Lecture 1
Review Syllabus and Assignments.
Comment on the textbook.
This course uses a modified Problem Bases Learning (PBL) format and a six-step process to teach
students how to make ethical decision about health care issues. The six steps are:
1)
2)
3)
4)
Collection of relevant information;
Identification of ethical problems and issues;
Analysis of problems and issues using ethical principles and guidelines;
& 5 ) consideration of practical alternatives and appropriate action regarding ethical problems
and issues and;
6) Evaluation of probable results
In class: View Who Should Survive? (1971 film, 10 minutes). Morris Library has a longer version with
panel discussion. Ask students for their reactions.
Film was commissioned by Eunice Kennedy Shriver, sister of Joe, John, Robert, Edward,
Rosemary. Rosemary had mental retardation and was institutionalized. EKS devoted her life
to helping those with disabilities, especially those with mental disabilities. She founded the
Special Olympics and pushed for the establishment of the National Institute of Child Health
And Human Development, now named for her, part of the NIH. “Widely discussed in the
press, the film helped to establish neonatal ethics as paradigmatic for the emerging field of
bioethics “ (Reich WT. 1996. “Re-visioning the origin of bioethics”, Kenn Inst Ethics J 6: 323326.) Director C. Guggenheim had previously made a film about Robert Kennedy. The
director’s son directed the film “An Inconvenient Truth”.
Lecture 2
I.
Morality and Moral Values
A. Dimensions of morality
1. Relational
2. Goal oriented: to protect a high quality of life for an individual or a community
3. Context dependent
B. Moral Judgment: involves particulars of a specific situation
C. Values: intrinsic things a person, group, or community holds dear
D. Moral duty: actions in response to claims placed on a person or society (can be on individual
level or a community)
E. Moral character or virtue: traits and dispositions or attitudes needed to be able to trust each
other and to provide for the flourishing of humankind such as compassion, courage, honesty,
faithfulness, respectfulness and humility
II.
Subgroups of Morality
A. Personal morality: collage of values, duties, actions, and character trait each person adopts as
relevant for his or her life
1. Integrity: acting in accordance with personal morality (integrity=oneness, wholeness,
unity) (tells the truth weather painful or not)
2. Ethical integrity: doing the morally right thing (issue is: not everyone will agree what
is the right thing to be done – thorny area)
**everyone has a personal morality and is a part of a societal morality….no man is an island**
III.
B.
Societal Morality: values and ideas of duty that derive from deep religious, philosophical, and
anthropological beliefs about human beings and their relationships with higher power (s) with
each other, and with the natural world
C.
Group Morality: moral guidelines adopted by a group
1. Professional codes of ethics (ie: doc sick with cancer, can’’t treat his patients, unethical:
harsh, but code of medical ethics)
2. Customs, policies, practices of an institution
Dimensions of Ethics: Study of and Reflection on Morality
A. Formal branch of philosophy: axiology (study of values) (philosophy=study of wisdom)
(subgroup of ethics – formal study of values)
1. Aesthetics: values in things artistic (this generation – intense on this, songs, dance,
acting; many difference in option on value of this)
2. Ethics: duty or obligation to respond to claims (ie: good Samaritan laws)
B.
C.
D.
Ethicists and ethics committees (hospital group, one is always an ethicists) (animal ethics
groups, not just all humans)
Normative and applied ethics
 Normative: standards/norms, well accepted
 Applied ethics: how to apply to reach a conclusion that is sensible and rationale
 Meta ethics: theory of ethics, ethical evidence to use to argue a case, present
Ethics and Law (why spend time talking about this when there are laws? There are things
that are legal but may not be ethical, and some things that are ethical but may not be legal.
Ethics and law don’t always coincide (would be ideal). In general, law is conservative; health
care is often behind where we are in terms of what we can do: treatments and ethics may be
way ahead of us). IE: abortion- it is perfectly legal in some circumstances to do one, but for
some individuals that is not the case
1. State interests: responsibility to intervene on behalf of persons (in circumstances)
a. To save the person’s life (ie: good Samaritan for accident)
b. To prevent the person’s suicide (Dr. Kevorkian-did not prevent, but helped,
Murderer?)
c. To protect a person from harm as an innocent third party
d. To protect a person as a bearer of the integrity of the professions – ie: HCP violating
the code of ethics, whistleblowing)
2. Licensing laws
3. Moral repugnance: analogous to a conscientious objector in war (ie: participating in
abortion. Something that is opposing to your views)
4. Limit of protection: burden of proof falls upon the individual
Lecture 2 and 3: The ethical goal of professional practice and prototypes of ethical problems
(primarily covering the caring response : chapt 2)
I. Goal of Professional Ethics: A Caring Response
A. Patient as focus in dealing with claims (expectations people have of one’s professional role)
that maximize positive results and minimize damage to patient
B. Patient-centered, or client-centered care that emphasizes the well-being of the whole person
C. Importance of effective communication
II.
Characteristics of a caring response
A. Navigation between friendly and professional conduct
1. Observing boundaries
2. Touching
B. Technical Competence
1. Treatment
2. Compassion
C. Professional responsibility: due care
1. Accountability
2. Ethical standard or ideal
3. Responsiveness
D. Rights and professional responsibility
1. Right: stringent claim or demand upon a person
2. Human rights: common to all people
3. Patient rights and health professionals (see pg. 40 in Purtilo and Doherty)
E. Burdens and benefits of a caring response
1. Personal relationships
2. Personal costs
F. Benefits of caring response
1. Participation in activities that society responds and values
2. Self-fulfillment
3. Job satisfaction
4. Self-knowledge
5. Promotion of more healthy humankind
III.
Prototypes of Ethical Problems
A. Recognition of an ethical question