These insights can be utilized by C. Principles are generalizations accepted as true connecting them in an appropriate set of and serving as tools for analysis concepts, principles and theories that D. Rights considered relationships between control the judgments we make about people which exists as entitlements or claims of cases. one with correlative obligations of others. They are based on the principle of justice MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO  Living well with others is what matters, III. INDIVIDUALISM building up society, serving the common  Judgment is based on whether it is the good agent's personal choice (individualism; autonomy, libertarianism) or on the Advantage: agent's good characteristic traits (virtue) - It avoids a social and antisocial  Personal choice uses emotions or tendencies of the "me" generation subjective gut feelings, intuitions Limitation:  It relies on the good sense and moral - It may lose sight of individual rights and sensitivity of ordinary people to make personalities and tend towards cultural best judgments in their own relativism circumstances VI. OTHERS 1. Relativism or Subjectivism Advantages  Standard of right or wrong is relative to  It is spontaneous and straightforward people, time, and to place  Decisions are usually good  No absolute standard  It respects autonomy, moral pluralism,  It becomes easier for human beings to and the complexities of the individual exploit, manipulate, oppress or even situation hurt others - Limitation: No intrinsically unethical or Limitations immoral acts since the intention or the end  They depend on personal experiences justifies even an unethical or evil means and circumstances at the particular time Examples: and judgment may differ at another time - Terrorist instills fear (robbing,  They may be affected by rhetoric or kidnapping, and killing) to call passion or magnetism attention of the government as a  They are neither objective nor logical so justified means in the attainment of leave little or no basis for criticizing/ their goal defending generalizing -Caring for the sick relies on the  They allow compromise of civilizations subjective feelings and thinking, most basic values, potentially antisocial whims and caprice of caregivers IV. VIRTUES 2. Proportionalism  Habits that orient person towards good.  Specific situations or circumstance is an Advantages: exception to the absolute ethical norm - Easy to defend they are most in line  Employs Commensuration with the paradigm of a healthcare  If the good that results from the act is provider who is service oriented greater that the harm to be caused, the Limitations act is ethical, even if the act is in violation - Role models in the profession and at of the norm the present times are difficult to find. - Limitations: Many have only one or two virtues -Cannot offer a clear and practical and objective answer on how to measure V. COMMUTARIANISM and the goodness of HA  Judgment is based primarily on interconnectedness MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028  MEDICAL ETHICS AND GOOD CLINICAL PRACTICES ETHICAL THEORIES AND PRINCIPLES 1st YEAR | A.Y. 2024-2025 | AUGUST 25, 2024 DR. SAIPUDDIN-CORDERO -Does not admit absolute values or disvalues against which goodness or badness of HA may be measured - Draws both from Utilitarianism and situational ethics Examples:  Rape victim may feel justified in aborting the fetus since mother is convinced that her life outweighs the life of the unborn  Mother wants abortion out of love and concern for other children so as not to compromise care and education of other children 3. Situationalism  It is the nature of the situation that determines whether the act is good and bad  No HA is intrinsically good or bad because there are no absolute rules or norms Limitations: -Free flowing due to the diversity of circumstances that situations present -As long as the motive and the circumstances can be described as loving -Caregiver and not the patient is the object of concern Example: - When prognosis is not encouraging and patient's life situation is subjectively perceived by the caregiver to be burdensome if the patient's life were prolonged UTILITARIANISM DEONTOLOGY VIRTUE Morality Consequences Conformity to Perfecting depends “Cost/Benefit” moral principles one’s on… character Key Mill, Bentham Kant Aristotle philosophers Jargon Greatest Categorical Telos Happiness Imperative Principle “Do unto others as you would have them do unto you.” MEDICAL ETHICS AND GOOD CLINICAL PRACTICES FERVIENTE 2028