jrr/HT10

Medical ethics: introduction

Janet Radcliffe RichardsProfessor of Practical Philosophy

University of Oxford

Oxford Uehiro Centre for Practical Ethics

jrr/HT10

Clinical practice

Apprenticeship

jrr/HT10

Clinical practice

Apprenticeship Explanation

jrr/HT10

Clinical practice

Current scientific beliefs

Apprenticeship Explanation

jrr/HT10

Clinical practice

Current scientific beliefs

Descriptions of cases

Apprenticeship Explanation

jrr/HT10

jrr/HT10

jrr/HT10

jrr/HT10

jrr/HT10

Clinical practice

Current scientific beliefs

Descriptions of cases

Apprenticeship Explanation

jrr/HT10

Clinical practice

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

Clinical practice

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

FACTUAL ISSUESDescriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

Descriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

Clinical practice

Scientific reasoning and

research

Current scientific beliefs

FACTUAL ISSUESDescriptions of cases

EnquiryApprenticeship Explanation

jrr/HT10

jrr/HT10

jrr/HT10

jrr/HT10

jrr/HT10

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

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

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

jrr/HT10

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.

jrr/HT10

‘Ethical’ is ambiguous

• Sometimes it means ‘in line with accepted professional standards’

• Sometimes it means ‘morally right’

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

jrr/HT10

Disagreements and difficulties can come from either source

jrr/HT10

The case of Dr Cox

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

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

jrr/HT10

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

jrr/HT10

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

jrr/HT10

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

jrr/HT10

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

jrr/HT10

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

jrr/HT10

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

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 right to kill her

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

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

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 right to kill her

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

jrr/HT10

The values determine which facts are even relevant

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

jrr/HT10

The advance of science and technology increases the significance of value issues in practical

reasoning.

jrr/HT10

Recent and current controversies

• Conjoined twins• Time limit for abortion• Sustaining patients in PVS• Fertility matters• Organ donors and the dying process

jrr/HT10

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

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:

Y2 Non-competent patient/ jrr/ Dec 2005

Treatment in the non-competent patient’s best interests

Y2 Non-competent patient/ jrr/ Dec 2005

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