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PHLB09 lecture 1.docx

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PHLB09 – Lecture 1 Ms K.  She is 87 and living with advanced dementia.  She has a written Advanced Directive indicating her wishes to have all resuscitative and life- sustaining measures applied.  She has been intubated for advanced dyspnea accompanying pneumonia.  Her physicians suspect intestinal obstruction, but an MRI is required to confirm. Consent is a moral issue because it deals with autonomy, self-determination There‘s the issue of social justice, because MRIs are expensive, is she entitled to it? Because she‘s advanced in her illness, what quality of life would she have afterward? Weigh the consequences, how threatening is the intestinal problem? Maybe her wishes have changed since she‘s signed the document – what about her family‘s wishes? Baby X  The infant is born with Anencephaly: there is a main brain stem but a lack of functioning cerebrum.  The baby will never gain consciousness—lacks the neocortex responsible for cognition.  Infants born with the condition typically die within a few hours to a few days after birth.  The parents would like to donate the baby‘s organs, but transplant organs need to be removed while there is still circulation or immediately after death.  Since there is a partially functioning brain stem and spontaneous respiration, the infant cannot be declared brain dead. Utilitarian – get the organs to help the greater good Moral definition of death: partial brain death, no consciousness Legal concept of death: whole brain death, no heart and lung function; legally the baby‘s not dead. Details of how long organs last after death? Parents were ok with harvesting organs before death The value of the infant‘s life in the first place – this baby‘s life in exchange for five other lives. What makes human life valuable? Our DNA? Consciousness? Quality of life? How do we make hard ethical decisions in the medical context?  Codes of ethics and conduct  Legal statutes  Morality Professional codes of ethics: E.g.:  Hippocratic Oath  American Medical Association  Canadian Medical Association  College of Physicians and Surgeons Legal Statutes  We look to federal and provincial law for guidance.  What if the law gets it wrong? Is it the responsibility of HCPs to lobby to get the bad law off the books? Morality Moral Theory and Ethics: PHLB09 – Lecture 1  How ought we behave?  What is right and wrong?  What has value? Why?  Morality  Is there a single, universally true morality? Isn‘t morality subjective? Ethics:  Ethics: ―The systematic study of morality; the study of concepts and theoretical justification involved in practical reasoning or reasoning meant to be applied to govern individual behavior‖ (4). Metaethics: the study of morality as a concept Normative Ethics: concern the content of moral judgments and their justifications Metaethics ―involves considering whether morality can exist, whether morality can be justified, what the nature of morality is, what the sources for morality are, and what is the nature of moral statements‖ (4). Examples of metaethical claims:  Moral statements can be true or false.  Morality is the system of rules that are instrumental to human flourishing.  Morality is subjective.  God is the source of morality.  Reason is the source of morality.  Cultural norms are the source of morality. (Notice that this is not a consistent set of metaethical claims) Metaethics E.g.:  Subjectivism  Cultural Relativism  Objectivism Subjectivism: is the view that ―an individual decides what to do according to his own conscience because all individuals are equally ‗right‘ and no one is wrong‖ (8)  What is morally correct is up to the individual.  There‘s no universal standard of right or wrong Cultural Relativism: ―a majority in the individual culture, society, or country
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