Discussion of Medical Ethics

1
Discussion of Medical Ethics

• Tommie W. Farrell, MD
• May 31, 2007

2
Objectives

• Be able to identify key periods of history
  pertaining to codes of ethics, what influences
  brought them about and how they influenced
  medical ethics (slides 3-4)
• Be able to show a step wise process in making an
  ethical decision (5-6)
• Distinguish from each other four different
  frameworks for considering ethical principles
  (7-10)
• Take a scenario and apply the steps and four
  frameworks to make an ethical decision (class
  discussion)

3
Hippocrates

• Statement of principles, probably 5th century
  B.C.
• Protected rights of patients
• Appealed to the inner and finer instincts of the
  physician
• Did not impose any sanctions or penalties
• http//www.pbs.org/wgbh/nova/doctors/oath_classica
  l.html

4
Timeline of Codes

• Thomas Percival Code of Ethics, 1803
• Responding to the medical practices of the day
  and the injustices he saw
• AMA Code of Medical Ethics, 1846
• Defining itself as a professional body with
  sovereignty over patient care
• http//www.library.dal.ca/kellogg/Bioethics/codes/
  codes.htm
• Nuremburg Code, 1947
• Birth of bioethics in research
• Response to the atrocities of human subjects
• http//www.library.dal.ca/kellogg/Bioethics/codes/
  nuremburg.htm
• Current AMA code of ethics
• Clarification within a modern era
• http//www.ama-assn.org/ama/pub/category/2512.html

5
How to Make an Ethical Decision

• 1. Evaluate and communicate
• sometimes what appears complicated needs only
  clarification
• 2. Consider the ethical principles
• 3. Make the decision
• - identify key decision makers
• - never in isolation
• 4. Document the decision
• 5. Implement the decision and change it when
  necessary
• 6. Respond to objections and challenges

6
How to Make an Ethical Decision

• Evaluate and communicate
• sometimes what appears complicated needs only
  clarification
• 2. Consider the ethical principles
• 3. Make the decision
• - identify key decision makers
• - never in isolation
• 4. Document the decision
• 5. Implement the decision and change it when
  necessary
• 6. Respond to objections and challenges

7
Selected Ethical Frameworks

• Principle Based
• Beneficence Promote patient well-being
• Autonomy Respect patient self-determination
• Nonmaleficence Do no harm
• Justice Protection of vulnerable populations and
  fair allocation of resources

8
Selected Ethical Frameworks

• Virtue Based
• focuses on character traits and behaviors of
  physicians and what it means to be a good
  physician
• Fidelity to trust and promise
• Effacement of self-interest
• Compassion and caring
• Intellectual honesty knowing when to say I
  dont know
• Prudence deliberating and discerning
  alternatives in situations of uncertainty and
  stress

9
Selected Ethical Frameworks

• Caring Based
• Recognizes that principle-based systems may
  ignore relationships and responsibilities
• Connections to others are central to what it
  means to be human
• Caring requires
• Receptivity to the patient
• Responsibility toward the patient
• Creation of an educational environment that
  fosters caring

10
Selected Ethical Frameworks

• Respect for Personhood
• Treatment of the patient must value the inherent
  dignity of each person regardless of age,
  debility, dependence, race, color, or creed
• Actions must reflect the patients current needs
• Decisions must value the person and accept human
  mortality

11

• Class Discussion