ethics ch01 intro
TRANSCRIPT
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Chapter 1Introduction to Ethics
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Any Good I Can Do
I expect to pass through the world but once. Any good therefore that I can do, or any kindness I can show to any creature,let me do it now. Let me not defer it, for I shall not pass this way again.
Stephen Grellet, French/American religious leader (1773-1855).
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Learning Objectives - I
Understand relevant ethical theories Describe ethical principles
Understand concepts of morality, virtues,& values. Understand concept of situational ethics.
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Learning Objectives - II
Provide a foundation to help inunderstanding ethical dilemmas.
Learn how to determine the rightness &wrongness of alternative courses of action.
Understand how ethical dilemmas occur when values, rights, duties, & loyaltiesconflict.
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Ethics Defined - I
Branch of philosophy Study of morals & character
Study of principles of human dignity Ethics provide us with "moral principles" or
universal rules that us know what to do.
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Ethics Defined - II
Involves how individuals decide to live within accepted & desirable principles
in harmony with the environment & oneanother Micro-ethics : individuals view of right &
wrong Macro-ethics : global view of right & wrong
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MILESTONES - I
1932 72 - Tuskegee Study of Syphilis 1946 - Military Tribunal for War Crimes
1949 - Nuremberg Trials Intl Code of Medical Ethics
1954 - First Kidney transplant
1960s - Cardio-pulmonary resuscitation
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MILESTONES - II
1968 - Harvard Medical School report on Brain Death Criteria
1964 - World Medical Association 1970 - Patient as a Person
by Paul Ramsey
paternalism questioned 1971 - Kennedy Institute of Ethics at
Georgetown
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MILESTONES - III
1972 - Informed Consent 1974 - National Research Act
1976 - Substituted Judgment In the Matter of Karen Ann Quinlan 1978 - Presidents Commission for Study
of Ethical Problems in Medicine
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MILESTONES - IV
1990 - Physician Assisted Suicide 1990 - Patient Self-Determination Act
1994 - Oregons Death with Dignity Act 1996 - HIPAA
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MILESTONES - V
2001 - President's Council on Bioethics 2003 - Human Genome Fully Sequenced
2006 - Stem Cell Research Controversy
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Theory: Normative Ethics I
Determining what moral standards shouldbe followed
General normative ethics Determining correct moral principles
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Theory: Normative Ethics II
Applied ethics Application of normative theories to
practical moral problems, for example,
Abortion Euthanasia Physician assisted suicide Stem Cell Research
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Theory: Consequential Ethics
The morally right action involves maximum balance of good or evil
Utilitarianism form of consequentialism philosophy that advocates the greatest good
for the greatest number everyone is obligated to do whatever will
achieve the greatest good for the greatestnumber.
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Theory: Non-Consequential Ethics
Rightness or wrongness of an action isbased on properties intrinsic to the action. not on its consequences
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Theory: Deontological Ethics
Focuses on duty to others Forms
Religious Ethics based on religious beliefs
Secular Ethics based on codes developed by societies that have
relied on customs
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Principles of Health Care Ethics
Autonomy right to make ones own decisions
Beneficence principle of doing good
Nonmaleficence avoid causing harm
Justice obligation to be fair
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Age & Justice - I
Should an 89 year old patient get a hearttransplant because he or she is higher onthe waiting list to receive a heart transplantthan a ten year old girl?
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Age & Justice - II
Should a pregnant 39 year old singleparent get a heart transplant because heor she is higher on the waiting list toreceive a heart transplant than a ten year old boy?
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Which Disaster PatientsGet Treated First?
Room #1: Severely injured patients notexpected to live.
Room #2: Severely injured patients mostlikely to live if treated.
Room #3: Injured patients will live but willsuffer varying degrees of disability if nottreated promptly.
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Emergency Care
Two patients in critical condition, who getstreated first:
1 st patient who walks through door younger patient patient most likely to survive patient who can pay for services patient with most serious condition
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Scarce Resources
What happens when resources are scarce& only one of two patients can be treated?
What should be the determining factors age position in life patient wishes . . .
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Morality
Is a code of conduct. Implies quality of being in accord with
standards of right & good conduct. Describes class of rules held by society togovern the conduct of its individualmembers.
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Morals
Ideas about what is right & wrong. Guides to behavior that rational persons
put forward for governing their behavior.
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Moral Responsibility
Requires a person to question his or her own values.
Requires a person not only to examinewhat one considers right thing to do ingiven situation, but why it is the right thingto do.
A moral dilemma occurs when moral ideasof right & wrong conflict.
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Moral Judgments - I
Judgments concerned with what anindividual or group believes to be right or proper behavior in a given situation.
Involves assessment of another personsmoral character based on how he or sheconforms to moral convictions establishedby the individual &/or group.
Lack of conformity typically results in: moral censure condemnation possibly derision of the violators character
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Moral Judgments - II
What is considered right varies from nationto nation, culture to culture, religion toreligion, & person to person.
No universal morality. Whatever guide to behavior an individual
regards as overriding & wants to beuniversally adopted is considered thatindividual's morality.
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Morality Legislated
Law is distinguished from morality in that the law has explicit rules, penalties, &
officials who interpret the laws & applythe penalties.
Laws are created to set boundaries for societal behaviour. laws are enforced to ensure that
expected behavior happens
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Virtues - I Approach to Normative Ethics
Attitudes, dispositions, or character traitsthat enable us to be and to act in waysthat develop this potential.
Character traits valued as being good differentiate good people from bad people guides to our actions imply moral excellence or beneficial quality
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Virtues - II Approach to Normative Ethics
Practiced at all times habitual excellence and character must be continuously practiced in order for
any person to maintain oneself in virtue
Virtues are habits. Once acquired, theybecome characteristic of a person
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Value
The relative worth placed on somevirtuous behavior.
What has value to one person may nothave value to another.
Value is a standard of conduct. Values are used for judging the goodness
or badness of some action. Values are standards by which we
measure goodness in our lives.
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Values
Intrinsic Value something that has value in & of itself
Instrumental Value something that helps to give value to
something else money is valuable for what it can buy
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Virtues & Values - I
Commitment Conscientiousness
Cooperativeness Courage Discernment
Fairness
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Virtues & Values - II
Faith Fidelity
Freedom Generosity Happiness
Honesty/Trustworthiness/Truth-Telling
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Virtues & Values - III
Hopefulness Humility
Integrity Kindness Prudence
Respect Self-respect
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Values May Change
If ones basic needs for food, water,clothing & housing have not been met,ones values may change in such a waythat a friendship, for example, might besacrificed if ones basic needs can bebetter met as a result of the sacrifice.
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Values Can Change
People make value judgments & choicesamong alternatives.
Values one so dearly proclaims maychange as needs change.
Motivating power of a person's actions area necessity of survival.
Values give purpose to each life. Theymake up ones moral character.
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Differing Values
If moms estate is being squandered at theend of life a family member financiallywell-off may want to hold on to momdespite the financial drain on her estate.
Another family member financiallystruggling to survive may more readily see
the futility of expensive medical care & findit easier to let go.
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Situational Ethics - I
Situational ethics refers to a particular view of ethics, in which absolute standardsare considered less important than therequirements of a particular situation.
The importance of a particular value mayvary as ones situation changes.
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Situational Ethics - II
Moral values & moral character can becompromised when faced with difficultchoices.
Good people behave differently in differentsituations.
Good people sometimes do bad things
Ones moral character can sometimeschange as circumstances change thus the term situational ethics .
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Sustaining Life: Situational Ethics
A decision not to use extraordinary meansto sustain life of an unknown 84 year oldmay result in a different decision if the 84year old is ones mother.
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Ethical Decision-Making
Ethical decision-making is the process of deciding, what the right thing to do is in theevent of a moral dilemma.
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Case: High in the Andes - I
Those who survived the plane crashhigh in the Andes Mountains were facedwith some difficult survival decisions.Their need to survive illustrates to whatlengths one may go in certain situationsin order to survive (see text page 28).
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High in the Andes - II
How might you change as circumstanceschange?
Describe how your consultative advicemight change based on the patientsneeds, beliefs, & family influences.
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A Case of Paternalism
The family physician does not fully informMr. Smith as to the seriousness of hisillness and how the consequences of thevarious alternative treatments might affecthis life style.
Discuss the ethical & legal issues.
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Ethical & Legal Issues
Ethical issues Autonomy Paternalism
Legal issues Informed consent
Refer to Chapter 12
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Practical Suggestions
Be a good listener Listen with the intent to learn not to find fault
or argue.
Listen to contribute & resolve ethicaldilemmas.
Believe in good values
Become virtuous by practicing good values until they become
habits.