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Introduction to Medical Ethics
Ray Noble
Centre for Reproductive Ethics and Rights
UCL Institute for Women’s Health
University College London
Moral and Ethical Responsibility
What is Ethics?
Moral and Ethical Responsibility
How best we may deal
with conflicting moral
decisions or actions
Moral and Ethical Responsibility
Ethics usually considers
alternative courses of
action in relation to moral
imperatives.
Moral and Ethical Responsibility
Ethics is a systematic
approach to decision
making
Moral and Ethical Responsibility
Ethics is NOT simply
following ‘the rules’
Moral and Ethical Responsibility
How can I act in the ‘best
interests’ of my patients
and my community?
Moral and Ethical Responsibility
How best can I fulfil
duties to my patients and
my community?
Moral and Ethical Responsibility
Ethics is a) analytical and
b) practical
Moral and Ethical Responsibility
Ethics seeks to set up
‘guidelines’ for good
practice. But ethical
practice is case-sensitive.
‘All humans are equal’
Consider this simple
analytical problem. Is this
an ethical statement?
‘All humans are equal’
But we are not equal! We
are all different with
different abilities and
needs.
‘All humans should be treated
equally’
Is this an ethical
approach?
‘All humans should be treated
equally’
But this would be unfair
because we are not the
same! Ethics should take
account of our
differences.
‘All humans should be treated
Fairly’
Is this an ethical
approach?
‘All humans should be treated
Fairly’
This looks better. So now
we need to define what
we mean by ‘fairly’
‘All humans should be given an
equal consideration of their
interests.
This says that we should
a) treat our patients as
individuals and b)
consider their interests as
individuals.
‘All patients should be given an
equal consideration of their
interests.
This says that we should
a) treat our patients as
individuals and b)
consider their interests as
individuals.
The ethical doctor – ethical tools
Consequences
Duties
Benefits
To whom?
Harms
How extensive?
The ethical doctor – ethical tools
First define the ethical dilemma
Consequences
Duties
Benefits
To whom?
Harms
How extensive?
A premature baby
A baby born prematurely at 24 weeks is put in
intensive care. She is not thriving and scans
suggest she has profound brain damage. She
cannot breathe unassisted and the care team
believe she is suffering and it is not in her best
interest to keep her alive. The parents do not
agree. What should the clinicians do?
The ethical doctor – ethical tools
Consequences
Duties
Benefits
To whom?
Harms
How extensive?
Principles
Four fundamental principles are often applied in modern medical ethics:
Respect for individual autonomy – individuals are regarded as moral agents
with duties and obligations and the capacity to understand and make
ethical decisions.
Principle of beneficence – seek to do good
Principle of non-maleficence – avoid doing harm
Principle of Justice – people should be treated fairly.
Beauchamp, T.L and Childress, J.F. Principles of biomedical ethics (5th
Edition, 2001).
Autonomy and informed consent
A pregnant woman decides to have a triple marker test for Down’s
screening. After she has given the blood she decides she does not want
to know the result as she wants to have the baby. The test result shows a
high risk of Down’s syndrome. The clinician feels there will be a high
social and economic burden on the family and would like to convey the
test result to the patient to inform her decision making. What should the
obstetrician do?
Case scenario
1 ) What are the major ethical dilemmas?
2) Consequences: what are the consequences of any given course of action?
Consider both benefits and harms
3) Duties and Obligations: what are the duties of the clinician? Is this a case of
conflict of duties? To whom does the clinician owe these duties? If so how best
can this dilemma be resolved?
4) Consider the categorical imperatives. Is this a case of respect for autonomy
and informed consent? If so are there sufficient grounds to ignore her
wishes?
5) Application of principles.
How might the four key ethical principles of ethical clinical practice be applied?
Autonomy and informed consent
You are a doctor working in a busy practice in London, UK. One of your
patients is a fifteen year old girl who has come to see you to ask advice
about contraception and sexually transmitted diseases. She explains that
she has a regular boyfriend with whom she is now having sexual
intercourse. At age fifteen in the UK she is considered a minor.
Introduction to Medical Ethics
Ray Noble
Centre for Reproductive Ethics and Rights
UCL Institute for Women’s Health
University College London