IFMSA Ireland

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IFMSA Ireland International Conference
2004 Windows Into Medicine Medical ethics
Beginning of life issues Dr T Everett
Julyan Glasgow, UK Saturday 16th October 2004,
Dublin The Scottish Council on Human
Bioethics www.schb.org.uk
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• There is nothing good or bad,
• but thinking makes it so
• Hamlet

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Overview

• Why do we need medical ethics?
• What are medical ethics?
• How can we decide what is ethical and what is
  not?
• Abortion A worked example

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Why do we need medical ethics?

• Examples
• HIV
• Leprosy
• CAN versus OUGHT
• The END cannot justify the MEANS

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Why do we need medical ethics?

• The reality of morality
• c.f. mind versus brain
• c.f. colour, colour-blindness and the
  electromagnetic spectrum

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What are medical ethics?

• eth-icnoun
• 1. a. A set of principles of right conduct.
• b. A theory or a system of moral values.
• 2. ethics (used with a sing. verb)
• The study of the general nature of morals and of
  the specific moral choices to be made by a
  person.
• 3. ethics (used with a sing. or pl. verb)
• The rules or standards governing the conduct of a
  person or the members of a profession.

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What are medical ethics?

• A definition
• The systematic study or practice
• of moral behaviour within medicine

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How can we decide what is ethicaland what is not?

• Gut-feeling?
• Reason?
• Conscience?
• Consensus?
• Consequences?
• Relativism?
• Authority?

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Different approaches

• Deontological
• Teleological
• Consequentialist
• Others

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Different approaches

• Deontological
• Rule-based
• e.g. Hippocratic Oath

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Different approaches

• Teleological
• Purpose-based
• e.g. Natural Law

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Different approaches

• Consequentialist
• Results-based
• e.g. Utilitarianism

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Different approaches

• Others
• Mixed approaches
• e.g. Principlism
• (autonomy, beneficence, non-maleficence, justice,
  veracity, privacy, confidentiality, fidelity)

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Areas of ethical relevance
MOTIVES
ACTIONS
CONSEQUENCES
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Different approaches

• Discuss strengths and weaknesses of
• deontology (rules)
• teleology (purpose)
• consequentialism (results)
• principlism (autonomy, etc)
• with respect to
• motives
• actions
• consequences

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Different approaches

• Deontological (rules)
• Strengths
• Weaknesses

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Different approaches

• Teleological (purpose)
• Strengths
• Weaknesses

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Different approaches

• Consequentialist (results)
• Strengths
• Weaknesses

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Different approaches

• Principlism (autonomy, etc)
• Strengths
• Weaknesses

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Differences in common

• There is an OUGHT
• There is an ought IN REFERENCE TO SOMETHING
• We don't agree on WHAT THAT SOMETHING IS
• God? Nature (evolution)?
• or what?

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A combined approach?
MOTIVES
PURPOSE
RULES
HAPPINESS
ACTIONS
SURVIVAL
PRINCIPLES
CONSEQUENCES
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Abortion A worked example

• Some facts
• One of the most commonly performed gynaecological
  procedures in the UK
• At least 1 in 3 UK women have an abortion by age
  45
• 50 million deaths annually worldwide
• 50 million abortions annually worldwide

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Abortion A worked example

• Any action which is taken
• with the intention of ending the life
• of a conceptus
• (zygote, morula, blastocyst, embryo or fetus)

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Abortion A worked example

• 1. 15 Prim, raped by father 6 weeks ago
• 2. 38 Para2, screeninghigh risk of Down's
• 3. 31 Para3, previous eclampsia, C-section and
  subsequent puerperal psychosis
• 4. 22 Prim, going on holiday next year
• Motives actions consequences
• Rules purpose results principles

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Abortion A worked example

• Facts
• When does life begin?
• Values
• Actual values
• Is killing wrong? What is a person?
• Balance between values
• Right to choose versus Right to life

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Conclusions

• Medical ethics
• Necessary
• Integral
• Ubiquitous
• Principled
• Generalisable
• Multifactorial
• Complex

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• Do to others what you would have them do to you
• Jesus Christ