Medical Ethics Introduction

The Origins of the Field and Its Current Status The Beginnings: a) The Nuremburg Code, 1948 b) Life Magazine article on dialysis selection committees, November 1962 Earlier Points of Origin: Babylonian Codes Hippocratic Code/Oath Islamic Codes Jewish Codes Emphasize physician-physician or physician-patient relationship

The Origins of the Field and Its Current Status Current Status of Medical Ethics 1) Number of Courses Required 2) Medical Ethics programs in medical schools, nursing schools, HRP, etc. 3) Journals, e.g. Hastings Center Report, Journal of Medicine and Philosophy 4) Centers, e.g. Hastings Center, Kennedy Center at Georgetown University, Midwest Bioethics Center, K.C. 5) Rise of Hospital Ethics Committees 6) Massive Media Coverage

The Social Context: Why Is Medical Ethics So Prevalent? Some factors: 1) Federal Government support, e.g. IRBs, national commissions, publications 2) Rise of Medical Technology 3) Rise of 3rd Party Payers 4) American Distrust of the Professions 5) Rise of Professional Ethics 6) Critics of Medicine, e.g. Ivan Illych and Norman Cousins 7) Rise of Team Health Care

The Social Context: Why Is Medical Ethics So Prevalent? Some factors: 8) Women's Movement: * male dominance of medicine * focus on cure rather than care and prevention 9)Legalization, legislation, and litigation 10) Social interest in freedom and autonomy - decline in the status of medicine 11) Media Interest, e.g. Cruzan. Busalacchi, Siamese twins 12) Rise in the Cost of Medicine: how much can we afford?

Some Historical Points: 1940's and 1950's Human subjects research IRB's Doctor-patient relationship: a)buyer and seller b)child and parent c)individual and agent of society d)client and professional e)passive recipient and active provider f)the powerless and the powerful g)friend and friend

Some Historical Points: 1940's and 1950's (cont.) Doctor-patient relationship (cont.): h)contractual relationship: a legal agreement based on mistrust i)covenant relationship: a mutual agreement based on trust j)gatekeeper relationship informed consent informed refusal proxy consent/refusal competence death/dying

Some Historical Points: 1960's and 1970's privacy and confidentiality abortion/status of the fetus allocation of scarce resources definition of death

Some Historical Points: 1980's genetics issues nursing ethics professional ethics reproductive issues AIDS animal rights

Some Historical Points: 1990's human genome project right to health care/health care reform managed care/professionalism fetal neural tissue transplantation cloning

Some Historical Points: 1990's (cont.) stem cell research and therapy gerontological issues cross-cultural medical ethics alternative medicine non-Western medicine

Some Basic Concepts in Medical Ethics Person: 1)What is a person? What's the definition of a person? Persons usually have rights: to life to thrive to be protected from harm If rational or competent, to make decisions for themselves, etc. What makes a person the same person over time?

Some Basic Concepts in Medical Ethics Person: 2)What is the status of a potential person? If x is a potential person, does x have all the rights of a person? Is personhood a matter of either/or? Is it a matter of degrees? 3)What about past persons? If something was a person, does it have the rights of a person? 4)What about partial persons, e.g., the retarded, the demented, the senile, the partially competent?

Some Basic Concepts in Medical Ethics Person: 1)What is a person? What's the definition of a person? Persons usually have rights: to life to thrive to be protected from harm If rational or competent, to make decisions for themselves, etc. What makes a person the same person over time?

Some Basic Concepts in Medical Ethics Autonomy: 1)Definition 2)Autonomy as a value, i.e., persons have autonomy Autonomy: self-determination by competent agents autos = self nomos = law

Some Basic Concepts in Medical Ethics Autonomy (cont.): Autonomy: autonomy as a value, i.e., persons have autonomy, should be respected as agents autonomy as a goal, something to be achieved autonomy vs. paternalism autonomy vs. harm principle

Some Basic Concepts in Medical Ethics Quality of Life: 1)Who defines? 2)An external definition? Same for everyone? 3)Internal definition Normal vs. Abnormal Natural vs. Artificial Health vs. Disease

Some Basic Concepts in Medical Ethics Quality of Life: Ordinary vs. Extraordinary Rights vs. Responsibilities Life vs. Quality of Life Person vs. Living Thing/Thing