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?