Surviving Professional Life Surviving Professional Life Ethically : Ethically :

A Perspective from the Idea of A Perspective from the Idea of Respect for PersonsRespect for Persons

Prof. Donna Knapp van Bogaert, PhD, D. Prof. Donna Knapp van Bogaert, PhD, D. PhilPhil

Steve Biko Centre for BioethicsSteve Biko Centre for BioethicsFebruary 21, 2007 10h00-11h00February 21, 2007 10h00-11h00

GEMPGEMP

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OutlineOutline

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OutcomesOutcomes

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Respect for PersonsRespect for Persons

What does it mean to respect persons ?What does it mean to respect persons ? From where did the idea come that we From where did the idea come that we

should respect persons?should respect persons? Ethical theory grounding respect for Ethical theory grounding respect for

persons.persons. Case study & ExampleCase study & Example Arguments against; Difficulties Arguments against; Difficulties

facedrsonsfacedrsons

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Case Study (1)Case Study (1)

You and four of your fellow medical You and four of your fellow medical students are on duty in a busy out-students are on duty in a busy out-patient department (OPD). patient department (OPD).

You are all sitting writing up patient You are all sitting writing up patient

notes when your superior, a notes when your superior, a registrar, calls all of you over to the registrar, calls all of you over to the cubicle in which he is working. cubicle in which he is working.

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On the examination table is a man On the examination table is a man who appears to be around 70 who appears to be around 70 years old. years old.

His clothes are near the bed and His clothes are near the bed and you notice that they look like those you notice that they look like those typically worn by members of a typically worn by members of a conservative religious community.conservative religious community.

You also observe that this elderly You also observe that this elderly man is clearly embarrassed.man is clearly embarrassed.

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The registrar is in the process of The registrar is in the process of performing a digital rectal performing a digital rectal examination on him. examination on him.

““Hey guys, you’ve got to feel this”, Hey guys, you’ve got to feel this”, the registrar exclaims, “you the registrar exclaims, “you shouldn’t miss the rare opportunity shouldn’t miss the rare opportunity of palpitating a tumor this size!”of palpitating a tumor this size!”

And the five of you, in turn, And the five of you, in turn, proceeded to insert your fingers into proceeded to insert your fingers into the rectum of this man and perform the rectum of this man and perform a digital rectal examination. a digital rectal examination.

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In 2003, a BMJ article exposed that In 2003, a BMJ article exposed that nearly ¼ of rectal and vaginal nearly ¼ of rectal and vaginal examinations were performed on examinations were performed on anaesthetised patients by medical anaesthetised patients by medical students without the patient’s students without the patient’s knowledge or consent knowledge or consent (Sokol 2004).(Sokol 2004).

Case Study (2) Case Study (2)

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CommonalitiesCommonalities

Both involve medical studentsBoth involve medical students Both involve patientsBoth involve patients Both involve medical hierarchyBoth involve medical hierarchy Both have significant ethical Both have significant ethical

dimensionsdimensions

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Respect for Persons:Respect for Persons:Grounding All RelationshipsGrounding All Relationships

Origins Origins Applications to healthcare practice Applications to healthcare practice

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Immanuel KantImmanuel Kant

1700’s1700’s PhilosopherPhilosopher LogisticianLogistician TeacherTeacher (Bachelor, extremely (Bachelor, extremely

Punctual & invented Punctual & invented garter contraption to garter contraption to keep his stockings up keep his stockings up as they were always as they were always falling down).falling down).

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Kant’s Second Formulation of Kant’s Second Formulation of the the Categorical ImperativeCategorical Imperative

Persons as ends-in-themselves Persons as ends-in-themselves

To respect people is to treat them as To respect people is to treat them as ends in themselves. ends in themselves. He He sees people assees people as autonomous (Gr. Self-rule; self-governance) . autonomous (Gr. Self-rule; self-governance) . The opposite of respecting people is treating them as The opposite of respecting people is treating them as mere mere

meansmeans to an end. to an end.

Always treat persons (rational agents) as ends-in-themselves Always treat persons (rational agents) as ends-in-themselves and never merely as means to your own ends.and never merely as means to your own ends.

Case StudyCase Study

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Who or what should be Who or what should be respectedrespected

For Kant, the proper object of respect is the For Kant, the proper object of respect is the will. So if we respect persons, our respect will. So if we respect persons, our respect necessarily includes knowledge, freedom, necessarily includes knowledge, freedom, choice – the things that are involved in having choice – the things that are involved in having a will (wille).a will (wille).

Other possible objects of respect are Other possible objects of respect are Feelings and emotionsFeelings and emotions People or things who are not living People or things who are not living Non-human AnimalsNon-human Animals All living entities included in the “natural world”All living entities included in the “natural world”

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Immanuel KantImmanuel Kant

One of Kant’s most enduring One of Kant’s most enduring contributions to moral philosophy was his contributions to moral philosophy was his emphasis on the notion of respect.emphasis on the notion of respect.

From the notion that each human is of From the notion that each human is of intrinsic value and as such deserves to be intrinsic value and as such deserves to be treated with respect, such notions as e.g. treated with respect, such notions as e.g. informed consent, confidentiality, & informed consent, confidentiality, & humane treatment are further supported. humane treatment are further supported.

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Discussion Discussion

Looking at the case study from a Kantian Looking at the case study from a Kantian perspective : Respect for Personsperspective : Respect for Persons Who are the role players?Who are the role players? What are their relationships?What are their relationships?

Power – How does it fit into the picture?Power – How does it fit into the picture? What should students do if they observe What should students do if they observe

unethical professional behavior? unethical professional behavior? What should ethical students do if they observe What should ethical students do if they observe

unethical behavior on the part of other students?unethical behavior on the part of other students? What recommendations would you give to other What recommendations would you give to other

students concerning ethically surviving student students concerning ethically surviving student life? life?

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STEP 1WHAT IS THE PROBLEM?

Formulate the ethicalproblem or dilemma

STEP IIKEEP AN OPEN MIND

1. AVOID solutions requiring

NO THOUGHTon your part

2. TALK

to others

3. Be responsive to appropriate FEELINGS or EMOTIONS

4. Be open to ALTERNATIVE

UNDERSTANDINGS and VIEWS

5. Be open to the best impartial REASONS

STEP IIIAscertain information & facts relevant to the

case.

STEP IVIdentify and weigh the

ethicalVALUES and STANDARDS

applicable to the case

STEP VConsidering their relative weight, APPLY the ethical values and standards to the facts, and make a

DECISION

Professionaldeclarations, oaths

and codes

HPCSA or other national

guidelines, rules

Religion, belief systems

Precedents

Society’s traditions

Decision tree for complex ethical reasoning

ACTION(act or omission)

Environmental issues

Consider whatthe LAW says

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Selected ReferencesSelected References

Singer, M. 1961, Singer, M. 1961, Generalization in Ethics.Generalization in Ethics. NY: NY: Alfred Knopf. Alfred Knopf.

Sokol, D.K. 2004. How to be a “good” medical Sokol, D.K. 2004. How to be a “good” medical student. student. Journal of Medical Ethics,Journal of Medical Ethics, 30612. 30612.

van Bogaert, DK. 2005van Bogaert, DK. 2005 Ethics & Moral Philosophy: Ethics & Moral Philosophy: A ReaderA Reader. Pretoria: Dept of Family Medicine U . Pretoria: Dept of Family Medicine U Limpopo. Limpopo.

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Thank you