Medical Ethics

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Medical Ethics

Definition – Values, Morals, and Ethics

1. Values - Fundamental beliefs that define difference between right and wrong, good and bad, justice and injustice.

Examples: honesty, integrity, compassion, duty, courage, honour, responsibility, patriotism, respect, fairnessINCLUDES utilitarian practical values – excellence, quality, service, safety.

2. Morals are the VALUES such as above that we attach to a system of beliefs. May be religious, political, green etc

3. Ethics How we make decisions and act out our morals.

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Christian Values based on

1. Ten Commandments

2. Sermon on the Mount

3. The story of the Good Samaritan

4. Commandment to “Love your neighbour as yourself”

5. Jesus teaching of the Sheep and Goats

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Factors that limit individual ethical practice

1. The Law of the Land

2. Regulationa. By employersb. Professional bodiesc. Clinical Practice guide lines – NICEd. Financial restraint

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12C Byzantine manuscript of Hippocratic oath

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Engraving of Hippocrates – Peter Paul Rubens 1638

Summary of Hippocratic oath

1. Share his art with teachers and disciples2. Follow a regime that he thinks will benefit his

patients3. Abstain from anything deleterious or mischevious4. Give no deadly medicine nor give a pessary to

procure an abortion5. Practise his art with purity and holiness6. Go to houses for the benefit of the sick and

abstain from mischief and corruption7. Refrain from seduction of females and slaves8. Will not divulge what is told in connection with

his professional service

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History

1. First Code of Ethics - Formula comitis achiatrorum – 5C AD

2. First book - “The Conduct of a Physician” by Ishaq bin al-Ruhawi

3. Jewish thinker Maimonades and Theologian Thomas Aquinas wrote about medical ethics

4. 1794 Thomas Percival - First modern code of medical ethics.

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Ethical Principles

1. Autonomy and Rights

2. Beneficence - Do good

3. Non-maleficence – Do no harm

4. Justice

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Christian perspective on Ethics

1. Autonomy and rights

Dignity and respect, Consent, Confidentiality, Honesty and truthfulness;Patients make their own decisions.

Conflicts of Consent2. Wrong decisions, 3. Patient /doctor disagreement, 3. Patient /other party disagreement

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2. Beneficence (Do good)

Most up to date and effective procedures,Wish of the patient respected,Act with kindness, compassion & respectWell trained staffGood equipmentSuitable environment Safe implantsSafe and reputable drugs

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Beneficience - Conflicts

Trying to do good may cause harm

Pain killers,Radiotherapy,Adverse reactions to drugsSurgery may be fatalStriving officiously to save lifeOver treatment

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3. Nonmaleficence (Do no harm)

Positive steps to prevent harmStaff recruitment & trainingAudit Equipment

Decisions about when and when not to treat

Decisions to cease treatment > deathPassiveRemoval of supportEuthanasia

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Euthanasia

Problem of consent (depression, may feel pressurised)law of the land, Religious principles - life is sacredReduces confidence in Doctors

Alternative - generous pain relief, Hospice care

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3. Nonmaleficence (Do no harm)

Positive steps to prevent harmStaff recruitment & trainingAudit Equipment

Decisions about when and when not to treat

Decisions to cease treatment > deathPassiveRemoval of supportEuthanasia

Patient/Doctor relationship

4. Justicea. For the individual

Emergency, non emergencyTreatment of the elderly

b. For people in general use of national resources

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Medical Ethics

Christian perspective

1. God created us in his own image and gave us life for a purpose - so we must respect it

2. Jesus was very definite about caring for the sick

3. We should know how to behave through love

4. Clinicians should be permitted to practise according to their professional training and faith

5. They should be regulated by their peers16