HSCI319W Midterm
Review Session
By the SFU Health Ethics Club
Moral Theories: Deontology (Kantianism)
Kant and Ross
 Duty-based


Some behaviours are morally
obligatory or prohibited

Prima facie duties (take priority
over other duties, ex: fidelity,
reparation, gratitude, justice,
beneficence, self-improvement,
nonmaleficence)
Beneficence: acts performed for
the overall benefit of a patient
(doing good)
 Categorical imperative: a
universally binding,
unconditional, or absolute moral
requirement (ex: do not kill)
 Autonomy: ability of an individual
to govern themselves, formulate
and pursue their own goals and
values

Moral Theories: Utilitarianism

Bentham and Mill

Principle of utility: belief that we ought to
maximize beneficial and minimize harmful
consequences for the greatest number of
people

Cost-benefit analysis

Moral agent: rational individual who is capable
of understanding the consequences of their
actions and is held responsible for the choices
they make

Nonmaleficence: do no harm

Rule utility: (use first) use general rules that
benefit all people and acknowledge and
protect individual rights

Act utility: (use second, if can’t use rule
utility) make decisions on a case-by-case basis

Justice: duty to give each individual equal
consideration based on contextual details of
the situation, and to treat similar cases
similarly
Moral Theories: Biomedical Ethics


Four principles:

Respect for autonomy

Beneficence

Nonmaleficence

Justice
Moral community: group
of moral agents who agree
to limit their behaviour in
order to achieve personal
and social benefits (ex:
professional code of
ethics)
Moral Theories: Paternalism,
Libertarianism, and Communitarianism

Paternalism: the policy of people
in power to restrict the freedoms
of those dependent on them “for
their own good”

Libertarianism: focus on personal
freedom of choice, autonomy, and
concerned about state
(government) interference in
personal affairs as it may limit
freedom

Communitarianism: moral decisions
are made based on what is best for
the group/society
Note: can you see any similarities between libertarianism and Kantianism?
Or communitarianism and utilitarianism?
Scenario: Compulsory Vaccinations?



When is it ethically justifiable to
mandate a vaccination? What
conditions need to be met?
 Should child benefits only be
paid to those who have their
children vaccinated (Australia)
Should we grant nonmedical
exemptions from mandated
vaccinations? Pros and cons of
limiting this to religious

Answer using:

Autonomy

Beneficence

Nonmaleficence

Justice
Case 1: Refusing Treatment While
Incompetent

A brilliant physics prodigy named Scott has a history of mental illness and has
been hospitalized in psychiatric units on multiple occasions for his erratic
behaviour associated with bipolar disorder. Upon his latest hospitalization,
doctors recommended treatment including anti-psychotic medications. Scott
refused to take the medication even though he knew he was mentally ill and
would not be allowed to return home unless he took it.

Should Scott be able to determine his own course of treatment even when he
may or may not be in a competent mental state? Defend your position using
moral theories or principles.
Case 2: HIV and Confidentiality

Carlos is a 21-year-old HIV+ gay man who is in hospital for a gunshot wound.
He is sent home to recover in the care of his older sister, who does not know
of his sexual orientation or HIV status. Carlos is very concerned that if his
sister knew, she would tell their father and he would be disowned by the
family.

Would Carlos’s physician be morally justified in breaching patient
confidentiality on the grounds that he had a “duty to warn”? Defend your
position using moral theories or principles.
Case 3: Prenatal Diagnosis and Abortion or
Infanticide through Declining Treatment

A woman becomes pregnant later in life, putting her child at risk of
developing Down syndrome. Her physician offers for her to have a test for the
condition done early in the pregnancy so she can decide whether to continue
the pregnancy, but she refuses. The baby is born with Down syndrome, and
needs life-saving heart surgery in order to survive, but with the surgery could
live a long and healthy life. The mother refuses to let the child have the
surgery, saying it s no different than had she had the test done in the first
trimester and chose to abort then, and it is her decision to make.

Is the mother justified in making this claim? Defend your position using moral
theories or principles.
Case 4: Illegal organ transplant and
medical care

Bob, a 50-year-old man with diabetes, is on dialysis for chronic renal failure
and on the waiting list for a kidney transplant. Because he is in relatively
good health, he is low on the list. His physicians advise him that he could be
on the list for up to 3 years and that his health during that time would not
be jeopardized, aside from the risks and inconveniences associated with
long-term dialysis. He does not have family members or friends that are
willing to donate a kidney. Unable to find a living donor and dismayed at the
thought of remaining on dialysis for years, Bob decided to use his financial
resources to purchase a kidney through the black market overseas and
undergo a transplant despite of the dangers involved. After returning from
his trip, he undergoes septic shock due to an infection from the kidney
transplant and is bumped up on the list to receive a kidney and immediate
medical care.

Should Bob have received care despite his reckless behaviour? Defend your
position using moral theories or principles.
Case 5: Cultural Health Remedies

You are a general practitioner and a mother comes into your office with her child
who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to
remove his shirt and you notice a pattern of very distinct bruises on the boy's torso.
You ask the mother where the bruises came from, and she tells you that they are
from a procedure she performed on him known as "cao gio," which is also known as
"coining." The procedure involves rubbing warm oils or gels on a person's skin with a
coin or other flat metal object. The mother explains that cao gio is used to raise out
bad blood, and improve circulation and healing. When you touch the boy's back with
your stethoscope, he winces in pain from the bruises. You debate whether or not you
should call Child Protective Services and report the mother.

Should we completely discount this treatment as useless, or could there be
something gained from it?

When should a physician step in to stop a cultural practice? (If someone answers
"when it harms the child" remind that person that there is some pain in many of our
medical procedures, for example, having one's tonsils removed)

Should the physician be concerned about alienating the mother and other people of
her ethnicity from modern medicine?

Do you think that the physician should report the mother?