A character based as opposed to a principle based theory.
-deemphasizes rules, consequences and particular acts
Ideology that states that Persons must not be treated solely as a means to our ends - persons are ends in themselves
-absolute right and wrong
An action or principle is right if it produces greatest utility of good vs. evil for a group of people
-do which ever is the ultimate good despite the consequences
Looks at consequences of each individual act and calculates utility each time the act is performed.
-rules don't matter
-each situation is unique
Looks at the consequences of having everyone follow a particular rule and calculates the overall utility of accepting or rejecting the rule.
-can break rule only if utility is greater
Totality of character traits such as good, bad, or somewhere in between.
Ideology that believed there is absolute right and wrong as well as a necessity to consider consequences of individual choice.
Prima Facie Duty
-"at first sight"
-obligations must be fulfilled
-Can't always agree on right and wrong
Derives from the Greek work for "bedside"
The study of standards of right and wrong
-What we ought to do
What are the four principles of Bioethics?
What is autonomy?
a norm of respecting the decision-making capabilities of autonomous persons
Two conditions of autonomy
Liberty - independence from controlling influences
Agency - capacity for intentional choice
What is Beneficence?
An ethical obligation to act for the benefit of others
-a group of norms for providing benefits and balancing benefits against risks and costs.
-Who benefits from my actions and in what way?
What are the two principles of Beneficence?
Positive beneficence requires the provisions of benefits.
Utility requires that benefits and drawbacks be balanced
What is Nonmaleficence?
refrain from doing what damages the patient's interest.
-reduce or minimize harm
What philosopher used nonmaleficence?
-"Above all (or first) do no harm"
What is Justice?
the fair, equitable, and appropriate treatment in light of what is due or owed to a person.
Commonly held principles of Justice
To each person an equal share.
"To each person according"
- to need.
- to effort.
- to contribution.
- to free-market exchange.
Theory that uses previous cases to reach moral conclusions
-from cases to principle
Three areas of concern for Casuistry
Focus on cases-not clinician
What is distributive justice?
fair, equitable, and appropriate distribution in society
-determined by justified norms that structure the terms of social cooperation.
-(ex: goods and services, political and civil rights).
What is principlism?
defined principles as general guides that leave considerable room for judgment in specific cases and provide substantive guidance for the development of more detailed rules and policies.
-4 principles ANMJ
What came out of the Nuremburg Code of 1947?
-Informed consent -essential.
-Research- based on prior animal work.
-Risks justified by anticipated results.
-Only qualified scientists conduct research.
-avoid physical and mental suffering
-no research where death or disabling injury is expected
Three aspects of the Belmont Report
- Respect for Persons
Ethical Principles and Guidelines for Research Involving Human Subjects
A process of informing potential research participants about the research
-What they will be asked to do.
Two types of informed consent
Expressed- Directly and specifically given
Implied-Reasonably assumed from conduct
What is Disclosure?
Information necessary to make an informed judgment
Three methods of Disclosure
1. Reasonable physician standard
2. Reasonable Patient Standard
3. Subjective Standard
All health care professionals have a code of _____.
-Professional Ethics distinguishes the role of moral standards formulated from within from standards imposed by external bodies.
The ability to make a decision.
The LEGAL determination of the ability to make a decision.
Patient Self Determination Act
-The patient need not complete an advance directive.
-The Hospital must document in the patient's records.
-Capable patient may change or reject an AD any time (verbally or in writing.)
Four Surrogate Decision makers
2.Health Care Professionals
3. Institutional Ethics Committees
4. The Judicial System
Decisions to forego a particular treatment are best evaluated using the _______.
What is the most obvious ethical justification for withholding or withdrawing decisions?
-A judgment about the efficacy or futility of treatment.
-There is no moral obligation to:
-perform useless or futile treatments or
- continue life dependent on technology.
Death occurs when either:
1. Irreversible cessation of circulatory and respiratory functions, or
2. Irreversible cessation of all functions of the entire brain, including the brain stem
-cannot donate organs until "dead"
Two types of advanced directives
Living Will- provider controlled
Durable Power of Attorney-more flexible
*Patient Self Determination Act- PT controls
Intentional taking of another's life to promote a "good" or merciful death.
Can be voluntary or
What is Paternalism?
The physician compromising or overruling patient autonomy.
The Justice of war.
Jus ad bellum
-Justification for resorting to force as a means of achieving political objectives.
Jus in bello
Justice in war.
-Considerations on how a war is prosecuted.
-By What Means
-Treatment of Prisoners
Justice after war
Jus post bellum
-Considers how war is ended
-terms of peace
-reestablishment of "normal" life.
-e.g The Marshal Plan/ Iraq
not telling a patient of his/her condition because it will put the patient at risk
Hippocrates said " As to disease, make a habit of two things- ___ or at least ________.
do no harm.
-don't treat PT if medicine is "powerless" over disease
What is consequentialism?
When making a decision, the ends justify the means.
What came out of the Karen Quinlan case?
Decision to forgo life sustaining treatment
-privacy (liberty) gave the right to the family to withdraw treatment.
-Also gave legal immunity to attending physicians following the request of the family to withdraw life sustaining treatment.
What came out of the Larry MacAfee case?
-Right to die case
-absent conflicting state interests, competent adults have the right to refuse medical treatment.
What came out of the Elizabeth Bouvia case?
-a competent adult had the constitutional right to end their life.
What came out of the Nancy Cruzan case?
Decision to forgo life sustaining treatment
-Allowed the parents of woman in a PVS to direct her physician to remove her life support.
What came out of the Tuskegee Syphilis Study?
-use of human subjects in trials in heath care/science investigation
-how not to conduct research
- creation of the National Center of Bioethics at Tuskegee University
What is Supererogation?
-Acting above and beyond the call of duty.