Medical Ethics Notes

MedicoPlexus

Medical Ethics

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1. History and development of medical ethics. Factors for the formation of contemporary medical ethics.  

Bioethics was preceded by medical ethics, which focused primarily on issues arising out of the physician–patient relationship. The ancient Hippocratic literature (not limited to the Hippocratic Oath) enjoins doctors to use their knowledge and powers to benefit the sick, to heal and not to harm, to preserve life, and to keep in the strictest confidence information that ought not to be spread about (though precisely what must be kept confidential is not detailed). 4 basic principles of medical ethics (in ‘Principles of biomedical ethics’) 

1. Autonomy 
2. Beneficence 
3. Non-maleficence 
4. Justice 

Factors that have shaped modern medical ethics 

• Public healthcare (definition: preventing disease, prolonging life, promoting health through organized efforts & informed choices of society, organizations, communities & individuals.) 
• Advances in medicine and technology 
• Changes in attitudes of individuals 

The term ‘bioethics’ was coined in the early 1970s by biologists who brought to the public’s attention two pressing issues:  

1. The need to maintain the planet’s ecology, on which all life depends 
2. The implications of advances in the life sciences toward manipulating human nature. 

Contemporary medical ethics:  

Cost: 

many of the tools of modern medicine are very expensive, and thus out of the reach of many who might benefit from them. -> debate over payment for healthcare -> In most industrialized countries, the provision of health care is viewed as the responsibility of government.  

• national health insurance 
• Egalitarians: no care should be provided unless it is available to all who need it 
• tiered health care: system that allows some medical services to be distributed by the market. 

Value of preserving life: 

Respirators were originally invented for people who were expected to recover and be able to breathe on their own. However, they began to be used on people in persistent vegetative states, forcing medical professionals to ask whether this was an appropriate use of technology. Should people who are permanently/ irreversibly unconscious be kept alive indefinitely? Research with human subjects, genetics, organ transplantation, death and dying, and reproduction 

2. Moral dilemmas and moral reasoning. Levels of moral reasoning. Ethical decision making. Ethics and law.  

Moral dilemma = situations where a choice is to be made between 2 options, neither of which resolve the situation in an ethically acceptable fashion 

Moral reasoning = process by which individuals try to determine the difference between what is right and what is wrong 

Levels of moral reasoning (developed by Kohlberg) 

1. Preconventional morality (in younger years of life) 
   1. Stage 1: Obedience and punishment 
      1. Child/individual is good in order to avoid being punished 
      2. If punished they must have done wrong 
   2. Stage 2: Individualism and exchange 
      1. Recognition that there is not just one right view that is handed down by the authorities 
      2. Different individuals have different viewpoints 
2. Conventional morality (most adolescents and adults) 
   1. Stage 3: Good interpersonal relationships 
      1. Individual is good in order to be seen as being a good person by others 
      2. Answers relate to approval by others 
   2. Stage 4: Maintaining the social order 
      1. Individual becomes aware of the wider rules of society 
      2. Judgements concern obeying the rules in order to uphold the law and to avoid guilt 
3. Postconventional morality 

a. Stage 5: Social contract and individual rights 

i. Individual becomes aware that while rules/laws might exist for the good of the greatest number, there are times when they will work against the interest of particular individuals 

b. Stage 6: Universal principles 

i. Individuals have developed their own set of moral guidelines which may or may not fit the law 

Ethical theory = a broad set of moral principles (or just one overriding principle) that is used in measuring human conduct 

2. main groups 
   1. Teleological theory 
   2. Deontological theory 

3. main branches of ethics 

• Metaethics = An analysis of concepts and methods of reasoning 
• Normative ethics = An analysis of what those moral standards ought to be – Applied ethics = the practical application of moral considerations