Defining a Moral Problem

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Defining a Moral Problem

• Samantha Mei-che Pang
• RN, PhD
• School of Nursing
• The Hong Kong Polytechnic University

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Traditional and contemporary ethical values in
biomedicine and healthcare
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• Hippocratic Oath (400BC)
• Nightingale Pledge (1893)
• International Council of Nurses Code of Ethics
  (1953, last revision2005)
• Declaration on Bioethics and Human Rights (UNESCO
  2005)
• Declaration of Helsinki, World Medical
  Association (1964, last revised 2008)
• The Patient Charter (Hospital Authority Hong
  Kong, 1994)
• Code of Professional Conduct for the Guidance of
  Registered Medical Practitioners, Medical Council
  of Hong Kong (1957, last revised 2009)

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Traditional Medical Ethical Values in the
Hippocratic Oath

• I will prescribe regimen for the good of my
  patients according to my ability and my judgment
  and never do harm to anyone.
• To please no one will I prescribe a deadly drug,
  nor give advice which may cause his death.

Do no harm and do good
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Ethical values upheld in the Nightingale Pledge
(1893)

• I will abstain from whatever is deleterious and
  mischievous and will not take or knowingly
  administer any harmful drug.

Do no harm
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Nightingale Pledge

• I will do all in my power to elevate the standard
  of my profession, and will hold in confidence all
  personal matters committed to my keeping, and all
  family affairs coming to my knowledge in the
  practice of my profession.

Respect for person privacy confidentiality
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Nightingale Pledge

• With loyalty will I devote myself to the welfare
  of those committed to my care.

Do good
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Universal Declaration on Bioethics Human Rights
UNESCO 2005

• To provide a universal framework of principles
  and procedures to guide States in the formulation
  of their legislation, policies or other
  instruments in the field of bioethics

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Bioethical Principles (UNSECO 2005)

• Human dignity and human rights
• Autonomy and individual responsibility
• Consent and persons without the capacity to
  consent
• Respect for human vulnerability and personal
  integrity
• Privacy and confidentiality
• Non-discrimination and non-stigmatization
• Respect for cultural diversity and pluralism
• Benefit and harm
• Solidarity and cooperation
• Social responsibility and health
• Sharing of benefits
• Protecting future generations
• Protection of the environment, the biosphere and
  biodiversity

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Patients Charter, Hospital Authority Hong Kong
1994

• Responsibilities
• Provide accurate and relevant information
• Comply with prescribed treatment
• Respect others rights and follow hospital rules
• Keep appointment
• Do not ask for fake certification
• Do not waste medical resources

• Right to medical treatment
• Right to information
• Right to choices
• Right to privacy
• Right to complaint

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Ethical Values in Patient-Health Professional
Relationship

• Do good
• Do no harm
• Fidelity
• Privacy

Trust-based, covenantal
Autonomy-based, contractual

• Respect for autonomy
• Informed consent
• Patient rights

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Ideal Scenario
Doing no harm
Social responsibility
Doing good
Equity
Respect for autonomy
Virtuous character
Holistic inclusion of patient family
Professional competence
Following institutional rules regulations
Communal work attitude
Values preferences
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A 60 years old man has undergone a comprehensive
health assessment and is found to have probable
dementia. The family members request the
attending doctor not to tell the patient.
Survey A
Survey B
What is the problem? What is the ethical issue
at stake?
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Define the moral problem?

• Withholding information from the patient

• Right of family member to access the patients
  medical information without the patients consent
• Respect for autonomy

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Doing no harm
Social responsibility
Mental competence? The patients wish to know?
Patient vulnerability?
Doing good
Equity
Respect for autonomy
Virtuous character

• Competing ethical viewpoints
• Holistic inclusion of the patient family and
  doing no harm to the patient
• Respect for autonomy and doing good to the
  patient

Holistic inclusion of patient family
Professional competence
Following institutional rules regulations
Communal work attitude
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The patient is suffered from multiple stroke,
advanced dementia and is totally dependent. The
doctor has indicated Do-not-resuscitate (DNR) for
the patient. The family requests to try
everything to preserve the patients life.
What is the problem? What is the ethical issue
at stake?
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Define the moral problem

• Is the medical team obliged to provide medically
  futile treatment upon the patients family
  request?

• Professional integrity
• Goal of medical care preserve life or prolong
  dying
• The patients wish/advance directive

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The patient is suffered from multiple stroke,
advanced dementia and is totally dependent. The
doctor has indicated Do-not-resuscitate (DNR) for
the patient. The family requests to try
everything to preserve the patients life.
Is the patient terminally ill? What is medical
futility? Has the patient indicated any prior
wish? What does it mean by dignified care to the
patient?
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• Ethical justification

The set of reasons for providing moral groundings
to ones course of action?