ivms shaping professionalism: bioethics iii

7/22/2019 IVMS Shaping Professionalism: Bioethics III

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Marc Imhotep Cray, M.D.

Shaping Professionalism:Bioethics III

Medical EthicsPrepared and presented by

Marc Imhotep Cray, M.D.Basic Medical Sciences and Clinical Knowledge (CK) Teacher
http://www.imhotepvirtualmedsch.com/http://www.imhotepvirtualmedsch.com/


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Medical ethics Medical ethics is grounded in

philosophical ethics, it concerns itself

with the ethical questions and dilemmasin medicine.

Medical ethics is not any special ethics

but an ethics which deals with specialcases from medical practice.
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Doctor-patient relationship Medical ethics has three centres:

doctor, patient and society.

Its centre is the doctor-patientrelationship.


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The moral duties of the doctor The duty to help, cure

The duty to promote and protect the patients

health The duty to inform

The duty to confidentiality

The duty to protect the patients life

The duty to respect the patients autonomy

The duty to protect privacy

The duty to respect the patients dignity


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The moral rights of the patient The right to high quality medical service

The right to autonomous choice

The right to decide

The right to be informed

The right to privacy The right to health education

The right to dignity


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Principles of biomedical ethics Nonmaleficence

Beneficence

Respect for autonomy

Justice


7/22Marc 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 sickaccording to my ability and judgement,

but I will never use it to injure or wrongthem.



Nonmaleficence and

beneficence The principle of nonmaleficence asserts

an obligation not to inflict harm

intentionally. Principles of beneficencepotentially demand more than theprinciple of nonmaleficence, because

agents must take positive steps to helpothers, not merely refrain from harmfulacts.



The differerence of two

principles Nonmaleficence

One ought not to

inflict evil or harm

Beneficence

One ought to

prevent evil or harmOne ought toremove evil or harm

One ought to do orpromote good



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 referto the self-rule or self-governance ofindependent Hellenic city-states. Autonomyhas since been extended to individuals and

has acquired meanings as diverse as self-governance, liberty rights, privacy, individualchoice, freedom of the will, causing onesbehaviour, and being ones own person.



Autonomous personWe analyze autonomous persons intems of

liberty(independence from controllinginfluences)

agency(capacity for intentional action)



Autonomous actionWe analyze autonomous action in termsof persons who act

Intentionally

Withunderstanding

Without controlling influencesthatdetermine their action



To respect an autonomous

agentis to acknowledge that persons right to holdviews, to make choices, and to take actionsbased on personal values and beliefs. Suchrespect involves respectful action, not merelya respectful attitude. Respect involvestreating persons to enable them to actautonomously, whereas disrespect forautonomy involves attitudes and actions thatignore, insult, or demean others autonomyand thus deny a minimal equity to persons.



Informed consent is

analyzable through the account of autonomous choice. A

person must do more than express

agreement or comply with a proposal. He/shemust authorize through an act of informedand voluntary consent.

in terms of the social rules of consent in

institutions that must obtain legally validconsent from patients or subjects beforeproceeding with therapeutic procedures orresearch.



The standards used to

determine the incompetence Inability to express or communicate a

preference or choice.

Inability to understand ones situation and itsconsequences.

Inability to understand relevant information.

Inability to give a (rational) reason.

Inability to give risk/benefit related reasons. Inability to reach a reasonable decision.



Paternalism

Defined as the intentional overriding of onepersons known preferences or actions byanother person, where the person who

overrides justifies the action by the goal ofbenefiting or avoiding harm to the personwhose will is overriden.



Weak paternalism

In weak paternalism an agentintervenes on ground of beneficence or

nonmaleficence only to preventsubstantially nonvoluntary conduct, i.e.to protect persons against their own

substantially nonautonomous actions.



Strong paternalismStrong paternalism involves interventionsintended to benefit a person despite thefact that the persons risky choices and

actions are informed, voluntary andautonomous.



A central problem inbiomedical ethics

Whether respect for autonomy ofpatients should have priority over

professional beneficence.



The concept of justice

The terms fairness, desert (what isdeserved), and entitlement (that to whichone is entitled) have been used by variousphilosophers in attempts to explicate

justice. These accounts all interpret justiceas fair, equitable, and appropriate

treatment in light of what is due or owedto person.



Principles of distributive justice

To each person an equal share (formalequity)

To each person according to need

To each person according to effort To each person according to contribution

To each person according to merit

To each person according to free-marketexchanges

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Reference Resources andFurther Study

Bioethics Online Study Recourses

NIH - Bioethics ResourcesUniversity of Toronto - Joint Center for BioethicsWorld Medical Association - Medical Ethics Manual

Virtual Mentor

Video Education (drimhoteptv)

IVMS-MEDICAL ETHICS & PROFESSIONALISM12 videos, 3 hrs. and 16 min.http://www.youtube.com/playlist?list=PL08E700EA3F8313EB

E-Textbook

Medical Ethics Today: The BMAs handbook of ethicsand law Books; 3 edition (January 30, 2012)Updateshttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-today

Best Price $148.33or Buy New $181.49
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ivms shaping professionalism: bioethics iii

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