8 Jan, 2013
The principles of medical ethics:
Respect for autonomy (self-determination, self-guided-ness)
Beneficence (patients’ best interest)
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
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?
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?
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
-Would killing the baby be considered murder since it is a living breathing entity
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
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,
“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