Biomedical Ethics: Week 1

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Chapter2Biomedical.pdf

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Chapter 2

Principles of Health Care Ethics

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Principles of Ethics

• Extends your foundation of ethics. • Gives you ways to apply ethics to practical

situations. • The four most often used in health care are

nonmaleficience, beneficence, autonomy, and justice.

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Nonmaleficience

• Sometimes this is translated as “first do no harm”.

• Ethical theories define harm in different ways. • Consequentialist says harm is that which

prevents good. • Natural law says harm is something that limits

our potential.

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Nonmaleficence

• Deontologists say harm is something that prevents you from doing your moral duty.

• Virtue ethicists say harm is something that leads you away from practicing high moral character.

• Ethical egoists say that harm is something that goes against your self interest.

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Harm in the Clinical Setting

• Harm is something that negatively affects patients.

• Clinically, we think of physical harm but other harm is possible.

• Harm is also caused by negligence. • Harm can be caused by violating autonomy.

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Beneficience

• Beneficence comes from the Latin word for good- “bene”- and means to benefit.

• Requires a decision to engage in beneficent acts or to be altruistic.

• It is a fundamental principle of health care practice.

• What theories support beneficence?

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Health care and Beneficience

• The standard of altruism is higher for health care professionals.

• Altruism is expected. • Beneficence sometimes is extended to

paternalism when the health care professional makes decisions for the good of the patient.

• What is this called?

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Autonomy

• Autonomy means that you can rule yourself. • It implies a respect for others. • In health care, we have a duty to treat, but not

to judge. • What are the conditions necessary for

autonomy in health care?

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Specific Competence

• Is defined as the ability to do some things but not others. So, you can be competent in a limited way.

• In issues where a person is not competent, the concept of substitute judgment can be used. This is also involves the idea of reasonable person’s decision.

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Specific Competence

• Coercion can also affect a person’s ability to exercise autonomy.

• Issues of competence and autonomy also are part of informed consent and other health care issues which are discussed in later chapters.

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Justice

• The term can be used to mean fairness. • Aristotle thought we should treat similar cases

in a similar way unless there was some relevant or material difference.

• We need to examine types of justice: procedural and distributive.

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Procedural Justice

• This is sometimes called due process. • It means that you get your turn; you are

treated like everyone else. • Procedural injustice can occur with employee

situations. • Due process is also involved with policy

making in procedural justice.

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Distributive Justice

• This form of justice involves balancing benefits and burdens.

• Health care resource allocation is one example of an distributive injustice?

• Health care is a scarce resource, so • Resource allocation issues are common in

health care; what are some examples of these issues?

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Material Reasons to Discriminate

• Basic argument is that the person deserves it or needs it

• In the U.S., if you work hard, you deserve to be rewarded.

• In contrast, if you disobey the law, you deserve to be punished.

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Discrimination based on Need

• Need can be based on misfortune or disability. • Need can be based on special talents or

abilities and on opportunities. • Need can be based on past discrimination. • Need can also be based on structural social

problems.

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In the larger society…

• There is a need to discriminate based on material need.

• You are rewarded based on how much you contribute.

• You are also rewarded based on how much effort you put forth.

• This thinking also applies to patient care. Can you give some examples?

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Need based on Misfortune

• Misfortune can lead to discriminate based on or against need for care.

• For example, life threatening situations are treated before minor emergencies.

• Special talents or the potential loss of opportunity can be arguments for special treatment.

• What other groups fall into the need based category?

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Need based on past Discrimination

• Redress of past injustices may be a reason for different treatment.

• The health care system has responded to the needs of some special groups.

• Structural problems have also been considered in needs based discrimination; what are some examples?

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Distributive Justice and Rights

• We are still debating if health care is a right or a commodity.

• Need to think about whether something is a legal right or a moral right.

• There are many types of right and many overlap each other (See figure in text).

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Legal or Positive Rights

• Legal right means that someone has a legal obligation to fulfill your right.

• Positive right means that you are entitled to something.

• Sometimes legal rights become that which you can enforce.

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Substantive Rights

• Can be legal rights or not. • They are right to a particular thing such as

education, health care, minimum wage, etc. • Different nations have differing opinions

about substantive rights for their citizens.

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Negative Rights

• You have the right to be left alone. • The Bill of Rights lists many negative rights. • The negative right of one person may be in

conflict with the negative right of another (i.e. smokers).

• Other negative rights include freedom from sexual harassment, and medical record privacy.

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Process, Natural, and Ideal Rights

• You have the right of due process. • Natural rights means that you respect the

attributes that people have in nature. • These rights allow humans to reach their full

potential. • Natural rights express our common morality

and ideal rights inspire.

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Reflective Equilibrium Model

• Making ethical decisions requires considered judgments.

• These judgments require rational moral reasoning.

• Ethical theories and principles are used to explain moral reasoning.

• Reflective equilibrium model provides a process for considering and reconsidering decisions.

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Reflective Equilibrium Model

Common morality

Considered judgments

Ethical principles

Ethical theories

Health care issue at hand

Reflective equilibrium at work

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How can you Use the Model in Practice?

• Describe a situation where making an ethics choice might be difficult.

• Now, use Reflective Equilibrium Model to assist you in deciding the most ethical decision to make.

• Why is this model not in common practice in health care?

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In Summary…

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  • Slide Number 1
  • Chapter 2
  • Slide Number 3
  • Principles of Ethics
  • Nonmaleficience
  • Nonmaleficence
  • Harm in the Clinical Setting
  • Beneficience
  • Health care and Beneficience
  • Autonomy
  • Specific Competence
  • Specific Competence
  • Justice
  • Procedural Justice
  • Distributive Justice
  • Material Reasons to Discriminate
  • Discrimination based on Need
  • In the larger society…
  • Need based on Misfortune
  • Need based on past Discrimination
  • Distributive Justice and Rights
  • Legal or Positive Rights
  • Substantive Rights
  • Negative Rights
  • Process, Natural, and Ideal Rights
  • Reflective Equilibrium Model
  • Reflective Equilibrium Model
  • How can you Use the Model in Practice?
  • In Summary…