ETHICS IN THE FIELD OF MEDICAL TECHNOLOGY

• ETHICS

  •       Is moral code that guides how an individual should behave.

  •        As a branch of knowledge, it deals with moral principles  

  Ethics is also about the individual's search for meaning while dealing with human problems
• o   Logical – Problem of Reasoning

  o    Epistemological -  problems of the truth

  o   Cosmological          – problems    of the universe

  o   Ethical – Problem of Morality

  o    Aesthetical – problems of art and beauty

  o   Scientific – problems of science (can be answered based on experiment)
• Ethics deals with    a        diverse prescription of universal concepts and principles that serve as foundation of moral beliefs  
• Ethics

  • The nature of the good

  • The nature of human person
  • Criteria of Judgement
• Morality

  •       Fundamental

  convictions of human agent.

  •       Character of moral agent

  •       Use of norms  

  • Situational analysis
• •       The word ethics is derived from the  Greek word ethos, which means “Character"

  •       Serves          as       a        guide for DECISION-MAKING               based

  on one’s belief (school of ethics)
• Theories of ethics

  •       Ethical Relativism

  •       Ethical Pragmatism

  •       Ethical Utilitarianism
• Ethical relativism

  “What is right for you, may not be right for someone else.”

  •       Also known as moral relativism  

  •       Is school of ethics anchored on the principle that morality is relative to the norms of a particular culture

  •        This theory based on norms relative to a particular culture or society.

  •       Ethical relativism acknowledges society diveristy that every society has a unique moral design and culture; and people’s beliefs are greatly influenced  by culture

  •       Challenge: The preservation of its cultural uniqueness and acknowledgement of cultural differences  
• Ethical pragmatism

  •       Pragmatic: dealing with things sensibly and realistically in a way that is based on

  practical rather than theoretical considerations

  •       Chalres Sanders Peirce (1870) and further developed by William James  

  •       Considered as America's most distinctive and major contribution to the field of philosophy.

  •       More of a theory of knowledge, truth, and meaning rather than morality.

  •       Pragmatic conception of good and truth can be applied in the medical context especially in terms of decision making and moral reasoning.
• Ethical Utilitarianism

  •       “THE GREATER GOOD”

  •       determines right from wrong by focusing on outcomes

  •       If the end justify the means …

  •       Jermey Bentham (1748 – 1832)  and John Stuart Mill (1806 -1873).

  •       School of ethics states that the rightness and wrongness of actions is determined by their consequences  

  •       “actions are good insofar as they tend to promote happiness , bad as they tend to produce unhappiness. The utility or usefulness of an action is determined by the extent to which it promotes happiness rater than its reverse

  (Mill).”
• Professional Ethics

  •       are the civil code behaviors  considered correct by members of the profession for the good of both the patients and the professionals (to build trust, and integrity of the profession)

  •       Medical Ethics is discipline/ methodology for  considering the implications of medical  technology/ treatment and what ought to be or

  •       The principle which should guide the members  of the medical profession in course of their  practice of medecine and their dealing with  their patients
• GOALS OF MEDICAL INTERVENTION

  Restoration of Complete Health  

  Relief of symptoms

  Restoration of function

  Maintenance of Compromised Function, without further Deterioration

  Saving Life or Prolong Life   

  Patient education and health education.
• Goals of Medical Intervention depends on

  • Nature of Disease
  •  Option available
  •  Reference of the Patient  
  • Social, culture, and economic factors
• Moral Duties of medical professionals

  •        The duty to help cure

  •       The duty to promote and protect the patient’s health

  •       The duty to inform  

  •       The duty to confidentiality

  ·      The duty to protect the patient’s life

  ·      The duty to respect the patient’s  autonomy (must be aware of the medical assessment)

  ·      The duty to protect privacy

  The duty to respect the patient's dignity
• Moral rights of the patient

  • The right to high quality medical services
  • The right to autonomous choice (no bias)
  • The right to decide
  • The right to be informed
  • The right to privacy
  • The right to health education
  • The right to dignity
• Autonomy

  •       Right to self determination

  •       Competence – Legal determination

  •       Liberty – freedom to influence course of life/treatment  

  •       Right to       information    and    self determination
• Beneficence

  •       Do good or promote good  

  •       The common usage of the term beneficence suggests acts of mercy and charity.

  •       Patient's welfare is the first consideration

  •       Do only what benefits the patient (Do the less expensive treatment)

  •       Non abandonment
• Confidentiality

  •       Obligations    to       maintain        information

  •       Exceptions apply to appropriate agencies if there is a risk to greater societal harm

  •       Information to be revealed must have the consent of the patient

  •       Disclosure must not exceed what is required
• Non-maleficence

  •       Do not inflict evil or harm  

  •       Calculate risks and benefits of harm if cannot be avoided (the risk cannot exceed the benefits of the patient)  

  •       Respect the sanctity of life
• Equity/ social justice

  •       “Social justice” refers to fair distribution of healthcare needs and services. Regardless of their social status  
• DNR (Do Not Resuscitate)

  •       CPR (Cardiopulmonary Resuscitation)  

  and Advanced Cardiac Life Support (ACLS) are interventions that can be offered to all patients within the hospital. 

  •       The initiation is best performed after an understanding by physicians, patients, family, staff has been reached.
• Code Blue  – signal to the emergency team of the need to respond (oxygenation, ventilation, cardiac massage, electroshock, emergency drugs)
• ·      No code: Do not Resuscitate  
• ·      Slow code: the team slows down the resuscitation so as to appear to be providing care but it is only an illusion  
• Chemical code: similar in intent to slow code. The team provides the drugs but not other forms of resuscitation 
• DNR GUIDELINES

  o Should be document in written medical record

  o   Should specify the exact nature of the treatments to be withheld

  o   Patient should participate in DNR decisions when they are able

  o   Witholding CPR should be discussed with the healthcare team

  o   Should be reviewed on a regular basis  
• Euthanasia

  •       Dignified Death  

  •       Joseph fletcher (ethicist): “it is harder to morally justify letting someone die a slow and ugly death, dehumanized, than it is to justify helping him to escape from such misery.”
• An ethic of euthanasia

  o An individual’s life belongs to that individual to dispose of entirely as he or she wishes;

  o   The dignity that attaches to personhood by reason of the freedom demands also the freedom to take one’s own life;

  o   There is such a thing as life not worth living whether the cause be distress, illness, physical mental handicap;

  o   What is supreme in value is the human dignity that resides in the human’s rational capacity to choose and control life and death
• a.    The body parts are grasped at random with a long toothed clamp

  b.    The body parts are pulled from the fetal body out the vaginal canal

  c.     The remaining body parts are grasped and pulled out

  d.    The head is grasped and crushed in order to remove the vaginal canal

  e.    The placenta and remaining contents are suctioned from the uterus
• The pro-life position: anti-abortion, believes abortion is murder and should be stopped
• The pro-choice position: believes that the decision to abort is one of personal liberty and thus should be legal
• The doctrine of double effect

  The course chosen must be good or   at least morally neutral  

  The good must not follow as a consequence  of the secondary harmful effects

  The harms must never be intended but merely tolerated as causally connected with the good intended

  The good must outweigh the harm
• Constitution of the Republic of the Philippines (1987), Article II, Section 12. 

  • The State recognizes the sanctity of family and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception  
• 
  

  INFORMED CONSENT  

  • “what I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be noised about.”
  • Hippocratic oath
• An HIV positive patient will undergo surgery.

  -       Of course, the surgery team should be informed

  -       The patient should be aware that the medical staff is informed
• Dr. David Acer

  • Was an American Dentist who was accused of infecting 6 of his patients with HIV
  • “someone who has AIDS and continuous to practice is nothing better than a murderer.
• Genetic Engineering

  • A controversial ethical issue because it involves genetic manipulation that are perceived to be against normal standards set by the society. 
• Genetic Screening  -  Usually done       for      early diagnosis     of diseases: inborn error and terminate pregnancy
• Genetic Interventions -  People can now intervene in the biological process and control bad or defective genes.
• Stem cell therapy: Makes use of stem cells to treat or prevent diseases.