MEDICAL ethics

1. COM SKILLS & MEDICAL
ETHICS COURSE
CONTENT
COURSE LECTURER; MR. MWENYA PETER (MA, APPLIED ETHICS, BA,
PHILOSOPHY; PSYCH-SOCIO; BA, BUSINESS ADMINISTRATION; PM/MKT.
PGD IN ME, PGD; TM

2. UNIT :7 MEDICAL ETHICS AND PROFESSIONAL
PRACTICE
1. Philosophical basis and principles of medical
a. Ethical theories, deontology and utilitarianism
b. Medical research and ethics
c. Policy, legislation and regulation for COGs : The practice
d. Clinical incompetence
e. Interprofessional relationships
f. Relationship with other health workers
g. Relationship with unqualified practioners and traditional healers
h. The ethical dimensions: Responsibility to the Community

3. PHILOSOPHICAL BASIS OF MEDICAL ETHICS
1. Philosophical basis and principles of medical
 What are the philosophical foundations of medical ethics? The term ethics is derived from
Greek. noun meaning ‘character’ or ‘disposition’.
 It is used in Aristotle to denote those aspects of one's character that, through appropriate moral
training, develop into virtues
 ., a philosophical study on character. Ethics is concerned with what is good for individuals and
society. It involves developing, systematizing, defending, and recommending concepts of right
and wrong behaviour

4. PHILOSOPHICAL BASIS OF MEDICAL ETHICS
 Thomas Percival introduced the term “medical ethics” in 18032. Percival wrote
mainly about decorum but also examined the conduct of physicians in society
 In 1847, the American Medical Association adopted its first code of ethics,
largely based on Percival’s work. Western medical ethics as a field of studies
emerged and began to crystallise as part of the revival of applied ethics during
the second half of the 20th Century
 This period of time witnessed scientific discoveries and technological
innovations, on the one hand, and growing patients’ objections to medical
paternalism, on the other. These developments brought about the need to
rethink and rephrase medical obligations and patients’ rights. Ancient, liberal,
and socialist philosophies were the main engines for crafting the new field

5. CONT.
 In Utilitarianism, Mill argued that it is “the business of ethics to tell us what are our
duties, or by what test we may know them.
 Philosophical underpinnings are designed to administer unequal power relations
between patients and physicians. Patients lack knowledge, experience and expertise
 Furthermore, their ailment put them in a vulnerable condition. They voluntarily trust
their fate in the hands of physicians who have significant power over the patient
 Medical ethics aims to protect the best interests of patients and those of the medical
profession, equipping both with conceptual tools to assess the relationships and help
in preventing potential abuse of power.

6. PRINCIPALS OF MEDICAL ETHICS
FOUR PRINCIAPLS OF MEDICAL ETHICS
 Beneficence (doing good)
 Non-maleficence (to do no harm)
 Autonomy (giving the patient the freedom to choose freely, where they are able)
 Justice (ensuring fairness)

7. PRINCIPALS OF MEDICAL ETHICS
1. Beneficence is a value in which the provider takes actions or recommends
courses that are in the patients based interest
 it is not coercing or manipulating the patient into making a decision against their
values, even though it may objectively be the best decision for their health
 it is not euthanasia ( in most states)
 keep the individual patients in mind- Beneficence is not the same in all situations
when patient autonomy is compromised ( e.g, incapcity) Beneficence must be the
guiding ethics

8. PRINCIPALS OF MEDICAL ETHICS
2. AUTONOMY: In Western ethics and Political Philosophy AUTONOMY is the state or condition of self-
governance, or leading ones's life according to reasons, values, or desires that are authentically ones
own.
 An adult with the capacity to understand his medical problem can refuse any therapy or test.
 it does not matter if the treatment or test is simple, safe, and risk-free.
 It does not matter if the person will die without the treatment or test. the patient can refuse treatment
or test.
 Respecting Autonomy is more important than trying to do the right thing for a patient. Trying to do the
right thing for the patient is called beneficence.

9. PRINCIPALS OF MEDICAL ETHICS
3. Non-maleficence (to do no harm)
 Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar
of ethics.
 non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to
be caused to a ppatient through neglect. Any consideration of beneficence is likely, therefore,
to involve an examination of non-maleficence

10. DIFFERENCE BTWN NON-MALEFICENCE TO BENEFICENCE
• Non-Maleficence differs from beneficence in two major ways
1) first of all, it acts as a threshhold for treatment. if a treatment causes more harm
than good, then it should not be considered. This is in contrast to beneficence,
where we consider all valid treatment options and then rank them in order of
preference.
2) We tend to use beneficence in response to a specific situation-such as
determining the best treatment for a patient. In contrast, non-maleficence is a
constant in clinical practice. for example, if you see a patient collapse in a
corridor you have a duty to provide ( or seek) medical attention to provide injury.

11. JUSTICE
• Justice- Constitutes an ethical perspective in terms of which ethical decisions are
made on the basis of universal principles and rules, and in an impartial and
verifiable manner with a view to ensuring the fair and equitable treatment of all
people.
 Justice is an action in accordance with the requirments of some law. whether
these rules are grounded in human consensus or societal nroms, they are
supposed to ensure that all members of society receive fair treatment
 Example of Justice in ethics: patients diagnosed with cancer are entitled to a
renge of treatments including radio- and chemotherapy. These treatments are
expensive and treat a small, but significant proportion of patients.

12. ETHICAL THEORIES: DEONTOLOGY AND
UTILITARIANISM
• 1. Deontogology
The term deontology comes from the Greek word deon, meaning duty. The theory of deontology
states we are morally obligated to act in accordance with a certain set of principles and rules
regardless of outcome
 Deontology is also known as “duty-based ethics”. This ideology states that the correct course of
action is dependent on what your duties and obligations are. It means that the morality of an
action is based on whether you followed the rules, rather than what the consequence of following
them was.
 Example: If your terminally ill patient asks if they’ll be ok after a surgery they’re unlikely to
survive, a deontological approach would suggest you don’t lie to comfort them. That’s because
according to this concept, lying isn’t morally acceptable because it’s our obligation not to lie – no
matter the consequences.

13. IMMANUEL KANT ( DEONTOLOGY)
• Immanuel Kant
• Immanuel Kant was born in 1724 in the Prussian city of Königsberg.
• He was a philosopher and scientist specializing in many areas, including mathematics,
astrophysics, geography and anthropology. He wrote several dense, difficult-to-read but
highly influential texts regarding metaphysics, metaethics and practical morality, science,
history and politics
• In terms of ethics, the most significant of his works are Groundwork in the Metaphysics of
Morals (1785), Critique of Practical Reason (1788), and Metaphysics of
Morals (1798). These texts constitute the foundation of Kant’s own moral philosophy.

14. KANT AND THE THEORY OF DUTY
Some terminology to consider:
1) Moral agent: An agent is a person who performs an action; a moral agent is a person
with the capacity to act morally.
2) Maxim: rule or principle
3) Will: the faculty of deciding, choosing, or acting
 Deontological theories hold that some acts are always wrong, even if the act leads to an
admirable outcome.
 Actions in deontology are always judged independently of their outcome. An act can be
morally bad but may unintentionally lead to a favorable outcome.

15. Kant is responsible for the most prominent and well-known form of deontological ethics.
Kant’s moral theory is based on his view of the human being as having the unique capacity
for rationality. No other animal possesses such a propensity for reasoned thought and
action, and it is exactly this ability that requires human beings to act in accordance with
and for the sake of moral law or duty.
Kant believes human inclinations, emotions and consequences should play no role in
moral action; therefore, the motivation behind an action must be based on obligation and
well thought out before the action takes place.
Morality should, in theory, provide people with a framework of rational rules that guide and
prevent certain actions and are independent of personal intentions and desires.

16. DEONTOLOGY CONTINUATION
 According to Kant, the moral worth of an action is determined by the human will,
which is the only thing in the world that can be considered good without
qualification.
 Good will is exercised by acting according to moral duty/law. Moral law consists
of a set of maxims, which are categorical in nature – we are bound by duty to act
in accordance with categorical imperatives.

17. CRITICISMS OF KANT'S DEONTOLOGY
Criticisms
 One of the biggest criticisms of Kantian ethics is that it discounts outcome as a valid factor in
evaluating the morality of an action. While it is not necessarily wise to rely solely on outcome
(as in utilitarianism/consequentialism), it is not a good idea to completely ignore the outcome
altogether.
 Based on Kant’s formula of humanity, human life is sacred and inviolable, meaning one cannot
enslave a few people even if it would enable more people to lead better lives. Killing one person
to save the lives of millions is impermissible in Kantian ethics.
 At times Kantian moral duty seems to contradict our natural inclinations and common sense. If
we obey the moral law rather than our intuitions, we are acting morally. Deontological ethics is
weaker when it comes to informing us how to live well or developing virtues of character.

18. UTILITARIANISM
What Is Utilitarianism?
 Utilitarianism is a theory of morality that advocates actions that foster happiness
or pleasure and oppose actions that cause unhappiness or harm. When directed
toward making social, economic, or political decisions, a utilitarian philosophy
would aim for the betterment of society as a whole.
 Utilitarianism would say that an action is right if it results in the happiness of the
greatest number of people in a society or a group.

19. WHAT IS UTILITARIANISM?
• What Is Utilitarianism?
• Utilitarianism is a theory of morality that advocates actions that foster happiness or pleasure and oppose actions that cause
unhappiness or harm. When directed toward making social, economic, or political decisions, a utilitarian philosophy would aim for
the betterment of society as a whole.
• Utilitarianism would say that an action is right if it results in the happiness of the greatest number of people in a society or a group.
KEY TAKEAWAYS
• Utilitarianism is a theory of morality, which advocates actions that foster happiness and oppose actions that cause unhappiness.
• Utilitarianism promotes "the greatest amount of good for the greatest number of people."
• When used in a sociopolitical construct, utilitarian ethics aims for the betterment of society as a whole.
• Utilitarianism is a reason-based approach to determining right and wrong, but it has limitations.
• Utilitarianism does not account for things like feelings and emotions, culture, or justice.

20. UNDERSTANDING UTILITARIANISM
 Understanding Utilitarianism
 Utilitarianism is a tradition of ethical philosophy that is associated with Jeremy Bentham
and John Stuart Mill, two late 18th- and 19th-century British philosophers, economists, and
political thinkers.
 Utilitarianism holds that an action is right if it tends to promote happiness and wrong if it
tends to produce sadness, or the reverse of happiness—not just the happiness of the actor
but that of everyone affected by it.
• At work, you display utilitarianism when you take actions to ensure that the office is a
positive environment for your co-workers to be in, and then make it so for yourself.

21. UTILITARIAN ETHICS/ TYPES
• Utilitarian Ethics
"Rule" Utilitarian Ethics
• An example of rule utilitarianism in business is tiered pricing for a product or service for different types of customers. In the
airline industry, for example, many planes offer first-, business-, and economy-class seats.
• Customers who fly in first or business class pay a much higher rate than those in economy seats, but they also get more
amenities—simultaneously, people who cannot afford upper-class seats benefit from the economy rates. This practice
produces the highest good for the greatest number of people.
• And the airline benefits, too. The more expensive upper-class seats help to ease the financial burden that the airline
created by making room for economy-class seats.
"Act" Utilitarian Ethics
• An example of act utilitarianism could be when pharmaceutical companies release drugs that have been governmentally
approved, but with known minor side effects because the drug is able to help more people than are bothered by the side
effects. Act utilitarianism often demonstrates the concept that “the end justifies the means”—or it's worth it

22. THE LIMITATIONS OF UTILITARIANISM
The Limitations of Utilitarianism
In the workplace, though, utilitarian ethics are difficult to achieve. These ethics also can be challenging to maintain in our
business culture, where a capitalistic economy often teaches people to focus on themselves at the expense of others.
Similarly, monopolistic competition teaches one business to flourish at the expense of others.
A limitation of utilitarianism is that it tends to create a black-and-white construct of morality. In utilitarian ethics, there are no
shades of gray—either something is wrong or it is right.
Utilitarianism also cannot predict with certainty whether the consequences of our actions will be good or bad—the results
of our actions happen in the future.
Utilitarianism also has trouble accounting for values like justice and individual rights. For example, say a hospital has four
people whose lives depend upon receiving organ transplants: a heart, lungs, a kidney, and a liver. If a healthy person
wanders into the hospital, his organs could be harvested to save four lives at the expense of his one life. This would
arguably produce the greatest good for the greatest number. But few would consider it an acceptable course of action, let
alone an ethical one.