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Introduction to Medical Law, Ethics, and Bioethics Chapter 1 Medical Law and Ethics, Third Edition Bonnie F. Fremgen Why Study Law, Ethics, and Bioethics? Illegal is almost always unethical Basic understanding of law as it applies to medical practice is essential Helps protect employee and employer from lawsuits Assists medical professional in making decisions based on reason and logic rather than on just emotion Medical Law and Ethics, Third Edition Bonnie F. Fremgen Medical Law Addresses legal rights and obligations that affect patients and protect individuals, including health care employees Provides yardstick to measure actions Punishes unlawful actions Medical Law and Ethics, Third Edition Bonnie F. Fremgen Medical Practice Acts Apply to how medicine is practiced in individual states Define meaning of the practice of medicine in that state – – List requirements and methods for licensure Define what constitutes unprofessional conduct Medical Law and Ethics, Third Edition Bonnie F. Fremgen What Ethics Is Not Not about how you feel Not about sincerity of beliefs Not about emotional response Not only about religious beliefs Medical Law and Ethics, Third Edition Bonnie F. Fremgen Ethics Branch of philosophy related to morals, moral principles, and moral judgment Uses reason and logic to analyze problems and find solutions Concerned with actions and practices that improve welfare of people in a moral way 4 Mainstream Theories: Rights-based, Duty-based, Utility-based, Virtuebased Medical Law and Ethics, Third Edition – Bonnie F. Fremgen Medical Ethics Concerns issues related to practice of medicine Explores and promotes principles regulating conduct of health care professionals Involves consideration of others in deciding how to act Medical Law and Ethics, Third Edition Bonnie F. Fremgen Utilitarianism Greatest good for the greatest number Impact of actions on welfare of society as a whole Utilitarianism is forward looking – choose the option that brings about the overall better consequences. Each individual has equal worth (1/the number of people) Ends justify the means When a course of action will lead to overall better results (the ends), how you get there will not be relevant (the means). Medical Law and Ethics, Third Edition Bonnie F. Fremgen Duty-Based Ethics Focuses on performing duty Explores conflicts among duties A duty is not what one ought to do because someone else says you ought to do it. A duty is what one ought to do because reason dictates that you ought to do it in such and such circumstances. (respect persons vs respect yourself) Example: We respect patient’s wishes to honor their human dignity not because of the overall consequences. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Virtue-Based Ethics Emphasis on character traits, not on decisions or principles involved Seeking the “good life” or how one ought to be Examples: being fair, honest, … Medical Law and Ethics, Third Edition Bonnie F. Fremgen Rights-Based Ethics Emphasis on individuals’ rights Rights belong to all people Medical Law and Ethics, Third Edition Bonnie F. Fremgen A SIDE NOTE ON “RIGHTS” Rights talk often disguises as other kinds of ethical theories Look to the reasons why we ought to have such a right to reveal the kind of ethical theory supporting it: For example, we have a right to privacy because Medical Law and Ethics, Third Edition Bonnie F. Fremgen it will lead to a better democracy (utilitarian) that would respect persons and promote human dignity (duty-based) it is an entitlement from the constitution (social-based theory of ethics that is not discussed in the textbook) Because it is the fabric of the universe (rights based theory) Values That Drive Ethical Behavior Beneficence Fidelity Gentleness Humility Justice Do No Harm Trust Further Science ….. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Perseverance Responsibility Sanctity of life Tolerance Work Non-Judgmental Regard Professional Competence Interpersonal Ethics Respect Empathy Integrity Sympathy Honesty Compassion Fairness Loyalty Medical Law and Ethics, Third Edition Bonnie F. Fremgen Health care professional demonstrating empathy Figure 1-1 Medical Law and Ethics, Third Edition Bonnie F. Fremgen All patients are entitled to compassionate care Figure 1-2 Medical Law and Ethics, Third Edition Bonnie F. Fremgen Workplace Issues Privacy, or confidentiality Due process Sexual harassment Comparable worth Medical Law and Ethics, Third Edition Bonnie F. Fremgen Three-Step Ethics Model 1. Is it legal? 2. Is it balanced? 3. How does it make me feel? 1. 2. Think of your gut reaction not as evidence that something is wrong but as an initial prompt to pursue a concern further The other models then serve as a further guide. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Dr. Bernard Lo’s Clinical Model Gather information Clarify the ethical issues Resolve the dilemma Medical Law and Ethics, Third Edition Bonnie F. Fremgen Seven-Step Model for Examining Ethical Dilemmas 1. 2. 3. 4. 5. 6. 7. Determine the facts Define the precise ethical issue Identify the major principles, rules, and values Specify the alternatives Compare values and alternatives Assess the consequences Make a decision Medical Law and Ethics, Third Edition Bonnie F. Fremgen QUESTIONS? Medical Law and Ethics, Third Edition Bonnie F. Fremgen