Download An Introduction to Medical Ethics

An Introduction
to Medical Ethics
Christopher DeMella, Pharm.D.
PGY2 Academic Pharmacy Resident
VCU School of Pharmacy
Spring Semester, 2016
Objectives
• Define “medical ethics”
• Summarize the 4 primary ethical principles
• Illustrate Kohlberg’s theory of ethical development
Medical Ethics
• Ethics
o From the Greek ethos, meaning “character”
o Defines what is good for the individual and for society and establishes the
nature of obligations that people owe to themselves and one another
• Medical Ethics
o The standard of behavior used to guide medical practitioners in
relationships with patients, health professionals, and society
o “Trying to do the right thing while achieving the best possible outcome for
every patient.” – Medical Ethics for Dummies
Principles of Medical Ethics
• Beneficence
• Non-maleficence
• Autonomy
• Justice
Beneficence
• Promoting what is best for the patient
• Requires that health care providers:
o
o
o
o
o
Develop and maintain skills and knowledge
Continually update training (CEs)
Consider individual circumstances of each patient
Strive for net benefit
Acknowledge the patient’s wishes (autonomy)
Non-maleficence
• Do no harm
• Do the benefits outweigh the risks?
• Principle of double effect
o A single action may have a good and a bad effect
o In order to determine if the action is permissible, consider:
• The nature of the act must be good or neutral, it cannot be
intrinsically wrong
• The agent intends the good effect and not the bad either as a means
to the good or as an end itself
• The good effect must outweigh the evil that is permitted
Autonomy
• Recognizes the rights of individuals to make their
own decisions
o Free from both controlling interference by others and from limitations
• Basis for informed consent and advanced directives
o Disclosure of medically relevant information
• Exceptions to autonomy
o
o
o
o
Certain disabilities
Mental status
Maturity
Incapacity
Justice
• Describes how people are treated when interests
compete
• Persons who have similar circumstances and
conditions should be treated alike
• Considerations when evaluating justice:
o Fair distribution of scarce resources (distributive justice)
o Respect for people’s rights (rights based justice)
o Respect for morally acceptable laws (legal justice)
Kohlberg’s Theory of
Ethical Development
• Three distinct levels of moral reasoning, each with
two sub-stages
• People can only pass through the stages in order,
with each new stage replacing the reasoning
typical of the previous stage
• Not everyone achieves all the stages
Level 1: Pre-Conventional Morality
• Authority is outside the individual and reasoning is
based on the physical consequences of actions
• Stage 1: Obedience and Punishment Orientation
o The individual behaves in order to avoid being punished
o If a person is punished, they must have done wrong
• Stage 2: Individualism and Exchange
o The individual recognizes that there is not always just one right view
o Different individuals have different viewpoints
Level 2: Conventional Morality
• Moral standards of role models become internalized
• Stage 3: Good Interpersonal Relationships
o The individual is good in order to be seen as a good person
o Answers and behaviors are related to the approval of others
• Stage 4: Maintaining the Social Order
o The individual becomes aware of the rules of society so decisions are
based on obeying rules in order to uphold the law and avoid guilt
Level 3: Post-Conventional Morality
• Individual judgment is based on self-chosen
principles, and moral reasoning is based on
individual rights and justice
• Stage 5: Social Contract and Individual Rights
o The individual becomes aware that while rules/laws might exist for the
good of the greatest number, there are times when they will work against
the individual (Heinz’s dilemma)
• Stage 6: Universal Principles
o The individual has developed their own set of moral guidelines which may
or may not fit the law (human rights, justice, equality)
o The individual is prepared to defend these principles, even if it goes
against the rest of society
Comprehension Assessment
• Which of the following patients would be fully
capable of making an autonomous decision?
A. A patient with bipolar schizophrenia who is demonstrating aggravated
behavior and is refusing his monthly haloperidol injection
A. A patient with dementia and a DVT who is refusing to take warfarin in the
nursing home
A. A patient diagnosed with stage IV lung cancer who is refusing potentially
life-saving chemotherapy
A. A drug addict who requires inpatient IV antibiotics for treatment of an
infection but is attempting to leave AMA due to their addiction