PHIL 434 Midterm

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Medical Ethics and Issues
updated 7 years ago by dragonfly06
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nursing
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1

Ethical Principles:
Autonomy

•Personal freedom and self-determination
•The right to choose what will happen to one’s own person
•Health care deliverers’ respect for patients’ right to make decisions affecting care and treatment, even if the health care deliverers do not agree

2

Ethical Principles:
Beneficence

•The action one takes should promote good
•Dependent on how “good” is defined

3

Ethical Principles:
Non-malfeasance

•One should do no harm, including inflicting pain and suffering on others.
•Example: Nurse gives an injection for relief of postoperative pain
•Four Conditions
–The action itself must be “good” or morally indifferent
–The practitioner’s intent must be good
- The undesired effect must not be the means of attaining the good effect

4

Ethical Principles:
Veracity

•truth-telling
•Individuals should always tell the truth
•The whole truth must be told
•Arguments against- patients would forego medical care if they knew the whole truth

5

Ethical Principles:
Fidelity

•Keeping one’s promises or commitments
•May be an issue of patient’s family is assured they will be fully informed about loved one’s condition, but this may change in the event of emergency

6

Ethical Principles:
Paternalism

•Allows one to make decisions for another
•Allows no collaboration in the decision-making process, and totally removes the decision from the patient or the patient’s family members>
•The standard of best interest-allows health care personnel to assist in decision making when patients lack the expertise or data to make decisions.

7

Ethical Principles:
Distributed Justice

•People should be treated fairly and equally
•Arises when supplies are limited-
–e.g. two patients awaiting kidney transplant needed

8

Positive Eugenics

It is a social philosophy advocating the improvement of human genetic traits through the promotion of higher reproduction of people with desired traits

9

Negative Eugenics

Reduced reproduction of people with less desired or undesired traits

10

Lebensborn Program

Association in Nazi Germany with the intention of raising the birth rate of "Aryan" children from extramarital relations of "racially pure and healthy" parents on the basis of Nazi racial hygiene and health ideology.

11

Three Challenging Cases 1924-1935
1. BUCK VS. BELL

- Endorsed sterilization of the mentally deficient
- Medical Elimination of the Socially Inadequate-- United States Supreme Court endorsed state mandated surgery on unwilling patients
- Buck – first and only instance in which the court allowed a physician to perform an undesired and unneeded operation
- Medical malpractice suit to contest a doctor’s use of “therapeutic prerogative” to sterilize women without consent.
- Protecting physicians against malpractice suits

12

Three Challenging Cases 1924-1935
2. SKINNER VS OKLAHOMA

- Prohibiting sterilization of habitual criminals
- Sterilization of Hereditary Criminals
- 1931 - Oklahoma passed a sterilization law that mirrored the Virginia measure upheld by Buck.
- 1933, The law was tested in the Oklahoma Supreme Court, In re Main.
- Main was a resident of the Central Oklahoma State Hospital, his father had also spent time in mental hospitals
- Main was diagnosed as manic depressive and deemed as likely to produce socially inadequate children by Dr. D. W. Griffin.
- Subsequent to Samuel Main’s sterilization, 556 Oklahomans were sterilized between 1933-1963.
- Oklahoma Attorney General tested the law with Jack Skinner .
- Skinner was a three time felon and therefore fit the definition of habitual criminal under the statute for sterilization. (Felony = theft of $20).
- The Court confirmed the judgment in 5-4 decision. Skinner appealed.
- Based upon court notes from Justice William O. Douglas regarding the lack of correlation between Skinner and Buck stating that eugenic law did not apply in this case.
- The Court unanimously held that the Oklahoma law was unconstitutional

13

Three Challenging Cases 1924-1935
3. LOVING VS. VIRGINA

– overturning prohibitions on interracial marriage
•1924 Virginia Racial Integrity Act
–Passed following significant lobbying by John Powell and Dr. Walter A. Plecker
–Believed that miscegenation (racial mixing) is a threat to the white gene pool.
–Punishment – felony conviction and confinement of 1-5 years.
–Law survived several challenges until the case of Loving V. Commonwealth.
•Case initiated in 1958
–Indictment charging Mildred Jeter (a black woman) and Richard Loving (A white man) with violation of the ban on interracial marriage.
–They were married in D.C. n 1958 and moved to Virginia. They plead guilty and were sentenced to 1 year in jail.
–Trial judge suspended on the condition that they leave the state and not return together. Exile period of 25 years.

14

Virtue ethics

Virtue ethics emphasizes the role of one's character and the virtues that one's character embodies for determining or evaluating ethical behavior. Virtue ethics is one of the three major approaches to normative ethics, often contrasted to deontology which emphasizes duty to rules and consequentialism which derives rightness or wrongness from the outcome of the act itself. [1]

15

Ethics of Care

The ethics of care is a normative ethical theory; that is, a theory about what makes actions right or wrong. It is one of a cluster of normative ethical theories that were developed by feminists in the second half of the twentieth century. While consequentialist and deontological ethical theories emphasize universal standards and impartiality, ethics of care emphasize the importance of response. "The shift in moral perspective is manifest by a change in the moral question from "what is just?" to "how to respond?"[1] Ethics of care criticizes the applications of universal standards as "morally problematic, since it breeds moral blindness or indifference."[2]

The basic beliefs of the theory are:
1.All individuals are interdependent for achieving their interests
2.Those particularly vulnerable to our choices and their outcomes deserve extra consideration to be measured according to 1.the level of their vulnerability to one's choices
2.the level of their affectedness by one's choices and no one else's

3.It is necessary to attend to the contextual details of the situation in order to safeguard and promote the actual specific interests of those involved

16

Casuistry

Casuistry, or case-based reasoning, is a method in applied ethics and jurisprudence, often characterised as a critique of principle- or rule-based reasoning.[1] The word "casuistry" derives from the Latin casus (meaning "case").

Casuistry is reasoning used to resolve moral problems by extracting or extending theoretical rules from particular instances and applying these rules to new instances. The term is also commonly used as a pejorative to criticize the use of clever but unsound reasoning (alleging implicitly the inconsistent—or outright specious—misapplication of rule to instance), especially in relation to moral questions (see sophistry).

17

Coercion

Coercion is the practice of forcing another party to act in an involuntary manner (whether through action or inaction) by use of intimidation or threats or some other form of pressure or force, and describes a set of various different similar types of forceful actions that violate the free will of an individual to induce a desired response. These actions can include, but are not limited to, extortion, blackmail, torture, and threats to induce favors. In law, coercion is codified as a duress crime. Such actions are used as leverage, to force the victim to act in a way contrary to their own interests. Coercion may involve the actual infliction of physical pain/injury or psychological harm in order to enhance the credibility of a threat. The threat of further harm may lead to the cooperation or obedience of the person being coerced

18

Kantian Theory

Kantian theory,the ethical theory of the 18th-century German philosopher Immanuel Kant. It focuses on the rightness or wrongness of actions in and of themselves, rather than on the consequences of those actions. According to Kant, the principles by which actions are judged right or wrong can be determined by reason, and the individual has a duty to act in accordance with these principles

19

Utilitarianism

Utilitarianism is a theory in normative ethics holding that the proper course of action is the one that maximizes utility, usually defined as maximizing happiness and reducing suffering.