صفحه 1:
صفحه 2:
Medical
Ethics
Introduction
صفحه 3:
The Origins of the Field and
Its Current Status
The Beginnings:
a) The Nuremburg Code, 1948
b) Life Magazine article on dialysis
selection committees,
November 1962
Earlier Points of Origin:
* Babylonian Codes
* Hippocratic Code/Oath
* Islamic Codes
* Jewish Codes
Emphasize physician-physician or physician-patient
relationship
صفحه 4:
The Origins of the Field and
Its Current Status
Current Status of Medical Ethics
1) Number of Courses Required
2) Medical Ethics programs in medical
schools, nursing schools, HRP, etc.
3) Journals, e.g. Hastings Center
Report, Journal of Medicine and
Philosophy
4) Centers, e.g. Hastings Center,
Kennedy Center at Georgetown
University, Midwest Bioethics
Center, K.C.
5) Rise of Hospital Ethics Committees
6) Massive Media Coverage
صفحه 5:
The Social Context:
Why Is Medical Ethics So
Prevalent?
Some factors:
1) Federal Government support, e.g.
IRBs, national commissions,
publications
2) Rise of Medical Technology
3) Rise of 3rd Party Payers
5
)
)
4) American Distrust of the Professions
) Rise of Professional Ethics
)
6) Critics of Medicine, e.g. Ivan Illych
and Norman Cousins
7) Rise of Team Health Care
صفحه 6:
The Social Context:
Why Is Medical Ethics So
Prevalent?
Some factors:
8) Women's Movement:
* male dominance of medicine
* focus on cure rather than care and
prevention
9) Legalization, legislation, and
litigation
10) Social interest in freedom and
autonomy - decline in the status of
medicine
11) Media Interest, e.g. Cruzan.
Busalacchi, Siamese twins
12) Rise in the Cost of Medicine: how
much can we afford?
صفحه 7:
Some Historical Points:
1940's and 1950's
Human subjects research
IRB's
Doctor-patient relationship:
a) buyer and seller
b) child and parent
c) individual and agent of society
d) client and professional
e) passive recipient and active provider
f) the powerless and the powerful
g) friend and friend
صفحه 8:
Some Historical Points:
1940's and 1950's (cont.)
Doctor-patient relationship (cont.):
h) contractual relationship: a legal
agreement based on mistrust
i) covenant relationship: a mutual
agreement based on trust
j) gatekeeper relationship
informed consent
informed refusal
proxy consent/refusal
competence
death/dying
صفحه 9:
Some Historical Points:
1960's and 1970's
privacy and confidentiality
abortion/status of the fetus
allocation of scarce resources
definition of death
صفحه 10:
Some Historical Points:
1980's
genetics issues
nursing ethics
professional ethics
reproductive issues
AIDS
animal rights
صفحه 11:
Some Historical Points:
1990's
human genome project
right to health care/health care
reform
managed care/professionalism
fetal neural tissue transplantation
cloning
صفحه 12:
Some Historical Points:
1990's (cont.)
stem cell research and therapy
gerontological issues
cross-cultural medical ethics
alternative medicine
non-Western medicine
صفحه 13:
Some Basic Concepts in
Medical Ethics
Person:
1) What is a person? What's the
definition of a person?
Persons usually have rights:
to life
to thrive
to be protected from harm
If rational or competent, to
make decisions for themselves,
etc.
What makes a person the same
person over time?
صفحه 14:
Some Basic Concepts in
Medical Ethics
Person:
2) What is the status of a potential
person?
If x is a potential person, does x
have all the rights of a person?
Is personhood a matter of
either/or?
Is it a matter of degrees?
3) What about past persons? If
something was a person, does it
have the rights of a person?
4) What about partial persons, e.g.,
the retarded, the demented, the
senile, the partially competent?
صفحه 15:
Some Basic Concepts in
Medical Ethics
Person:
1) What is a person? What's the
definition of a person?
Persons usually have rights:
to life
to thrive
to be protected from harm
If rational or competent, to
make decisions for themselves,
etc.
What makes a person the same
person over time?
صفحه 16:
Some Basic Concepts in
Medical Ethics
Autonomy:
1) Definition
2) Autonomy as a value, i.e., persons
have autonomy
Autonomy:
self-determination by competent
agents
autos = self
nomos = law
صفحه 17:
Some Basic Concepts in
Medical Ethics
Autonomy (cont.):
Autonomy:
autonomy as a value, i.e.,
persons have autonomy, should
be respected as agents
autonomy as a goal, something
to be achieved
autonomy vs. paternalism
autonomy vs. harm principle
صفحه 18:
Some Basic Concepts in
Medical Ethics
Quality of Life:
1) Who defines?
2) An external definition? Same for
everyone?
3) Internal definition
Normal vs. Abnormal
Natural vs. Artificial
Health vs. Disease
صفحه 19:
Some Basic Concepts in
Medical Ethics
Quality of Life:
Ordinary vs. Extraordinary
Rights vs. Responsibilities
Life vs. Quality of Life
Person vs. Living Thing/Thing