Sciences of conduct and behavior Sciences of decision-making - General ethics - Professional ethics Ethics Virtue Wisdom Tradition Culture Religion Belief Value Ethics
Ethics dilemma Ethics is about dilemma and the reasons reasons that we give for our choice of action “should do, ought to do”
Ethical Theories Deontology (deon = duty) Goal is thought to be the fulfillment of one’s duties or the carrying out of obligations without regard to one’s desire Consequentialism/Utilitarianism Actions are good or bad based upon their consequences Virtue ethics
Medicine is about that is the best For the patient Doing the right thing for the patient has not only a factual but also a moral dimension
In real life : Deciding what to do in real life can be complicated No easy answer We live in an ethically diverse society We cannot be saints all the times
Primary Goal of Bioethics “to enhance clinicians’ performance or ability to care for patients and family, leading to better quality of care”
Bioethics Doing good, avoiding harm Provides a process to think through complex problems, balance competing needs, views, opinions, values and beliefs Provides support to reduce moral distress Provides education on ethics models and techniques Provides education on relevant legal and policy issues Dependent on context/culture
The Core Ethical Questions Question 1 Question 1 : What does the patient wants ? (Autonomy) (Autonomy)
Question 2 Question 2 : What can be done for the patient and what are benefits and harms? (Benificence / Non-maleficence)
Question 3 : Are the patient’s requests fair and able to be satisfied? (Justice) (Justice)
Principles of Bioethics Autonomy Beneficence Non-maleficence Justice
Autonomy Providing patient with information Enabling patients to make informed medical choices Respecting patient’s right to refuse treatment Ensuring openness with patients Maintaining patient privacy Helping restore patient’s independence
Some Bioethics Issues Informed consent Confidentiality Truth telling Withholding information Substitution decision-making Refusal of treatment Advanced directives Maternal-fetal conflict
Some Bioethics Issues Double effects Withholding life-sustaining treatment Medical futility Mistake Conflict of interest Palliative care Resource allocation Research ethics
The Ethical Decision Procedure 1. Recognize that the case raises an important ethical problem 2. What is the dilemma ? What is the problem that has to be solved? 3. What are the alternatives? Determine reasonable alternative courses of action
The Ethical Decision Procedure 4. What are the key consideration? 5. Decide on a resolution to the problem 6. Consider your choice critically When would you be prepared to alter it? Consider the options of others Know your resources
Analytic Framework Medical factors Patient Preference Quality of life Contextual features
Medical Factors How was the diagnosis made? Does it fulfill any of the goals of treatment? What are the treatment alternatives Is the proposed treatment useless? What is the prognosis?
Patient Preferences What does the patient want? Does the patient have the capacity to decide? If not, who will decide for the patient? Do family members feel?
Quality of Life Quality of residual life What is the patient’s subjective acceptance of likely quality of life? What are the views of the care providers about the quality of life? Less than minimal?
Contextual Features Social, legal, economic, and institutional circumstances Cultural belief Support system and availability e.g. inability to pay for treatment, inadequate social support
: 7. Action required : Do the right thing! The Ethics Decision Procedure