1. Surviving Professional Life Ethically : A Perspective from the Idea of Respect for Persons Prof. Donna Knapp van Bogaert, PhD, D. Phil Steve Biko Centre for Bioethics February 21, 2007 10h00-11h00 GEMP

2. 2 Outline

3. 3 Outcomes

4. 4 Respect for Persons What does it mean to respect persons ? What does it mean to respect persons ? From where did the idea come that we should respect persons? From where did the idea come that we should respect persons? Ethical theory grounding respect for persons. Ethical theory grounding respect for persons. Case study & Example Case study & Example Arguments against; Difficulties facedrsons Arguments against; Difficulties facedrsons

5. 5 Case Study (1) You and four of your fellow medical students are on duty in a busy out-patient department (OPD). You and four of your fellow medical students are on duty in a busy out-patient department (OPD). You are all sitting writing up patient notes when your superior, a registrar, calls all of you over to the cubicle in which he is working. You are all sitting writing up patient notes when your superior, a registrar, calls all of you over to the cubicle in which he is working.

6. 6 On the examination table is a man who appears to be around 70 years old. On the examination table is a man who appears to be around 70 years old. His clothes are near the bed and you notice that they look like those typically worn by members of a conservative religious community. His clothes are near the bed and you notice that they look like those typically worn by members of a conservative religious community. You also observe that this elderly man is clearly embarrassed. You also observe that this elderly man is clearly embarrassed.

7. 7 The registrar is in the process of performing a digital rectal examination on him. The registrar is in the process of performing a digital rectal examination on him. “Hey guys, you’ve got to feel this”, the registrar exclaims, “you shouldn’t miss the rare opportunity of palpitating a tumor this size!” “Hey guys, you’ve got to feel this”, the registrar exclaims, “you shouldn’t miss the rare opportunity of palpitating a tumor this size!” And the five of you, in turn, proceeded to insert your fingers into the rectum of this man and perform a digital rectal examination. And the five of you, in turn, proceeded to insert your fingers into the rectum of this man and perform a digital rectal examination.

8. 8 In 2003, a BMJ article exposed that nearly ¼ of rectal and vaginal examinations were performed on anaesthetised patients by medical students without the patient’s knowledge or consent (Sokol 2004). In 2003, a BMJ article exposed that nearly ¼ of rectal and vaginal examinations were performed on anaesthetised patients by medical students without the patient’s knowledge or consent (Sokol 2004). Case Study (2)

9. 9 Commonalities Both involve medical students Both involve medical students Both involve patients Both involve patients Both involve medical hierarchy Both involve medical hierarchy Both have significant ethical dimensions Both have significant ethical dimensions

10. 10 Respect for Persons: Grounding All Relationships Origins Origins Applications to healthcare practice Applications to healthcare practice

11. 11 Immanuel Kant 1700’s 1700’s Philosopher Philosopher Logistician Logistician Teacher Teacher (Bachelor, extremely (Bachelor, extremely Punctual & invented garter contraption to keep his stockings up as they were always falling down).

12. 12 Kant’s Second Formulation of the Categorical Imperative Persons as ends-in-themselves Persons as ends-in-themselves To respect people is to treat them as ends in themselves. He sees people as autonomous (Gr. Self-rule; self-governance). To respect people is to treat them as ends in themselves. He sees people as autonomous (Gr. Self-rule; self-governance). The opposite of respecting people is treating them as mere means to an end. The opposite of respecting people is treating them as mere means to an end. Always treat persons (rational agents) as ends-in-themselves and never merely as means to your own ends. Always treat persons (rational agents) as ends-in-themselves and never merely as means to your own ends. Case Study Case Study

13. 13 Who or what should be respected For Kant, the proper object of respect is the will. So if we respect persons, our respect necessarily includes knowledge, freedom, choice – the things that are involved in having a will (wille). For Kant, the proper object of respect is the will. So if we respect persons, our respect necessarily includes knowledge, freedom, choice – the things that are involved in having a will (wille). Other possible objects of respect are Other possible objects of respect are Feelings and emotions Feelings and emotions People or things who are not living People or things who are not living Non-human Animals Non-human Animals All living entities included in the “natural world” All living entities included in the “natural world”

14. 14 Immanuel Kant One of Kant’s most enduring contributions to moral philosophy was his emphasis on the notion of respect. One of Kant’s most enduring contributions to moral philosophy was his emphasis on the notion of respect. From the notion that each human is of intrinsic value and as such deserves to be treated with respect, such notions as e.g. informed consent, confidentiality, & humane treatment are further supported. From the notion that each human is of intrinsic value and as such deserves to be treated with respect, such notions as e.g. informed consent, confidentiality, & humane treatment are further supported.

15. 15 Discussion Looking at the case study from a Kantian perspective : Respect for Persons Looking at the case study from a Kantian perspective : Respect for Persons Who are the role players? Who are the role players? What are their relationships? What are their relationships? Power – How does it fit into the picture? Power – How does it fit into the picture? What should students do if they observe unethical professional behavior? What should students do if they observe unethical professional behavior? What should ethical students do if they observe unethical behavior on the part of other students? What should ethical students do if they observe unethical behavior on the part of other students? What recommendations would you give to other students concerning ethically surviving student life? What recommendations would you give to other students concerning ethically surviving student life?

16. 16 STEP 1 WHAT IS THE PROBLEM? Formulate the ethical problem or dilemma STEP II KEEP AN OPEN MIND 1. AVOID solutions requiring NO THOUGHT on your part 2. TALK to others 3. Be responsive to appropriate FEELINGS or EMOTIONS 4. Be open to ALTERNATIVE UNDERSTANDINGS and VIEWS 5. Be open to the best impartial REASONS STEP III Ascertain information & facts relevant to the case. STEP IV Identify and weigh the ethical VALUES and STANDARDS applicable to the case STEP V Considering their relative weight, APPLY the ethical values and standards to the facts, and make a DECISION Professional declarations, oaths and codes HPCSA or other national guidelines, rules Religion, belief systems Precedents Society’s traditions Decision tree for complex ethical reasoning ACTION (act or omission) Environmental issues Consider what the LAW says

17. 17 Selected References Singer, M. 1961, Generalization in Ethics. NY: Alfred Knopf. Singer, M. 1961, Generalization in Ethics. NY: Alfred Knopf. Sokol, D.K. 2004. How to be a “good” medical student. Journal of Medical Ethics, 30612. Sokol, D.K. 2004. How to be a “good” medical student. Journal of Medical Ethics, 30612. van Bogaert, DK. 2005 Ethics & Moral Philosophy: A Reader. Pretoria: Dept of Family Medicine U Limpopo. van Bogaert, DK. 2005 Ethics & Moral Philosophy: A Reader. Pretoria: Dept of Family Medicine U Limpopo.

18. 18 Thank you