Ethics and the family medicine resident


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Presented at Providence Family Medicine Residency Spokane once in 2010 and again in 2012

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  • Categorical Imperative: act only in ways that you are willing to make it a law/duty for all others to act in the same wayThe first premise is that a person acts morally if his or her conduct would, without condition, be the "right" conduct for any person in similar circumstancesThe second premise is that conduct is "right" if it treats others as ends in themselves and not as means to an end.The conclusion is that a person acts morally when he or she acts as if his or her conduct was establishing a universal law governing others in similar circumstances
  • Ethics and the family medicine resident

    1. 1. Ethics and theFamily Medicine Resident From the beginning of life to the end and everything in between
    2. 2. Ethics and the Family Medicine Resident•BriefHistory of Bioethics as a field•Framework for Ethics•Tools and Processes for DecisionMaking•Review of topics in Bioethics•Case examples•Small Group Exercise
    3. 3. Frameworks for EthicsPrinciple Based Framework for Ethical Decision MakingBeauchamp & Childress: Autonomy Beneficence Non-maleficence Justice
    4. 4. Frameworks for EthicsValues & Virtues Based Framework for Ethical Decision Making Nel Noddings: Ethics of caring John Rawls: Veil of ignorance Martha Nussbaum: Capabilities approach Reciprocity Religious Directives for decision making are often based on the values held highest within that community
    5. 5. Frameworks for EthicsCultural and Religious Norms Social Contracts, Laws Professional Codes of Ethic Religious Traditions & Scriptures Personal experiences
    6. 6. Framework for EthicsCausistry Case – based approach to ethical decision making Most common way for Hospital ethics committees to work through cases and consultations Potter‟s Boxes Facts Values Principles Loyalties
    7. 7. Framework for Ethics Deontology  Duties  Ex: Immanuel Kant‟s Categorical Imperative Teleology  Consequences  Ex: John Stuart Mill, “Greatest Good for the Greatest Number”- Utilitarianism Both: Worth of persons Stanford Encyclopedia of Philosophy
    8. 8. • Autonomy • Reciprocity• Beneficence • Honesty• Nonmaleficence • Integrity• Justice • Worth of persons Principles Values Cases Cultural Teleology and vs. Religious Deontology• Traditions • Categorical• Beliefs Imperative• Experiences • Utilitarianism• Social Contracts & • Worth of Persons Laws
    9. 9. Principles Values Decision MakingCultural Teleology and vs.Religious Deontology
    10. 10. Topics Consent  Institutional Ethics Capacity  Conflicts of Interest in education and in patient care Disclosure  Just distribution of scarce Voluntariness/Autonomy resources Truth Telling  Infectious disease ethics Confidentiality  Transplantation ethics Surrogate decision making  Differences in Cultural Norms Genetics Research & IRBs
    11. 11. Topics Before birth  End of Life  Every Age In-between  Personhood  Advanced Directives  Allocation of Scarce  Contraception  Futility Resources  Donation and storing of  Brain Death vs. Cardiac  Money/Insurance Eggs and sperm Death  Access to care  Care of Embryos  Organ Donation  Urban vs. Rural  Mother vs. Fetus  Physician Assisted  Organ  Assisted reproduction Death Transplantation  Population issues  Palliative Sedation  Infectious Disease –  Withoding HIV & STIs  Genetic Screening and Counseling vs.Withdrawaling  Elective Procedures  Prenatal Screening  Artificial Hydration and  Psychiatric Care Nutrition  Opioid Prescribing  Sex Selection  Ventilation  Research & trials  Cloning  Surrogate Decision  Informed consent  Eugenics making  Blood transfusions
    12. 12. Famous Landmark Cases  Baby M- anencephaly  Helga Wanglie- When families disagree  Terri Shiavo, Nancy Cruzan- Withdrawling vs. Witholding Life Support: Artificial Nutrition and Hydration & Ventilator  Tuskeegee Syphillis Study
    13. 13. Local Cases Mr. K  21 yo near drowning in 2009, with brain damage and recurrent sepsis. Mr. K was an exchange student from Ghana, planning to study and play soccer at Whitworth Mr. C  Conscientious objection of Medtronic technologist to turn off dual ICD and Pacer in a gentleman who has chosen to allow natural death Ms. N  Bipolar clinic patient in active mania who refuses to go to SMH for Psychiatric evaluation. Due to her insurance, this is currently her only option for Psychiatric care.
    14. 14. Things we encounter in FMS DailyIn the Clinic Opioid prescribing Care of the Difficult patient Reproductive topics:  Contraception- daily OCPs and emergency contraception  IUDs, Tubals, Vasectomies Discussing Advanced Directives & POLST forms What to Do When Families DisagreeIn the hospital: Withholding and Withdrawaling life support
    15. 15. The Role of Conscience in Medical DecisionsDaniel Sulmasy, OFM, MD, PhDUniversity of Chicago Does conscience ever clash with professional duties? What do we mean by terms such as „conscience‟ and „conscientious objection‟? How should one approach a request from a patient that conflicts with one‟s individual conscience? Exploring how medical professionals can strive to preserve their moral integrity while also respecting and serving patients with whom they might have deep moral disagreements.
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