1. Bioethics Defined The study of ethical and moral issues related to the practice of medicine The study of moral conduct, right and wrong, Thus by definition NORMATIVE Norms are standards of societies that guide behavior

2. Bioethical Problems Technology and its use/nonuse Beginnings and endings of life Choice and rights Confidentiality and consent Relationships, power Much the same issues as the sociological

3. Types of bioethical views Utilitarianism—act and rule Kantian deontology Communitarian ontology Rights based (social justice)

4. Biomedical ethics Balfour Report Respect for autonomy Non-malfeasance Beneficence Social justice

5. Utilitarian Theory Utilitarianism—Greatest happiness principle—not individual happiness Consequence matters—only the end result matters Empirical, long term viewpoint, equity Cannot calculate happiness always Conflicts with set moral values

6. Rule Versus Act Utilitarians Rule --Formulates moral rules from the happiness equation to use later, case based Act– Applies calculus of happiness to each specific set of facts

7. Kantian Ethics Emmanuel Kant Consequences are important BUT how things happen –the procedure of social interaction– is important to ethics too Requires reasoning, abstractions and prior thought Dignity of man

8. Kantian Ethics Rights based, humanist Categorical imperative– Can I, as a rational agent, consistently will that everyone in a similar situation act in a particular way?

9. Social Contract What are we, as medical people, required to do? Parties to a contract; obligations of each A combination of rights and responsibilities Borne of the liberal rights era (1700s) Hobbesian (pragmatic) versus Kantian (equity)

10. Rights-based Legal Ethics Legal heritage Code versus case based Power of the state, responsibility of the state Individual focused Partially ignores the consequences of acts Includes issues of Feminism and Race

11. Communitarian Ethics Application of reason to ethical issues Community paramount interest Responsibilities before rights Individual action controlled

12. Non-moral Considerations Economic—Marxian Political

13. Example Health Reform Increases the general happiness (?) Legal considerations Processes for individual dignity Social justice (?) for whom

14. Summary Many differing ethical principles and theories All interact in some way to describe and drive principled actions by caregivers and patients Main theories are Kantian, utilitarian and social justice (rights based)