Chapter1- History & Theories.docx

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Health Sciences
Health Sciences 2610F/G
Patrick Clipsham

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  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 o Rather doctors should try and persuade patients to tell children of heritable disorders , unless probability of harm is high, doctors should uphold confidentiality and public trust o Better relations b/w doctors and patients, thus better consequences for patients overall  Most serious objection with both consequentialism is that doing whatever promotes the best consequences may violate ind interests and rights o fails to take seriously the separateness of persons- impersonal theory concerned more with the aggregative questions of how much of some good there should be than with the distributive question of who should have it o Does not pat attentions to claims of each person who stands to benefit/burdened by these decisions or policies - only deontology can respect these claims  Most well known deontologist is Kant, held fundamental principle of morality, "categorical imperative"  Categorical Imperative o Principle based on reason alone, specifically on the idea that humans are defined essentially in terms of the capacity for reason o Emotions should play no role in the motivation for action b/c they are too unstable to serve as basis for moral behaviour o Consists of 2 formulations: 1. Act only on that maxim by which you can at the same time will that it should become a universal law 2. Act so that you treat humanity, whether in your own person or in that of any other, always as an end and never as
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