1
Q
what’s ethics
A
how a person should behave (knowing)
2
Q
what’s morality
A
value of human being (doing)
3
Q
aim of ethics
A
to be good / act well in your profession
4
Q
what are the ethical claims
A
- descriptive / empirical
- normative / prescriptive / evaluate
5
Q
define descriptive / empirical claim
A
how the world is
6
Q
define normative / prescriptive / evaluate claim
A
how the world should be
7
Q
describe personal ethics
A
ethical values for situations in every day life
8
Q
describe professional ethics
A
rules / guidelines used for professional life
9
Q
describe ethical reasoning
A
the ability to identify, asses, and develop ethical arguments from a variety of ethical positions
10
Q
describe ethical argument
A
an argument based on ethical theories
11
Q
how to develop an ethical argument
A
Duty & Right (taking correct actions)
Character & Relationship (being good people)
Consequences (predicting best possible outcomes)
12
Q
how to decide what’s ethical
A
obedience (compliance)
Imitation (copying)
Feeling / Desire (presentment)
Intuition (instinct)
Habit (practice)
13
Q
Core values in medicine & medical ethics
A
Compassion (concern fro patient’s condition and distress)
Competence (scientific, technical, cultural, ethical abilities)
Autonomy / Self-determination (individual and collective devision-making procedures)
14
Q
Ethical code in medicine
A
- help resolve disputes
- adhere to professional duty & maintain a clear conscience
- identify and ethical challenge and not make self look uninformed
- maintain patient respect
- maintain respectful relationships with coworkers
- maintain efficiency in decision making and care process
- reduce burnout
15
Q
what happens in absence of ethics
A
- ethical violations
- medical errors
- patient feels their dignity isn’t repeated (they aren’t hear)
- lack of trust in doctor-patient relationship and the medical profession
- lack of adherence to treatment
- conflict of interest
- causing physical / emotional / financial / injury to patient through inappropriate behaviour
- doctors withholding / promoting treatments to meet personal or institutional interest
16
Q
modern issues in bioethics
A
- designer babies
- dna banks
- genetic modification and agricultural activity
- human genome and associated challenges
17
Q
3 ethical theories
A
- consequentialism (includes utilitarianism)
- deontology
- virtue ethics
18
Q
what’s consequentialism
A
best end results
19
Q
cons of consequentialism
A
- difficulties to predict end result
- difficulty in measuring and comparing the “goodness” of consequences
- choosing different time periods may produce different consequences
- ignores things we regard as ethically relevant
20
Q
what’s utilitarianism
A
best end result for most people
21
Q
decision making method to utilitarianism
A
- identify different actions
- determine benefits / risks of actions
- choose that w/ most benefits
22
Q
types of utilitarianism
A
- act
- rule
23
Q
act utilitarianism
A
principles of utility used to guide actions
24
Q
rule utilitarianism
A
principle of utility used to make rules which in turn guide actions
25
Utility & welfare maximisation
providing max amount of wellbeing for the most amount of people
26
cons of utilitarianism
- difficult to know with certainty whether the consequences of our actions will be good or bad
- requires assigning values to the benefits / harms resulting from our actions
- severe limitations accounting for values such as justice and individual rights
27
what's deontology
correct action if it follows the rules
28
cons of deontology
- 1 set of rules not suitable for all cases
29
pros of deontology
- simple to apply (=following rules)
- fits well with our natural intuition
- doesn't require weighing benefits --> avoids subjectivity and uncertainty
30
types of deontology
- hypothetical imperative
- categorical imperative
31
what's hypothetical imperative
do this in order to get that
32
what's categorical imperative
do this!
33
define virtue ethics
taking certain person's behaviour as an indication of their character
34
4 cardinal virtues
- Prudence
- Justice
- Fortitude
- Temperance
35
what's prudence
right reason applied to action
--> take counsel , judge , command
36
what's justice
treat equals equally
37
what's fortitude
moral courage to make right decision
38
what's temperance
all decision made free from self-interest
39
distinctive focus of virtue ethics
- considering character
- right acts for right reason
- golden mean (whatever is moderate is right)
40
parameters of an ethical act
- self (are you ready to accept yourself)
- universalisability (I you can universalise and act and its still right, then its ethical)
- means (people are equal and deserve equal treatment and respect)
41
Rule based ethical theory in medical practice
- doctor attends to each patient w/ same set of rules
- rules which are set before consultation and aren't permitted to be broken
- the moral acts of the doctors are to judged in terms of their conformity to rules, duties or obligations
42
determination of healthcare allocation
- QALYs
- DALYs
43
QALYs
generic measure of disease burden, including both quality and quantity of life live
44
DALYs
measure of disease burden, expressed as the cumulative number of years lost due to ill-health / disability
45
Gnome
to wit/ judge what departure from common rules is called upon (moral intelligence)
46
What's dignity
basic values of human beings entitling them to respect
- being treated like somebody
47
what does dignity include
- respect
- privacy
- autonomy
- self-worth
48
when is dignity at risk
- sickness
- decline / toward death
- disability
- lack of capacity
- elderly
- childhood
- prison
49
4 principles of healthcare ethics
- Autonomy
- Beneficience
- Non-maleficience
- Justice
50
what's autonomy
self-rule (patient decides treatment)
51
what does autonomy depend on
- capacity
- necessity
- risk to others
52
what's beneficence
doing good for patients
53
what's non-maleficence
avoid harm
54
what's justice
treat equals equally
55
what are human rights
respect for the person and their dignity
--> human right and moral rights are complementary
56
what are physicians' legal rights
doctor's duties and obligations towards protecting citizens
57
what's a clinical ethics committee comprised of
- admin.
- legal members
- medical ethics academics
- religious rep.
- lay members
58
structured case analysis model
- summarise case
- state moral dilemmas
- state assumptions being made / to be made
- analyse case w/ reference to
- ethical principles
- consequences
- professional codes
- the law
- acknowledge justifiable ethical solutions and those that aren't justifiable
- state preferred approach w/ explanation
59
what's consent
voluntary agreement
--> respects patient's autonomy (primacy of consent)
60
what happens if patient is unconscious
- seek rep
--> if rep isn't present and emergency, presume consent given
61
main idea of WMA Dec. on patient rights
- right to self- determination (autonomy)
- consent
- patient rights
62
3 requirements for valid consent
- competence
- voluntariness
- information
63
information
- procedures
- alternative (other treatment options)
- risks / benefits
- questions
- diagnosis
- prognosis
- uncertainties
- purpose of treatment
- bills
- conflict of interest
64
consent = continuous
can change mind (must be repeatedly gained)
65
types of consent
- explicit (actively given)
- implied (reasonably inferred but not directly expressed)
66
respecting patient's autonomy
- preconditions
- information
- consent
67
preconditions
competence / ability to understand and decide
--> voluntariness in deciding
68
information
- disclosure of info.
- rec. of a plan
- understanding of info. and plan
69
consent
- decision (in favour of plan)
- authorisation (of chosen plan)
70
exceptions to requirements of informed consent
- patient voluntarily passes authority to physician
- disclosure of info. causing harm to patient
71
what's capacity
ability to give permission to have treatment or to withhold permission and refuse treatment
72
what does capacity comprise of
- understand (info. relevan to decision)
- retain (info.)
- use (decision making process)
- communicate (decision)
73
what happens if patient isn't capacitous
- proxy-decision maker
- advance decisions (living wills)
74
mental capacity act
- adults have rights to own decision
- everyone's encouraged to own decisions
- right to make unwise decisions
- proxy = best decision for patient
- proxy doesn't affect patient's freedom
Medical Ethics Midterm
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