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Ethics in Medicine
Zika Virus Case
A 20 year old female, a recent Honduran immigrant,
presents for evaluation of missed menstrual periods.
Her past medical and surgical history is
unremarkable, except for a brief flu-like illness one
month ago. She relates, through an interpreter, that
she is sexually active. Physical examination is
within normal limits except for an enlarged uterus.
Her pregnancy test is positive. A pelvic ultrasound
was ordered.
Fetal Ultrasonography at 19 Weeks of Gestation.
Driggers RW et al. N Engl J Med 2016. DOI: 10.1056/NEJMoa1601824
Magnetic Resonance Imaging of the Fetal Brain at 19 Weeks of
Gestation.
Driggers RW et al. N Engl J Med 2016. DOI: 10.1056/NEJMoa1601824
Stakeholders
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Patient(s)
Primary physician
MFM specialist
Neonatologist
State Health Officer
Governor
Family
• Spouse
• Society
Ethical Theories
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Consequentialism
Deontology
Virtue ethics
Utilitarianism
Ethics of care
Principlism
Principlism
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Beneficence
Nonmaleficence
Justice
Autonomy
Principlism
• Beneficence
– All actions should be for the good of the patient
– Assumes the patient’s interest is the sole focus of
any action
– Aligns with Kant’s Categorical Imperative
Principlism
“If the end of medicine is healing, a goal of
beneficence, then arguably medicine is fundamentally
a beneficent undertaking. If so, beneficence grounds
and determines the professional obligations and
virtues of the physician.”
Stanford Encyclopedia of Philosophy
Principlism
• Nonmaleficence
– No action should harm the patient
– Aligns well with the Hippocratic tradition
– "The physician must ... have two special objects in
view with regard to disease, namely, to do good or
to do no harm" (Hippocrates. Epidemics, book I, sect. 11, trans. Adams)
– More complex meaning in a modern context
Principlism
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Beneficence
Nonmaleficence
Justice
Autonomy
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Risk-Benefit Analysis
Principlism
• Justice
– Has both individual and collective dimensions
 All patients in like circumstances should be treated same way.
 The benefits and burdens of a society should be distributed
with equity.
– Strongly supported in human-subjects research
– Variable expression in direct patient care
Principlism
• Autonomy
– Recognizes the individual patient as an
independent moral agent
– Supports the right of self-determination
– Highly-valued in American culture
– Expressed in health care as informed consent
Is one theory sufficient?
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Casuistry
Consequentialism
Virtue ethic
Utilitarianism
Care ethics
Principlism
“We feel forward for what is to be hoped”
Jacob Bronowski (1908-1974)