Medicine and Ethics Chapter 6
Introduction Ethics concerns itself with the philosophies underlying ideal relationships between human beings, as well as the promotion of the highest good for humanity as a whole. Decisions that people make based on ethical beliefs can quite possibly alter the course of human existence.
This chapter will examine: Rights and duties as related to ethics Four types of ethical problems Making ethical decisions The impact that CEJA has had on ethical decisions made by healthcare professionals The reasons that confidentiality is an ethical issue CEJA opinions
History of Ethics in Medicine Ethics explores the moral right or wrong of an issue. Ethics should not be confused with etiquette. Etiquette refers to courtesy, customs, and manners.
Code of Hammurabi Earliest written code of ethics Written in approximately 2250 B.C. Elaborated on the conduct expected of a physician Set the fees a physician could charge
Oath of Hippocrates Written in approximately 400 B.C. by Hippocrates Greek physician Known as the Father of Medicine Administered to medical school graduates even today
Percival’s Code of Medical Ethics Thomas Percival Physician, philosopher, and writer from Manchester, England Published his Code of Medical Ethics in 1803
AMA Code of Ethics Formulated in 1847 at the first annual AMA meeting Specifically acknowledged Percival’s Code of Ethics as its foundation
American Medical Association AMA was established in 1846 Provides information and support to physicians
Council on Ethical and Judicial Affairs CEJA consists of nine active members of the AMA Includes one resident physician Includes one student member CEJA is responsible for interpreting the AMA Principles of Medical Ethics as adopted by the House of Delegates
Components of theAMA Code of Ethics Four components: Principles of medical ethics Fundamental elements of the patient-physician relationship Current opinions of the CEJA with annotations Reports of the CEJA
Publications Code of Medical Ethics: Current Opinions with Annotations Contains the first three components Contains discussion of more than 135 ethical issues encountered in medicine Reports of the Council on Ethical and Judicial Affairs Discusses the rationale of the Council’s opinions
Making Ethical Decisions We must first understand… the elements of ethics. types of ethical problems. the decision-making process.
Elements of Ethics Three general elements of ethics Duties: Obligations that a person has or perceives himself or herself to have Rights: Claims that a person or group makes on society, a group, or an individual Character traits: A disposition to act in a certain way
Types of Duties Nonmaleficence Refraining from harming oneself or another person Beneficence Bringing about good Fidelity Concept of promise-keeping Veracity Telling the truth
Types of Duties Justice Fair distribution of benefits and burdens among individuals and groups in society having legitimate claims on those benefits Reparations Righting a wrong Gratitude * Feeling grateful after being the beneficiary of someone’s goodness
Rights Versus Privileges The Bill of Rights guarantees certain liberties that we enjoy as U.S. citizens. Americans do not have the RIGHT to healthcare services; it is a privilege. Rights apply to all people within a group without prejudice. Consider the phrase “the RIGHT to life.”
Character Traits Not always an indication as to how a person will act in every situation. No human being is perfect. Humans are often unpredictable.
Types of Ethical Problems Ethical Distress A situation in which certain course of action is indicated, but some type of hindrance or barrier prevents that action
Ethical Distress From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.
Types of Ethical Problems Ethical Dilemma A situation in which an individual is faced with two or more choices that are acceptable and correct, but doing one precludes doing another
Ethical Dilemma From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.
Types of Ethical Problems Dilemmas of Justice Focuses on the fair distribution of benefits to those who are entitled to them
Dilemmas of Justice From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.
Types of Ethical Problems Locus of Authority Two or more authority figures have their own ideas about how a situation should be handled, but only one of those authorities will prevail
Locus of Authority From Purtilo R: Ethical dimensions in the health professions, ed 4, Philadelphia, 2005, WB Saunders.
Recognizing Ethical Problems It is not always easy to recognize the type of ethical problem present. Sometimes, a mixture of problems exists.
The Ethical Decision-Making Process Purtillo presents a five-step method for making ethical decisions: Gather relevant information Identify the type of ethical problem Determine the ethical approach to use Explore practical alternatives Complete the action
Current Opinions of CEJA Abortion Should a woman who has been raped and become pregnant have an abortion?
Current Opinions of CEJA Abuse What harm can come to a patient’s family if medical professionals are incorrect about their assessment of abuse?
Current Opinions of CEJA Allocation of Health Resources If the CEO of American Airlines, the winner of last year’s Best Actor Oscar, and a drug-abusing mother of three were all equally ill and needed a liver transplant, who should receive it?
Current Opinions of CEJA Artificial Insemination A man fertilized eggs that were frozen for later use, but he died without having made provision for the use of those eggs after his death. Should the man’s wife be able to use the eggs?
Current Opinions of CEJA Stem Cell Research A medical student is recruited to work with a physician who is researching paralysis. Once the project is underway, the student discovers that the physician is using embryos that have been questionably obtained. What should the student do?
Current Opinions of CEJA Surrogate Motherhood What is a fair length of time to give a surrogate mother to petition to void a surrogacy contract?
Current Opinions of CEJA Human Cloning If a couple loses their child through death but it were possible to clone the child, what concerns would be present for the family?
Current Opinions of CEJA Genetic Counseling What could happen if parents were to “design” a baby, but it arrived flawed in some way or did not meet their expectations?
Current Opinions of CEJA Physician-Assisted Suicide If a patient mentioned in passing that he or she would want the right to commit suicide in the event of a terminal illness, would you support that decision if the situation did arise?
Current Opinions of CEJA Surrogate Decision Making A physician recommends that a patient be taken off life support. The patient lives with his homosexual partner and has not seen his parents in 10 years. The partner does not wish to remove life support, stating that the patient would want every opportunity to live. If the parents disagree, whose decisions should prevail?
Current Opinions of CEJA Withholding or Withdrawing Life-Prolonging Treatment How would a medical assistant handle the family of a patient who asks for advice about withdrawing life-prolonging treatment? To whom should the medical assistant defer the question?
Current Opinions of CEJA Quality of Life A mentally ill single woman who is institutionalized becomes pregnant and refuses to give up her maternal rights so that the child can be adopted. Even if she were to reconsider, what complications would result if the child were born deaf and with a severe liver disorder? Should the child be fed and cared for by the hospital staff?
Current Opinions of CEJA Clinical Trial and Investigation If your brother were homosexual and wanted to participate in clinical trials for a vaccination against HIV, would you support his decision?
Current Opinions of CEJA Cost of Healthcare Services Should an 87-year-old patient with cardiovascular disease and stomach cancer undergo expensive breast reconstructive surgery?
Current Opinions of CEJA Organ Donation A woman dies with a living will that states that she wishes her organs to be donated. Her mother, still living, disagrees and does not want her daughter’s organs donated. What should the health professional do in this situation?
Current Opinions of CEJA Capital Punishment A very emotional patient, the parent of a child who was raped and killed, has been given the opportunity to attend the execution of the murderer. During a visit to her family physician, she expresses concerns about being able to cope with the memory of her daughter during the execution and asks you if you would attend in the same situation. How to you handle this?
Ethical Issues Surrounding HIV HIV-positive individuals deserve privacy, as do all patients. Unique identifiers help maintain confidentiality.
Ethics and the Human Genome Human Genome Mapping Project was completed in 2003. Data will be studied for years to come. Access to genetic information presents privacy concerns as to who owns the genetic information and who controls it. As genetic technology advances, the application of ethics to that technology must also be considered.
Other Ethical Issues Interprofessional Relationships Medical professionals should speak up when errors by other professionals are suspected. Referrals to other professionals should be made only when one is confident in his or her ability. Physicians in private practices are free to decide whom they will treat. Sports medicine physicians must consider the patient first and not make medical decisions based on potential game outcomes.
Other Ethical Issues Confidentiality and Patient Privacy It is unethical and unacceptable to divulge any information about a patient to any person not directly involved in the patient’s care. All information in the record must be kept in strict confidence.
Confidentiality restrictions apply to all patient medical records, including separately filed x-rays, etc.
Other Ethical Issues Advertising Only deceptive trade practice regulations govern advertising by medical facilities and practitioners.