HEALTH CARE ETHICS (BIOETHICS) • Animal experiments first

NCM 108 • Avoid suffering

• No intentional death or disability
Ethics and Morality • Protection from harm
• Ethics is a set of moral principles and a code for • Subject free to stop / withdraw
behavior that govern an individual’s actions with • Qualified investigators
other individuals and within society. • Investigator will stop if harm occurs
• Morality is what people believe to be right and
good, while ethics is a critical reflection about Comparing Law and Ethics
morality. • Law, ethics, and bioethics are different but
related concepts.
Law • Laws are mandatory to which all citizens must
• Laws are brought about by tension, agitation adhere or risk civil or criminal liability.
and conflict by dramatic situations. • Ethics relate to morals and help us organize
• Laws are societal rules or regulations that are complex information and competing values and
obligatory to observe. interests to formulate consistent and coherent
• Laws protect the welfare and safety of society, decisions.
resolve conflicts, and are constantly evolving.
• Laws have governed the practice of medicine for Ethical Dilemma:
over one hundred of years. • Value conflicts, no clear consensus as to the
“right” thing to do. A conflict between moral
obligations that are difficult to reconcile and
Bioethics
require moral reasoning.
• Bioethics refers to the moral issues and
• Situations necessitating a choice between two
problems that have arisen as a result of modern
equal (usually undesirable) alternatives.
medicine and medical research.
• Issues in bioethics are usually life-and-death
issues! Ethical Issues in Modern Healthcare
• Ethical and bioethical principles can be In modern healthcare and research, value
personal, organizational, institutional or conflicts arise where often there appears to be no
worldwide. clear consensus as to the “Right thing to do.”
• Now often known as medical ethics or clinical These conflicts present problems requiring moral
ethics – hospital based issues. decisions, and necessitates a choice between two
• Philosophical study of ethical issues brought or more alternatives.
about by advances in scientific and medical Examples:
technologies Bioethics: origin, definition, • Should a parent have a right to refuse
methodology. The foundation of the doctor-patient immunizations for his or her child?
relationship models. technologies • Does public safety supersede an individual’s
• Bioethical dilemmas arise when different parties, right?
albeit all well-meaning, hold divergent values that
lead to opposing viewpoints on appropriate Ethical Theories: Ideas and Actions
actions • Deontology (duty)
• Consequentialism (actions)
History of Bioethics • Virtue Ethics/Intuition (morals and values)
• Started as concerns regarding research ethics
• Nuremberg Doctors’ Trial -- 23 German Deontology /Nonconsequentialism:
physicians who either participated in the Nazi - Derived from the Greek word, Deon, meaning
program to euthanize persons deemed “unworthy duty. Considers that some acts are right or wrong
of life” or who conducted experiments on independent of their consequences. Looks to
concentration camp prisoners without one’s obligation to determine what is ethical and
experiments on concentration camp prisoners answers the question: What should I do and why
without their consent were tried. The trial lasted should I do it?
140 days. 85 - Rules which express our duties.
witnesses testified and almost 1,500 documents Ex.
were introduced. 16 of the doctors charged were > Killing someone to give their organs to
found guilty. 7 were executed. someone else may ignore our duty.

The Nuremberg Code Problems:

• Voluntary consent -Always following duties of conduct can lead to
• Anticipate scientific benefits negative consequences.
• Benefits outweigh risks
> Allowing a massive bomb to explode by refusing ○ One does not justify one’s choice but does not
to torture someone. so in reasonable manner
• Disclosure
Consequentialism: Also called Teleological, • Comprehension
Greek word, Telos, meaning end or consequence. • Voluntariness
Actions are determined and justified by the 2. Right to informed decision
consequence of the act. Consequentialists 3. Right to informed choice
consider all the consequences of what they are 4. Right to refuse treatment
about to do prior to deciding a right action. This 5. Right to die
also answers the question: What should I do and 6. Freedom of choice
why should I do it?
Limitations of Patient’s Rights
Virtue Ethics: Contrary to other ethical theories, • 2 Methods of Obtaining Informed
virtue ethics tells us what kind of person one Consent
ought to be, rather than what they do. The focus ○ Written Consent
is on the character (goodness) of the person. ○ Verbal Consent
• In emergency cases the types of patient
Ethical Principles need not require informed consent.
> Conflict is inevitable. Ethical principles provide ○ Comatose obtunded patient
the framework/ tools which may facilitate ○ Blind or illiterate patients
individuals and society to resolve conflict in a fair, ○ Underaged Patients
just and moral manner. ○ Language Barriers

• Autonomy/Freedom RIGHTS OF PATIENTS

• Veracity 1. Right to considerate and respectful care.
• Privacy/Confidentiality 2. The patient has the right to obtain from his
• Beneficence/Nonmaleficence physician complete current information
• Fidelity concerning his diagnosis, treatment, and
• Justice prognosis in terms that the patient can be
reasonable expected to understand.
Autonomy 3. The patient has the right to receive from his
• The right to participate in and decide on a physician information necessary to give informed
course of action without undue influence. consent prior to the start of any procedure and/or
• Self-Determination: which is the freedom to act treatment.
independently. Individual actions are directed 4. The patient has the right to refuse treatment to
toward goals that are exclusively one’s own. the extent permitted by law and to be informed of
the medical consequences of his action.
“Autos”- self, “Nomos”= rule 5. Right to every consideration of his privacy
- Right to self determination concerning his medical care program.
- Treat each individual as an autonomous subject. 6. The patient has the right to expect all
- Individuals have right to make treatment communications and records to his care should
decisions be treated as confidential.
- Must have the capacity to make 7. The patient has the right to expect that, within
decisions independently: its capacity, the hospital must provide a
○ Developmental reasonable response to his/her request for
considerations services.
○ Health related challenge. 8. Right to obtain info regarding any relationship
of his hospital to other health care and
The Moral Issue of Patient’s Right educational
Patient’s Right- The moral and inviolable power institutions in so far as his care is concerned.
vested in him as a person to do, hold or demand 9. The patient has the right to be advised if the
something on his own. hospital proposes to engage in or perform human
experimentation affecting his/her care of
Types of Patient’s Right treatment. Right to refuse to participate in such
1. Right to informed consent research projects.
> Four Major Elements of Informed 10. The patient has the right to expect
Consent reasonable.
• Competence- 11. The patient has the right to examine and
○ One has made a decision receive an explanation of the hospital bill,
○ One has the capacity to justify one’s choice regardless of source of payment.
12. Patient has the right to know the hospital rules
and regulations apply to his/her conduct as a
patient

Privacy/ Confidentiality
• Respecting privileged knowledge.
• Respecting the “self” of others.

- Confidentiality refers to the duty to protect

privileged information and to share entrusted
information responsibly. It stems from the notion
that a person's wishes, decisions, and personal
information should be treated with respect.
>As a general rule, health care providers have a
responsibility to avoid disclosing personal and
medical information that has been entrusted to
them without the patient’s consent.
- Privacy refers to the right to be free from
interference. Privacy is supposed to enable
individuals to exert control over their own lives,
which includes deciding who should have access
to personal information, and when and how this
information will be disclosed.

Veracity
• The duty to tell the truth.
Truth-telling, honesty.