Health Sciences 2610F/G Chapter Notes - Chapter 1: Bioethics, Normative Ethics, Primum Non Nocere

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1: History and Theories
January-21-13
11:06 AM
HISTORY AND THEORIES
Primim non nocere - "first do no harm"
Biomedical ethics is grounded in study of moral philosophy
Percival expanded the Hippocratic oath focus on the doctor-patient relationship to a broader
social ethic of medicine, emphasizing professional responsibility of the physician
o Emphasized "nonmaleficence" (not harming) and "beneficence" (benefiting) towards
patients also doctors responsibility to the medical profession and to society at large
Biomedical ethics become a discipline in its own right, discipline emerging at intersection of
science, medicine and ethics
Developments in medical practice/research over the second half of the 20th century led to ethical
principles in addition to nonmaleficence and beneficence
Patient- based principle of "autonomy" came to complement the physician-based principles of
nonmaleficence and beneficence
Autonomy: having the capacity and the right to self-determination, formulate and follow a life
plan of ones own making
o Includes right to accept or refuse medical treatment in accord with ones interests
Respect for autonomy derives from 2 distinct traditions of moral theory
1. Kant's principle of respect for persons as autonomous ends-in-themselves
o Principle are core of deontological tradition
2. Mill's principles of liberty
o Says that a person is sovereign over their own body and mind
o Individuals freedom can be restricted only when is exercise would harm others
o Principle at core of the liberal tradition
Main issues how scarce medical resource could be distributed fairly among people with equal
needs with its scarcity mean that not everyone's needs could be met
Justice is defined in terms of fairness, justice emerged as 4th main principle in medical ethics
Ability to artificially sustain life forced a revision of the definition of death, shifting focus form
hear/lungs to the brain- death occurs when all brain functions permanently cease
The Need for Theories
Ethical theories provide a framework that enables us to critically reflect on and refine the
intuitions generated by issues and cases
o Enable us to give reasons for or against a position
Action or policy is obligated is it is supported by an ethically decisive reason - reason outweighs
any opposing reason for not acting or not implementing a policy
Action or policy is prohibited is there is an ethically decisive reason against it
Action or policy is permitted if there is no ethically decisive reason against
Biomedical ethics is a species of practical normative ethics- study of what one is obligated or
permitted to do, or prohibited from doing
Normative ethics- concerned with how people ought to act, what sorts of polices ought to be
implemented, "normative"- norms of society, standards of right and wrong action/behaviour
Descriptive ethics- concerned with hoe people do in fact behave, not how they ought to behave
Metaehtics- deals with formal question of the point of this, focuses on meaning of terms, "right",
"wrong", "good" and "bad" and on the form of arguments used to justify actions
Whereas normative ethics focuses on the content of morality, met ethics focuses on the nature
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Normative ethical theories have 2 criteria in common
1. Objectivity- right course of action is based on the best reasons for doing it, reasons can be
recognized universally by anyone and therefore cannot be reduced to any particular view
2. Impartiality- reasons for action assume that each persons needs/interests are equally
important, claims of all people given equal weight
o Together these criteria are safeguards against arbitrariness and personal or group bias in
justifying behaviour
Metaehtics also concerned with questions of whether 2 criteria or normative ethical theories cited
in the previous paragraph can be met
Consequentialism and Deontology
Consequentialism and deontology 2 ethical theories most frequently cited to defend different
positions in biomedicine
Nonmaleficence and beneficence are consequentialist principles concerned with benefiting and
not harming patients in bring about best outcome of a treatment
Autonomy- deontological principle concerned with- patients rights, dignity/value, doctors
corresponding duty to respect them
Justice may be characterized as either deontological or consequentialist principle concerned with
what is due of owed to persons in terms of the distribution of benefits and burdens among them
"Prima Facie"- moral obligation on one that is binding unless it is overridden or outweighed by
competing moral obligation
Consequentialism defines rightness or wrongness of action in terms of consequences
o Actions are justified by the amount of good they bring about
Utilitarianism- says that one should at to promote the greatest good for the greatest number
o Increases happiness, and diminish suffering in securing net overall benefit
Consequentialist are more concerned with the greatest good than with the good of the greatest
number
Deontology- defines rightness or wrongness of an action in terms of a duty or obligation to respect
the rights and values of persons
Consequences can matter but they are not the main motivation for action
Consequentialism- obligation is to promote good outcomes, deontology obligation is to respect
persons as ends-in-themselves
Consequentialism says that what makes an action or policy right is that it brings about better
consequences
Principle of utility, "Greatest Happiness Principle"- actions are right if they promote happiness ,
and wrong if they promote suffering- equality, act in a way that each person counts for one, and
nobody counts for more than one
2 types of Consequentialism
1. Act- consequentialism- an act is obligatory if it promotes better consequences then any of
its alternatives
o ICU- number of patients exceeds hospital beds, highest priority is given to those who
are likely to return back to normal functioning- selecting one patient over another is
permissible b/c brings about better consequence than giving each of the patients
equal chance for treatment
o Could be bad if a doctor breaches confidentiality for a good cause b/c people will not
trust medical profession
2. Rule- consequentialism- often invoked to avoid problem with act-consequentialism
o What general rules will promote best consequences in long run, assuming everyone
accepts and complies with them
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