Second version of my lecture on medical ethics / bioethics to the Learning Unit II class of the UP College of Medicine as part of IDC 201: History of Medicine. This was presented last May 9, 2018.
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The Doctor and the Good Life - Introduction to Bioethics and Natural Law
1. The Doctor and
the Good Life
Cary Amiel G. Villanueva, M.D.
UP College of Medicine Class 2017
Integrated Liberal Arts and Medicine Program
IDC 201: History of Medicine
An Introduction to
Bioethics and Natural Law
2. Hello!
DISCLOSURE
I am not (yet) a philosopher nor a bioethicist.
I am a doctor with an interest in bioethics.
Content based on my personal study and do not
necessarily reflect the views of my employer
nor of my affiliations
5. LEARNING OUTCOMES
At the end of the lecture, the student should be able
to:
1. Describe the scope of medical ethics and bioethics
2. Distinguish bioethical theories including the four
principles and natural law approaches
3. Apply natural law principles to selected bioethical
cases
7. Medicine is about people.
Medicine is about helping
people live good lives.
8. ETHICS
â Moral philosophy
â âA normative discipline that attempts to determine at the
most general level which human actions are morally right
and which are wrongâ
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
9. ETHICS
â Is about three things:
Good
the thing desired, the ideal
Right
opposite of wrong as defined by some law
Ought
personal obligation, duty, responsibility
Kreeft, P. (2003). Ethics: A history of moral thought course guide [PDF]. The Modern Scholar.
Recorded Books, LLC
13. ⢠What is a human being?
⢠What is a person?
⢠Is the fetus a person?
⢠How should we treat human
beings?
⢠How should we treat human
beings with severe mental
disability?
⢠Is it permissible to eliminate
human beings with undesirable
traits? (eugenics)
Ontogeny
Ethics
15. ââModern medical technology has raised many
difficult ethical questions at both
the beginning and end of life.â
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
âOn the other hand, human conduct has always had
the ability to affect life, either positively or negatively;
thus, bioethics â albeit by another name â
has existed for quite some time.â
16. â
âSome of the contemporary questions of bioethics
are essentially old questions in a new form.â
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
18. Solemn Oath
âI swear by Apollo
Physician and Asclepius
and Hygieia and Panaceia
and all the gods and
goddesses, making them
my witnesses, that I will
fulfil according to my
ability and judgment this
oath and this covenantâ
âIf I fulfil this oath and do
not violate it, may it be
granted to me to enjoy life
and art, being honored
with fame among all men
for all time to come; if I
transgress it and swear
falsely, may the opposite
of all this be my lot.â
HIPPOCRATIC OATH
Translation from the Greek by Ludwig Edelstein.
19. Respect for Mentors
âTo hold him who has
taught me this art as equal
to my parents and to live
my life in partnership with
himâ
HIPPOCRATIC OATH
20. Duty to the Sick
âWhatever houses I may
visit, I will come for the
benefit of the sickâ
âI will apply dietetic
measures for the benefit
of the sick according to my
ability and judgment; I will
keep them from harm and
injustice.â
HIPPOCRATIC OATH
21. Not to Harm
âI will neither give a deadly
drug to anybody who
asked for it, nor will I make
a suggestion to this effect.
Similarly I will not give to a
woman an abortive
remedy. In purity and
holiness I will guard my
life and my art.â
HIPPOCRATIC OATH
22. Confidentiality
âWhat I may see or hear in
the course of the
treatment or even outside
of the treatment in regard
to the life of men, which
on no account one must
spread abroad, I will keep
to myself, holding such
things shameful to be
spoken about.â
HIPPOCRATIC OATH
23. HUMAN EXPERIMENTATION
âNazi Medical Experiments (1940s)
âTuskegee Syphilis Experiment (1930-1970)
âWillowbrook Hepatitis Study, New York (1963-1966)
24. 20th CENTURY MEDICAL ETHICS
âNuremberg Code (1947)
Following the Nuremberg Trials of Dr. Mengele et al.
âDeclaration of Helsinki (1964) â
World Medical Association
âIt is the duty of the physician to promote and safeguard
the health of the people. The physicianâs knowledge and
conscience are dedicated to the fulfilment of this duty.â
âIn medical research on human subjects, considerations
related to the well-being of the human subject should
take precedence over the interests of science and
society.
25. 20th CENTURY MEDICAL ETHICS
The Birth of Bioethics (Jonsen)
⢠1962, November 9 - Life Magazine Article:
âThey Decide Who Lives, Who Diesâ
Seattle committee decides which patients enter into new
chronic hemodialysis program
⢠1966, June 16 - Henry Beecherâs New England Journal
of Medicine Article
Cites 22 unethically designed and conducted studies
published in journals
Jonsen, A. (1993). The birth of bioethics. Hastings Center Report, 23(6): S1-S15. doi:10.2307/3562928
26. 20th CENTURY MEDICAL ETHICS
The Birth of Bioethics (Jonsen)
⢠1967 â First Heart Transplant
Christian Barnard transplants a human heart. Questions
on the source of the organ raised.
⢠1967, March 31 â In the Matter of Karen Ann Quinlan
New Jersey Supreme Court upholds parentsâ decisions
to remove life support vs. doctors and hospital
Jonsen, A. (1993). The birth of bioethics. Hastings Center Report, 23(6): S1-S15. doi:10.2307/3562928
27. 20th CENTURY MEDICAL ETHICS
The Birth of Bioethics (Jonsen)
⢠1968 â Harvard Medical Schoolâs âBrain Deathâ
Committee headed by Beecher proposes definition of
âbrain deathâ
⢠1969
The Hastings Center founded by Dan Callahan and
Will Gaylin
The Kennedy Institute of Ethics at Georgetown
University founded by Andre Hellegers
Jonsen, A. (1993). The birth of bioethics. Hastings Center Report, 23(6): S1-S15. doi:10.2307/3562928
28. Belmont Report (1978):
3 principles
â Respect for persons
â Beneficence
(and Non-maleficence)
â Justice
Beauchamp and
Childress: 4 principles
â Beneficence
â Non-maleficence
â Autonomy
â Justice
20th CENTURY MEDICAL ETHICS
29. MODERN PHYSICIANâS PLEDGE
Declaration of Geneva
World Medical Association
â First adopted in 1948
â Recently revised
October 14, 2017
Cook, M. (2017, November 30). World medical association updates Hippocratic oath.
https://www.mercatornet.com/mobile/view/world-medical-association-updates-hippocratic-oath
30. MODERN PHYSICIANâS PLEDGE
Declaration of Geneva
World Medical Association
â A pledge, rather than an oath
â Innate universal laws replaced by positive law
1948: âeven under threat, I will not use my medical
knowledge contrary to the laws of humanityâ
2017: âI will not use my medical knowledge to violate
human rights and civil liberties, even under threatâ
aaa
Cook, M. (2017, November 30). World medical association updates Hippocratic oath.
https://www.mercatornet.com/mobile/view/world-medical-association-updates-hippocratic-oath
31. MODERN PHYSICIANâS PLEDGE
Declaration of Geneva
World Medical Association
â Implicitly permits abortion
â 1948: âI will maintain the utmost respect for human life
from the time of conception.â
â 2017: "âI will maintain the utmost respect for human
lifeâ
â Puts a heavy emphasis on autonomy
2017: âI will respect the autonomy and dignity of my
patientâ
aaa
Cook, M. (2017, November 30). World medical association updates Hippocratic oath.
https://www.mercatornet.com/mobile/view/world-medical-association-updates-hippocratic-oath
33. PHILIPPINE BIOETHICS
Alora, A.T., & Lumitao, J.M. (2001). Beyond a western bioethics: Voices from the developing world.
Washington, DC: Georgetown University Press
Western Bioethics Filipino Bioethics
Focuses on the individual Focuses on social units (the family)
Oriented to principles Articulated in lived moral virtues
Uses discursive terms
Is part of the phenomenological
world of living experience
A thought system An embodied activity of virtue
34. PHILIPPINE BIOETHICS
â PMA Code of Ethics
Article I. General Principles
Article II. Duties of Physicians to their Patients
Article III. Duties of Physicians to the
Community
Article IV. Duties of Physicians to their
Colleagues and to the Profession
Article V. Duties of Physicians to Allied
Professionals
Article VI. Relationship of Physicians with the
Health Products Industry
Article VII. Amendments
35. PHILIPPINE BIOETHICS
â PMA Code of Ethics
âOn entering the profession, a physician assumes
the obligation of maintaining the honorable
tradition that confers the well deserved title of a
âfriend of mankindâ. (Article I, Section 2)
âA physician shall waive his professional fees to
a colleague, his or her spouse, children and
parents who are financially dependent on him.â
(Article IV, Section 1)
36. PHILIPPINE BIOETHICS
â PCP Code of Ethics
â All members shall be exemplary in their
behavior as members of the community and of
the profession. They shall work harmoniously
and regard as uppermost the best interest of
patients who are entrusted to their care.
Although the internist is entitled to just
compensation, patientsâ welfare should be
primary.
â The internist shall ensure that the patientâs best
interest is safeguarded. He is obliged to inform
his patient as to the nature of illness,
diagnosis, progress of care and prognosis.
37. PHILIPPINE BIOETHICS
â Ethical and Legal Issues in the PH
â Abortion: illegal under the constitution but it happens
â Contraception: legal, expanded by the RPRH law,
subject to the SC TRO
â In vitro fertilization: legal
â Surrogacy: not allowed by local OB/GYN societies
â Capital punishment: outlawed in 2006
â Euthanasia: no specific law but contrary to general
sentiment
â Terminal sedation: not allowed by local hospice and
palliative care physicians
â HIV testing: generally opt-in
38. PHILIPPINE BIOETHICS
â When Ordinary Care Becomes Extraordinary
â The situation: Inequity in healthcare access
Corruption
Exorbitant cost of medicines
â Most cases in PH: not euthanasia but rather
knowing when "enough is enoughâ
McTavish, J. (2016). Justice and health care: When âordinaryâ is extraordinary. Linacre Quarterly, 83(1):26-34.
39. PHILIPPINE BIOETHICS
â When Ordinary Care Becomes Extraordinary
â âOrdinary (or extraordinary) is not simply a technical
explanation of the complexity of a treatment, but
rather a description of the overall set of
circumstances including the treatment proposed,
the burden imposed, the degree of success, pain
incurred, as well as the financial situation of the
patient and family.â
McTavish, J. (2016). Justice and health care: When âordinaryâ is extraordinary. Linacre Quarterly, 83(1):26-34.
41. DEONTOLOGY
Immanuel Kant
duty / obligation
âDo not everâŚâ
PRINCIPLISM
Tom Beauchamp and
James Childress
prima facie principles
of biomedical ethics
UTILITARIANISM
John Stuart Mill
Jeremy Bentham
Maximization of
pleasure
Greatest good for the
greatest number
ETHICAL THEORIES
NATURAL LAW
Aristotle
Thomas Aquinas
The âGood Lifeâ
All action is oriented to
goods
45. âGood is to be done and pursued
and evil avoided.â
- Thomas Aquinas
46. âLife
âHealth
âFriendship
âKnowledge
âArt and beauty
âPractical reasonableness
âReligion
Human Flourishing
BASIC HUMAN GOODS
Brugger, E.C. (2016). The first principles of the natural law and bioethics. Christian Bioethics, 22(2):88-103.
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
47. FIRST PRINCIPLES
ââGood is what all things desire; this, then is the first
precept of the law, that good is to be done and pursued
and evil avoided.â (Thomas Aquinas, Summa Theologiae)
Brugger, E.C. (2016). The first principles of the natural law and bioethics.
Christian Bioethics, 22(2):88-103.
âOpenness to, pursuit of and no intentional damage to,
the basic goods across all personsâ
Tollefsen, C. (2008). The new natural law theory. In Lyceum, 10(1):1-18.
48. SCOPE OF BIOETHICS
Photo credits: (left) bionalogy.com/human_embryology.htm
(middle) screencap from "Beauty and the Beastâ (right) Shutterstock
49. BEGINNING OF LIFE
Abortion
- In medicine (obstetrics):
â Pregnancy termination before 20 weeksâ gestation or
with a fetus born weighing < 500 g (WHO / CDC)
â May be spontaneous (miscarriage), recurrent or induced
(medically or surgically)
- In ethics:
â Typically refers to intentionally induced termination of
pregnancy
50. BEGINNING OF LIFE
Pro-Choice Arguments
â Embryo or fetus is not a human being
â Womanâs autonomy over her body
51. Facts of Embryology
â âAlmost all higher animals
start their lives from a single
cell, the fertilized ovum
(zygote).â
â âThe time of fertilization
represents the starting point
in the life history, or ontogeny
of the individual. In its
broadest sense, ontogeny
refers to the individualâs
entire life span.â
BEGINNING OF LIFE
Carlson, B.M. (2003). Pattenâs foundations of embryology (6th ed.). Philippines: McGraw-Hill Education (Asia)
52. BEGINNING OF LIFE
Facts of Embryology
â âHuman development begins at fertilization when a
male gamete or sperm (spermatozoon) unites with a
female gamete or oocyte (ovum) to produce a single
cell â a zygote. This highly specialized, totipotent cell
marked the beginning of each of us as a unique
individual.â
- Moore and Persaud,
âThe Developing Humanâ
George, R.P., and Tollefsen, C. (2011). Embryo: A defense of human life. Princeton, NJ: The Witherspoon Institute, Inc.
53. BEGINNING OF LIFE
Abortion
â Violates the principle of non-maleficence
â Intentionally destroys the life on a human being
â Child is deprived of the good of life which allows the
other human goods to be enjoyed
â No other goods are preserved or promoted which
justify the loss of life
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
54. Contraception
â Damages the possibility
of future life coming out
from the act
In Vitro Fertilization
â Destruction of embryos in
the process
â Analogous to âmakingâ
â âthe child is being
brought into being as a
benefit to the parentsâ
â âthe child is being treated
merely as a means to
someone elseâs endâ
Tollefsen, C. (2014). In vitro fertilization
should not be an option for a woman.
In Arp, R., and Caplan, A. (eds.). Contemporary
Debates in Bioethics. John Wiley & Sons, Inc.
BEGINNING OF LIFE
Photo credit: http://www.ihrivf.net/in-vitro-fertilization/
55.
56. CASE
A 26-year-old primigravid presents to the OBAS with
abdominal pain and vaginal bleeding on the 8th week
after her last menses.
On internal examination, her cervix is closed but has
cervical motion tenderness.
Pregnancy test done is positive. She is sent for
transvaginal ultrasound which reveals an extrauterine
gestational sac with fluid in the cul-de-sac.
She is diagnosed with an ectopic pregnancy and is
advised salpingostomy (surgical procedure to remove
the products of conception in the fallopian tube).
57. DOUBLE EFFECT
Principle of Double Effect
1. The action must be morally good or at least indifferent in its
object, ends and circumstances. It must not be evil in itself.
2. The good effect must immediately follow the act or at least
come simultaneously with the evil effect. The good effect
cannot be the consequence of the bad effect.
3. The intention of the doer must be morally good -- that is, one
desires the good effect. One foresees and permits the evil
effect but does not desire it. The evil effect can never be
desired, not even to bring about the good effect. Neither can
the doer desire both effects.
4. A proportionately grave reason must exist to justify the evil
effect. There should be a reasonable proportion between the
good intended and the evil permitted.
Monge, M. (2014). Ethics in medical practice:
Summary, explanation and defense of concrete ethical problems (2nd ed.). Manila: Sinag-tala Publishers
58. DOUBLE EFFECT
Applications of the Principle of Double Effect
â Ectopic pregnancy
- motherâs life vs. childâs life
- loss of fetal life is not intended
â Chemotherapy for cancer
- nausea, weakness, hair loss may be unavoidable
side effects
- treatment of the cancer
Monge, M. (2014). Ethics in medical practice:
Summary, explanation and defense of concrete ethical problems (2nd ed.). Manila: Sinag-tala Publishers
59. TRIUMPH OF SCIENCE OVER DEATH
Original photo from
upcm89.wordpress.com
Screencap from âExtremisâ (Netflix)
60. Proportionate means
Ordinary means
Ethically obligatory
Burdens < Benefits
Disproportionate means
Extraordinary means
Ethically optional
Burdens > Benefits
May be futile
SUSTAINING LIFE
Excessive burdens can be an ethical reason to
refuse potentially life-sustaining treatment.
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
61. END OF LIFE
Euthanasia
âPhysician intentionally ends the life of a patient to end
the patientâs suffering
âPatientâs death as a means to alleviate suffering
âActively seeking the patientâs death violates
non-maleficence (the good of life)
âRelated issue : physician-assisted suicide
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
63. END OF LIFE
Sedation
Proportional palliative sedation
âLeast amount of sedative to maintain adequate control
of symptoms
âIntention is to relieve pain/suffering
Palliative sedation to unconsciousness
(terminal sedation)
â Sedative enough to make the patient unconscious
â Intention is to relieve pain/suffering by killing the
patient
Based on class discussions with Farr Curlin and Christopher Tollefsen in the Wiitherspoon Instituteâs Medical Ethics Seminar
65. MEDICAL ETHICS
âDeals with ethical questions arising from the
doctor-patient relationship
âFocused on the medical profession (i.e. physicians)
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
66. The Doctor (Sir Luke Fildes)
Photo credit: kerrisdalegallery.com
67. What is the doctor-patient relationship
oriented towards?
68. THE END OF MEDICINE
Possible ends of medicine
⢠Happiness
⢠Social adjustment or civic virtue
⢠Prevention of death or prolongation of life
The proper end of medicine is health.
cf. Kass, L.R. (1975). Regarding the end of medicine and the pursuit of health. The Public Interest, 40 :11-42.
70. HEALTH
âReductionist view:
health as the absence of disease
âWorld Health Organization / Alma Ata definition:
âa state of complete physical, mental and social
wellbeing, and not merely the absence of disease or
infirmityâ
âLeon Kassâ definition:
âthe well-working of the organism as a wholeâ
cf. Kass, L.R. (1975). Regarding the end of medicine and the pursuit of health. The Public Interest, 40 :11-42.
71. HEALTH
Leon Kass (1975)
Health: âthe well-working of the organism as a wholeâ
âA natural standard or norm
âA state of being that reveals itself in activity as a
standard of bodily excellence or fitness
âRecognizable if not definable
âTo some extent attainable
Unhealth, rather than illness or disease, is the opposite
of health.
cf. Kass, L.R. (1975). Regarding the end of medicine and the pursuit of health. The Public Interest, 40 :11-42.
72. HEALTH
Surgery and Anesthesia
â Surgery: âcontrolled traumaâ
â Anesthesia: âreversible comaâ
â Putting a patient in temporary unhealth to potentially
improve health or sustain life
73. HEALTH
Risk-Benefit Analysis
â Probable benefits should outweigh the potential risks
Examples:
â Preoperative clearance / risk stratification
â Anticoagulation for patients with atrial fibrillation
(risk of stroke vs. risk of bleeding)
â Best possible match for blood transfusions,
e.g. O positive
â Palliative care for end-stage cancer
76. VOCATION
The Medical Vocation
â Vocation: a call towards commitments towards
some goods
â Medical vocation: oriented to the good of health
Based on Discussions with Christopher Tollefsen
77. VOCATION
Patientâs Responsibility for Oneâs Health
ââ(The) person primarily responsible for the health
of the patient is the patient, not the physician
(though the patient ought to seek medical advice
whenever that is required to help her safeguard her
health.â
Physicianâs Responsibility
â Not a technician: "A physician should always put
the true good of the patient first, and not simply
do what they are asked to do.â
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
78. AUTONOMY and AUTHORITY
Autonomy
â From Greek: self + law = âself-directingâ
Authority
â Authority of Expertise (Doctor)
The doctor makes claims on health-related outcomes
â Decisional Authority (Patient)
Based on patientâs vocational commitments
Based on class discussions with Christopher Tollefsen
79. CONSCIENCE
ââConscience therefore is where the objective and
universal Moral Law and the individual person meet.â
ââConscience is not the source of good and evil. It is
not the maker of the law but rather a judge of how
the law is correctly applied to a specific action.â
Monge, M. (2014). Ethics in medical practice:
Summary, explanation and defense of concrete ethical problems (2nd ed.). Manila: Sinag-tala Publishers
80. CONSCIENCE
Principle of Conscience
ââEvery agent should perform an action only if she
judges it to be morally permissible, and should
refrain from performing it if she judges it to be
morally impermissible."
Gomez-Lobo, A. & Keown, J. (2015). Bioethics and the human goods: An introduction to natural law bioethics.
Washington, DC: Georgetown University Press
81. Formal Cooperation
Openly or secretly
consents to the act of
another
Cooperates with the
intention
Material Cooperation
Physical assistance to an
action without willing
consent
Does not cooperate with
the intention
COOPERATION
Monge, M. (2014). Ethics in medical practice:
Summary, explanation and defense of concrete ethical problems (2nd ed.). Manila: Sinag-tala Publishers
82. CONSCIENCE
Conscientious objection
âRespect for provider autonomy
âRespect for the principle of conscience
âExamples:
Jehovahâs witness refusing blood transfusions
Philippine Supreme Court struck down RH Law provision
requiring physicians to refer patients for services against
their conscience
83. ââAny bill that compels Doctors to
act against their conscience and 2,500 years
of ethics should and will fail.â
Dr. Michael Gannon
Australian Medical Association
84. TAKE HOME ARGUMENT
âPremise 1:
As doctors, we have the obligation to be good.
âPremise 2:
Bioethics shows us how to be good.
âConclusion:
We have an obligation to study bioethics.
86. LEARN MORE BIOETHICS
Inquies Pro Medicina:
Conversations on
Science, Medicine, Law
and Philosophy
facebook.com/bioethicsstudygroup
Oliver M. Tuazon, MSc
(Charis Foundation)
Ma. Rosanna De Guzman, MD, MS
(UP-PGH Psychiatry)
Jose Maria Mariano, MS, PhD
(University of Asia & the Pacific)
87. ââThe vocation of the physician, at its core, is little changed
in the millennia since the Oath of Hippocrates was first
uttered: to give care to another person to the utmost of
oneâs abilities, respecting the innate dignity of that person
and all the while subordinating oneâs personal wants in a
gift of self.â
From âThe Vocation of a Doctorâ, http://www.thepublicdiscourse.com/2011/07/3458/
Donald W. Landry, MD, PhD
Chair, Department of Medicine,
Columbia University, New York City
88. Thanks for your attention!
ANY QUESTIONS?
Contact me
cavillanueva@upm.edu.ph
@caryamiel (Twitter)
caryamiel.wordpress.com
89. Credits
Special thanks to all the people who made and released
these awesome resources for free:
â Presentation template by SlidesCarnival
â Photographs by Unsplash
Editor's Notes
Oxford English Dictionary: âthe discipline dealing with ethical issues relating to the practice of medicine and biology or arising from advances in these subjectsâ
âOntology seeks to identify what something is, its nature.â
The Belmont Commission was charged to identify basic principles which should underlie the conduct of biomedical and behavioral research involving human subjects
Tom Beauchamp and James Childress, philosophers
While the Declaration of Helsinki focused on ethical principles regarding human experimentation, the Declaration of Geneva laid out physiciansâ ethical duties
In other words, the idea of innate right and wrong has been displaced by positive law. In some circumstances, at least, right and wrong may be defined by the government.
According to Drs. Alora and Lumitao, Filipino bioethicists from UST:
âThe focus of Western bioethics is individual; elsewhere it focuses on social units. Western bioethics often is oriented to principles; Filipino bioethics on the other hand, is not articulated primarily in principles but in lived moral virtues. Whereas Western bioethics is almost always expressed in discursive terms, Filipino bioethics is part of the phenomenological world of living experience. For the West, bioethics is a framework for thought, a conception system. For the Philippines, it is a way of life, an embodied activity of virtue.â
âThe primary locus of assessment of the good is not the individual but the family⌠Maintenance of harmony within the family and among peers takes precedence over other concerns for social justice or honesty, which from this perspective appear to be anonymous formal principles that are disengaged from concrete moral community life.â
Around 1960s ethicists turned to two predominant ethical systems
ASK QUESTION: What problems do you think can arise from this ethical theory or system?
Critiques of principlism:
Subjective
Balancing and specification
American or Western standards vs. Asian standards
Thomas Aquinas was not only a theologian but he was a great medieval philosopher. He systematized many great
Self-evident
Bioethics spans the whole life of a person from the beginning of life to the end of life.
FOR NEXT SLIDE: So what is the problem with abortion? Simply, it violates the principle of non-maleficene.
2 patients with acute myeloid leukemia:
One went on to complete several cycles of chemotherapy nearing remission.
The other went downhill. She was persistently neutropenic and succumbed to severe infections. She eventually expired.
Burdens (physical, psychological, financial, etc.) imposed by the treatment vs. benefits of the treatment
Judged with reference to the individual patient
For example: initiating hemodialysis. Older consultants would say, âKung hindi kaya, huwag na simulan.â
Families sell their properties, their kalabaw and make utang but in the end the patient dies.
Others have tried to hide this in euphemism: physician-assisted death and medical aid in dying.
NEXT VIDEO: Sherlock
Intention = end of an action + means sought to bring about that end
âWhereas medical ethics concerns ethical questions arising in the context of the doctor-patient relationship, bioethics ranges more widely.â
âMedical ethics rightly focuses on the moral requirements within a particular profession, whereas bioethics unavoidably deals also with issues of a more general nature.â
Dr. Abraham Verghese makes the observation that the painting portrays the doctor without any clinical tools such as a stethoscope or a thermometer. Rather, the focus is on the physician looking intently at the ill child whose parents watch sorrowfully from behind.
"The practice of medicine is ancient. The relationship between physicians and patients goes back thousands of years and is based upon an intimate understanding of the patient's health...and a relationship between the doctor and the patient."
Dr. Louis Weiner of Georgetown University
Disease: a recognizable pattern of signs and symptoms
âHealthyâ body part: by analogy, we know what a healthy part is because of their integration into the whole -> the part can be sacrificed for the whole
Cancer patients: assess their functional status, the possible benefits versus harm that surgery, chemotherapy or radiotherapy will bring
CHALLENGE: When you become clerks and interns, get real informed consent.
Informed consent is not a signature.
Drew much media attention including Donald Trump and Pope Francis. Bambino Gesu Hospital in Rome.
Charlie Gard 2017: mitochondrial depletion syndrome
Alfie Evans 2018: yet undiagnosed neurologic disorder
THE QUESTION: Who decides for the child?
In the past two hours weâve been talking about philosophy, itâs fitting that we end with a logical argument.