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Ethics, too, are nothing but reverence for life. This is
what gives me the fundamental principle of morality,
namely, that good consists in maintaining, promoting,
and enhancing life, and that destroying, injuring, and
limiting life is evil.
Albert Schweitzer
2012
Marek Vácha
INTRODUCTION TO MEDICAL
ETHICS
HTTP://WWW.YOUTUBE.COM/WATCH?V=YIZT79UKUFQ
Gyges´ ring
 Plato in The Republic has one of his characters
ask us to engage in a though experiment. He
tells the story of Gyges´ring, whose effect was to
make its wearer invisible. What would prevent
the possessor of the ring from commiting any
crime he felt like committing? He could never be
caught. Would we not all be tempted, if we had
such a ring, to do whatever our heart desired,
knowing we would not, could not, be found out?
 there are two ways
how to create
order:
 by use of power
 by use of self-
restraint
 when only police or
army stand
between order nad
riots, freedom itself
is at risk
Tottenham,
august 2011
Science x Ethics
 science investigates what is
 ethics investigates what ought to be
Science
 The composition of mammalian blood is
plasma 55% and cellular elements 45 %
 leukocytes are: basophils, eosinophyls,
neutrophils, lymphocytes, monocytes
 IgE antibodies are produced in response
to initial exposure to an alergen bind to
receptors an mast cells
 blood glucose level is about 90mg/100ml
Ethics
 when, if ever, is possible to take a gift or
gratuity from a patient?
 Is it permissible to lie to a patient if it is for
his or her good?
 what obligations do I have to a colleague
and fellow practitioner when I suspect that
the colleague I am working with is abusing
alcohol or appears chemically impaired
while on duty?
Ethics
 …and what about
the Bodies
exhibition?
 Is this show
ethically neutral?
 …or good?
 …or bad?
"Friendly embryos"
http://www.cuni.cz/IFORUM-9834.html
There are more complicated questions...
 Is there any sort of pursuit of knowledge that
might be forbidden?
 is there a category of a "forbidden knowledge"?
 Is there any sort of research that should not
be publicly funded?
 Is there any sort of genetic knowledge that it
might be better not to know?
 Is any basic research ethically mandatory in
some way?

http://www.youtube.com/watch?v=HkW0C-NyNtQ
There are more complicated questions...
 should the use of cloning by somatic cell
nuclear transfer (the technique used to
produce Dolly) be allowed in order to help
as infertile couple have a child?
 should the entire UK population and all
visitors to Britain be compelled to provide
DNA samples as a means of enabling the
police to detect the perpetrators of
criminal acts?

(Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. 2nd ed- Oxford University
Press, Oxford. p. 3)
There are more complicated questions...
 Is it possible to say that
 future benefits justify the present
practices?
 future abuses do not disqualify present
uses?
There are more complicated questions...
 Is a goal of the medicine painless,
suffering-free and, finally, immortal
existence?
SCIENCE AND ETHICS
Science x Ethics
 Methodological Naturalism:
 what natural world contains
 how it arrived at its current state
 laws that regulate its behavior
 Ontological Naturalism:
 nothing else exists
Science and Philosophy
Philosophy
Science
The aim of the medicine: to elongate the life of the patient
„the art of living“
the ethics according to Aristote
the lenght of life
biological medicine
The aim of the medicine: to elongate the life of the patient, „a horizontal“ of his/her
life
The aim of the moral philosophy: to give a meaningfulness of the life of the patient,
„a vertical“ of his/her life
Ethics and Morality
 Ethics is primarily a matter of knowing
 Morality is a matter of doing
 morality is what people believe to be right
and good
 ethics is the critical reflections about
morality and the rational analysis of it.
Good ethics start with good facts!
1. Defining the problem
2. Descriptive – defining what is going on,
description of who the patient is, who the
family is, what is their moral world; what
the options are in terms of diagnosis,
therapy, prognosis, goals, what can be
done, weighting the risks and benefits.
3. Normative – ethics arises from value
conflict – concerns itself with the „should“
questions
Descriptive Ethics and Normative
Ethics
 Descriptive Ethics
 What do people think is right?
 philosophical schools, religions etc.
 Normative Ethics
 identification of values
 what behavior is good and why
 supported by arguments
 what should I do and why?
 Whereas descriptive ethics attempts to
describe and explain those moral views
that in fact are accepted,
 normative ethics attempts to establish
which moral views are justifiable and thus
ought to be accepted.
Normative Ethics
 Normative ethics is the attempt to
determine what moral standards should
be followed so that human behaviour and
conduct may be morally right.
 Normative ethics is concerned with
establishing standards for conduct and is
commonly associated with theories about
how one ought to live.
The position of the teacher
 the teacher is not in „God-like position“
 the teacher is not
 a harbinger of an ultimate truth
 a opinion-maker
 the teacher doesn´t say „how things are“
 his/her task is more complicated
 to tell to the students what is known about the
problem
 and then he/she try to moderate the discussion
The Scandal of Philososphy
 We have moved forward in medicine during
the past 2 000 years
 we now know much better the human body than
Hippocrates knew
 ..but have we move forward in philosophy?
 is our contemporary philosophy better than the
philosophy of Aristote?
 maybe not!
 the philosophy might be somewhere between
art and science
The Problems of teaching Philosophy
 the notions are generally not so clear as in
science
 there is no such thing like „hard data“
 different people could have different opinions
 „there is only one science but many philosophies“
 everyone has his/her own philosophy
 a philosophy is joint to the person of the
philosopher and his/her epoch
 …but is it true?
What is the difference between a
postmodernist and a member of
the Mafia?
The Mafia makes you an offer
you can´t refuse. A posmodernist
makes you an offer you can´t
understand.
Ethical relativism
„Well..... well.... we will think about it.“
Ethical relativism
 there is no goodness or badness
 there is no rightness or wrongness
 ....there are only opinions
 Dostojevskij: if God does not exists, all is
permitted.
Why to start with Philosophy?
 In the history of the human spirit I distinguish
between epochs of habitation and epochs of
homelessness. In the former, man lives in the
world as in the house, as in a home. In the
latter, man lives in the world as in an open
field and at times does not even have four
pegs with which to set up a tent.
 In the former epochs anthropological thought
exist only as a part of cosmological thought.
In the latter, anthropological thought gains
depth and with it, independence.

(Martin Buber: Between Man and Man)
A PROBLEM OF
PERSONHOOD
…WHAT DOES IT MEAN TO BE A HUMAN?
E.O. Wilson
 the organism is only DNA´s way of making
more DNA
 the hypothalamus and limbic system are
engineered to perpetuate DNA
 these centers flood our consciousnessn with all
the emotions – hate, love, guilt, fear, and others
– that are consulted by ethical philosophers who
wish to intuit the standards of good and evil

(Wilson, E.O., (2000) Sociobiology. The New Synthesis. Twenty-Fifth Anniversary Edition. The Belknap
Press of Harward University Press. Cambridge, Massachusetts, and London, England. p. 3)
E.O. Wilson
 The hypothalamic-limbic complex of a
highly social species, such as man,
„knows“, or more precisly it has been
programmed to perform as if it knows, that
its underlying genes will be proliferated
maximally only if it orchestrates behavioral
responses that bring into play an efficient
mixture of personal survival, reproduction,
and altruism

(Wilson, E.O., (2000) Sociobiology. The New Synthesis. Twenty-Fifth Anniversary Edition. The Belknap
Press of Harward University Press. Cambridge, Massachusetts, and London, England. p. 4)
Common Morality
 is a product of human experience and
history and is a universaly shared product
 is found in all cultures
 is not relative to cultures and individuals,
because it transcends both

(Beauchamp, T.L., Childress, J.F., (2009) Principles of Biomedical Ethics. 6th ed. Oxford University Press,
New York, Oxford, p. 4)
 Herodotus (5th century BC): During Darius´s reign, he
invited some Greeks who were present to a conference, and
ask them how much money it would take for them to be
prepared to eat the corpses of their fathers; they replied that
they would not do that for any amount of money. Next,
Darius summoned some members of the Indian tribe known
as Callatiae, who eat their parents, and asked them in the
presence of the Greeks, with an interpreter present so that
they could understand what was being said, how much
money it would take for them to be willing to cremate their
fathers´ corpses; they cried out in horror and told him not to
say such appalling things. So these practises have become
enshrined as customs just as they are, and I think Pindar
was right to have said in his poem that custom is king of all.

(Blackburn, S., (2001) Ethics. A Very Short Introduction. Oxford University Press, Oxford, p. 18)
animals?
women
nationalities
(nazism)
colour of skin
(American Civil War)
people in the same geographical
locality
tribe
family
The Universal Declaration of Human
Rights
 Article 7
 All are equal before the law and are entitled
without any discrimination to equal protection of
the law. All are entitled to equal protection
against any discrimination in violation of this
Declaration and against any incitement to such
discrimination.
(Nash, R.F., (1989) The Rights of Nature. A History of
Environmental Ethics. The University of Wisconsin Press,
Madison, London. p. 5)
WHAT DOES IT MEAN TO BE A
HUMAN PERSON…?
What is a person…?
 human eggs?
 enemies in war
 embryos or fetuses?
 different races
 newborns?
 women and children
 the brain dead?
 nonhuman animals?
 cybrids?
A Theory Based on
 biological species
 cognitive capacity
 moral agency
 sentience
 communal relationship
A Theory based on Cognitive Properties
 a person has to have :
 self-consciousness
 freedom to act and capacity to engage in
purposeful actions
 ability to give and to appreciate reasons for
acting
 capacity to communicate with other persons
using a language
 rationality and higher order volition
A Theory Based on Sentience
 person = a being capable of feeling pain a
pleasure
 having the capacity of sentience is a
sufficient condition of moral status
 pain is an evil, pleasure a good
 to cause pain to any entity is to harm it
 even if you were not cognitively capable,
morally capable, or biologically human, pain
and suffering would be real to you
A Theory Based on Sentience
 in this theory a fetus does have moral
status at some point after several weeks
of development, and thus abortions at that
point would be prima facie impermissible
 this point is prior to the stage of development
at which some legal abortions now occur.
A Theory Based on Sentience
critique
 any individual lacking the capacity for sentience
lacks moral status
 this theory disallows moral status for early-staged
fetuses as well as for all who have irreversibly lost the
capacity for sentience, such as patients with severe
brain damage
 the degree of moral status and the level of moral
protection can vary according to conditions such
as the quality, richness, or complexity of life
 as loss of capacity occurs, humans (and nonhumans)
will have a decreased moral status
 In this way, the most vulnerable beings can become
the most vulnerable to abuse and exploitation. No
theory is morally acceptable that yields this conditions
A Theory Based on Moral Agency
 a person…
 is capable of making moral judgments about
the rightness or wrongness of actions
 has the motives that can be judged morally
 = capacity for moral agency gives an
individual moral respect and dignity
A Theory Based on Relationships
 relationships between parties account for
moral status
 the less the degree to which the fetus can
be said to be part of a social matrix, the
weaker the argument for regarding
her/him as having the same moral status
as persons
 once fetuses are detected in utero by
stethoscope or sonogram, they become in
significant respects part of a social matrix
A Theory Based on Relationships
critique
 is it true, that only social bonds and
attitudes alone determine moral status?
 the different degrees of moral status, such
as moral agents having a higher degree of
status than individuals lacking such
agency
 no matter how much we love a favorite
plant or institution, neither the plant nor
the institution gains status by virtue of this
relationship
A Theory Based on Human Properties
 All humans have full moral status and only
humans have that status
 an individual has moral status if and only if
that inidividual
 is conceived by human parents, or
 is an organism with a human genetic code
 to be a living member of the species
Homo sapiens sapiens is a necessary and
sufficient condition of moral respect
A Theory Based on Human Properties
 no human is excluded on the basis of a
property such as being a fetus, having
brain damage, or having a congenital
anomaly.
 the moral status of human infants,
mentally disabeld humans, and those with
a permanent loss of consciousness is not
in doubt
A Theory Based on Human Properties
 all humans have human rights, whether or
not the rights are legally recognized in a
political state
 je sice pravda, že lidoopi vnímají bolest a
lidé v PVS ne, to ale neznamená, že by
nebylo rozdílu!
Peter Singer
 „human being“ and „human person“
 person = being able to feel pleasentness and
unpleasentness
 patient in PVS or human embryo is not a
person, a dog is.
Peter Singer
 if we set a moral frame to incorporate all the
people, a lot of animals are inside as well
 if we set a moral frame to incorporate no
animals, a lot of people are left out as well.
Peter Singer
 creatures included in Singer´s moral
community has to posses nervous systems
of sufficient sophistication to feel pain
 ethics ceases to apply somewhere „between
a shrimp and oyster.“
 ethics ends at „the boundary of sentience.“
 the fact that a deer does not think like a
person was no more relevant in the
assignation of rights than the advanced
quality of Einstein´s thought compared to an
average person´s.
Peter Singer
 creatures included in Singer´s moral
community has to posses nervous systems
of sufficient sophistication to feel pain
 ethics ceases to apply somewhere „between
a shrimp and oyster.“
 ethics ends at „the boundary of sentience.“
 the fact that a deer does not think like a
person was no more relevant in the
assignation of rights than the advanced
quality of Einstein´s thought compared to an
average person´s.
Peter Singer
"We protest his hiring because Dr.
Singer denies the intrinsic moral worth
of an entire class of human beings newborn children - and promotes
policies that would deprive many
infants with disabilities of their basic
human right to legal protection against
homicide." ... Princeton University student
petition protesting Peter Singer's hiring.
Empirical Functionalism
„person“
ethics ceases to
apply somewhere
„between a
shrimp and
oyster.“
„person“
osoba = to, co vnímá
libosti a nelibosti
Peter Singer
Peter Singer
 "When the death of a disabled infant will lead
to the birth of another infant with better
prospects of a happy life, the total amount of
happiness will be greater if the disabled
infant is killed. The loss of the happy life for
the first infant is outweighed by the gain of a
happier life for the second. Therefore, if the
killing of the hemophiliac infant has no
adverse effect on others it would be right to
kill him." (Practical Ethics)
Speciesism (P. Singer)
 = the belief, that we are entitled to treat
members of other species in a way in
which it would be wrong to treat members
of our own.
Specieism
 „If we compare a severely defective human
infant with a nonhuman animal, a dog, a pig,
for example, we will often find the nonhuman
to have superior capacities, both actual and
potential, for rationality, self-consciousness,
communication, and anything else that can
plausibly be considered morally significant.
Only the fact that the defective infant is a
member of the species homo sapiens, leads
it to be treated differently from the dog or
pig.“

Singer, P., (1983) Sanctity of life or quality of life. Pediatrics,72:128-129
Stephen Hawking
„person“
Ontologický personalismus
„person“
Ontologický
personalismus
Nazism
„person“
Ontological Personalism
„person“
Ontological
Personalism
A Theory Based on Human Properties
 All humans have full moral status and only
humans have that status
 an individual has moral status if nad only if that
inidividual
 is conceived by human parents, or
 is an organism with a human genetic code
 no human is excluded on the basis of a property
such as being a fetus, having brain damage, or
having a congenital anomaly.
 the moral status of human infants, mentally
disabeld humans, and those with a permanent
loss of consciousness is not in doubt
A Theory Based on Human Properties
 all humans have human rights, whether or
not the rights are legally recognized in a
political state
Critique
 dividing Homo sapiens sapiens to two groups
 black x white
 germans x non-germans
 communists x noncommunists
 in-group x out-group
 beings x persons
 ...was not good in any case
 The attempt to produce Heaven on Earth
often produces Hell. (Karl Popper)
New York 1948: Universal Declaration of Human Rights
 Everyone is entitled to all the rights and
freedoms set forth in this Declaration,
without distinction of any kind, such as
race, colour, sex, language, religion,
political or other opinion, national or social
origin, property, birth or other status.
(Article 2)
 ...taught us the paradoxical truth that
nations survive not by wealth but by the
help they give to the poor, not by power
but by the care they extend to the weak.
Civilisation become invulnerable only
when they care for the vulnerable.

Sacks, J., (2011) The Great Partnership. God, Science and the Search for Meaning. Hodder & Stoughton,
London. p.290
THE PROBLEM OF
RESPONSIBILITY
Ethics
behaviorism:
 give me a dozen healthy infants, well-formed,
and my own specified world to bring them up
in and I´ll guarantee to take anyone at random
and train him to become any type of specialist
I might select – doctor, lawyer, artist,
merchant-chief and, yes, even beggar-man
and thief, regardless of his talents, penchants,
tendencies, abilities,vocations, and race of his
ancestors.
B.F. Skinner
 there is an innate tendency to respond to
rewards and punishments in certain ways
 …but the pattern of rewards and
punishments is the immediate and primary
cause of behavioral outcomes
Environmentalism
 = we are what we learn
 environmentalism dominated psychology until
1960s
 Postmodern secular culture tends to
underemphasize responsibility, thereby
generating a strange contradiction.
 On the one hand we have almost unlimited
freedom to choose.
 On the other, when things go wrong, it is
rarely our fault. Something or someone else
is to blame: poverty, discrimitation, a difficult
childhood, the educational system,
psychological abuse, the media, the
government, junk food, or any other of the
proliferating varieties of exculpation.
 An employee, fired for consistently showing
up late to work, sues his employers on the
grounds that he is a victim of „chronic
lateness syndrome“. The Economist noted
about the United States, „If you lose your job
you can sue for the mental distress of being
fired… if you drive drunk and crash you can
sue somebody for failing to warn you to stop
drinking. There is always somebody else to
blame.“

(Sacks, J., (2005) To Heal a Fractured World. The Ethics of Responsibility. Continuum, London, p. 182)
 „Nature is strong and she is pitiless. She
works in her own mysterious way, and we
are her victims. We have not much to do
with ourselves. Nature takes this job in
hand, and we play our parts.“
 1925, Clarence Darrow.
 The flight from responsibility into
victimhood is the oldest of all human
temptations
 „learned helplessness“