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PHCY 210 > Ethics > Flashcards

Ethics Flashcards

1
Q

What is ethics?

A
  • Ethics is about how we should live
  • All cultures have ideas about things that are right or wrong
    • these ideas are universal; part of being human
    • But they may vary over time/culture
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2
Q

What is bioethics?

A
  • The study of ethical controversies and dilemmas in medicine and the life sciences
  • Interdisciplinary
    • Medicine, science, politics, law, philosophy, theology, sociology
  • Applied ethics - applying theories to actual ethical problems to determine the best method and/or outcome
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3
Q

Where do ethical problems come from?

A

Somebody neglects values/transgresses a norm

  • Cheating on exams
  • Poisoning a patient to kill them

We encounter a situation that is

  • Autonomous vehicles
  • Genetic engineering

There is a conflict in values

  • Circumcision
  • Abortion
  • Chemical castration of sex offenders
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4
Q

Where do our values come from

  • A good life, ethically speaking, is one that is consistent with the values we hold
A

A variety of places

  • Family/upbringing
  • Culture/society
  • Friends/peer group
  • Our basic nature
  • Religion
  • Past Decisions
  • Intuitions
  • Social Media
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5
Q

Ethical Reasoning

A
  • People need reasons to act: a reason is an idea, however vague, of what to do and why
  • Ethical reasoning = Articulating the reasons for your actions, and testing them against other reasons (We do this all the time)
  • We wont necessarily come to a consensus - there might be ongoing debate , but debate will
    • Help to identify those values that are in common (and those that aren’t) and
    • may find a mutually acceptable compromise
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6
Q

Ethical Reasoning and healthcare

A
  • Good health professionals articulate why they do what they want to do and engage in ethical dialogue with others
  • Good decisions are those that best uphold the relevant values
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7
Q

Cartwright Inquiry (NZ, 1988)

A
  • National Womens Hospital (1950s-1980s)
  • Lack of treatment for abnormal cervical cancer cells
  • No consent
  • Health and disability commission
  • Code of Health and Disability Services Consumers Rights
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8
Q

Concepts

  • The most common way of approaching ethics, but not the only way
A
  • Autonomy
  • Beneficence
  • Non-Maleficence
  • Justice
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9
Q

Autonomy

A
  • Self-rule: The freedom to make your own decisions about matters concerning your ‘person’
  • Relates to
    • Informed consent
      • Honesty
      • Competency
    • Respect
    • Confidentiality (inc. data protection)
  • What should be the scope of a persons freedom, especially if her choices affect others
  • How much should health professionals influence a patients decision?
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10
Q

Beneficence

A
  • Doing good - protecting and promoting wellbeing

Common difficulties

  • What counts as a benefit eg amputation of a healthy limb
  • Long term v. short term
  • Therapeutic uncertainty
  • Who should benefit eg giving sedatives to disruptive rest home residents
  • Balancing risks and harms
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11
Q

Non-Maleficence

A
  • The duty not to inflict harm on others
  • Hippocratic Oath= first do no harm
  • Many medical interventions involve harming the patient, so harms and benefits must be weighed against each other
    • Minimise harm
  • Common difficulties
    • Similar to beneficence eg what counts as a harm
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12
Q

Justice

A
  • Treating all people fairly and without discrimination
    • Respecting rights
    • Criminal Justice; Social justice (eg right to vote)
  • Distribute Justice: Concerns the effects of social and political structures on health, and the distribution across society
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13
Q

Justice

Key Questions

A
  • Who is responsible for addressing ill-health?
  • How should health services be funded?
  • Which services should be provided?
  • Who should receive these services?
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14
Q

Ethics is different from

A
  • Religion
  • Majority decision
  • Intuition or gut feeling
  • Etiquette
  • Law
  • Professional codes of practice
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15
Q

Religion: Ethics cannot be based solely on “Christian” morality because we live in a pluralistic society. We can have ethics without having any religion (at least most people believe this)
However – Christian morality, based on the Ten Commandments underlies the common law.

Majority decision: the majority can be wrong e.g. racist people in the past. However, often what the majority thinks is ethical turns out to be ethical (is there a better way of saying this i.e. just because it’s the majorities view, doesn’t make it unethical).

Intuition: but too what extent does our intuition guide our ethical reasoning, and sometimes we look back and ask whether we ‘feel good’ about the decision we made.

Etiquette – being nice. You can be nice to someone but unethical e.g. being lovely to a patient and then disrespecting their autonomy/ not telling them the truth.

A

frdgtfy

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16
Q

In ethics, we have the concept of autonomy (discussed last week), from this stems the notion of informed consent – if you’re free to make your own choices, then you are free to consent (or to refuse to give consent) to medical procedures.

In the law patients (competent ones) have to give (informed) consent. Here the law is based on the ethical principle of autonomy.

However, ethics and law are NOT the same

A

Ethics and Law

17
Q

Differences between ethics and law

A
  • The law should reflect ethics, but doesn’t always
  • It’s not possible to legislate for everything
    • Lying to your parents - unethical but not illegal
  • “law and morality are not the same.. yet the absolute divorce of law from morality would be of fatal consequence” (Lord Coleridge)
18
Q

Differences between ethics and law

A

The law should reflect ethics, but doesn’t always
Some arguably ethical things are illegal e.g. euthanasia, recreational cannabis
Some arguably unethical things are legal e.g. tax havens
It sometimes takes the law a long time to catch up with ethics

Ethics can change as can laws
19
Q

Ethics and professional codes

A

Animation

Professional Codes are often based on ethics e.g. principle two of the 2018 Pharmacy CoE considers patient choice, and in 2A discusses autonomy, which is directly related to the ethical concepts.

Ethics is not the same as professional codes for much the same reasons that ethics is not the same as the law i.e. the professional code (law) may get it wrong, and it may take Codes a long time to catch up with ethics.

Professional codes may be more onerous than the law

20
Q

Code of ethics v. Code of Rights

A

Code of ethics
- Not (directly) law

Code of Rights
- Part of the law

21
Q

Code of ethics v. Code of Rights

A

Code of Ethics – authored by the Pharmacy council, part of professional guidelines, not itself a legal document (Although does have some legal standing as it’s mention of R4 of the CoR)

Code of Rights – part of the law (via the Health and Disability Commission Act 1994)

22
Q

Animation - L15, slide 9

A

Diagram 1: Ethics informs law and professional codes, (but professional codes may also be written into the law)

Diagram 2: There are similarities between law, ethics and professionals, and there are instances in which all 3 will converge. But this is not always the case.

23
Q

Ethical reasoning and concepts

A
  • Autonomy
    • Truth-telling/veracity
  • Beneficence
  • Non-maleficence
  • Justice
  • Dignity
24
Q

Ethical reasoning and concepts

A

Ethical reasoning – Articulating reasons, and testing them against other reasons.

The concepts help guide our ethical reasoning.

25
Q

Autonomy

A
  • Individuals have the right to choose what is best for themselves i.e. to make choices in accordance with their own life plan
    • Informed, competent people
    • So long as the choice doesn’t infringe on the rights of others
  • Compare paternalism i.e. ‘doctor knows best’
26
Q

Autonomy example

A

Informed competent people –
Competent: a three year-old won’t always know what’s best for themselves e.g. I want ice-cream for breakfast
Informed: if we don’t have the correct information, we can’t make a good decision. For example, imagine you only tell a patient about one inexpensive, and not particularly effective treatment and neglect to tell them about a cheaper and more effective treatment. Because the individual hasn’t been properly informed they can’t give informed consent. Though they have consented, they haven’t given informed consent, and so autonomy not respected.
Infringing on rights of others e.g. killing someone else, demanding a very expensive treatment when there’s a cheaper one available

Paternalism – Quite an old-fashioned idea, but how much should health professionals influence a patient’s decision? Doctor knows best i.e. some things (EBM) health professional will know best, but you won’t know best about a person’s life plan. Therefore, decision-making needs to be a collaborative approach between patient/HCP. See P2 of the pharm CoE, which says that pharmacists must enable and involve the patient to make a decision.

27
Q

Problems relating to autonomy

A

Determining competency

  • Is a very odd choice a red flag for incompetency? (kevin Wright)
  • Determined on a case-by-case basis

Conflict with other concepts

  • Beneficence
  • Non-maleficence
  • Justice
28
Q

Problems relating to autonomy example

A

Case by case basis: Beware of using broad categorisations e.g. people with dementia/learning impairment
Competency is particular to the individual and can fluctuate
Competency depends on the gravity of the decision
Mature minors

Conflict with beneficence – Kevin Wright case – it’s arguable that it wouldn’t be in Kevin’s best interests to have his foot amputated, which conflicts with autonomy
Someone demands antibiotics when they are going to be of no use. It will also decrease antibiotic resistance, so here it’s arguable that demanding antibiotics that are not medically indicated infringes on the rights of others

Conflict with non-maleficence – it’s arguable that amputating Kevin’s foot would be harmful/if the antibiotics have side effects (as well as no benefit) then they’re harmful.

Conflict with justice - demanding a very expensive treatment when there’s a cheaper (and just as effective) one available,

29
Q

Beneficence/non-maleficence

A

Beneficence

  • Doing good - Protecting and promoting wellbeing
  • To act in the patient’s best interest

Non-Maleficence

  • Do no harm
    • Minimise harm: harms and benefits must be weighed against each other
30
Q

Beneficence/non-maleficence

A

Minimise harm: many medical interventions involve harming the patient, so harms and benefits must be weighed against each other

31
Q

Problems relating to Beneficence/non-maleficence

A

What counts as a benefit? Who determines what is beneficial?

  • Short term v long term harms and benefits
  • Physical v. psychological harms/benefits
  • Therapeutic uncertainty

Conflict with autonomy

Conflict with justice

32
Q

Problems relating to Beneficence/non-maleficence example

A

What counts as a benefit – use Kevin Wright case as an example.

Conflict with autonomy – should we refuse to amputate Kevin Wright’s foot because it’s not in his best interests/harmful? Should we refuse antibiotics and risk the person never going back to the doctor/pharmacist again (i.e. feeling belittled)

Conflict with justice – giving your patient the very best treatment with the least harms may be very expensive, and could mean other patients lose out e.g. doctors who always mark their referrals as urgent, vit C case

33
Q

Justice and related problems

A
  • Treating all people fairly and without discrimination; respecting rights
  • Distributes justice - caused by scarcity of resources
  • Problems
    • Conflict with other principles
    • What is fair?
34
Q

Justice and related problems example

A

Conflict with beneficence – drug A would be best for the patient, but it’s very expensive, so patient gets a cheaper, inferior drug.

Conflict with non-maleficence – drug x may give the patient some unpleasant side effects, drug y avoids these side-effects but is very expensive.

‘It’s not fair’ is one of the first ‘arguments’ that many kids learn.
What is fairness? V hard to answer.

35
Q

Cutting the cake - what is fair?

A
  • Equal shares
  • Equal outcomes - share according to need
  • Share according to merit
  • Share according to free market exchanges
36
Q

Cutting the cake - what is fair?

EXAMPLE

A

Need – what if some people are very hungry, and slightly different what if some people have already had two pieces of cake but are still hungry
Merit - share only with those who have contributed to society in some way
$ - “Healthcare is just like any other commodity and should be available to those who can afford to buy it” the right of the wealthy to spend their money as they choose (i.e. on their health)
Donation – can I give my piece of cake to someone else

Transparency. In so far as possible, we expect for the rules of distribution to be open (public), and subject to discussion. Generally, if we know what the rule is, and know that it is fair, we can accept missing out because of that rule.

37
Q

Case: Mr J

A

L15, pg 17 & 18

PHCY 210 (2 decks)

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