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jrr/HT10 Medical ethics: introduction Janet Radcliffe Richards Professor of Practical Philosophy University of Oxford Oxford Uehiro Centre for Practical Ethics

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Medical ethics: introduction. Janet Radcliffe Richards Professor of Practical Philosophy University of Oxford Oxford Uehiro Centre for Practical Ethics. Apprenticeship. Clinical practice. Explanation. Apprenticeship. Clinical practice. Explanation. Apprenticeship. - PowerPoint PPT Presentation

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Page 1: Medical ethics: introduction

jrr/HT10

Medical ethics: introduction

Janet Radcliffe RichardsProfessor of Practical Philosophy

University of Oxford

Oxford Uehiro Centre for Practical Ethics

Page 2: Medical ethics: introduction

jrr/HT10

Clinical practice

Apprenticeship

Page 3: Medical ethics: introduction

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Clinical practice

Apprenticeship Explanation

Page 4: Medical ethics: introduction

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Clinical practice

Current scientific beliefs

Apprenticeship Explanation

Page 5: Medical ethics: introduction

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Clinical practice

Current scientific beliefs

Descriptions of cases

Apprenticeship Explanation

Page 6: Medical ethics: introduction

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Page 7: Medical ethics: introduction

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Page 8: Medical ethics: introduction

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Page 9: Medical ethics: introduction

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Page 10: Medical ethics: introduction

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Clinical practice

Current scientific beliefs

Descriptions of cases

Apprenticeship Explanation

Page 11: Medical ethics: introduction

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Clinical practice

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

Page 12: Medical ethics: introduction

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Clinical practice

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

Page 13: Medical ethics: introduction

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Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

Page 14: Medical ethics: introduction

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

FACTUAL ISSUESDescriptions of cases

EnquiryApprenticeship Explanation

Page 15: Medical ethics: introduction

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

Page 16: Medical ethics: introduction

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

FACTUAL ISSUESDescriptions of cases

EnquiryApprenticeship Explanation

Page 17: Medical ethics: introduction

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Page 18: Medical ethics: introduction

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Page 19: Medical ethics: introduction

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Page 20: Medical ethics: introduction

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Page 21: Medical ethics: introduction

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Page 22: Medical ethics: introduction

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Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Current legal and professional

standards

FACTUAL ISSUES

VALUE ISSUES

Descriptions of cases

The elements of medical education

Page 23: Medical ethics: introduction

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Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Current legal and professional

standards

FACTUAL ISSUES

VALUE ISSUES

Descriptions of cases

The elements of medical education

Page 24: Medical ethics: introduction

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Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Current legal and professional

standards

FACTUAL ISSUES

VALUE ISSUES

Descriptions of cases

Moral enquiry

The elements of medical education

Page 25: Medical ethics: introduction

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What is medical ethics?

‘Ethics’ has two quite different meanings:

1. A particular set of standards. In this sense ‘medical ethics’ is the set of standards accepted as appropriate for doctors.

2. Moral philosophy: an enquiry into questions about moral standards, including what standards we ought to have.

Page 26: Medical ethics: introduction

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‘Ethical’ is ambiguous

• Sometimes it means ‘in line with accepted professional standards’

• Sometimes it means ‘morally right’

Page 27: Medical ethics: introduction

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Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Current legal and professional

standards

FACTUAL ISSUES

VALUE ISSUES

Descriptions of cases

Moral enquiry

The elements of medical education

Page 28: Medical ethics: introduction

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Disagreements and difficulties can come from either source

Page 29: Medical ethics: introduction

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The case of Dr Cox

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How Dr Cox might have defended his action

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 31: Medical ethics: introduction

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Different ways of challenging Dr Cox

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 32: Medical ethics: introduction

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Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 33: Medical ethics: introduction

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Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was not right to kill her

Page 34: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 35: Medical ethics: introduction

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Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She was being put under pressure by the family • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 36: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She was being put under pressure by the family • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was not right to kill her

Page 37: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 38: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • He could easily have controlled the pain by

consulting an expert colleague• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 39: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• She wasn’t in pain - just getting attention• She wanted to die • He could easily have controlled the pain by

consulting an expert colleague• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was not right to kill her

Page 40: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 41: Medical ethics: introduction

jrr/HT10

Different ways of challenging Dr Cox

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• Killing people or helping them to die is always

wrong-------------

So it was right to kill her

Page 42: Medical ethics: introduction

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Different ways of challenging Dr Cox

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• Killing people or helping them to die is always

wrong-------------

So it was not right to kill her

Page 43: Medical ethics: introduction

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The values determine which facts are even relevant

Page 44: Medical ethics: introduction

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How Dr Cox might have defended his action

• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled

the pain• People who are in uncontrollable pain and want

to die should be helped to do so-------------

So it was right to kill her

Page 45: Medical ethics: introduction

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The advance of science and technology increases the significance of value issues in practical

reasoning.

Page 46: Medical ethics: introduction

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Recent and current controversies

• Conjoined twins• Time limit for abortion• Sustaining patients in PVS• Fertility matters• Organ donors and the dying process

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Page 48: Medical ethics: introduction

Y2 Non-competent patient/ jrr/ Dec 2005

The ‘best interests’ principle

When a patient is not competent to consent to treatment, the doctor must act in the

patient’s best interests

Page 49: Medical ethics: introduction

Y2 Non-competent patient/ jrr/ Dec 2005

Treatment in the non-competent patient’s best interests

• Length of life?• Absence of pain?• Mental abilities/ level of awareness?• Physical abilities?• Appearance to relatives and friends?• Patient’s former character and wishes?

Which elements matter at all? e.g:

Page 50: Medical ethics: introduction

Y2 Non-competent patient/ jrr/ Dec 2005

Treatment in the non-competent patient’s best interests

Page 51: Medical ethics: introduction

Y2 Non-competent patient/ jrr/ Dec 2005

Page 52: Medical ethics: introduction

Y2 Non-competent patient/ jrr/ Dec 2005

Mill’s ‘Harm Principle’

…the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.

John Stuart Mill, On Liberty, 1859


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