Medical ethics: introduction
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Transcript of Medical ethics: introduction
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Medical ethics: introduction
Janet Radcliffe RichardsProfessor of Practical Philosophy
University of Oxford
Oxford Uehiro Centre for Practical Ethics
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Clinical practice
Apprenticeship
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Clinical practice
Apprenticeship Explanation
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Clinical practice
Current scientific beliefs
Apprenticeship Explanation
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Clinical practice
Current scientific beliefs
Descriptions of cases
Apprenticeship Explanation
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Clinical practice
Current scientific beliefs
Descriptions of cases
Apprenticeship Explanation
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Clinical practice
Current scientific beliefs
Descriptions of cases
EnquiryApprenticeship Explanation
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Clinical practice
Current scientific beliefs
Descriptions of cases
EnquiryApprenticeship Explanation
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Descriptions of cases
EnquiryApprenticeship Explanation
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Clinical practice
Scientific reasoning and
research
Current scientific beliefs
FACTUAL ISSUESDescriptions of cases
EnquiryApprenticeship Explanation
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Descriptions of cases
EnquiryApprenticeship Explanation
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
FACTUAL ISSUESDescriptions of cases
EnquiryApprenticeship Explanation
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Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Current legal and professional
standards
FACTUAL ISSUES
VALUE ISSUES
Descriptions of cases
The elements of medical education
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Current legal and professional
standards
FACTUAL ISSUES
VALUE ISSUES
Descriptions of cases
The elements of medical education
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Current legal and professional
standards
FACTUAL ISSUES
VALUE ISSUES
Descriptions of cases
Moral enquiry
The elements of medical education
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What is medical ethics?
‘Ethics’ has two quite different meanings:
1. A particular set of standards. In this sense ‘medical ethics’ is the set of standards accepted as appropriate for doctors.
2. Moral philosophy: an enquiry into questions about moral standards, including what standards we ought to have.
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‘Ethical’ is ambiguous
• Sometimes it means ‘in line with accepted professional standards’
• Sometimes it means ‘morally right’
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jrr/HT10
Clinical practice
Scientific reasoning and
research
Current scientific beliefs
Current legal and professional
standards
FACTUAL ISSUES
VALUE ISSUES
Descriptions of cases
Moral enquiry
The elements of medical education
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Disagreements and difficulties can come from either source
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The case of Dr Cox
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How Dr Cox might have defended his action
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was not right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She was being put under pressure by the family • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She was being put under pressure by the family • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was not right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • He could easily have controlled the pain by
consulting an expert colleague• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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jrr/HT10
Different ways of challenging Dr Cox
• She wasn’t in pain - just getting attention• She wanted to die • He could easily have controlled the pain by
consulting an expert colleague• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was not right to kill her
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jrr/HT10
Different ways of challenging Dr Cox
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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Different ways of challenging Dr Cox
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• Killing people or helping them to die is always
wrong-------------
So it was right to kill her
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jrr/HT10
Different ways of challenging Dr Cox
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• Killing people or helping them to die is always
wrong-------------
So it was not right to kill her
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The values determine which facts are even relevant
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jrr/HT10
How Dr Cox might have defended his action
• Mrs B was in terrible pain• She wanted to die • No available medication could have controlled
the pain• People who are in uncontrollable pain and want
to die should be helped to do so-------------
So it was right to kill her
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The advance of science and technology increases the significance of value issues in practical
reasoning.
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Recent and current controversies
• Conjoined twins• Time limit for abortion• Sustaining patients in PVS• Fertility matters• Organ donors and the dying process
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Y2 Non-competent patient/ jrr/ Dec 2005
The ‘best interests’ principle
When a patient is not competent to consent to treatment, the doctor must act in the
patient’s best interests
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Y2 Non-competent patient/ jrr/ Dec 2005
Treatment in the non-competent patient’s best interests
• Length of life?• Absence of pain?• Mental abilities/ level of awareness?• Physical abilities?• Appearance to relatives and friends?• Patient’s former character and wishes?
Which elements matter at all? e.g:
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Y2 Non-competent patient/ jrr/ Dec 2005
Treatment in the non-competent patient’s best interests
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Y2 Non-competent patient/ jrr/ Dec 2005
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Y2 Non-competent patient/ jrr/ Dec 2005
Mill’s ‘Harm Principle’
…the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.
John Stuart Mill, On Liberty, 1859