What is ethics?
- Deciding what we should do
- Find reasons for and against
Describe the ethical tree
- Consequences (a decision is right if it brings the best consequences)
- Duty
- Virtue (the kind of person you want to be)
What is utilitarianism?
- A form of consequentialism (considering consequences) which states that the right action is that which brings about the maximum overall happiness.
- All other things being equal, saves the most lives or reduces suffering in the most people.
What is a democratic approach to consequences?
Equal weight given to each individual when calculating overall happiness
List the problems with just thinking about concequences
- Some actions are (almost) always wrong
- Very difficult to be certain of consequences
- Could justify heinous actions (for the greater good)
- Irrelevant if the decision maker is a bad person
- Irrelevant whether a decision is unjust
What are duty based theories?
- Dentological
- Certain actions are right or wrong irrespective of the consequences
- Eg. duty to not kill or torture, duty to tell the truth
- This is simple, as it doesnt require prediction or calculation of consequences
What are the issues with duty?
- How do you decide what is right or wrong?
- What if moral duties conflict?
- Absolves the individual from moral responsibility for the consequences, even if the consequences are very bad
What is virtue ethics?
- A virtue is a character trait a human being needs to flourish or live well
- The best life of a human being consists in the exercise of the virtues e.g. honesty, integrity, wisdom, courage, fairness, compassion
- Virtues can be nurtured and developed
- The right course of action is the course that a virtuous individual would take
- You should not lie, as an honest person would not lie
What is moral identity?
- A sense of the kind of person you want to be
- An individual’s own moral compass
- Nurtured through reflection on moral dilemmas and lived experiences
What is moral imagination?
- Recognition and sympathy for the suffering of others
- Respect for others
Define autonomy
- Deciding the direction in which your life should go
- Being free to make your own choices in life
What are the two aspects important in autonomy?
- Instrumental value (we know ourselves better)
- Intrinsic value (it is our own life)
- Intrinsic value is more important - a fundamental aspect of being human
Why is intrinsic value of autonomy important?
As without free will we do not have moral responsibility
Why may patients make bad health choices?
- The bad health choice may be in their best interest
- Even if they are wrong about something being in their best interest, they should be able to choose what is done to their body
Why is bodily autonomy different?
- In healthcare, choices will have a direct impact on the individuals body
- We usually choose how to conduct our lives
How is autonomy respected?
- Enable autonomous choices
- Range of choices
- Adequate information
- Clear explanation
- No pressure
- Be non-judgemental
- Time to consider options
Why is respecting autonomy important in medical care?
- Helps doctors give better advice
- Improve shared decision making
- Improve confidence
- Improve trust
- Improve adherence
When are there limits to autonomy?
Preventing harm to others
Define paternalism
Overriding or undermining an individual’s autonomy based on the belief that to do so is in their best interests e.g. withholding bad news or playing down side effects of a treatment
Is paternalistic dishonesty sometimes justified?
- Technical information can be difficult to put across
- Outcomes are uncertain
- Patients may not be able to handle information, it might cause distress
Why is withholding information rarely justified?
Consequences:
- Many patients with a serious illness suspect their diagnosis.
- Uncertainty causes anxiety
- Patients may not trust their doctor if they feel she/he is not being honest with them
Duty to respect autonomy:
- Knowing the diagnosis and prognosis is important for making other important decisions
- Most patients want to be told their diagnosis
Virtue:
- Honesty is an essential virtue of doctors
Is lying worse than withholding the truth?
Yes
- Restricts autonomy more
- Impossible to tell patients everything
- Less likely to cause mistrust
- Moral duty not to lie
No
- Wrong to assume a patient doesnt want to know
- Will cause equal mistrust
- If the intention is the same then morally equivalent
- Moral duty not to withhold info important to the patient
