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Kelin Emmett

8 Jan, 2013 PHLB09 Introduction: The principles of medical ethics:  Respect for autonomy (self-determination, self-guided-ness)  Beneficence (patients’ best interest)  Non-maleficence  Justice What is medical ethics?  What is morally just and accepted in society today  Whats and whys (a question of guidance) we ask when we undergo a task  In medical ethics, we not only evaluate the moral reasoning but we evaluate how we should respond to certain situations within the medical field  Medical ethics can be classed as a separate field from ethics but it overlaps in many similar ways and generally refers to the basic principles of ethics Case 1:  Elizabeth Macdonald, from Windsor, ON has severe multiple sclerosis, mobility issues and her throat has recently become paralyzed. It is degenerative but not terminal. She travels to Zurich, Switzerland and is given barbiturates under supervision of medical facility.  In Canada, assisting a person to commit suicide is illegal. -Was her behaviour moral? -Did the medical personnel present at the time do the right thing, morally and legally? Case 2:  Dax cowart, 25yrs old burned severely on 65% of his body, repeatedly throughout hus entire painful treatment asked to be left to die (attempted twice after his recovery)  Doctors ignored his refusal of treatment and treated him anyway, he recovers after the incident with blindness and goes on to become a lawyer and is happily married. -Did the doctors do the right thing? Was the fact that the doctors made a decision for him morally justified, could he have been irrational due to the pain of the treatment when he had been asked to be left alone?(Consider the fact that he is now happily married) -What were the moral issues here? -Could he have been considered to be psychologically sane after making the decision to commit suicide? Case 3:  A baby is born with anencephaly (absence of cerebral hemispheres and cerebellum – basically without a brain and thus will neither be conscious nor ever have basic conscious function). For several days the baby will breathe on its own  Its organs are perfectly healthy and can be used as donors to other needy babies, but not if the infant dies naturally -Is it right to keep the baby alive although knowing the fact that he will never achieve consciousness? (Consider the difference between coma patients and this one) -Can we consider the baby dead? Does the fact that he still has healthy organs and is technically with a beating heart consider him alive? -Is it morally justified to consider this child to be dead and to salvage the living organs to save other lives? -Would killing the baby be considered murder since it is a living breathing entity Case 4:  Ms. K, 35yrs old, pregnant and refuses amniocentesis (a test that predicts down’s syndrome, purely informative) being extremely uncomfortable with abortion  The baby is now born with downs’ syndrome and intestinal blockage requiring surgery, without the surgery the baby will die, however with the surgery, the baby may be severely mentally impaired but will live a long life. The parents refused the surgery. -Does denying surgery for the child make the parents murderers? -Are they exempted from murder due to it being their decision being the baby’s legal guardians and due to the fact that the baby is incapable of making a decision/ suggestion at all? Case 5:  24yr old woman admitted to hospital with heroine overdose, needle marks show her addiction is long term. When she comes to, she admits to having HIV, Hepatitis C and being pregnant. She shows no interest in treatment or prenatal care (she indicates she just wants to leave and get high again)  She leaves the hospital after her recovery from overdose -Is it morally sound to voice treatment onto a person who’s under addiction for their own benefit? -Is it right to force treatment onto her for the benefit of her child? (What’s stopping this woman from making an abortion considering the fact that she is a drug addict?) Chapter 1 notes Rights that have been assigned by an act of law can be revoked with adequate justification for example, the right to receive a basic education can be temporarily revoked after a nuclear attack or natural disaster. Immanuel Kant viewed deontology as a duty based system of morality in which individuals’ motives are the basis for judging their actions morally right or wrong. Kant agreed with Aristotle that the characteristic that makes humans different from other living things and that therefore comprises their essential value, is our ability to reason, to discover the objective moral laws that govern our behaviour (he believed that moral duties are categorical aka unqualified, non-conditional, universal and absolutely binding on all people at all times. Kant also proposed that rational humans have 2 types of duties: perfect and imperfect duties. Perfect duties are duties that are obligatory and can never be breached (do not lie, keep your promises) Imperfect duties are duties that aim at a particular outcome, like duties of beneficence so they are of secondary importance and will always be superseded by perfect duties in any conflict. Kant’s theory uses one principle, the categorical imperative in 2 forms: C11 “universalizability”, and C12, st “humanity as an end-in-itself”, any proposed action must 1 be put through C11 before anything else, and then if it can be universally accepted, it is put through C12. “humanity as an end-in-itself” means respect for an individuals’ rationality and her autonomy, the ability to make decisions to guide her own life, in other words, we must not use people only as tools to achieve out purposes, however Kant does not say we cannot use people, he’s saying these behaviours are appropriate only if at the same time, the actor also respects the other individuals as being valuable simply in their existence without doing anything for anyone (this can be said to be the source of western foundation today) Problems with Kant’s theory: 1) The absolute nature of the imperatives makes the theory result in horrific and what many think are clearly immoral outcome. (hiding Jews from Nazis, moral decision is to lie to save their lives or to follow Kant’s teachings and not lie and give the Jews up knowing full well they will die) 2) Beneficence is only an imperfect duty, not obligatory always and secondary to perfect duties whenever there is a conflict. (breaking a promise to be home for a certain time to save a life) William David Ross offered his own version of deontology which many viewed as a solution to problems in Kant’s theory. Instead of appealing to absolute duties, Ross believed in duties that are obligatory unless they are strong, compelling reasons to override them. He follows 7 limited duties of which may be shuffled in order of importance:  Fidelity – keeping both explicit and implicit promises  Reparation – righting previous wrongs one has commited  Gratitude – acknowledging services rendered by others  Justice – rewarding acts of merit and thwarting those that aren’t meritorious  Beneficence – bettering the condition of others in the world  Self-improvement – improving one’s own virtue or intelligence  Nonmaleficence – refraining from injuring others “if any of these duties conflict, we must make a considered decision to choose which is most appropriate for the situation” The most widely recognized theory is Utilitarianism (cost-benefit analysis), this is a consequence based theory in which the rightness or wrongness of actions is determined by the outcome of the actions. The individual would provide the principle of utility to decide what should be done; this requires that one maximize benefit or good consequences while minimizing harm or bad consequences to create an overall balance of benefit or good. The 1 western thinker to provide a full information of utilitarianism was Jeremy Bentham. He believed that in any particular situation what people seek is pleasure and what they avoid is pain, his theory is called hedonistic utilitarianism
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