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Part I

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  • 1. Medical Ethics for PA Students Charles Walker, PA-C, PhD Department of Orthopaedic Surgery LSU Health Sciences Center Shreveport, LA. July 2005
  • 2. Medical Ethics Issues: A Quick Look
    • Human Studies
  • 3. Medical Ethics Issues: A Quick Look
    • Allocation of Scare Resources
  • 4. Medical Ethics Issues: A Quick Look
    • Karen Ann Quinlen
  • 5. Medical Ethics Issues: A Quick Look
    • Abortion
  • 6. Medical Ethics Issues: A Quick Look
    • Euthanasia
  • 7. Medical Ethics Issues: A Quick Look
    • Cost Benefit Analysis
  • 8. Medical Ethics Issues: A Quick Look
    • Transplant Issues
  • 9. Medical Ethics Issues: A Quick Look
    • Fertility Issues
  • 10. Medical Ethics Issues: A Quick Look
    • Stem Cell / Cloning/ Genetics
  • 11. Medical Ethics Issues: A Quick Look
    • Ownership of Private Property / Patents
  • 12. Medical Ethics Issues: A Quick Look
    • What Does It Mean To Be Human?
  • 13. Systematic Ways to Think About Medical Ethics Issues
    • Ethical Theories of Medical Ethics
      • Deontological Ethics
      • Teleological Ethics
  • 14. Deontological Ethics
    • Immanuel Kant described Deontological Ethics in 18 th Century
  • 15. Deontological Ethics
    • Deontological Ethics
      • Deon Gr. for duty
      • Duty Oriented
      • certain acts can be judged to be right or wrong in themselves
  • 16. Deontological Ethics
    • Kant’s Categorical Imperative:
      • Always act in such a way that you can also will that the maxim of your action should become a universal law.
      • Act so that you treat humanity, both in your own person and in that of another, always as an end and never merely as a means.
  • 17. Deontological Ethics
    • In an ethics of duty, the ends can never justify the means. 
    • Individual human rights are acknowledged and inviolable.
  • 18. Deontological Ethics
    • Kant's ethics poses two great problems that lead many to reject it:
      • 1. Unlike the proportionality that comes out of the utility principle, the categorical imperative yields only absolutes . Actions either pass or fail with no allowance for a "gray area." Moreover, the rigid lines are often drawn in unlikely places. For example, lying is always wrong--even the "polite lie."
      • 2. Moral dilemmas are created when duties come in conflict, and there is no mechanism for solving them. Utilitarianism permits a ready comparison of all actions, and if a set of alternatives have the same expected utility, they are equally good. Conflicting duties, however, may require that I perform logically or physically incompatible actions, and my failure to do any one is itself a moral wrong.
  • 19. Teleological Ethics
    • Jeremy Bentham and J S Mill described Teleological or Consequentialist Ethics
  • 20. Teleological Ethics
    • Teleological or Consequentialist Ethics
      • Teleos Gr. for goal or end
      • Goal Oriented
      • rightness or wrongness of an act is to be judged in terms of the consequences it produces
  • 21. Teleological Ethics
    • Actions are right to the degree that they tend to promote the greatest good for the greatest number
    • Utilitarianism is a simple theory and its results are easy to apply
  • 22. Teleological Ethics
    • “ The good" is defined in terms of well-being (Aristotle's eudaimonia ), and distinguished not just quantitatively but also qualitatively between various forms of pleasure .
    • The principle defines the moral right in terms of an objective, material good.
    • Bridge gap between empirical facts and a normative conclusion--cost/benefit analysis
  • 23. Teleological Ethics
    • It is not always clear what the outcome of an action will be, nor is it always possible to determine who will be affected by it. Judging an action by the outcome is therefore hard to do beforehand.
    • It is very difficult to quantify pleasures for cost/benefit analysis (but since this only has to be done on a comparative scale, this may not be as serious an objection as it at first seems).
    • The calculation required to determine the right is both complicated and time consuming. Many occasions will not permit the time and many individuals may not even be capable of the calculations.
    • Since the greatest good for the greatest number is described in aggregate terms, that good may be achieved under conditions that are harmful to some, so long as that harm is balanced by a greater good.
    • The theory fails to acknowledge any individual rights that could not be violated for the sake of the greatest good. Indeed, even the murder of an innocent person would seem to be condoned if it served the greater number
  • 24. Case Studies
    • Mr Wilkinson is a 77-year-old who lives with his wife and son. He is terminally ill with cancer of the lung with liver secondaries. Over the last few months he has deteriorated, he has also lost a lot of weight. It has now been decided that Mr Wilkinson should be admitted for assessment and pain control.
    • He is currently taking co-codamol for pain relief but it is felt by the nursing staff that his pain relief would be better met through use of morphine. However, Mr Wilkinson has stressed that he does not want to start taking morphine having heard terrible stories about people who have taken it.
    • The ward staff express their concerns to you that they feel Mr Wilkinson is in pain and that he looks uncomfortable. The staff have asked him on several occasions but he always says he's ok. During previous respite admissions, Mr Wilkinson has told nursing staff that he does not want to be drugged to death, He feels the Lord will receive him when he is ready.
    • One week after his admission, he deteriorates. He becomes semi-conscious - he is dying. During periods of consciousness he becomes very agitated, screaming at times - especially when moved.
    • The nursing staff on the ward are very distressed by this. The wife and son are asked if they would agree to morphine or sedation being given to the patient. They refuse.
    • The next day the son appears ambivalent about the decision to withhold morphine.
    • Both the Consultant and nursing staff feel that morphine should be given. The junior doctors and staff feel that the wishes of the family should be observed as they are worried about a complaint.