ETHICSETHICS

Foundation of BioethicsFoundation of Bioethics

TOPIC OUTLINETOPIC OUTLINE

DefinitionDefinition Human ActsHuman Acts

DefinitionDefinition ElementsElements ModifiersModifiers NormsNorms

LawLaw ConscienceConscience

Sanctity of Human LifeSanctity of Human Life Universal Principles of Biomedical EthicsUniversal Principles of Biomedical Ethics

DEFINITIONDEFINITION

““bios”bios” - life + ethics - life + ethics Application of ethics to biological Application of ethics to biological

sciences, medicine and related fieldssciences, medicine and related fields A systematic study of human A systematic study of human

behavior specifically in the fields of behavior specifically in the fields of life sciences and health care, as life sciences and health care, as examined in the light of moral values examined in the light of moral values and principlesand principles

HUMAN ACTSHUMAN ACTS

Actions that proceed from the Actions that proceed from the deliberate free will of mandeliberate free will of man

* Acts of man – actions that do not * Acts of man – actions that do not require man’s rationalityrequire man’s rationality

ElementsElements

KnowledgeKnowledge

FreedomFreedom

VoluntarinessVoluntariness

ModifiersModifiers

IgnoranceIgnorance ConcupiscenceConcupiscence FearFear ViolenceViolence HabitHabit

IgnoranceIgnorance

Absence of knowledge in a person Absence of knowledge in a person who is required to know what he who is required to know what he does not knowdoes not know*Innocence – absence of knowledge in *Innocence – absence of knowledge in

person who is not required to know what person who is not required to know what he doesn’t knowhe doesn’t know

ConcupiscenceConcupiscence

Refer to emotions and feelings of man Refer to emotions and feelings of man in relation to his actions, Passionsin relation to his actions, Passions

Concupiscible passions Concupiscible passions Inclined to favor good as their objectsInclined to favor good as their objects

Irascible passionsIrascible passions Perceived by the sensation as evilPerceived by the sensation as evil Offer hardship in the acquisition of their Offer hardship in the acquisition of their

objectsobjects

FearFear

Induces the will to do what it would Induces the will to do what it would not do otherwisenot do otherwise

Emotion that apprehends evil and Emotion that apprehends evil and manifests itself in the desire to get manifests itself in the desire to get away, avoid, or escape as far as away, avoid, or escape as far as possible, from the impending threatpossible, from the impending threat

ViolenceViolence

Application or use of physical power Application or use of physical power or external force on a person by or external force on a person by another for the purpose of another for the purpose of compelling him to do something compelling him to do something against his willagainst his will

HabitHabit

A constant and easy way of doing A constant and easy way of doing things acquired by repetition of the things acquired by repetition of the same actsame act

NormsNorms

set of directives that guide us in set of directives that guide us in making decisions on what we ought making decisions on what we ought to do or to be, dictated LAWS and our to do or to be, dictated LAWS and our own CONSCIENCEown CONSCIENCE

LawsLaws

an ordinance of reason promulgated for an ordinance of reason promulgated for the common good by one who has the common good by one who has legitimate authoritylegitimate authority

an authoritative order that is just, honest, an authoritative order that is just, honest, useful to a certain degree of permanency, useful to a certain degree of permanency, promulgated or made known to the promulgated or made known to the subject, and can possibly be fulfilled.subject, and can possibly be fulfilled.

is a body of authoritative rules by which is a body of authoritative rules by which civilized society regulates the conduct of civilized society regulates the conduct of its membersits members

Classifications of LawClassifications of Law

Not enforced by stateNot enforced by state Eternal LawEternal Law

Divine reason or will commanding the Divine reason or will commanding the preservation of the natural order of things preservation of the natural order of things and forbidding its disturbanceand forbidding its disturbance

Applies intrinsically and absolute Applies intrinsically and absolute perfection in every human actperfection in every human act

Model of all lawsModel of all laws

Classifications of LawClassifications of Law

Not enforced by stateNot enforced by state Natural LawNatural Law

Eternal law as known to humans through reasonEternal law as known to humans through reason Neither communicated in a supernatural way nor Neither communicated in a supernatural way nor

as a result of a command of legislature or as a result of a command of legislature or authorityauthority

Derived from the very nature of human beings, Derived from the very nature of human beings, identical to God’s willidentical to God’s will

Properties:Properties: Universal – binds every person at all times and in all placesUniversal – binds every person at all times and in all places Immutability – unchanging Immutability – unchanging Indispensability – no one is dispensed or excused from its Indispensability – no one is dispensed or excused from its

observanceobservance

Classifications of LawClassifications of Law

Not enforced by stateNot enforced by state Moral lawMoral law

Dictate of one’s conscience to be the right Dictate of one’s conscience to be the right conductconduct

Classifications of LawClassifications of Law

Enforced by state as to purposeEnforced by state as to purpose Substantive lawSubstantive law

Prescribes the right and obligations of Prescribes the right and obligations of persons with each other and with societypersons with each other and with society

Procedural lawProcedural law aka adjective or remedialaka adjective or remedial Concerned with mechanical rules that Concerned with mechanical rules that

govern the means by which substantive govern the means by which substantive rights and duties are vindicated & enforcedrights and duties are vindicated & enforced

Classifications of LawClassifications of Law

Enforced by state as to subject-Enforced by state as to subject-mattermatter Public lawPublic law

Regulates the relationship between state Regulates the relationship between state and subjectand subject

Private lawPrivate law Regulates the relationship of individualsRegulates the relationship of individuals

ConscienceConscience

Is the practical judgement of reason Is the practical judgement of reason upon an individual act as good and to upon an individual act as good and to be performed, or as evil and to be be performed, or as evil and to be avoidedavoided

Judgement on the goodness or Judgement on the goodness or evilness of the action, not on its evilness of the action, not on its usefulness or other practical usefulness or other practical considerationsconsiderations

Concepts of ConscienceConcepts of Conscience

Heteronymous conscience Heteronymous conscience Is tied to normative ethics, focusing Is tied to normative ethics, focusing

solely on laws and obligations, solely on laws and obligations, commands and prohibitionscommands and prohibitions

Autonomous conscienceAutonomous conscience Is totally subjective, ignores the law Is totally subjective, ignores the law

and determines by itself what is right and determines by itself what is right and what is wrongand what is wrong

Levels of ConscienceLevels of Conscience

AntecedentAntecedent Whole process of making a judgement in Whole process of making a judgement in

conscience before the moral actconscience before the moral act ConcomitantConcomitant

Actual awareness of being morally Actual awareness of being morally responsible for the goodness or the badness responsible for the goodness or the badness of the particular which we are carrying out.of the particular which we are carrying out.

ConsequentConsequent Process of reflection on one’s moral Process of reflection on one’s moral

responsibility relative to past actions.responsibility relative to past actions.

SANCTITY OF HUMAN LIFE SANCTITY OF HUMAN LIFE

Religious ApproachReligious Approach Human life has dignity and there is Human life has dignity and there is

something sacred about it because it something sacred about it because it comes from Godcomes from God

Rational/Humanistic ApproachRational/Humanistic Approach The idea of sacredness of life is The idea of sacredness of life is

generated by the experience of being generated by the experience of being alive and of the experiencing the alive and of the experiencing the elemental fear of extinctionelemental fear of extinction

UNIVERSAL PRINCIPLES OF UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICSBIOMEDICAL ETHICS

Autonomy / Self-DeterminationAutonomy / Self-Determination Veracity / Truth-tellingVeracity / Truth-telling BeneficenceBeneficence NonmaleficenceNonmaleficence ConfidentialityConfidentiality JusticeJustice Role FidelityRole Fidelity

Autonomy / Self-DeterminationAutonomy / Self-Determination ““autos”autos” – self, “ – self, “nomos” – nomos” – governancegovernance The individual is free to choose and The individual is free to choose and

implement one’s own decision, free from implement one’s own decision, free from deceit, duress, constraint, or coerciondeceit, duress, constraint, or coercion

3 basic elements: 3 basic elements: Ability to decide, The Ability to decide, The power to act upon your decisions and a power to act upon your decisions and a Respect for the individual autonomy of Respect for the individual autonomy of othersothers

* * PaternalismPaternalism – intentional limitation of the autonomy – intentional limitation of the autonomy of one person by another, where the person who of one person by another, where the person who limits the autonomy appeals exclusively to limits the autonomy appeals exclusively to grounds of benefit to the other persongrounds of benefit to the other person

Veracity / Truth-tellingVeracity / Truth-telling

Binds both the health practitioner Binds both the health practitioner and the patient in close association and the patient in close association of truthof truth

BeneficenceBeneficence

Acts of mercy or charity, may Acts of mercy or charity, may include any action that benefits include any action that benefits anotheranother

NonmaleficenceNonmaleficence To refrain from inflicting harmTo refrain from inflicting harm Primum Non NocerePrimum Non Nocere – “First do no harm” – “First do no harm”

*Principle of Double Effect *Principle of Double Effect The course chosen must be good or at least The course chosen must be good or at least

morally neutralmorally neutral The good must not follow as a consequence The good must not follow as a consequence

of the secondary harmful effectsof the secondary harmful effects The harm must never be intended but merely The harm must never be intended but merely

tolerated as casually connected with the tolerated as casually connected with the good intendedgood intended

The good must outweigh the harmThe good must outweigh the harm

ConfidentialityConfidentiality

Include the American Hospital Include the American Hospital Association’s Patient’s Bill of Rights rules Association’s Patient’s Bill of Rights rules 5 and 6 right of privacy5 and 6 right of privacy

5. The patient has the right to every 5. The patient has the right to every consideration of his privacy concerning his consideration of his privacy concerning his own medical care program. Case discussion, own medical care program. Case discussion, consultation, examination, and treatments consultation, examination, and treatments are confidential and should be treated are confidential and should be treated discreetly. Those not directly involved in his discreetly. Those not directly involved in his case must have permission of the patient to case must have permission of the patient to be presentbe present

6. The patient has the right to expect that all 6. The patient has the right to expect that all communications and records pertaining to his communications and records pertaining to his care should be treated as confidentialcare should be treated as confidential

JusticeJustice

Aristotle : “Equals must be treated Aristotle : “Equals must be treated equals and un-equals must be treated equals and un-equals must be treated un-equals” un-equals”

WHO definition: “A state of complete WHO definition: “A state of complete physical, mental and social well being, physical, mental and social well being, and not merely the absence of and not merely the absence of infirmity”infirmity”

*Compensatory justice – individuals seek *Compensatory justice – individuals seek compensation for the wrong being donecompensation for the wrong being done

*Retributive justice – calls for equal suffering*Retributive justice – calls for equal suffering

Role FidelityRole Fidelity

Requires the practitioner to practice Requires the practitioner to practice faithfully within the constraints of faithfully within the constraints of the rolethe role