Shaping Professionalism:

Bioethics III Medical Ethics

Prepared and presented by Marc Imhotep Cray, M.D.
Basic Medical Sciences and Clinical Knowledge (CK) Teacher

Marc Imhotep Cray, M.D.

Medical ethics

Medical ethics is grounded in philosophical ethics, it concerns itself with the ethical questions and dilemmas in medicine. Medical ethics is not any special ethics but an ethics which deals with special cases from medical practice.

Marc Imhotep Cray, M.D.

Doctor-patient relationship

Medical ethics has three centres: doctor, patient and society. Its centre is the doctor-patient relationship.

Marc Imhotep Cray, M.D.

The moral duties of the doctor

The duty The duty health The duty The duty The duty The duty The duty The duty

to help, cure to promote and protect the patients to to to to to to inform confidentiality protect the patients life respect the patients autonomy protect privacy respect the patients dignity

Marc Imhotep Cray, M.D.

The moral rights of the patient

The The The The The The The

right right right right right right right

to to to to to to to

high quality medical service autonomous choice decide be informed privacy health education dignity

Marc Imhotep Cray, M.D.

Principles of biomedical ethics

Nonmaleficence Beneficence Respect for autonomy Justice

Marc Imhotep Cray, M.D.

Hippocratic oath 5-4 centuries B.C.

An obligation of nonmaleficence and an obligation of beneficence are both expressed in the Hippocratic oath: I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them.

Marc Imhotep Cray, M.D.

Nonmaleficence and beneficence

The principle of nonmaleficence asserts an obligation not to inflict harm intentionally. Principles of beneficence potentially demand more than the principle of nonmaleficence, because agents must take positive steps to help others, not merely refrain from harmful acts.

Marc Imhotep Cray, M.D.

The differerence of two principles

Nonmaleficence One ought not to inflict evil or harm

Beneficence One ought to prevent evil or harm One ought to remove evil or harm One ought to do or promote good

Marc Imhotep Cray, M.D.

The concept of autonomy

The word autonomy is derived from the Greek autos (self) and nomos (rule, governance or law). It was first used to refer to the self-rule or self-governance of independent Hellenic city-states. Autonomy has since been extended to individuals and has acquired meanings as diverse as selfgovernance, liberty rights, privacy, individual choice, freedom of the will, causing ones behaviour, and being ones own person.

Marc Imhotep Cray, M.D.

Autonomous person
We analyze autonomous persons in tems of liberty (independence from controlling influences) agency (capacity for intentional action)

Marc Imhotep Cray, M.D.

Autonomous action
We analyze autonomous action in terms of persons who act Intentionally With understanding Without controlling influences that determine their action

Marc Imhotep Cray, M.D.

To respect an autonomous agent

is to acknowledge that persons right to hold views, to make choices, and to take actions based on personal values and beliefs. Such respect involves respectful action, not merely a respectful attitude. Respect involves treating persons to enable them to act autonomously, whereas disrespect for autonomy involves attitudes and actions that ignore, insult, or demean others autonomy and thus deny a minimal equity to persons.
Marc Imhotep Cray, M.D.

Informed consent is analyzable

through the account of autonomous choice. A person must do more than express agreement or comply with a proposal. He/she must authorize through an act of informed and voluntary consent. in terms of the social rules of consent in institutions that must obtain legally valid consent from patients or subjects before proceeding with therapeutic procedures or research.

Marc Imhotep Cray, M.D.

The standards used to determine the incompetence

Inability to express or communicate a preference or choice. Inability to understand ones situation and its consequences. Inability to understand relevant information. Inability to give a (rational) reason. Inability to give risk/benefit related reasons. Inability to reach a reasonable decision.

Marc Imhotep Cray, M.D.

Paternalism
Defined as the intentional overriding of one persons known preferences or actions by another person, where the person who overrides justifies the action by the goal of benefiting or avoiding harm to the person whose will is overriden.

Marc Imhotep Cray, M.D.

Weak paternalism

In weak paternalism an agent intervenes on ground of beneficence or nonmaleficence only to prevent substantially nonvoluntary conduct, i.e. to protect persons against their own substantially nonautonomous actions.

Marc Imhotep Cray, M.D.

Strong paternalism
Strong paternalism involves interventions intended to benefit a person despite the fact that the persons risky choices and actions are informed, voluntary and autonomous.

Marc Imhotep Cray, M.D.

A central problem in biomedical ethics

Whether respect for autonomy of patients should have priority over professional beneficence.

Marc Imhotep Cray, M.D.

The concept of justice

The terms fairness, desert (what is deserved), and entitlement (that to which one is entitled) have been used by various philosophers in attempts to explicate justice. These accounts all interpret justice as fair, equitable, and appropriate treatment in light of what is due or owed to person.
Marc Imhotep Cray, M.D.

Principles of distributive justice

To each person equity) To each person To each person To each person To each person To each person exchanges

an equal share (formal according according according according according to to to to to need effort contribution merit free-market

Marc Imhotep Cray, M.D.

Reference Resources and Further Study

Bioethics Online Study Recourses NIH - Bioethics Resources University of Toronto - Joint Center for Bioethics World Medical Association - Medical Ethics Manual Virtual Mentor Video Education (drimhoteptv)

IVMS-MEDICAL ETHICS & PROFESSIONALISM 12 videos, 3 hrs. and 16 min. http://www.youtube.com/playlist?list=PL08E700EA3F8313EB

E-Textbook Medical Ethics Today: The BMAs handbook of ethics and law Books; 3 edition (January 30, 2012) Updates http://bma.org.uk/practical-support-at-work/ethics/medical-ethics-today Best Price $148.33 or Buy New $181.49

Marc Imhotep Cray, M.D.