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Ethics in Medicine

Ethics in Medicine
1. Physician’s professionalism and
2. What ethics is not?
The Central Person in Healthcare
 To be a physician is
extremely complex
What does a physician’s
means to you?
Take a minute or two
and write down your
thoughts as a definition!
What is Physician’s Professionalism?
Physician’s professionalism comprise numerous
qualities of physicians:
 It is a vocation or calling and implies service to
 It has a scientific knowledge base which is kept
up to date
 It has a special relationship with those whom it
serves – patients.
 It has particular ethical principles and norms
Scientific questions
Scientific questions
 Ask testable questions
about the world
 Can be explored through
scientific inquiry
 Rely on empirical and
measurable evidence
Example: How does kidney
transplant function in the
organism of recipient?
Cultural/Religious questions
 Cultural/Religious questions
 Ask us what would be in line
with the common practices of
a particular culture, or with
religious belief or practice
 Example: What does my
religion or culture say on
whether it is acceptable to
donate kidney transplant?
Legal questions
 Ask us what the law requires
or forbids us to do.
 Non-compliance with law
leads to legal sanctions or
 Ethics informs the law, but
sometimes laws are not
ethical and other times the
ethically right thing to do
may be illegal.
Example: Is it legal or not to sell
kidney in your home country?
Is it morally right?
Ethical questions
Ethical questions
 Ask us what the ‘right’ thing to
do is – what we ‘should’ or
‘ought’ to do?
 Arise because of our social
responsibility to others and
because our behavior can
influence the welfare of other
 Are generated by conflicts
among principles and values
held by individuals or groups
Ethical questions (cont.)
 Require moral reflection,
i.e. consideration of
person’s responsibilities,
duties, values, and
 Example: Should
individual who donate
kidney transplant choose
who should be the
recipient of their organ?
What answer is morally
Case 1. Truth-telling and Trust
 Thao, 80-year-old Asian woman is
hospitalized with pulmonary
 Her family asks that she not be told
about her diagnosis, because in her
home country tuberculosis was
considered fatal and to tell her would
be like giving her "a death sentence.“
 1.Ask questions (scientific/ legal/
cultural/ ethical) proper for the case!
 2.Should you respect the family's
Case 2. Truth-telling and Trust
 Timothy, 65-year-old is
diagnosed with metastatic
cancer of the pancreas.
 Timothy has just retired from a
busy professional career, and he
and his wife are about to leave
on a round-the-world cruise that
they have been planning for
1. Ask questions (scientific/ legal/
/ ethical) proper for the case!
2. Should you tell him his
Right to Know the Truth
Telling the truth in clinical context is an ethical obligation, but
determining just what constitutes the truth remains a
clinical judgment.
Right to know the truth for individual patient:
 “Doctors must take appropriate steps to find out what
patients want to know about their condition and
JMC / British Medical Association
Relations between doctor and patient
changed radically (cont.)
Key Concepts
 Values
 Values are the inner standards by which we make decisions
about right and wrong, should and shouldn't, good and bad.
They also tell us which are more or less important when we
have to posit one value over another.
 Morals
 Morals have a greater social element to values and tend to have
a very broad acceptance. Morals are far more about good and
bad than other values. We thus judge others more strongly on
morals than values. We can describe a person as immoral, yet
there is no word for them not following values.
Key Concepts (continued)
 Ethics
As opposed to ‘commonsense morality’, ethics involves a
critical reflection on how best to live a moral life (Aristotle).
 1) A theory or a system of moral values (e.g. ethic of nonviolence).
 2) A branch of philosophy dealing with values relating to
human conduct, with respect to the rightness and
wrongness of certain actions and to the goodness and
badness of the motives and ends of such actions.
 3) The rules or standards governing the conduct of a
person or the members of a profession (e.g. medical
2. What ethics is not?
What ethics is not?
A. Codes of ethics
 “If we call them ethics we may to believe that they are all
there is of ethics, and presently be worshipping the code
rather than the ethics itself, so unreasoning a reverence is
in our souls for statutes, fines, and punishments, so strong
a tendency to make rules the end and aim of life rather
than simply conveniences, changeable contrivances”
Lavinia Dock (1900)
 Nevertheless, codes could serve as helpful instruments “to
prop up the steps of those who are young in selfgovernment or feeble in self-control”.
What ethics is not?
B. Law
 Law is the body of official rules and regulations, generally
found in constitutions, legislation, judicial opinions, and
the like, that is used to govern a society and to control the
behavior of its members.
Legal decision
 Is made on the basis of what is required or prohibited
by law.
 Is motivated by desire to avoid legal sanctions or
punishment for non-compliance.
 ‘What is not forbidden, is permitted’ (‘Your Liberty To
Swing Your Fist Ends Just Where My Nose Begins’).
Law controls the scope of ‘outer’ freedom (liberty).
Ethical decision
 Is guided by personal moral values and principles.
 Moral principles are chosen autonomously on the
basis of critical reflection.
 They are backed by moral reason and/or by feelings
of guilt, shame, moral remorse which operate as
kinds of moral sanctions.
Ethics controls the scope of ‘inner’ freedom.
Clinical decision
 Is based on an established body of knowledge and
‘reasonable’ professional opinion on how this knowledge
should or should not be applied in a clinical situation.
Case 1. An advise to seek a ‘second opinion’.
 A middle-aged woman suffering moderately severe retrosternal
chest pain and shortness of breath presented to the emergency
department of a large city hospital.
The ECG showed a number of cardiac arrhythmias, all of which
where suggestive of an acute cardiac condition.
A junior first-year medical resident examined the woman and
decided she should be admitted immediately for further cardiac
monitoring and tests.
The registrar ‘on call’ declined to admit her, since there were no
‘cardiac beds’ available and he was not convinced that the ECG
findings indicated a life-threatening cardiac condition.
He discharged the woman, advising her to see her own general
practitioner the following morning.
What ethics is not?
C. Hospital etiquette
 Ethics speaks to morally significant rights and wrongs, with
behavior guided by reflective reasoning and application of
moral values, and
 seeks to maximize moral interests of all people equally.
 Etiquette speaks more to professional style, with behavior
guided by unreflective requirements of custom and
convention, and
 serves the interests of particular institution or person in
particular circumstances.