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Transcript
Ethics in the Practice
of Health Profession
Josefina S. Isidro-Lapeña MD, MFM
Associate Professor 3
UP College of Medicine
What is ETHICS ?

Branch of philosophy that examines rights
and wrongs, what should or ought to be
done


PL Nandi
Not synonymous with what is legal, moral
or standard of practice
What is ETHICS ?

System of thinking about choices or
decisions based on widely accepted
guidelines capable of working with
different moral, religious and cultural
values

HM Mitchell
What is ETHICS ?
A
GENERAL TERM THAT
REFERS BOTH TO
MORALITY
and
ETHICAL THEORY
What is MORALITY?
COMMON MORALITY
Refers to social conventions about right
and wrong human conduct that are so
widely shared that they form a stable
communal consensus
Ethical theories
Utilitarianism: consequences based
theory
 Obligation based theory
 Virtue based theory
 Rights based theory
 Community based theory
 Ethics of care: relationship based
 Case based reasoning: casuistry
 Principle based theories

CLINICAL ETHICS is
grounded in the belief that
medicine is an inherently moral
enterprise. Sick persons ask
physicians to help them get better
and physicians profess to be
morally committed and technically
competent to help the sick.
Panna L. Nandi
Arch Surg, 2000: 135
The 4 Principle Approach




Abstract rallying points for reflection
Starting foundational points NOT solely
sufficient nor final appeals
Must be contextualized – gives it meaning,
implications, complexity, limits, exceptions
and the like
Prima facie = binding unless they
conflict with obligations expressed in
another moral principle
RESPECT FOR AUTONOMY



Rooted in liberal traditions of individual
freedom
Innate right of a person to make choices
affecting his/her own life and welfare free
of coercion
NB: Implications of paternalism
NON MALEFICENCE



Primum non nocere (Above all do no
harm)
Obligation not to inflict harm intentionally
and not imposing risks of harm
Negligence of Professional standards of
care cause harm
BENEFICENCE


Moral obligation to act for the benefit of others;
to help others further their important and
legitimate interests
Distinguish ideal vs obligatory
Y is at risk of significant loss or damage to life or
health or some other major interest
 X’s action is needed to prevent this loss
 X’s action has a high probability of preventing the
loss
 X’s action would not present significant risk, cost
or burden to x
 The expected benefit for Y outweighs any harm
cost or burden to X

JUSTICE


FAIR EQUITABLE AND APPROPRIATE
treatment in light of what is due or owed
to persons
One who has a valid claim based in justice
has a RIGHT

Health promotion

Use of contraceptives

Abortion

False certificates

Drug detailing
ETHICAL DISCOURSE

JUSTIFICATION

SPECIFICATION

BALANCING/
OVERRIDING
Justification

Showing that one has sufficient reason for
the act



Deductive : top down
Inductive : bottom up
Coherentism : achieve coherence

All moral systems present some level of
indeterminateness and incoherence, they do not
have the power to eliminate various contingent
conflicts among principles and rule.
Dr. G has a PhD on biochemistry and is a
very good levelheaded researcher.
Unfortunately, one of his children needed
very expensive treatment that depleted
family savings and there is no end yet to
needed drugs. He was offered a rather
enormous salary if he will be part of a
team that will do research on developing
biochemical weapons for warfare.
Furthermore, if he will not agree it is likely
that a fanatic will be asked instead.
Specification
If a principle lacks
adequate
specificity, it is
empty and
ineffectual
Specification


Informed consent
“Always obtain oral or written consent for
any medical intervention with competent
patients EXCEPT in emergencies, low risk
situations and when patient waive the
right to adequate information”
Balancing/over riding


Deliberation and judgment about the
relative weight of norms
Prima facie obligations must be fulfilled
unless it conflict on a particular occasion
with an equal or stronger obligation.

Not subjectively but with use of Relevant factual
information
 The
decision making process
claims ethical validity for
statements that have been
subjected to rigorous and rational
analysis.
 This then becomes a better guide
to action, in important matters
than either one’s initial gut
reaction or blind adherence to
pre-existing rules.
The Professional

Health professional



Commitment to provide important services
Distinctive education and skills that patients
typically lack and that morally must be used
to benefit patients
Code of Professional Ethics

Articulated statement of the role morality of
the members of the profession
Four Focal Virtues of the
Health Professional
Compassion
Discernment
Trustworthiness
Integrity
ETHICS is a system of thinking about difficult
decisions.
Sometimes the particulars of a given situation
creates tension and both caregivers and patients
will have to determine which is paramount.
Ethical principles help us to avoid leaving important
considerations/ persons out of the decision
making process.
Mitchell HR
Health Care Ethics
But what is
TRUTH ? Is
truth
unchanging
law …We
both have
truths…are
mine the
same as
yours?