IN MORAL

PHILOSOPHY

AN INTRODUCTION

Introduction

This document has been written & designed by Rahul Pathak.

Sources
New Scientist, Medical Ethics: A very short introduction, Moral Philosophy by James Rachels.

Contact
Information here is the property of www.sci2.co.uk.

Beneficence /1
Preserve what is in the best interest of the patient.

Autonomy /2
This word has Greek origins (auto=self, nomos=rule or law), in moral philosophy this refers to self governance. The central interest of this being an autonomous choice or more specifically autonomous action.

Non-Maleficence /3
The welfare of the patient is the main goal in healthcare, this is the fundamental principle of medicine primum non nocere above all do no harm.

Justice /4
Should have access to the same care and resources as other patients as well as respect for the law.

Four Principles.
These are the 4 moral principles relevant to the subject matter, their relationships is what determines what is permissible in differing ethical scenarios. These broad principles provide the basis of ethical theory and they are the empirical source of each scenario that may focuses on ethics, morality and moral philosophy. The word morality is concerned with how people ought to live their lives, what is the right thing to do is in a given situation. It concerns differing social institutions and the rules that define our way of life which is embedded in our culture. It is abstract hence, applicable to behaviour in a variety of scenarios. Philosophers study the four principles given on the left alongside justifications to attempt to create a system of standards or a moral point of view which may define how we ought to live our lives. Knowing this the words ethics and morals become interchangeable as do moral/ethical theory, morality although is isolated to social convention. Abstract moral principles such as those to the left inevitably will conflict, which creates these ethical dilemmas. These conflicts must be acknowledged and it must be decided which moral consideration is to be given priority. Should we lie to save a life? Steal to protect a secret? These are the problems where in real life situations rules may be (such as giving a blood transfusion to a Jehovahs Witness) ignored. Most moral principles are embedded in public society; however it is in an indistinguishable format. Alongside personal belief and religious dogma a reasoned justified position is often lost. This document aims to give a sense of precision to any ethical scenario, but it must be said the philosophy can provide a reasoned and systematic approach to differing situations but it does not supply mechanical solutions for decision making.

Consent is the voluntary, un-coerced decision made by a sufficiently competent or autonomous person.

INFORMEDCONSENT
The core issue seems to be whether it is important to deceive anyone or, to sacrifice a few people in the interest of science (the utilitarian view). This conflict between autonomy and beneficence is what is at the centre of this scenario. The conflict between consent and deception was notably brought up by the Milgram experiment, his lack of information to the subjects administering the shocks to an unknown actor being the conflict. Coupled with the atrocities committed by the Nazi movement coupled with the Nuremberg code raised the question of what informed consent really means. The GMC defines it as Consent is the voluntary, un-coerced decision made by a sufficiently competent or autonomous person on the basis of adequate information and deliberation, to accept rather than reject some proposed course of action. This means that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her wishes. At the moment patients can make their own medical conditions or delegate this task to another party. If the patient is incapacitated laws around consent say that the decision may be taken by the next of kin. If it there are a conflict of views and what is in the patients best interest is put into question a judge is often used to make the decision for them. Although the concept of benefit is subjective from person to person, ultimately selecting to their wishes and adds a sense of trust which is vital to the patient doctor relationship however, there is a fine line between coercion and persuasion in which should be respected.

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INFORMEDREFUSAL
There are cases where informed refusal has been ignored; the important thing here is to balance Autonomy with Beneficence in this case autonomy has been overruled and beneficence has been considered to have greater weight. In some cases some health care professionals will accept the patients refusal as valid and in others will consent to treatment even thought it has not been given since this will in their view ultimately benefit the patient and therefore society. This is sometimes over complicated if the patient is under 16 and refuse treatment when the parents refuse even though the Patient understands the facts and implications and chooses to refuse. If 16 or under the person is subject to the Gillick competency test depending on the healthcare professionals recommendation.

This can only be completed when the person in question in Gillick competent (only if 16 years or younger) i.e. has the mental capacity to understand the consequences of their actions. This could also be done with the presence of a living Will e.g. A DNR is a do not resuscitate order, if in the event of a severe cardiac or respiratory arrest resuscitation will not be attempted.

MEDICALCONFIDENTIALITY

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The conflict at the heart of medical confidentiality is in what circumstances you should outweigh the patients autonomy. Individual autonomy provides the ethical foundation of confidentiality and requires that people should be in control about the information about themselves and determine who should have access to it and in what circumstances. Respect for private life is a human right, and the ability to discuss information in confidence of others is rightly valued. Keeping control of facts about ones self can have an important impact on a persons sense of security, freedom of action and self respect. Hence, the duty of
confidentiality is a relatively non-negotiable tenet of medical practice.

If information is given to a healthcare professional and undertakes care it is a confidential matter, the details of which may only be shared in limited and highly restricted circumstances. Hence, individuals can claim control over the information which they regard as private. It is only in the very extreme circumstances would you outweigh a patients autonomy if without exposure it may cause the patient or others death or harm.

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Moral rights however, are part of the grey matter; the unspoken truths that are never really mentioned.

RIGHTS

&

DUTIES

Rights essentially are assertions on what society believes deserve respect and status; we have the right to privacy, healthcare etc. They occupy a prominent place in moral theory and political doctrine, however what is a right? We must accept that if a persons claim is valid it is accepted and laws are passed (and vice versa). Moral rights however, are part of the grey matter; the unspoken truths that are never really mentioned but granted, the right to privacy, right to make a free decision, right to die etc. Although it remains controversial whether rights are based on duties or duties are based on rights it is evident that acceptance of duties grants rights. This for a healthcare professional creates the duty not to interfere with autonomous decisions as well as the actions of others. Hence, rights are correlative to the duty to enable others to make autonomous decisions, and empirically the moral theory behind rights and duties are derived from the principle of autonomy.

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RESOURCEALLOCATION
A balance needs to be struck between respect for individual autonomy, benefiting the whole population and fair distribution of limited resources (distributive justice). Should respecting a persons autonomy to make decisions about their treatment mean that they should be able to choose an expensive treatment over a cheaper treatment? If the consequence of complying with such a choice is that treatment will be unavailable to other patients because of the limited available resources this may not be fair. This is the main conflict which arises in resource allocation and the ethical considerations. The utilitarian or QALY(best quality adjusted life year) based approach could be said to treat unequals equally, in that it does not take account of differences in need for health care but focuses entirely on the benefit gained. However, this does not take into account the degree of how different people are sick. This approach implies that all people start from a similar level of sickness which is untrue seeing as there are people whom are sicker than others.

In the context of health care it could be argued that resources should be allocated to ensure that those in poorest health, or greatest need, are as well off, in terms of health, as they can be.

MEDICALRESEARCH

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The relationship between research, ethics and Medicine has a conflicted history; with researchers complaining that they are prevented from the exploits of beneficial research by overly bureaucratic laws, Ethicists complaining that corporations prey on the vulnerable in 3rd world countries and Healthcare professionals complaining that they have a limited number of treatments. Healthcare research is a vital aspect of good healthcare, it is essential that good research is carried out and advances in healthcare are to be made, for this to be achieved human participation is vital. However it is important that the subject is fully informed and that they are aware of the rules. Especially if you are targeting the vulnerable spectrum of the population such as children or 3rd world countries, since they are often unable to make their voice heard. To tackle these issues the declaration of Helsinki has been signed and states that In medical research of Human subjects, considerations related to the well-being of the human subject should take precedence over the interests of science and society. In this way drug trials have developed double standards in which at one hand you need to consider the ethical implications of what the trial may hold for people and on the other hand youre trying to reduce the inequalities in global health and push the boundaries of medicine which is intrinsic to development.

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