Medical Ethics

1
Medical Ethics

• Introduction

2
The Origins of the Field and Its Current Status
The Beginnings a) The Nuremburg Code, 1948 b)
Life Magazine article on dialysis selection
committees, November 1962

• Earlier Points of Origin
• Babylonian Codes
• Hippocratic Code/Oath
• Islamic Codes
• Jewish Codes

Emphasize physician-physician or
physician-patient relationship
3
The Origins of the Field and Its Current Status
Current Status of Medical Ethics 1) Number of
Courses Required 2) Medical Ethics programs in
medical schools, nursing schools, HRP, etc. 3)
Journals, e.g. Hastings Center Report, Journal of
Medicine and Philosophy 4) Centers, e.g. Hastings
Center, Kennedy Center at Georgetown University,
Midwest Bioethics Center, K.C. 5) Rise of
Hospital Ethics Committees 6) Massive Media
Coverage
4
The Social ContextWhy Is Medical Ethics So
Prevalent?
Some factors 1) Federal Government support, e.g.
IRBs, national commissions, publications 2) Rise
of Medical Technology 3) Rise of 3rd Party
Payers 4) American Distrust of the Professions 5)
Rise of Professional Ethics 6) Critics of
Medicine, e.g. Ivan Illych and Norman Cousins 7)
Rise of Team Health Care
5
The Social ContextWhy Is Medical Ethics So
Prevalent?
Some factors 8) Women's Movement male
dominance of medicine focus on cure rather
than care and prevention 9) Legalization,
legislation, and litigation
10) Social interest in freedom and autonomy -
decline in the status of medicine 11) Media
Interest, e.g. Cruzan. Busalacchi, Siamese
twins 12) Rise in the Cost of Medicine how much
can we afford?
6
Some Historical Points
1940's and 1950's
Human subjects research IRB's
Doctor-patient relationship a) buyer and
seller b) child and parent c) individual and
agent of society d) client and professional e) pas
sive recipient and active provider f) the
powerless and the powerful g) friend and friend
7
Some Historical Points
1940's and 1950's (cont.)
Doctor-patient relationship (cont.) h) contractua
l relationship a legal agreement based on
mistrust i) covenant relationship a mutual
agreement based on trust j) gatekeeper
relationship
informed consent informed refusal proxy
consent/refusal competence death/dying
8
Some Historical Points
1960's and 1970's
privacy and confidentiality abortion/status of
the fetus allocation of scarce resources definitio
n of death
9
Some Historical Points
1980's
genetics issues nursing ethics professional
ethics reproductive issues AIDS animal rights
10
Some Historical Points
1990's
human genome project right to health care/health
care reform managed care/professionalism fetal
neural tissue transplantation cloning
11
Some Historical Points
1990's (cont.)
stem cell research and therapy gerontological
issues cross-cultural medical ethics alternative
medicine non-Western medicine
12
Some Basic Concepts in Medical Ethics
Person 1) What is a person? What's the
definition of a person? Persons usually have
rights to life to thrive to be protected from
harm If rational or competent, to make decisions
for themselves, etc. What makes a person the same
person over time?
13
Some Basic Concepts in Medical Ethics
Person 2) What is the status of a potential
person? If x is a potential person, does x have
all the rights of a person? Is personhood a
matter of either/or? Is it a matter of
degrees? 3) What about past persons? If
something was a person, does it have the rights
of a person? 4) What about partial persons, e.g.,
the retarded, the demented, the senile, the
partially competent?
14
Some Basic Concepts in Medical Ethics
Person 1) What is a person? What's the
definition of a person? Persons usually have
rights to life to thrive to be protected from
harm If rational or competent, to make decisions
for themselves, etc. What makes a person the same
person over time?
15
Some Basic Concepts in Medical Ethics
Autonomy 1) Definition 2) Autonomy as a value,
i.e., persons have autonomy Autonomy self-determi
nation by competent agents autos selfnomos
law
16
Some Basic Concepts in Medical Ethics
Autonomy (cont.) Autonomy autonomy as a value,
i.e., persons have autonomy, should be respected
as agents autonomy as a goal, something to be
achieved autonomy vs. paternalism autonomy vs.
harm principle
17
Some Basic Concepts in Medical Ethics
Quality of Life 1) Who defines? 2) An external
definition? Same for everyone? 3) Internal
definition Normal vs. Abnormal Natural vs.
Artificial Health vs. Disease
18
Some Basic Concepts in Medical Ethics
Quality of Life Ordinary vs. Extraordinary Rights
vs. Responsibilities Life vs. Quality of
Life Person vs. Living Thing/Thing