Medical Ethics
اسلاید 1: www.tabaye.ir
اسلاید 2: Medical EthicsIntroduction
اسلاید 3: The Origins of the Field and Its Current StatusThe Beginnings:a) The Nuremburg Code, 1948b) Life Magazine article on dialysis selection committees, November 1962 Earlier Points of Origin: Babylonian Codes Hippocratic Code/Oath Islamic Codes Jewish CodesEmphasize physician-physician or physician-patient relationship
اسلاید 4: The Origins of the Field and Its Current StatusCurrent Status of Medical Ethics1) Number of Courses Required2) Medical Ethics programs in medical schools, nursing schools, HRP, etc.3) Journals, e.g. Hastings Center Report, Journal of Medicine and Philosophy4) Centers, e.g. Hastings Center, Kennedy Center at Georgetown University, Midwest Bioethics Center, K.C.5) Rise of Hospital Ethics Committees6) Massive Media Coverage
اسلاید 5: The Social Context: Why Is Medical Ethics So Prevalent?Some factors:1) Federal Government support, e.g. IRBs, national commissions, publications2) Rise of Medical Technology3) Rise of 3rd Party Payers4) American Distrust of the Professions5) Rise of Professional Ethics6) Critics of Medicine, e.g. Ivan Illych and Norman Cousins7) Rise of Team Health Care
اسلاید 6: The Social Context: Why Is Medical Ethics So Prevalent?Some factors:8) Womens Movement:* male dominance of medicine* focus on cure rather than care and prevention9)Legalization, legislation, and litigation10) Social interest in freedom and autonomy - decline in the status of medicine11) Media Interest, e.g. Cruzan. Busalacchi, Siamese twins12) Rise in the Cost of Medicine: how much can we afford?
اسلاید 7: Some Historical Points:1940s and 1950sHuman subjects researchIRBsDoctor-patient relationship:a)buyer and sellerb)child and parentc)individual and agent of societyd)client and professionale)passive recipient and active providerf)the powerless and the powerfulg)friend and friend
اسلاید 8: Some Historical Points:1940s and 1950s (cont.)Doctor-patient relationship (cont.):h)contractual relationship: a legal agreement based on mistrusti)covenant relationship: a mutual agreement based on trustj)gatekeeper relationshipinformed consentinformed refusalproxy consent/refusalcompetencedeath/dying
اسلاید 9: Some Historical Points:1960s and 1970sprivacy and confidentialityabortion/status of the fetusallocation of scarce resourcesdefinition of death
اسلاید 10: Some Historical Points:1980sgenetics issuesnursing ethicsprofessional ethicsreproductive issuesAIDSanimal rights
اسلاید 11: Some Historical Points:1990shuman genome projectright to health care/health care reformmanaged care/professionalismfetal neural tissue transplantationcloning
اسلاید 12: Some Historical Points:1990s (cont.)stem cell research and therapygerontological issuescross-cultural medical ethicsalternative medicinenon-Western medicine
اسلاید 13: Some Basic Concepts in Medical EthicsPerson:1)What is a person? Whats the definition of a person?Persons usually have rights:to lifeto thriveto be protected from harmIf rational or competent, to make decisions for themselves, etc.What makes a person the same person over time?
اسلاید 14: Some Basic Concepts in Medical EthicsPerson: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?
اسلاید 15: Some Basic Concepts in Medical EthicsPerson:1)What is a person? Whats the definition of a person?Persons usually have rights:to lifeto thriveto be protected from harmIf rational or competent, to make decisions for themselves, etc.What makes a person the same person over time?
اسلاید 16: Some Basic Concepts in Medical EthicsAutonomy:1)Definition2)Autonomy as a value, i.e., persons have autonomyAutonomy:self-determination by competent agentsautos = self nomos = law
اسلاید 17: Some Basic Concepts in Medical EthicsAutonomy (cont.):Autonomy:autonomy as a value, i.e., persons have autonomy, should be respected as agentsautonomy as a goal, something to be achievedautonomy vs. paternalismautonomy vs. harm principle
اسلاید 18: Some Basic Concepts in Medical EthicsQuality of Life:1)Who defines?2)An external definition? Same for everyone?3)Internal definitionNormal vs. AbnormalNatural vs. ArtificialHealth vs. Disease
اسلاید 19: Some Basic Concepts in Medical EthicsQuality of Life:Ordinary vs. ExtraordinaryRights vs. ResponsibilitiesLife vs. Quality of LifePerson vs. Living Thing/Thing
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