What is principalism?
4 principles: not hierarchical, autonomy has gained importance with patient-centred care. If conflict between principles may prioritise one over the other. Justice often less important than others.
- Respect for autonomy: respect decision making capacities, increasingly recognising views of those with limited autonomy – lacking capacity does not mean should override wishes
- Beneficence (overall benefit): to patients rather than everybody > legal duty of care (general duty of best interest and legal duty of best interest if lacking capacity)
- Non-maleficence (avoid harm): most procedures carry potential harm but may be justified against potential benefits
- Justice: ensure fair allocation of services and treatment within society; at individual level – promote equality among patients from all walks of life, irrespective of nationality, culture or religion.
What is consequentialism?
Two types?
Consequence of act, not the act itself (morally correct action is the one that results in best overall outcome, regardless of means used to achieve the consequences).
- Utilitarianism: maximising happiness to largest number of people (and minimising pain): how efficient activity is at achieving outcome e.g. hedonistic utilitarianism; requires impartiality (not promoting interests of self / family); and considered across time (no preference for the happiness occurring now – future generations considered). Arguably conflicts with justice; as suggests we can do things through harmful means to maximise benefit e.g. harvesting organs from one individual to save many others..
- Principle of proportionalism: act done with good intention can be rendered morally bad by being disproportionate to its end i.e. murder vs self-defence – goes against doctrine of double effect?
What is deontology?
How an activity that leads to a certain outcome is conducted is more important than the outcome itself – end does not necessarily suffice to justify the means.
Pros: ‘moral space’ – less demanding than consequentialism as can act freely within certain constraints.
Cons: no definitive list of duties exists, does not say what to do when two duties conflict.
What is virtue ethics?
Focuses on what our acts mean in relation to our status as moral individuals – resides in a category of its own, not really in conflict with other theories of ethics.
Virtues of a good doctor: honesty, compassion, respect, non-judgemental, courage, benevolence, conscientiousness, confidence, humility, empathy, trustworthiness, self-awareness, enthusiasm, professionalism, personable, altruism, discernment, integrity, justice.
What is casuistry?
Case-based approach, applying other theories, reflecting on previous decisions and common law.
What is meant by ‘rights’?
Rights can be political, religious, personal (e.g. bodily integrity, right to life), and attached to certain groups (students, patients, parental).
Legally recognised rights (‘true’ rights) vs moral rights: moral rights ought to be granted but cannot sanction people who interfere with them.
Article 5 of HRA?
“Everyone has the right to liberty and security of person. No one shall be deprived of his or her liberty [unless] in accordance with a procedure prescribed in law”
- relevant for DOLS!
What is the article relevant to DOLS and disability?
Article 14 of the UNCRPD “the existence of a disability shall in no case justify a deprivation of liberty.”
Article 2 of HRA?
Right to life
Does not extend to fetus
Article 12 HRA?
‘Right to have a family’ but not absolute right – refusal to fund treatment where clinically less effective may be justifiable in light of limited resources?
Article 8 HRA?
Protects bodily integrity from unwanted interference.
