Overview –Readings –Introduction to Ethical Foundations –Clarification of basic terms...
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![Page 1: Overview –Readings –Introduction to Ethical Foundations –Clarification of basic terms –Clarification of the historical context of western medical ethics.](https://reader036.fdocuments.in/reader036/viewer/2022081512/56649ee85503460f94bfa420/html5/thumbnails/1.jpg)
Overview
– Readings
– Introduction to Ethical Foundations
– Clarification of basic terms
– Clarification of the historical context of western medical ethics
– Clarification of the current North American context
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Readings
• Medical Ethics and the Place of Faith
• Medical Ethics and Secular Approaches
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Introduction to Ethical Foundations
Main take-away point of class
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Clarify
The Big Fish
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Clarification of basic terms
• Bioethics
• Medical ethics
• Clinical ethics
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Bioethics
Broad term describing the study of ‘what’ constitutes ‘good/bad’ judgments and ‘right/wrong’ actions when faced with biological dilemmas
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Medical Ethics
Emphasis is the study of ethics applied to medicine and medical care
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Clinical Ethics
• Subdivision of medical ethics
• Focus is on ethical issues surrounding a patient’s interface within medical community decision making complex i.e. patient-physician treatment decisions
• This is the primary area of our class
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Clarification of historical of western medical ethics context
• Quiescent Period-the Hippocratic ethic
• Period of Principlism
• Period of Anti-principlism
• Period of Crisis
• Period of Social Utility
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North American Context
• Varying expressions of Principlism
• Varying expressions social utility
• Lingering expressions of Christian ethic
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Two contrasting worldviews
– Judeo-Christianity (Abahamic Traditions in PC terms)
– Darwinian Naturalism
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Judeo-Christian Supernaturalism
– Judeo-Christian Hippocratic Ethic
– Christian Virtue Ethics
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Darwinian Naturalism
• Principlism
• Social Contract
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Principlism
• Beneficence
• Non-maleficence
• Autonomy
• Justice
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Variation on Principlism
• Medical indication (medical norms)
• Patient Preference (autonomy)
• Quality of life (Beneficence/non maleficence)
• Contextual features (includes justice)
Albert Jonson: Clinical Ethics
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Social Contract
• Contracts made with voluntary consent to receive or give up benefits and burdens to its members, health care institutions and health care distributions must conform to the dictates of agree upon principles
• Equitable distribution of health care should be conceived in terms of justice
• Done under the ‘veil of ignorance’
• Mini/max principle
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The proper way to think abut health-care spending is tofocus on the NET SOCIAL VALUE ADDED by health care,defined as:
Net social value Added by = Health System
Gross Value Added by - Health Care to Patients
The Opportunity Costs of that Care for Society
Among these opportunity costs are:• education of our young• basic science R&D• nation’s public infra-structure• national security and defense
David B. Reuben: Portland Providence Medical Center Grand Rounds Providence Nov. 16, 2011
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A Matrix for Ethical DecisionMaking in a Pandemic
Dr. John Tuohey
An Example of Applied Synthesis of Principlism and Social Contract
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Always Clarify
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Robert Orr’s Method• Framing the medico-ethics question
• Four elements for medical clarification
• Clarifying decision making agency
• Clarifying institutional level issues
• Operative norms and values
• Discussion
• Recommendations
• Follow-up
• Comments
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Framing the Medico-ethics Question
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Four elements for medical clarification
• Patient History
• Diagnosis
• Prognosis
• Treatment plan
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Clarifying decision making agency
• Patient capacity
• Legal competency
• Surrogate agency
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Clarifying institutional level issues
• Distinctives in policy and procedure
• Legal implications
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Operative norms and values
• Primary agents
• Mitigating agents
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Discussion
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Recommendations
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Follow-up and Comments
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Ethics Exercise
• Interactive Exercise
• Orr’s Method