Power point presentation Slides Presented in Lectures at Services institute of Medical Sciences Lahore

1. 1
VALUES, MORALS
AND ETHICS: SOME
DEFINITIONS AND
EXPLANATIONS

2. 2
WHY BE AWARE?
Medical schools and doctors are committed to
learn and treat patients according to
socially acceptable moral values
As clinicians, it is important we know
what is meant by the terms
“values morals and ethics” and to be
aware of the dangers of
INDOCTRINATION.

3. 3
DEFINITIONS
1. What are values?
Values are internalized principles that
individuals hold, which can order their
lives
2. What elements do values encompass?
• ATTITUDES
• BELIEFS
• BEHAVIOUR

4. 4
MORALS
VALUES can also be
called MORALS so these
terms can be
interchanged. Both
refer to the individualised
principles held by
individuals that guide
HOW we act, and what
we OUGHT to do.
So what then are Ethics?

5. 5
ETHICS
 Ethics is therefore the
RATIONALISATION of WHY we
OUGHT to behave in a particular
manner and involves an analysis of
what we mean by the terms GOOD,
BAD etc.
 It involves analysing WHY one action
is RIGHT and another is WRONG.

6. 6
ETHICS AS A SCIENCE?
 For this reason, Ethics has been
called a SCIENCE:
 “…a normative science of the conduct
of human beings living in societies – a
science which judges this conduct to
be right or wrong, to be good or bad,
or in some other way” [William Little,
1971, pp. 1-2].

7. 7
JUST REMEMBER:
 ETHICS, MORALS, VALUES are NOT
technically the same, but we we do tend to
use the terms interchangeably – so just be
aware the there are differences.
 The differences can be summarised as:
MORALS and VALUES refer to principles
that guide our actions,
 ETHICS explains why we hold those
principles.

8. 8
WHY BE CONCERNED?
• Not everyone will always
agree to what the terms
right, wrong good or bad,
appropriate or inappropriate
mean. WHY???
• And to return to an earlier
question - why should we be
concerned?

9. 9
WHY WE ARE
CONCERNED:
 We are concerned with Values and
Ethics because we are clinicians. And
the importance of values in the
medical curriculum has been
acknowledged for a long time. The
influential Wiltshire Report [1993]
refers specifically to values in “Values
and the Medical Curriculum” for the
following reasons:

10. 10
Medical colleges ARE
PLACES WHERE
doctors LEARN…..
skills
processes
content
and
VALUES

11. 11
REMEMBER!!
Medical Schools can never be
VALUE-FREE
 Clinicians can never be VALUE-
FREE
 So this is why it is important to
promote SHARED values in an
educational context.

12. 12
SHARED VALUES
 Although each of us has a unique
world view, there have to be some
some shared values (societal norms,
professional codes of ethics)
otherwise it would be impossible for
any members of society to agree on
any standards of behaviour.

13. 13
As doctors, we believe in:
 Effective learning and teaching
 Quality and continuous improvement
 Respect and recognition for people
 Participation and consultation
 Professional and responsive services
 Equity and social justice
 Accountability for our actions and outcomes
 Effective and efficient management within
available resources.

14. 14
TO FINISH
 A quote from Jean-Jacques Rousseau
is pertinent here: “Men (sic) always
love what is good or what they find
good: it is in judging what is it good
that they go wrong.”

15. 15
PART 2:
INDOCTRINATION.

16. 16
INDOCTRINATION
 Is a problem that can occur in an open as
well as a closed society
 In an open society, it is due to the fact that
there are often no agreed “absolutes” i.e.
right or wrong, truths or falsehoods
 Often occurs when a clinicians presents
material that may not be acceptable to some
families
 They may accuse the doctor of
indoctrinating rather than treating their
patients.

17. 17
What is Indoctrination?
 Indoctrination is NOT to be confused
with conditioning, use of brute force, or
use of threats
 Indoctrination involves WILLINGNESS
 An indoctrinated person is one who
says and acts in a particular way
because they WANT to

18. 18
ETYMOLOGY
 Indoctrination means to instill or imbue with
doctrines
 A doctrine comes from Latin word “doctrina”
simply meaning “teaching
 During Middle Ages, doctrina came to mean
the Church doctrines or dogma
 Indoctrinating still just meant teaching but
came to mean teaching anything that was
not proven fact
 Finally, adopted pejorative meaning of
teaching in a biased, unethical way.

19. 19
IDENTIFICATION
There are 4 elements involved in
Indoctrination:
1. The content to be told
2. The methods used
3. The outcomes for the patients
4. The intention of the doctor
Not all 4 have to be present but often
are

20. 20
INTENTIONS
 Although all 4 elements are important,
INTENT alone can be sufficient:
 “ A person indoctrinates Patients if they treat
with the intention that the patients believe
Clinicians regardless of the evidence”.
And the test to ascertain if anyone is
indoctrinated is: they WANT to believe
Clinicians despite any contrary evidence
presented!

21. 21
PART 3: CODES OF
PROFESSIONAL ETHICS

22. 22
CODES OF ETHICS
1. Two Famous Codes
a) Code of Hammurabi
(Babylonia 1792-1750
BC): Law Code
b) Corpus Hippocratus:
Medical Ethics
The Hippocratic Oath

23. 23
PROFESSIONAL
ETHICS
1. QUESTION: What is a
Code of Professional
Ethics?
ANSWER: Guidelines that
tell members of a
professional body HOW
we OUGHT to behave in
order to satisfy our ethical
judgments.

24. 24
2. QUESTION: What is a Professional Body?
ANSWER: A group of professionals who
through their professional association can
support, encourage, enhance and
maintain standards.
3. QUESTION: What can a Code of Ethics
include?
ANSWER: Prescriptions
Sanctions
Relationships
4. QUESTION: Why do we have a Code of
Ethics?
ANSWER: It means we, as a
professional body, are ACCOUNTABLE.

25. 25
USES
5. QUESTION: How can
we use a Code of Ethics
ANSWERS:
a) It should give
REASONABLE people
(the reasonable person
test) a REASON to do
what they believe to be
RIGHT
b) It should give a
reasonable person
a reason NOT to
do what they
believe to be
WRONG
c) It can help define
or re-define the
nature of the
situation we are
faced with

26. 26
6. QUESTION: Are members
bound by BTR Code of Ethics?
ANSWER: Yes, because sanctions
can be applied for serious
breaches. Periodically, members
names are removed from roll for
misconduct.
These instances are recorded in
the BTR newsletter.
7. QUESTIONS: Any Criticisms of
our Code??

27. 27
SUMMARY
a) There can be sanctions if Code is
broken
b) A Code of Ethics is concerned with
getting members to behave in certain
ways that have been determined to be
morally desirable or appropriate by those
members
c) Codes of Ethics increase the likelihood
that people will behave in certain ways by
bringing to mind their actions

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SUMMARY CONTINUED
d) Code itself can never force a member to
behave in a particular way - but
SANCTIONS can prevent their continued
membership of profession. Even if
member works against Code, it does not
prevent Code from being valid.
e) Codes of Ethics can fulfill the role of
PUBLICALLY expressing a profession’s
commitment to some moral or ethical
standard or set of behaviours
f) A Code of Ethics should NOT just include
guidelines on HOW members ought to
behave but include the reasons WHY.

29. 29
 A recent survey asked to rank from
highest to lowest which professions
they regarded as being the MOST
ethical down to the LEAST ethical.
What would you list as your top 5 and
your bottom 5?
AND TO FINISH-
THE MOST ETHICAL
PROFESSIONS?

30. 30
HOW DID YOU FARE?
LEAST ETHICAL
19. Union Leaders
20. Advertisers
21. Estate Agents
22. Journalists
23. Car Salesmen
MOST ETHICAL
1. Doctors
2. Nurses
3. Pharmacists
4. Teachers
5. Dentists

31. 31
THANK YOU!
 THANKYOU all so much for being so
incredibly enthusiastic and committed
and to this lecture. I have enjoyed
every lecture and I know people are
getting late, I do hope you have
enjoyed thinking about me and this
lecture.