Ethics of Science and Technology Chapter 1 (2024-25)

Ethics of Science and Technology Chapter # 1 Introduction and Principles of Ethics First Semester 2024-25 1  Outline 1.Definition: Ethics and morals Biomedical ethics Laws Ethical dilemma Uncertainty, ou...

Ethics of Science and Technology Chapter # 1 Introduction and Principles of Ethics First Semester 2024-25 1  Outline 1.Definition: Ethics and morals Biomedical ethics Laws Ethical dilemma Uncertainty, outrage, and distress in ethics 2. Ethical Principles 2  Ethics and Morality Morals are derived from the Latin mores, means custom or habit. Morals are the basic standards for what we consider right and wrong (good or bad) that typically are based on religious beliefs, social influences (including education), group norms, culture, and life experiences Morals or standards are often based on religious beliefs and, to some extent, social influence and group norms. Moral defines personal character and is usually unchanging 3  Ethics and Morality The word ethics is derived from the Greek term ethos, which means customs, habitual usage, conduct, and character Ethics is a set of moral principles and a code for behavior that govern an individual’s actions with other individuals and within the society The basis of ethics is Moral. Ethics is a branch of philosophy (the study of beliefs and assumptions) referred to as moral philosophy Ethics: Specific area of study of morality that concentrates on human conduct and human values Ethics answer the question about what one ought to do in a given situation. 4  Ethics and Morality So, ethics and morals are related to each others. Ethics stresses a social system in which those morals are applied (standards or code of behavior expected by the group to which the individual belongs; depend on others in practices. e.g. healthcare providers have a duty to practice ethically and morally) Ethics is not a religion or a law (but both can be the basis of ethical decisions that we make) 5  Ethics and Morality In healthcare organizations, “organizational decisions inevitably have a moral dimension.”= we need to make judgments requiring consideration of what is right or best for our clients, their families, and the community (often are based on ethical and moral values). Some of these decisions can be based on clinical knowledge but many will require additional expertise in ethics and moral decision making. 6  Biomedical ethics Biomedical ethics or Bioethics refer to the moral issues and problems that have arisen as a result of modern medicine and medical research (as science and technology produce new ways of knowing). Issues in bioethics are usually life-and-death issues (because bioethics refer to ethical problems linked to the present and the future of human life) Ethical and bioethical principles can be personal, organizational, institutional or worldwide. Ethics is interdisciplinary field in which many providers (such as Physicians, nurses, social workers, psychiatrists, clergy, philosophers, and theologians) are joining to address ethical questions in health care 7  Law The “Law”: is a standard or rule of conduct established and enforced by the government OR the principles and regulations established in a community by some authority and applicable to its people Laws are societal rules or regulations that are obligatory (mandatory) that all people must adhere (observe, must follow/ obey). Laws protect the welfare and safety of society, resolve conflicts, and are constantly changing. Law and ethics are different but related concepts. Laws have governed the practice of medicine for over one hundred of years 8  Ethical Dilemma Ethical/moral dilemma: any situation in which guiding moral principles cannot determine which course of action is right or wrong In dilemma: Two or more clear principles apply but they support inconsistent courses of action= no perfect solution as there value conflicts or no clear consensus (agreement) on the “right” thing to do. Requires moral reasoning before making a decision then people have to have the rationales to defend their decisions. An ethical dilemma must be ethical in nature, not legal. If something is a law, you then have the ethical choice to follow the law or not. 9  Ethical Dilemma Example: 1. Should children with serious birth defects be kept alive? 2. Who should receive a needed heart transplant—a young 34-year-old male with a wife and two children or a 78-yearold gentleman who also has diabetes? 3. Should assisted suicide be an alternative for an individual experiencing great pain and suffering from terminal stages of cancer? 4. Should abortion be an alternative for a 14-year-old got pregnant as the result of rape? 10  Ethical issues Moral uncertainty/conflict: When the healthcare provider is unsure which moral principle to apply, or even what the problem is. It is common with new healthcare providers, they’re not sure what they are supposed to be doing Moral distress: When the healthcare provider knows the right thing to do but organizational constraints keep them from doing it Moral outrage: An individual witnesses an immoral act by another but feels powerless to stop it 11  Ethical Principles Ethical Principles (& Ethical theories): 1) Are the basic ideas that are starting points for understanding and working through a problem. 2) They provide the framework/ tool that help in resolving conflict in a fair and moral manner. 3) They are the TENTS that are important to consider in all situations 4) Establish common ground between health care provider and professionals, patient, family, and society 5) Permit people to take a consistent position on specific or related issues 12  Basic Ethical Principles 1. Rights 2. Autonomy 3. Privacy and Confidentiality 4. Beneficence and Nonmaleficence 5. Justice 6. Fidelity 7. Veracity 8. The standard of best interest 13  1. Rights Rights form the basis of most professional codes and legal judgments o Self-determination rights (Autonomy) o Rights and cultural relativism: individuals hold different sets of values must be respected. o Rights of the respect o Rights of the unborn o Rights of privacy and confidentiality (not sharing information) 14  ‫‪Example of patients right in a Jordanian hospital‬‬ ‫للمريض الحق في ‪:‬‬ ‫‪.1‬العناية باحترام واعتبار‪.‬‬ ‫‪.2‬اخذ معلومات كافيه ممن يعتني به عن مرضه وعالجه ومستقبله‬ ‫المرضي‪.‬‬ ‫‪.3‬اتخاذ قرارات تخص خطة العناية والعالج وله ان يرفض المعالجة الى‬ ‫الحد الذي يسمح به القانون بعد ان يوضح له ما يترتب على ذلك من امور‪.‬‬ ‫‪.4‬السرية والخصوصية في جميع مراحل العالج وسرية المعلومات الطبية‪.‬‬ ‫‪.5‬مراجعة ملفه الطبي كامالا‪.‬‬ ‫‪.6‬تلقي اقصى درجات العناية المتاحة في المستشفى وان يحصل على‬ ‫التحويل الالزم عند عدم توفر العالج في المؤسسة المتواجد فيها حاليا ا‪.‬‬ ‫‪.7‬ان يعلم بالعالقات التجارية التي تديرها المستشفى والتي تتعلق بعالجه‪.‬‬ ‫‪.8‬المشاركة في االبحاث والدراسات بمحض ارادته وبدون اكراه‪.‬‬ ‫‪.9‬استمرارية العالج في مختلف المؤسسات الصحيه خارج المستشفى‪.‬‬ ‫‪.10‬معرفة سياسات المستشفى ومسؤولياتها ومن ضمنها معرفة تفاصيل‬ ‫تكاليف عالجه بغض النظر عن الجهة الدافعة‪.‬‬ ‫توصيات تتعلق بصحته خاصة في نهاية الحياة‪.‬‬ ‫‪15‬‬ ‫‪.11‬كتابة أي‬  2. Autonomy Autonomy: the right of self-determination, independence, self-reliance, and freedom or the right to make one’s own decisions. Respect for autonomy means that healthcare provider must recognize the individual’s uniqueness (treat each individual as an autonomous subject, not everything can be applied to all people) and the right to choose personal goals (decisions), even when WE do not agree with those decisions Following the principle of autonomy means to respect a client's right to make decisions even when those choices seem not to be in the client’s best interest. 16  Autonomy Autonomy is closely tied to informed consent (clients be provided clear and sufficient information to make good decisions for themselves) example: patients should give informed consent before carrying out tests and procedures There may be restrictions on the autonomy such as when one person’s autonomy interferes with another individual’s rights, health, or well-being. Example: Can a patient with a highly communicable disease have to do whatever he wants even to expose the community to the disease? In the clinical setting, this principle is usually violated when a health care provider disregards client's subjective accounts of their symptoms (e.g. pain) 17  Autonomy Must have a capacity to make decisions independently: oDevelopmental considerations oHealth related challenge Paternalism / Parentalism: treatment of /caring for people in a fatherly manner (an individual assumes the right to make decisions for another (restricting autonomy: not allowing them to have rights or responsibilities)) * Paternalism / Parentalism considered acceptable when patient does not have decision making capacity. In such case, best-interest standard should be applied. In case where parents have denied their children lifesaving care, the courts have, on occasion, overturned the parent’s 18 decision on the best-interest standard.  3. Privacy and Confidentiality Privacy includes a number of aspects: 1) Personal space (physical privacy) 2) Personal data (informational privacy) 3) Personal choices including cultural and religious affiliations (decisional privacy) 4) Relationships with family members and other intimates (associational privacy). Informational privacy: The right of individuals to hold information about themselves in secret and free from the knowledge of others. Confidentiality: The assurance that information about identifiable persons, will not be disclosed (told) without consent (invasion of privacy) except as allowed by law. 19  4. Beneficence/ Nonmaleficence Beneficence: o Means “doing good” which is the Heart of caring o Health care provider should implement actions that benefit clients and their families. o In an increasing technologic health care system, doing good can also pose a risk of doing harm (e.g. intensive exercise program). o What is ‘good’? Good = thing of a favorable character which promotes decent things such as life, development, quick recovery from surgery …… 20  4. Beneficence/ Nonmaleficence Beneficence: o Sometimes it is difficult to have a prefect answer such as in: Is the ongoing support of life good if that life is filled with pain? If giving good care to one patient means that lesser care will be given to another one? o Who will determine what is good for a specific person? Doctor? Use autonomy? What if he is infant? unconscious or mentally incompetent? 21  Beneficence/ Nonmaleficence Nonmaleficence: o The duty of “do not cause harm”/ prevention of intentional harm/remove harm. o Harm can mean deliberate/intentional harm, risk of harm, and unintentional harm. Example: the discomfort associated with debridement of wounds, adverse drug reactions, and the side effects of such treatments as chemotherapy for cancer o Intentional harm is always unacceptable. o The risk of harm is not always clear o Nonmaleficence is more necessary than beneficence because you’re going beyond just trying to do good to that patient, you’re trying to prevent harm 22  Beneficence/ Nonmaleficence Examples of beneficent actions: oResuscitating a drowning victim oProviding vaccinations for the general population oEncouraging a patient to quit smoking o Encouraging a patient to start an exercise program. Examples of nonmaleficent actions: oStopping a medication that is shown to be harmful (Stopping medical therapies when they are futile= clearly have the potential for adverse outcomes such as chemotherapy for terminally ill patient) oRefusing to provide a treatment that has not been shown to be effective. 23  5. Justice Fairness, treat alike cases similarly (equity), the quality of being just or fair Types of Justice: o Comparative Justice: Making a decision based on criteria and outcomes (Need, age, Effort,…..). e.g.: How to determine who qualifies for one available kidney. 55 year old male with three children versus a 13 old girl. o Noncomparative Justice: decision made not based on criteria or outcomes. e.g.: a method of distributing needed kidneys using a lottery system (chance). 24  6. Fidelity Fidelity: means to be faithful to agreements or promises, and responsibilities that one has made to oneself and others, both implicitly and explicitly 1. Implicit: promises that are implied 2. Explicit: promises that are explicitly stated Health care providers have responsibilities to clients, employers, government, society, profession, & themselves Fidelity is the foundation of the concept of accountability (the answerability for the outcome of the task or process you are responsible to (Responsibility refers to the obligation to perform the task or comply with the rule)). 25  7. Veracity Refers to telling the truth (avoid lying) or not intentionally deceiving or misleading patients. Often a source of ethical challenges arising from differences in personal beliefs and unique cultural features should I tell the truth when it is known that doing so will cause harm? Does tell a lie when it is known that the lie will relieve anxiety and fear? Should I lie to dying people? 26  8. The standard of best interest Applied when a decision must be made about a patient’s health care (by or family or healthcare provider) and the patient is unable to make an informed decision (incompetent persons, children). The decision is made after taking into account factors that may benefit or harm the patient It is an application of the of beneficence and nonmaleficence The decision may be based on the individual’s wishes (verbal statements or by written documents such as living wills) 27  Double Effect Some actions can be morally justified even though consequences may be a mixture of good and evil Double Effect invoked to explain the permissibility of an action that causes a serious harm as a side effect of promoting some good end. Example: Medications given for the comfort (the acceptable effect pain relief is the purpose of the medication) of the dying patient may hasten death to some extent (the secondary effect, is not the intended effect). Action must meet 4 criteria: o The action itself is morally good or at least neutral o You intend the good effect and not the evil (the evil may be foreseen but not intended) o There is favorable balance of good over evil o There be a proportionately serious reason for permitting the evil effect 28