Ethics and Bioethics Lecture Notes PDF

Ethics and Bioethics What is ethics? philosophical reflections on morality application of a moral code of conduct and good behavior in the field of professional endeavor 'ethos': theory of things about the individual’s search of meaning while dealing with human problems which could be –...

Ethics and Bioethics What is ethics? philosophical reflections on morality application of a moral code of conduct and good behavior in the field of professional endeavor 'ethos': theory of things about the individual’s search of meaning while dealing with human problems which could be – LOGICAL, EPISTEMOLOGICAL, COSMOLOGICAL, ETHICAL, AESTHETICAL OR SCIENTIFIC. ETHICS MORALITY Theoretical Based on principles practiced Prescriptions/critiques by a particular community nature of the good fundamental convictions of human agent nature of human character of moral agent person use of norms criteria of judgment situational analysis SCHOOLS OF ETHICS Ethical Relativism/Moral Relativism morality is relative to the norms of a particular culture some cultures may accept certain acts and behaviors that are unacceptable to other cultures acknowledges societal diversity Ethical Pragmatism more on a theory of knowledge, truth and meaning rather than morality applied in the medical context in terms of decision making and moral reasoning What is bioethics? medical ethics ethical theory of medicine Theories Deontological rightness or wrongness of an action, not on the consequence Teleological an action is morally right if the outcome is good Virtue rightness or wrongess of an action depends on how a virtuous person would act in a given situation Deontological Ethics Divine Command an action is right if declared by God to be right moral obligations arise from the command of God Categorical Imperative (Immanuel Kant) universalizability principle  imagine if everyone does it (unfair to make an exception of yourself)  if you do a thing, you're universalizing that action formula of humanity  humans are not mere objects that exist to be used by others  humanity as an end Teleological Ethics Utilitarianism (John Stuart Mill and Jeremy Bentham) an action is right if it results in happiness or satisfaction focuses on results and consequences humans: primal desire to seek pleasure and avoid pain “We should act always so as to produce the greatest good for the greatest number, NOT JUST FOR OURSELVES.” Teleological Ethics 2 Types of Utilitarianism Act utilitarianism choose the action that produces the greatest good for the greatest number Pain is pain regardless of who's experiencing it. Rule utilitarianism live by rules that are likely to lead to the greatest good for the greatest number think long-term and in a larger scale Teleological Ethics Hedonism maximum pleasure is the ultimate life goal Egoism right action is maximized if it benefits one's self human nature as wholly self-centered and self-motivated Asceticism voluntary abstinence from various sorts of worldly pleasures otherworldly asceticism (monks, hermits) and worldly asceticism (Amish communities) Teleological Ethics Altruism motivation is to benefit someone other than one's self to do good to others/to prevent harm to them Negative Consequentialism passive avoidance of bad outcomes minimizing bad outcomes rather than promoting good outcomes Virtue Ethics based on the inherent nature of the individual rather than on the consequence of the acts “Act as a virtuous person would act in the same situation.” “Doing the right thing at the right time in the right way in the right amount toward the right people.” Virtue Ethics How can one become virtuous? Learn it from experience or from other people. Why should one become virtuous? to attain the pinnacle of humanity EUDAIMONIA: a life well-lived honing your strengths/working on your weaknesses to become the very best person you could be a person living in eudaimonia will do good things Principles of Bioethics Autonomy the act of respecting the decisions of others rejection of paternalistic ethics: rigid and secular traditions Beneficence doing an action that benefits others increasing the ratio of good over evil Principles of Bioethics Non-maleficence avoidance of doing harm to others if you're not competent to do something, you should not do it Justice application of legal ethics in the profession impose fairness to everyone involved Ignorance and Negligence Ignorance lack of technical or theoretical knowledge in the act of doing work examples: incompetent, no experience, no knowledge of consequence, failure of job execution Negligence failure to use reasonable care failed to take an action that a reasonable person would do did something that a reasonable person would not do Historical Accounts Code of Hammurabi complete and extant collection of 282 Babylonian laws enacted during the reign of Hammurabi (1792-1750 BCE) “If a physician makes a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.” Hippocratic Oath most widely known of all Greek medical texts requires a physician to uphold a number of professional ethical standards Moral Issues 1. Abortion 2. Euthanasia 3. Genetic Engineering Genetic Screening – screen, choose and select the genes for proper detection of any genetic disease and other chromosomal malfunctions Genetic Interventions – genetic control, therapy and surgery Stem-cell therapy In-vitro Fertilization (IVF) Negligence a duty was owed the duty was not met injury or harm was done failure to meet the duty owed resulted to the injury (proximate cause) compensation Burden of proof: on the person claiming damages Negligence Plaintiff persons who are entitled to damages natural or artificial (corporations) unborn child is not entitled to damages (only the parents): birth determines personality Defendant person who may be held liable doctrine of respondeat superior: apparent authority, an employer is responsible for the actions of the employees performed within the course of employment captain of the ship rule: the operating surgeon is the in-charge of the operating room and all personnel connected with the operation Negligence Professional negligence/Malpractice: testimony of experts (supported by texts and articles) Ordinary diligence required by law: diligence of a good father of a family (Art. 1163 of the Civil Code)  Art. 19. “Every person must, in the exercise of his rights and in the performance of his duties, act with justice, give everyone his due and observe honesty and good faith.” Art. 20. “Every person who, contrary to law, wilfully or negligently causes damage to another, shall indemnify the latter for the same.” Art. 21. “Any person who wilfully causes loss or injury to another in manner that is contrary to morals, good customs or public policy shall compensate the latter for the damage.”  GR 160889: Dr. Milagros Cantre vs. Spouses John David and Nora Go April 1992: fresh gaping wound (2 1/2 x 3 1/2 in) on Nora's left arm after delivery nurse: burn, Dr. Cantre: bp cuff JD brought Nora to NBI: bp cuff is not the cause of the wound June 1993: spouses Go filed a complaint for damages against the hospital and doctors who handled Nora Go RTC: decreed P 786,000 damages Court of Appeals (March 1997): decreed P 200,000 in damages and only Dr. Cantre should pay  SC (April 2007) Hippocratic Oath: mandates all physicians to give primoridal consideration to the well-being of the patient (intent is immaterial) Cantre: the injury was due to the constant taking of BP on Nora's arm, the droplight did not touch Nora's body Doctrine of res ipsa loquitur (the thing speaks for itself) mere existence of an injury to justify the presumption of negligence on the part of the person who controls the instrument causing the injury accident does not ordinarily occur in the absence of someone's negligence (the injury is not ordinary) caused by the instrumentality within the exclusive control of the defendant (whether the BP cuff or droplight caused the injury does not matter) elimination of the possibility of contributing conduct which would make the plaintiff responsible SC affirmed the CA's decision  GR 124354: Erlinda Ramos v. Court of Appeals Ramos: had brain damage after wrongful administration of anesthesia by Dr. Gutierrez (ICU for 1 month and died 4 months later) brain damage does not normally occur in the process of gall bladder operation: anesthesia instruments c/o Dr. Gutierrez negligence was proximate cause of patient's brain damage expert testimony is not necessary in non-technical matters: an ordinary person can tell if anesthesia is administered properly Dr. Gutierrez committed act of exceptional negligence and professional irresponsibility captain of the ship doctrine  GR 118231: Dr. Victoria Batiquin v. Court of Appeals Dr. Batiquin performed Caesarean section on Mrs. Flotilde Villegas Villegas: abdominal pain and feverish post-op another surgery: a piece of rubber glove inside the abdomen caused the infection of ovaries doctrine of res ipsa loquitur Bioethical Issue: William Beaumont: US Army surgeon, father of gastric physiology experimented on a patient's hole or fistula in the stomach Human Subjects of Research Unit 731 in Harbin, China (1935-1945) biological and chemical warfare research unit of the Japanese Imperial Army used 3000 patients or 'logs' vivisection: without anesthesia, after infecting people with disease germ warfare attacks: venereal disease, plague, cholera frostbite testing: freezing of limbs syphilis: forced inmates to have sex, vivisection to study disease progression rape and forced pregnancy: vertical transmission weapon testing: humans as live targets of grenades, bombs, flamethrowers Human Subjects of Research Nazi Experimentation (Buchenwald concentrantion camp, Germany) research on typhus: infected 40 subjects with typhus hormone implantation to cure homosexuality inmates shot to study gunshot wounds inmates starved to study nutrition removal of limbs to study regeneration research on malaria rubbing of glass and stone into wounds to test antibiotic efficacy  Nazi experimentation (Dr. Sigmund Rascher in Ravensbruck, Germany) study human survival during rapid changes of altitude sky ride wagon revival after freezing (icy water and blizzard exposure) 70/200 dead  Dr. Josef Mengele (Auschwitz concentration camp, Poland) ambitious/angel of death greet trains to examine prisoners injection of blue dye: studied inheritance of blue eyes forced female twins to have sex with male twins interchanged blood of identical twins created the effect of conjoined twins subjected 75 prisoners to electric shock  Mengele's reasons those people were to die anyway (Why not use them to advance medical knowledge?) banality of evil: ordinary people in relatively normal circumstances can do terrible things obedience to authority  a set of research ethics principles for human experimentation verdict: August 20, 1947 imposed a list of ten points that should be followed when experimenting on humans, including: informed consent positive results for society justification of the research subjects should be free to quit anytime avoid unnecessary physical and mental suffering or injury, or death  600 black men in Tuskegee, Alabama 399 with syphilis, 201 without to describe the natural progression of untreated syphilis no informed consent no treatment went on for 40 years ethically unjustified 1974: US government provided lifetime medical benefits and burial services to living participants  dermatological experiments in prisoners at Holmesburg Prison, Pennsylvania Dr. Albert Kligman, a dermatologist: tested shampoos, toothpastes, detergents, hair dyes, foot powders, deodorants, and the effectiveness of Retin-A, an anti-acne medication later on: radioactive materials, the defoliant dioxin, and mind- altering drugs (for Cold War purposes) questionable informed consent: prisoners are illiterate welcome change from a boring environment earning opportunity: 300-400 dollars  psychological effects of perceived power ordinary people are capable of doing unimaginable things August 14-20, 1971 at Stanford University, California Professor Philip Zimbardo (funded by the US Office of Naval Research) 10 prisoners, 11 guards guards: authoritarian, psychologically tortured 'inmates', abuse/aggression/assertion prisoners: passive acceptance, obedient (later: depression and emotional disorders) Ethical Question Is it morally acceptable to use scientific data or any other sort of information that has been obtained in an unethical way? moral duty to avoid tainted data rescuing something worthwhile from something that was wrong