Medical Ethics for PA Students

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Medical Ethics for PA Students

• Charles Walker, PA-C, PhD
• Department of Orthopaedic Surgery
• LSU Health Sciences Center
• Shreveport, LA.
• July 2005

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Medical Ethics Issues A Quick Look

• Human Studies

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Medical Ethics Issues A Quick Look

• Allocation of Scare Resources

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Medical Ethics Issues A Quick Look

• Karen Ann Quinlen

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Medical Ethics Issues A Quick Look

• Abortion

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Medical Ethics Issues A Quick Look

• Euthanasia

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Medical Ethics Issues A Quick Look

• Cost Benefit Analysis

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Medical Ethics Issues A Quick Look

• Transplant Issues

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Medical Ethics Issues A Quick Look

• Fertility Issues

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Medical Ethics Issues A Quick Look

• Stem Cell / Cloning/ Genetics

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Medical Ethics Issues A Quick Look

• Ownership of Private Property / Patents

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Medical Ethics Issues A Quick Look

• What Does It Mean To Be Human?

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Systematic Ways to Think About Medical Ethics
Issues

• Ethical Theories of Medical Ethics
• Deontological Ethics
• Teleological Ethics

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Deontological Ethics

• Immanuel Kant described Deontological Ethics in
  18th Century

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Deontological Ethics

• Deontological Ethics
• Deon Gr. for duty
• Duty Oriented
• certain acts can be judged to be right or wrong
  in themselves

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Deontological Ethics

• Kants Categorical Imperative
• Always act in such a way that you can also will
  that the maxim of your action should become a
  universal law.
• Act so that you treat humanity, both in your own
  person and in that of another, always as an end
  and never merely as a means.

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Deontological Ethics

• In an ethics of duty, the ends can never justify
  the means. 
• Individual human rights are acknowledged and
  inviolable.

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Deontological Ethics

• Kant's ethics poses two great problems that lead
  many to reject it
• 1. Unlike the proportionality that comes out of
  the utility principle, the categorical imperative
  yields only absolutes . Actions either pass or
  fail with no allowance for a "gray area."
  Moreover, the rigid lines are often drawn in
  unlikely places. For example, lying is always
  wrong--even the "polite lie."
• 2. Moral dilemmas are created when duties come in
  conflict, and there is no mechanism for solving
  them. Utilitarianism permits a ready comparison
  of all actions, and if a set of alternatives have
  the same expected utility, they are equally good.
  Conflicting duties, however, may require that I
  perform logically or physically incompatible
  actions, and my failure to do any one is itself a
  moral wrong.

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Teleological Ethics

• Jeremy Bentham and J S Mill described
  Teleological or Consequentialist Ethics

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Teleological Ethics

• Teleological or Consequentialist Ethics
• Teleos Gr. for goal or end
• Goal Oriented
• rightness or wrongness of an act is to be judged
  in terms of the consequences it produces

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Teleological Ethics

• Actions are right to the degree that they tend to
  promote the greatest good for the greatest number
  
• Utilitarianism is a simple theory and its results
  are easy to apply

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Teleological Ethics

• The good" is defined in terms of well-being
  (Aristotle's eudaimonia), and distinguished not
  just quantitatively but also qualitatively
  between various forms of pleasure.
• The principle defines the moral right in terms of
  an objective, material good.
• Bridge gap between empirical facts and a
  normative conclusion--cost/benefit analysis

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Teleological Ethics

• It is not always clear what the outcome of an
  action will be, nor is it always possible to
  determine who will be affected by it. Judging an
  action by the outcome is therefore hard to do
  beforehand.
• It is very difficult to quantify pleasures for
  cost/benefit analysis (but since this only has to
  be done on a comparative scale, this may not be
  as serious an objection as it at first seems).
• The calculation required to determine the right
  is both complicated and time consuming. Many
  occasions will not permit the time and many
  individuals may not even be capable of the
  calculations.
• Since the greatest good for the greatest number
  is described in aggregate terms, that good may be
  achieved under conditions that are harmful to
  some, so long as that harm is balanced by a
  greater good.
• The theory fails to acknowledge any individual
  rights that could not be violated for the sake of
  the greatest good. Indeed, even the murder of an
  innocent person would seem to be condoned if it
  served the greater number

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Case Studies

• Mr Wilkinson is a 77-year-old who lives with
  his wife and son. He is terminally ill with
  cancer of the lung with liver secondaries. Over
  the last few months he has deteriorated, he has
  also lost a lot of weight. It has now been
  decided that Mr Wilkinson should be admitted for
  assessment and pain control.
• He is currently taking co-codamol for pain
  relief but it is felt by the nursing staff that
  his pain relief would be better met through use
  of morphine. However, Mr Wilkinson has stressed
  that he does not want to start taking morphine
  having heard terrible stories about people who
  have taken it.
• The ward staff express their concerns to you
  that they feel Mr Wilkinson is in pain and that
  he looks uncomfortable. The staff have asked him
  on several occasions but he always says he's ok.
  During previous respite admissions, Mr Wilkinson
  has told nursing staff that he does not want to
  be drugged to death, He feels the Lord will
  receive him when he is ready.
• One week after his admission, he
  deteriorates. He becomes semi-conscious - he is
  dying. During periods of consciousness he becomes
  very agitated, screaming at times - especially
  when moved.
• The nursing staff on the ward are very
  distressed by this. The wife and son are asked if
  they would agree to morphine or sedation being
  given to the patient. They refuse.
• The next day the son appears ambivalent
  about the decision to withhold morphine.
• Both the Consultant and nursing staff feel
  that morphine should be given. The junior doctors
  and staff feel that the wishes of the family
  should be observed as they are worried about a
  complaint.