NCM 202 Bioethics PDF

NCM 202 – BIOETHICS...

NCM 202 – BIOETHICS EXAMPLE OF APPLIED ETHICS ETHICS 1. Professional Ethics - A prac ca l n o rma ve sci ence (based on real - deals with certain moral precepts or rules by which persons circumstances) behave and act in exercise of their calling or profession - Based on reason which studies human acts and provide (e.g. nursing ethics, teacher’s code of ethics for educators norms for their goodness and badness (no tosexual rela onships with students)) 2. Biology *Norma ve science – informa on interpreted for laws and public - A natural science concerned with the study of life and living policies organisms including their structure, func on, growth, *Norms – expected pa ern or behavior typical or standard in one origin, distribu on and taxonomy area 3. Bioethics - Ethics of life BIOETHICS - A branch of applied ethics which inves gates prac ces and - Moral philosophy (good and bad act of a nurse; developments in the life sciences and or biomedical elds systema zing concepts of good and bad; involves PNA OF - As an applied ethics, its primary and major predicaments 2002 for standard nursing prac ce) are those concerning life, health and death that have - It deals with morality, moral rec tude or the rightness and resulted from modern biological technology par cularly wrongness of human act the way they have a ected human values. Normal rec tude – correct, upright, honorable act or behavior *Life is the paramount concern of a registered nurse. *We must be factual in sharing informa on. *Administra on of KCl, bolus, leading to the death of a pa ent is a *Do due care. Prac ce intact integrity. wrong act *Breach of con den ality > civil liability, moral damages, *Good nursing acts are those that that are within the bounds of compensa ons, monetary considera ons 5M-7M nursing laws. EVOLUTIONARY PHASES OF BIOETHICAL STUDIES 1. BIOETHICS AS PRACTICAL SCIENCE 1. Medical Ethics - As a prac cal science, it deals with a - oldest phase of bioethical explora on systema zed body of knowledge that can be - a formula on of ethical norms for the conduct of health used, prac ced and applied to human ac on care professionals in the treatment of pa ents. *Researches are used; evidence-based - Codes of ethics were wri en by and for physicians as early *e.g. cranberry juice for UTI, Omega 3 included in the diet of pa ents as the 3rd century BC in the psychiatric ward food for the (brain) *Where Nursing ethics are cra ed from 2. BIOETHICS AS NORMATIVE SCIENCE HIPPORATIC OATH - it establishes norms or standards for the direc on and - oldest known formula ons of medical ethics, named a er regula on of human ac ons Hippocrates *Malprac ce – prac ce beyond the ethical boundaries of nursing law - to be kept from harm and injus ce (physician should not e.g. performing surgery as a nurse prescribe fatal drugs nor should suggest fatal drugs to be *Negligence: 2 Elements taken; a) Lack of foresight – e.g. did not put side rails up resul ng to the - rules out any form of abor facient and sexual rela ons injury of the pa ent or worse death between doctors and pa ents; b) Injury that caused lack of foresight - moral signi cance of con den ality, the medical secrecy) Ethics a empts to resolve these ques ons: RESEARCH ETHICS - How can one determine whether one is ac ng rightly or - refers to the use of humans as experimental specimens e.g. wrongly? prisoners, poor pa ents, children and fetuses. - Is there a norm of good and evil? - Third Reich-dictatorial regime of Adolf Hitler; superman concept as the culmina on of the philosophy will to power; experiment using human without consent was done TYPES OF ETHICS *Secure consent for minor pa ents and adult pa ents. 1. General Ethics/Norma ve Ethics *No claimant for cadaver – state must consent the release e.g. - diverse ethical formula ons of general and universal municipal o cer concepts and principles which serve as the founda on of morality NUREMBURG CODE - raises the problem of moral norm and a empts to - a empted to humanize the cruel and barbaric formulate and defend a system of fundamental ethical nature of experiments using human species in percep ons that se le which acts are good or evil German concentra on camps. It takes into - does not only apply general moral concepts and principles account the experimental subjects’ consent, but also speci es the par cular situa ons in life which they now known as informed consent, informed are valid and legi mate decision or informed choice - applied in an a empt to resolve speci c moral problems - Father of informed consent, informed choice *set of norms or standards that are customarily done (ac ons or behaviors are accepted and legal in some areas and in some not e.g. abor on, same sex marriage, polygamy, murder) tt ti ti ti tt ti ti ti ti ti ti ti ti ti fi ti ffi ti fi ti tt ti ti ti ti fi ti ti tt ff ti ti ti ti ti ti ti tt ti tt fi ti ti ti ti ti ft ti ti ti ti ti ti ti fi ti ti ti ti ti ti ti tt ti ti ti ti fi ti ti ft ti ti ti ti  - If our evalua on of the worth of a person is high, we shall PUBLIC POLICY be sensi ve to how close our ac on is to the deal; - accentuates the par cipatory aspect of decision making in - if it is low, then we shall be less sensi ve in achieving the a democra c set up with regard to the formula on of ideal. public policies for the bene t of all - the last arbiter of one’s moral decision - refers to the people’s e orts or involvement in formula ng public guidelines for both clinical cases and biomedical research KANT’S ETHICS (A FRAMEWORKF FOR MORAL REASONING) *Formed for the welfare of the public. IMMANUEL KANT (1724-1804) THE PERSONHOOD - Enlightenment philosopher from Königsberg, Prussia - Man is man by his intellect and by his ra onal will. (Kiliningrad, Russia) - Man is responsible for his ac ons. - Studied and later taught at the University of Königsberg - He alone is aware of what he is doing and is free to act or - He developed Kan an ethics not to act. - When he does not know what he is doing or when he is no INTRODUCTION longer free to act, the responsibility for his ac ons is no "Good ac ons have intrinsic value; ac ons are good if and only longer blamed to him. if they follow from a moral law that can be universalized.” – - Acts of irra onal animals and insane persons are devoid of Kant moral signi cance. They are amoral beings performing non-moral acts. CORE CONCEPTS 1. The Good Will HUMAN ACTS VS ACTS OF MAN - Kant argues that the only thing that is uncondi onally A. Human Acts good is a good will. - Are done with knowledge and full consent of the will. 2. Impera ves - One knows what one is doing and does it freely and - A rule or command that guide our ac ons. We make willingly. excep ons for ourselves all the me. - which are performed in the absence of either or both 2.1. Categorical Impera ve knowledge and full consent of the will. - Central concept of Kan an ethics, the founda on of - Ac ons commi ed by unconscious and insane persons, by morality, and a universal rule that applies to everyone. infants or by those who are physically forced to do Kant's famous formula ons of the categorical impera ve: something. "Act only according to that maxim whereby you can at the B. Acts of Man same me will that it should become a universal law." - Ac ons which merely happen in the body or through the 2.2. Hypothe cal Impera ve body without awareness of the mind or the control of the - Rule that depends on your goals or desires. "If I will will. X(desire), I must will Y(ac on)" 3 ELEMENTS OF HUMAN ACTS APPLICATION & IMPLICATIONS 1. Knowledge - awareness or consciousness of the condi ons and meaning REAL LIFE of our ac ons. An act performed during sleep or when a Truth-Telling and Promise-Keeping - Witnessing a friend commit a person is insane is not a human act. crime. 2. Freedom Ethical Dilemmas in Criminal Jus ce - Death penalty. - power to choose between 2 or more courses of ac on Respect for Persons in Medical Ethics: without being forced to take one or the other by anything Principle of informed consent in medical treatment. except your own will. Euthanasia 3. Voluntariness Business Ethics and Corporate Responsibility - Priori ze - Occurs when a man knows the purpose of his ac on. It is a transparency, ethical sourcing, and fair labor prac ces. will-act. *Absence of one in an act is considered acts of men e.g. sleepwalking CRITICISMS killer, homicide sleepwalking Rigidity - Kan an ethics is too rigid and in exible Lack of Emo on - Kan an ethics ignores the role of emo ons in IGNORANCE moral decision-making. - absence of knowledge in an individual who is supposed to Imprac cality - Kan an ethics is too imprac cal for everyday life. know it 1. Vincible – can be overcome by exer ng some e ort NATURAL LAW 2. Invincible – can hardly be removed even if one were to exert - describes that moral truths are objec ve and are based on extra e ort to overcome it actual events that are happening in the world. They are CONSCIENCE proven to be fact as they came from the study of nature - the moral faculty of a man which tells him subjec vely and human beings. what is good and evil - This concept is rooted in the idea that these laws are - sensi vity with regard to choosing our ac ons; universal and unchanging, applying to all human beings - the consciousness of human value is the basis of judgment regardless of culture or me period. we make concerning morality of our ac ons. KEY CONTRIBUTORS - Aristotle ti ti ti ti ti ff ti ti ti ti ti ti ti ti fi ti ti ti tt ti ti ti ti ti ti ff ti ti ti ti fi ti ti ti ti ti ti ti ti ti ti ti ti fl ti ti ti ti ff ti ti ti ti ti ti ti ti ti ti  - St. Paul of Tarsus contract approach, which assumes society agrees with all - St. Thomas Aquinas members in exchange for maintaining social rights ARISTOTLE JOHN RAWL’S THEORY OF JUSTICE - KEY CONCEPTS - Father of Natural Law 1ST Principle: The Principle of Equal Liberty - He emphasized the dis nc on between “physis” and - Every individual shall have an equal right to the broadest “nomos”. possible overall system of equal basic liber es and this - Natural law is the same everywhere despite the law entails freedom of conscience, expression, associa on, and di erences in every country. democra c rights - His concept is based on the idea that there is a natural - right of personal property is one of the basic liber es that order to the world. individuals should have, and that cannot be infringed or - He believed that the purpose of human life is to achieve amended by the government absolute right to unlimited “eudaimonia”. personal proper es is excluded - His understanding of what is nature and man-made 2nd Principle: The Principle of Equality requires four aspects: Holds that economic principles should be arranged in a way that they >what is made meet two requirements: >its form a) Bene t to the Least Advantaged: Economic bene ts should >how it came to be be distributed in a way that gives more to the least >its func on advantaged members of society. b) Fair Access to Posi ons: Every people should have an ST. PAUL OF TARSUS equal opportuni es regardless of their ethnicity, sex, or - St. Paul of Tarsus, also known as the Apostle Paul, touched social background. upon the concept of natural law in his le er to the Romans METHODOLOGY in the New Testament. Moral Force - Romans 2:14-15 - based on a hypothe cal contract 14 (Indeed, when Gen les, who do not have the law, do by nature - emphasizing contracts over consequences, the theory tries things required by the law, they are a law for themselves, even to avoid the moral dilemma of trea ng moral agents as though they do not have the law. means to an end. 15 They show that the requirements of the law are wri en on their Veil of Ignorance hearts, their consciences also bearing witness, and their thoughts - a thought experiment some mes accusing them and at other mes even defending them. - elimina ng our personal features and imagine ourselves in a conscious state before we were born ST. THOMAS AQUINAS Original Posi on - St. Thomas Aquinas de ned Natural Law as the belief that - tries to bring us closer to a posi on of equality the universe has a reasonable order that re ects divine - what sort of society would I want to be born into? law. Di erence Principle 4 Kinds of Law - what would be chosen by ra onal actors in the original a) Eternal Law – God’s plan for the world posi on b) Divine Law – Given from God to human - a principle in which inequality is allowed only when it c) Natural law – human can make choices bene ts the least fortunate d) Human Law – played out in tradi onal human law OBJECTIONS APPLICATION OF NATURAL LAW IN NURSING On Di erence Principle: The Merit-based System It jus es intui ons in healthcare se ngs about what is - it is not moral to base distribu ve shares on arbitrary morally right. factors It encourages nurses to use their reason to discern and - the non-arbitrary system of distribu ve shares based on uphold the objec ve moral order. e ort or contribu on succumbs to the arbitrariness of the The principles of natural law guide nurses in trea ng gene c lo ery of talents and the societal lo ery of those pa ents with respect and compassion. talents being currently valued It allows pa ents to have autonomy and have be er health - ins tu ons should deal justly with natural and societal care. inequali es It provides moral principles that transcend cultural and On Natural Distribu on temporal boundaries, such as the preserva on of human - It is neither just nor unjust, nor is it unjust that persons are life and the dignity of individuals. born into society at some par cular posi on but are simply natural facts. JOHN RAWLS’ THEORY OF JUSTICE - What is just and unjust is the way that ins tu ons deal with these facts. JOHN RAWLS (1921-2002) - an American poli cal and ethical philosopher, best known for his defense of egalitarian liberalism in his major work, A ROSS’ ETHICS Theory of Jus ce (1971) WILLIAM DAVID ROSS (1877-1971) THEORY OF JUSTICE - A Sco sh philosopher who made signi cant contribu ons - Rawls defends a concep on of “jus ce as fairness.” to moral philosophy. - He holds that an adequate account of jus ce cannot be derived from u litarianism as this focuses on the social ff ff ff ti ti ti ti fi fi ti ti tti ff ti fi ti ti ti ti tt ti ti ti ti ti ti ti ti ti ti ti ti ti ti fi ti ti ti ti ti ti ti ti ti ti ti tti ti fi ti tt ti ti tt ti ti fl tt fi ti ti ti ti ti tt  - Best known for his work in ethics, in which he developed a - Philosopher Aristotle, in his Nicomachean Ethics, suggests pluralis c approach in deontological ethics or non- that a di erent solu on than the ac on-centered ethical consequen alism. system of duty-oriented and consequence-oriented reasoning when he places the focus not on the par cular Core Idea: Focus on moral du es rather than consequences. ac on but rather on the HEART OF MORAL AGENT Special Aspect: Ross's emphasis on "prima facie" du es, which are *Bioethics is under the deontological ethics. Deontology comes from self-evident and can con ict with each other, requiring careful Greek word “deon”, meaning duty or obliga on. This is also under judgment. Norma ve Ethics, explaining that the morality of an ac on should be Key Du es: Basic obliga ons like keeping promises, avoiding harm, based on whether that ac on itself is right or wrong under a series of etc. rules rather than based on the consequences of the ac on. We must inves gate and we must know of the morality and inten ons behind ROSS’ PRIMA FACIE DUTIES every ac on when choosing a side. - Origin: LATIN primus ‘ rst” + facies ‘face’. - Prima facies are du es that are generally binding, but in DIFFERENT VIRTUES OF A HEALTH CARE PROVIDER speci c situa ons, they may be overridden by others. Examples of Du es Fidelity – steadfast faithfulness to one’s professions; keeping Fidelity: Promises and truthfulness promises to one’s profession, taking oaths Repara on: Making amends Honesty – quality of being honorable and upright in character and in Gra tude: Returning the favor ac on; the fairness and uprightness Jus ce: Fairness Integrity – uprightness in character and ac ons; giving the best care Bene cence: Helping others Humility – meekness of the heart; ac ons, execu ons of nursing Self-Improvement: Improving oneself interven ons with gentle spirit; accep ng individual’s human Non-Male cence: Avoiding harm to others imperfec ons Respect – esteem or honor showing recogni on or high regard to APPLICATION TO BIOETHICS self-worth How It Helps: Provides a framework for ethical decision- Self-respect – dignity; favorable es mate of opinion of oneself making in healthcare and research. Respect for authority Respect of others Examples: Compassion – signi es sympathy; understand one’s feelings - Respect for pa ent’s autonomy (Fidelity). Prudence – carefulness, precau on, a en veness, and good - Avoid harm and provide bene t to a pa ent’s medical judgment status (Non-Male cence). Courage – signi es bravery and fearlessness; face any danger or trouble without showing fear CONCLUSION Summary: Ross's ethics emphasize the con ict between moral and Mahatma Gandhi (Ethics of Health Care, 2019) du es. In which one is responsible to provide a balanced approach in Your beliefs become your thoughts. resolving ethical dilemmas rela ng to bioethics. Your thoughts become your words. Your words become your ac ons. Importance: Helps navigate complex moral issues by priori zing Your ac ons become your habits. du es and principles allowing exibility in ethical decision making. Your habits become your values. Your values become your des ny. HOW DO WE MAKE DECISION IN OUR HEALTH CARE WORK? 7 HABITS OF EFFECTIVE PEOPLE The ques on is NOT “What shall I do? But how do I carry my life to Be Proac ve – make choices based on the values and live well?” virtues; entails an cipa on of the trends and works to *We are guided with di erent ethical principles (e.g. duty ethics, promote the development of our profession; being a consequen al ethics, u litarian ethics, etc.) but in mes when the preven ve; think before ac ng decision is di cult, we use virtue ethics. Begin with and end in mind – mission and vision; visionary, mission-oriented, goal-directed, draw a blueprint VIRTUE as a guide - Refers to a par cular moral excellence (quality of doing Put rst things rst – priori za on; me management what is right and avoiding what is wro