What is the Hippocratic Core Principle?
Physician should benefit pt. according to physician's best judgement.
What are the 4 Hippocratic-like codes (wording)?
1. Declaration of Geneva
2. SUNY + SGU Codes
3. Florence Nightingale Pledge
4. Solemn Oath of Russian Physician
3 Hippocratic-like codes (principle only)
1. BMA Code of Ethics
2. AMA Code of Ethics (1847)
3. Percival's Code
What are the 5 non-Hippocratic codes (1980s)?
1. AMA - 1980 --> First major break from Hippoc. O.
(affirming pt. rights > patriarchal physician)
2. Children's Medical Association
3. American Nurse's Association
4. Federal Council of Medicine, Brazil
5. New Zealand Medical Assoc
What document provided a non-hippocratic solution to ethical research?
Nuremberg Code (research ethics)
- OK to experiment on pts. w/ INFORMED CONSENT
What are 5 codes outside of medicine that are non-hippocratic?
1. Soviet Oath of Physicians (1971)
2. AHA Pt Bill of Rights
3. US Consumers Bill of Rights
4. European Council on Human Rights
5. LIBERAL POLITICAL PHILOSOPHY (Kant)
What is UNESCO?
Universal Declaration on Bioethics and Human Rights
- guidelines for ethical practice of international medicine
What do all non-hippocratic codes have in common?
1. Concern with Pt. Rights & Social Welfare
2. Non-health professional groups (usually)
3. Duty/Rights > Consequentialism (may harm pt.)
T/F - Hippocratic codes are focused with Individualized Consequentialism
Focus of AMA Code 1957?
Focus of AMA Code 1980?
Duty-based, Social Welfare/Pt Rights
Focus of AHA Pt. Bill of Rights?
Individual Duty & Pt. Rights
What is Speciesism?
One's species determines level of moral standing
What are the 3 definitions of death?
Loss of moral standing occurs when:
1. Cardiac-oriented -> irrev. stop of circul + resp.
2. Whole-Brain view -> irrev. stop of brain/brainstem
3. Higher-Brain view -> irrev. loss of "consciousness"
Which definition of death is predominant?
- True death = no brainstem f(x)
Jurisdictions that don't use whole-brain view of death?
1. Japan - life w/i entire body
2. NJ/NY - orthodox jews believe life = breath (resp.)
What is the general reasoning behind okaying abortion?
Okay as long as fetus has NO moral standing
Potential vs. Capacity
Genetic program to dev. ability to carry out f(x)
Actual ability to carry out biologic f(x)
What are 3 consequentialist principles?
Beneficence = Do Good
Non-Maleficence = Do no harm
Utility = Do Good + Do no harm
Principle vs. Virtue
general moral characteristic of an action
moral characteristic of a person
Hippocratic Principle vs. Modern Medicine vs. Postmodern/Contemporary Medicine?
Subjective Judgement --> Objective Judgements --> Objective as possible w/ "Value Judgements"
+ more focused on pt. rights
List 4 goals of medicine that may conflict?
1. Saving lives
2. Curing disease
3. promoting health
4. relieving suffering
Hippocratic Oath vs. Primum no Nocere
Do good + Do no Harm -> max benefit + min harm
Firstly, Do no Harm -> worse TTx = most harm
Arithmetic vs. Geometric Combining (of hippocratic consequentialism)
Benefits - Harms = Judgement
Benefits : Harms RATIO Maximization = Judgement
4 Respect for Persons principles (DUTY-BASED)
1. Fidelity - confidentiality/loyalty
2. Autonomy - informed consent
4. Avoid Killing
Consequentialist vs. Duty-based views on Fidelity?
HO - okay to disclose if benefits for pt > harms
Duty-based = Never violate pt. confidentiality
Codes not permitting disclosure + exceptions
1. World Medical Association - NO exceptions
2. BMA (post 1971) - pt. permission & lawful reporting
3. AMA (post 1980) - harm self/others & lawful reporting
Consequentialist vs. Duty-based views on Autonomy
HO - no mention of Autonomy -> Therapeutic Princip.
DB - Always inform the pt.
Emerging consensus regarding Informed Consent?
Use Reasonable Person Std. + Subjective Pt. Std.
- disclose what you think is reasonable + what pt. would want to know
Describe evolution of Informing Standards.
Professional std -> Reasonable Person std -> Subjective std (what sp. patient would want to know)
justified moral/legal claims to entitlements/liberties
- Rights > Consequences
What are Negative Rights?
Liberty Rights - i.e. right to be left alone (freedom)
What are Positive Rights?
Entitlement Rights - i.e. right to a service
Nathanson vs. Kline
Ruling: Pt. is master of his body and should have INFORMED CONSENT to decide whether they want to refuse TTx.
Canterbury vs. Spence
Ruling: Informed Consent > Therapeutic Privilege
Consequentialist vs. Duty based view on Veracity?
HO - tell or w/h truth depending on benefits/harms
DB - Always tell the truth to the pt.
Examples of Active Killing vs. Letting Die (Passive Killing)?
Homicide, Assisted Homicide, Assisted Suicide
Withholding life support, Withdrawing life support
Where is Assisted Homicide legal?
Netherlands & Belgium
2 Arguments for Active Killing = Passive Killing (tolerance of both)
Consequentialist: person dies either way
DB: Autonomy = pt. has right to choose
3 Arguments for distinguishing Active vs. Passive killing (tolerate passive only)
1. Consequentialist: active killing = worse consequences
- more deaths
- society may become tolerant of killing
2. DB - Autonomy does not give Dr. right to actively kill
3. Active Killing = inherently wrong
Direct vs. Indirect killing?
- active = typical murder
- passive = knowingly let death happen
- active = killing as side effect of intention to ttx
- passive = forgoing life support
Ordinary vs. Extraordinary measures
Benefits > Harms
- always required
- can be high-tech, complex
Benefits < Harms
- can be low-tech, simple
3 classifications of incompetent pts.
1. Formerly Competent
2. Never competent + family/guardian
- includes formerly competent but NO AD
3. Never competent (no family/guardian)
- includes John Doe
How to TTx Formerly Competent pt. (moral & legal principles)
Moral Principle = "Autonomy Extended"
- via Advanced Directive (Substantive or Proxy)
Legal Principle = "Substituted Judgement"
- guided by pt's desires
How to TTx John Doe (never competent + no famly)
Moral Principle = "Hippocratic Utility" (unkn. Autonomy)
- based on Surrogate's judgement
- HEC, Attending Physician, Guardian ad Litem
Legal Principle = "Best Interest Std"
- should guide Surrogate decision
How to TTx Incompetent w/o AD but w/ Family
* Next of Kin speaks for pt. (unless deemed malicious)
Moral Principle = Limited Familial Autonomy
Legal Principle = Limited Familial Autonomy
Name 2 problems with Social Utility (Consequentialist)?
1. Quantification Problem - hard to quantify net good/bad
2. Inequity problem - Diff people get diff TTx (complicates quantification further)
What is the principle of Social Justice?
** Actions justified if they strive for a fair/efficient distribution
- typically NEED-based (concerned w/ pt. WELL-BEING)
What is the principle of Social Utility?
** Actions justified if they maximize NET GOOD
- typically EFFICIENCY-based
- Good outcomes > Individual Pt. harms
What are 4 theories for resolving competing principles?
1. Single-Principle Theory (pick one as best)
2. Balancing Theories
3. Ranking Theories
4. Ranking + Balancing Theories
Prima Facie vs. Duty Proper
Prima Facie = duties you're balancing
Duty Proper = duty that wins out
Drawback of physicians allocating resources?
Must abandon pt. centered ethic to increase benefit to others
Drawback of non-physicians allocating resources?
Give up decision-making power.