Medical Ethics The study of moral values and judgments as they apply to medicine What is the right thing to do ? Ben Sturgess

Code of medical ethics 400 BC - Hippocratic Oath 1948 - Declaration of Geneva 2006 - Good Medical Practice

Declaration of Geneva http://www. donoharm. org. uk/gendecl Declaration of Geneva http://www.donoharm.org.uk/gendecl.htm Revised 2005 I solemnly pledge to consecrate my life to the service of humanity; I will give to my teachers the respect and gratitude that is their due; I will practice my profession with conscience and dignity; The health of my patient will be my first consideration; I will respect the secrets that are confided in me, even after the patient has died; I will maintain by all the means in my power, the honour and the noble traditions of the medical profession; My colleagues will be my sisters and brothers; I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; I will maintain the utmost respect for human life; I will not use my medical knowledge to violate human rights and civil liberties, even under threat; I make these promises solemnly, freely and upon my honour

Normative Ethical Theories Classifying actions as right or wrong Virtue Ethics Consequentialism Utilitarianism vs Egoism Deontology Duty based Ethics

Virtue Ethics Ethical Theories Plato, Aristotle, Thomas Aquinus Virtues - the behaviours that allow a good life. Arête Practical wisdom – the reasoning when two virtues are in conflict. Phronesis E.g. Compassion vs Honesty Flourishing – The outcome of practicing the wise and virtuous life. Eudiamonia

Virtue Ethics Are teleological – They involve ‘The meaning of life’ and so they are based in culture Cardinal Western Virtues Temperance To act in moderation Prudence To judge between actions Fortitude To confront fear and pain Justice Moderation between self and others

Virtue Ethics Are teleological – They involve ‘The meaning of life’ and so they are based in culture Christian Faith, Hope and Charity (Love) Corinthians 13:13 Romans Authority, Humour, Mercy, Dignity, Tenacity, Frugalness, Gravity, Respectability, Humanity, Industriousness, Dutifulness, Prudence, Wholesomeness, Sternness, Truthfullness Buddist Right Viewpoint, Values, Speech, Action, Livelihood, Effort, Mindfulness, Meditation Samurai Not to be outdone in Bushido, Be use to one’s master, Filial to ones parents, Manifest great compassion

Utilitarianism Ethical Theories Jeremy Bentham 1861 An action is determined solely by its contribution to overall utility – The Greatest Happiness Act – Look at potential actions and chose that which promotes greatest happiness Rule – Look at the rule that leads to action and chose the rule that if continually followed leads to the greatest utility – The rule of not killing people Karl Popper 1945 Negative Utilitarianism Do the Least Harm The relief of suffering

Deontology – Duty Based Ethical Theories Immanuel Kant – 1724-1804 Value of acts are not based on goodness or badness of outcomes. Prerogatives – Agents do not always seek the best outcome Constraints – Limitations on the actions that an agent can take Contingent duties (circumstantial) The Duties of a Doctor GMC 2006 Categorical imperative (absolute) Based on priori (independent of experience) reasoning about the nature of things. “the duty to promote human freedom and rationality”

The Values of Medical Ethics Benificence - Salus aegroti suprema lex Make the care of your patient your first concern Non-malificence - primum non nocere First do no harm Protect and promote the health of patients and the public Double Effect – You can act if your intention is in the patients best interest but leads to his demise

The Values of Medical Ethics Autonomy - Voluntas aegroti suprema lex The patient has the right to choose or refuse treatment Respect patients' right to reach decisions with you about their treatment and care The right of self determination Article 19 - Universal declaration of Human Rights Justice The distribution of scarce resources Egalitarianism – The equal distribution of resources Utilitarian Bioethics - QuALYs

The Values of Medical Ethics Dignity Treat patients politely and considerately Respect patients' right to confidentiality Honesty Be honest and open and act with integrity Informed Consent

Questions Do you have any ?

Discussion

Summary Codes of Ethics – Duties of a Doctor Ethical Theories Virtue Utilitarianism - Bentham Deontological – Kant Values of Medical Ethics - Framework Beneficence Non-maleficence Autonomy Justice Dignity Honesty

Further Reading http://en.wikipedia.org/wiki/Ethics Being Good – Simon Blackburn Oxford Paperbacks ISBN-10: 0192853775 Medical Ethics & Law: An introduction – Victoria Tippett Radcliffe Publishing ISBN-10: 1857758943