Presentation on theme: "Christian Medical Ethics"— Presentation transcript:
1Christian Medical Ethics A basic explorationof fundamental conceptsand a problem solving process
2Common approaches to medical ethics Virtue ethics (Existential)Good = What a good person would doLook at motives and behaviourConsequence ethics (Teleological/ Utilitarian)Good = Aiming at good goal / consequencesLook at facts and consequencesDuty ethics (Deontological)Good = What the law saysLook at laws, protocols, standards, creeds, norms
3What is Christian medical ethics? Theological basis: Matthew 22: 37-39Application: How love our neighbour in healthcare?As a science: Reverent,systematic,analytical andcritical thinking abouthow medical professionals ought to behave.We consider virtues, consequences and duties in loving God and our neighbour
4Ethics problem-solving flow-chart Define moral problemDevelop possible courses of actionDetermine preferred course of actionDeploy planned course of actionDeployment evaluated and appropriately handled
5Case study: Patient requests euthanasia Christian nursing home, Christian doctor doing rounds with successorMale patient:Early sixties, divorced (no contact with ex-wife), three children (no contact with one of them, poor contact with the other two),Grew up in Christian environment, drifted away as teenager and stayed that wayPoor vascular system, upper leg amputations both sides because of this; still smoking - under supervision because of fire hazard; several large decubitus ulcersHas requested euthanasia once before. Doctor then explained that it is against the institutional code and against the doctors’ conscience to do so. Patient accepted it at that stage. His family was not informed about his request.Now complains of severe ongoing pain, feels depressed, sees no future for himself, requests euthanasia againDoctor reminds patient of earlier conversation; discusses the various complaints with patient; prescribes more potent pain relief protocol; adds that patient will have to move to other nursing home if he persists with euthanasia request; recommends a talk with a pastoral workerPatient declines pastoral care; promises to think more about the issue
6In the groups Appoint persons in following roles: Define the problem One person = doctor doing ward roundOne person = patientOne person = son who has no contactRest = ethics committee members of institutionDefine the problemDevelop possible courses of actionDetermine preferred course of action
71. Define moral problemWhat are the facts of the situation: medical, nursing, legal, economic, social, organisational?Who is involved?What does each party think about the situation?What are their responsibilities in the situation?What interests do they have in the situation?What are the underlying world view perspectives?Is there a moral dilemma? If so, which? More than one dilemma?What is the scope of the problem? (Micro, meso, macro?)State the problem as a specific question
82. Develop possible courses of action Which courses of action could be taken? (including those you would not agree with)What virtues / consequences / duties are relevant in each of the possible courses of action?Which virtues / consequences / duties are in danger of being neglected in each of the possible courses of action?What would each possible course of action mean for each of the key persons involved?If different underlying opinions / preferences / world view issues are evident, specify.
92.1a General Virtues and Vices Seven VirtuesFaithHopeLoveFortitudeTemperanceJusticePrudenceSeven VicesPrideEnvyGluttonyLustWrath / AngerGreedSlothQ: What does my conscience say? How become more Christ-like through grappling with problem?
102.1b Medical Virtues and Vices Seven Medical VirtuesCompassionMercyProfessionalismIntegrityCollegialityJusticePrudenceSeven Medical VicesColdnessCrueltyQuackeryCorruptionRivalryInjusticeCarelessness
112.2 Consequences: A Christian perspective Purpose: promote health interests of patientWhat will consequences be for:Ethical, religious, legal, economical, social and technical aspects? (? also aesthetic, linguistic and cultural aspects)Preventive, curative, palliative + terminal care?Health and well-being of involved parties?Consider these rules regarding consequences:Proportionality (benefit / burden analysis)Subsidiarity (least drastic / burdensome / expensive)Consider the scope of the consequences:Micro (personal), meso (institutional) and macro (whole field)Short term, long term, eternal
122.3 Duties: A Christian perspective Christian dutiesPro-shalom; not kill on purposeMarriage as safe circle for intercourse, conception and raising childrenRespect responsibility and freedom of choice of patientRepair of disease as safe circle for genetic manipulationRespect property of anotherRespect created sexual identityThe Law: What does the Bible say?Ten / two commandmentsLaw suited to humansLove is fulfilment of the lawMedical DutiesCareRespect for lifeBeneficence (do good)Non-maleficence (no harm)JusticeConfidentialityTrustworthinessInformed consentHippocratic OathMedical ethical codesProtocols, standardsProfessional responsibilities + position description
133. Determine preferred course of action Dialogue with relevant parties regarding possible courses of action; discuss virtues / consequences and duties of each possibilityUse feedback to improve quality of problem solvingDevelop criteria for evaluating the possible courses of action: what is acceptable / exemplary / unacceptableWhich criteria will count the most?Build convincing argumentation for your choice; refer to virtues, consequences and duties as well as the criteria for evaluating the courses of actionSeek to reach consensus about the preferred course of action. Use negotiation / mediation if requiredWhat protocol to follow if no consensus is reached?
144. Deploy planned course of action Plan: Make a good plan re course of action:Consider implications on care plans, treatment protocols, institutional plans and proceduresWho does what by when?Who is responsible for supervision of which part of the planned course of action?How will the implementation of the planned course of action be evaluated?What will consequences be of the evaluation?Do: Implement the plan
155. Deployment evaluated and appropriately handled Check: Evaluate the course of action as indicated in the planAct: Use information from evaluation to take appropriate steps towards a better future together
16Overview of the process StepVirtuesConsequencesDuties12345
17Overlap / different interpretations between doctor / patient VirtuesConsequencesDuties
18What happened with the patient who requested euthanasia? Patient satisfied with adequate pain relief and excellent care; withdrew euthanasia requestCondition later deteriorated seriously; this time took advice from successor doctor to get pastoral helpAs a consequence:Reconciliation between patient and GodReconciliation between patient and lost sonGratitude expressed towards successor and staffPatient died in peace just after this
19Faith Belief, trust, fidelity, loyalty, conviction Faith: trust God at His Word
20Hope Desire, expectation, reliance, belief Hope: certainty of better future based on God’s promises
21Love / Charity Generosity, benevolence, helpfulness, mercy Love: desire, choose and act for highest good
22Fortitude Strength, courage, endurance, resoluteness Fortitude: perseverance in integrity; strength of mind to endure adversity steadfastly; perseverance in facing danger for the sake of principle
24Justice Impartiality, fairness, equity, rightness, dispassion Justice: regard for fulfilment of obligations
25Prudence Wisdom, vigilance, carefulness, thoughtfulness, discretion Prudence: due regard for one’s own welfare; habitually careful to avoid error / danger
26PridePride is excessive belief in one's own abilities, that interferes with the individual's recognition of the grace of God. It has been called the sin from which all others arise.Thomas Aquinas said of Pride "inordinate self-love is the cause of every sin (1,77) ... the root of pride is found to consist in man not being, in some way, subject to God and His rule."
27EnvyEnvy is the desire for others' traits, status, abilities, or situation.Thomas Aquinas said of Envy: "Envy according to the aspect of its object is contrary to charity, whence the soul derives its spiritual life... Charity rejoices in our neighbour's good, while envy grieves over it." (2, 36, ad 3)
28GluttonyGluttony is an inordinate desire to consume more than that which one requires.Thomas Aquinas said of Gluttony: "Gluttony denotes, not any desire of eating and drinking, but an inordinate desire..." (2, 148, ad 1)
29LustLust is an inordinate craving for the pleasures of the body.
30AngerAnger is manifested in the individual who spurns love and opts instead for fury. It is also known as Wrath.
31GreedGreed is the desire for material wealth or gain, ignoring the realm of the spiritual. It is also called Avarice or Covetousness.Thomas Aquinas said of Greed: "it is a sin directly against one's neighbour, since one man cannot over-abound in external riches, without another man lacking them... it is a sin against God, just as all mortal sins, inasmuch as man contemns things eternal for the sake of temporal things." (2, 118, ad 1)
32Sloth Sloth is the avoidance of physical or spiritual work. Thomas Aquinas said Sloth is "sluggishness of the mind which neglects to begin good... [it] is evil in its effect, if it so oppresses man as to draw him away entirely from good deeds." (2,35, ad 1)