What are ethics?
Standards of right or wrong that prescribe
what humans ought to do
– Morals =personal morals
– Ethics = standards of society/profession
• Involves rights, obligations, benefit to society,
fairness, virtues
What is a right?
• Privileges or entitlements • Claim of an individual against the state /society • Not always recognised by other individuals or society Human Rights – Includes moral rights • Right to life • Right to liberty • Freedom of thought and expression • Equality before the law – In modern times tends to have political implication • Right to education • Right to healthcare • Right to seek asylum
What are the four principles of medical ethics?
Autonomy
Nonmaleficence
Beneficence
Justice
What is autonomy?
• When our actions are a result of our own
choices and decisions
• Assumes we, as individuals, are best placed to
decide what is in our best interests
• Based on the recognition of, and respect for,
an individual’s worth
• Must be weighed up against potential harm to
other individuals / society
– eg. vaccine debate
What is nonmaleficence?
• Above all do no harm
• One ought not to inflict evil or harm
– Intentionally refraining from actions that cause
harm ‐ physical, emotional, cultural or social harm
• Understanding patient’s perspective
The following are situations where nonmaleficence has NOT been respected • Unprofessional behaviour • Breaches of confidentiality • Medical mistakes • Lack of cultural sensitivity • Crossing social boundaries
What is beneficence?
- One ought to do or promote good
- One ought to prevent evil or harm
- One ought to remove evil or harm
- Understanding patient’s perspective
What is justice?
• Social
– Treating similar patients in a similar way
• Distributive
– Who gets a scarce resource?
What is paternalism?
• Acting for the best interest of others
– Person may not be in a position to let their wishes
be known (Soft)
– May act against the wishes of a person, holding
that it is for their good (Hard)
• Many laws are paternalistic
– Bike helmets, age restrictions on drinking
• May restrict a person’s autonomy
What are the 3 elements of informed consent (Autonomy)?
- Threshold element
- Competence - Information elements
- Disclosure of information
- Understanding of information - Consent Elements
- Voluntariness
- Authorisation
What does competency mean (threshold element) and what is required to achieve it?
Competency of the patient = ability to make decisions affecting their health
- Relevant to the context
- more intrusice or critical a procedure the higher level of competency needed
- May still be competent to make some decisions, this needs to be respected
What is confidentiality?
- Basic to be a good patient: doctor relationship
- Allows full disclosure by patient
- Some circumstances may allow doctors to breach confidentiality
- Harm to patient
- Harm to others
