Biomedical Ethics

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Biomedical Ethics

• The Physician-Patient Relationship

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Learning Objectives

• At the end of this unit you should be able to
• compare the medical codes of conduct in various
  religious and cultural traditions
• work in teams to analyze a case study pertaining
  to ethical issues surrounding the
  physician-patient relationship and be able to
  prepare a synopsis of the steps used to arrive at
  decisions regarding the case.

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Physician / Patient Relationship Issues

• Physicians Obligations and Virtues
• Patient Autonomy
• Truth Telling
• Informed Consent
• Multicultural Issues
• Conflicts of Interest

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Physicians Obligations and VirtuesDerived from
Hippocratic Oath

• Hippocratic Oath (Pythagoreans, 4th-5th c. B.C.)
• Medical Ethics (Percival, 1803)
• Declaration of Geneva (W.M.A., 1948)
• Principles of Medical Ethics (A.M.A., 1957, 1980)
• Solemn Oath of a Physician of Russia (R.A.M.,
  1992)
• A Patients Bill of Rights (A.H.A., 1992)
• Fundamental Elements of the Patient-Physician
  Relationship (A.M.A., 1993)
• Convention on Human Rights and Biomedicine
  (Council of Europe, 1997)
• Consumer Bill of Rights and Responsibilities
  (U.S.A. report, 1997)

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Physicians Obligations and Virtues Alternatives
to Hippocratic Oath

• The Oath of Asaph (Judaeus, 6th c. C.E.)
• On the Absolute Sincerity of Great Physicians
  (Sun, Szu-miao, 7th c. C.E.)
• Oath of Initiation (Carakasambita, ???)
• The 17 Rules of Enjuin (???, 16th c.)
• The Oath of a Muslim Physician (I.M.A., 1977)
• Maxims for Medical Workers (Constitution of the
  Peoples Republic of China, 1982)
• Ethical and Religious Directives for Catholic
  Health Care Services (Nat. Conf. Catholic
  Bishops, 1993)

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Physicians Obligations and Virtues Alternatives
to Hippocratic Oath

• African
• Native American
• (Literature difficult to obtain or not codified.)

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Patient Autonomy

• Patients right to self-determination
• Views on patient well-being
• Effect of illness on patient autonomy and
  competence
• Acceptable levels of paternalism
• Decisions consistent with patient history and
  values

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Truth Telling

• Deontological vs. Teleological views
• Lying for paternalistic reasons
• Patients not wanting to know the truth
• Truth that could hurt the patient
• Full disclosure
• Placebos

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Informed Consent

• An Issue of Autonomy
• Who is competent?
• Who is sufficiently informed?
• Is consent voluntary?

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Multicultural Issues

• Different ethics within
• cultures and sub-cultures
• Religion
• History

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Conflicts of Interest

• Patient welfare v.s. autonomy
• Preservation of life
• Relief of pain and suffering
• Restoration of physical and mental function
• Care of dying
• Patient welfare v.s. physician welfare
• Patient welfare v.s. financial interest
• Of physicians
• Of third-party entities
• Of society

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Case Studies

• Patient responsibility
• Voluntary sterilization and a young, unmarried
  man
• The dentist and patient autonomy
• Liberty and the elderly patient
• Managed care and the temptation to skimp on
  services

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Class DiscussionWithholding information about
risks (p. 697)Issue Patient autonomy

• Principled-Based Ethics
• Teleological approaches
• Ethical Egoism
• Act-Utilitarianism
• Rule-Utilitarianism
• Ross approach
• Deontological approaches
• Kantian approach

• Alternatives to Principle-Based Ethics
• Virtue Ethics
• Ethics of Care and Feminist Ethics
• Casuistry
• Reflective Equilibrium

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Quiz

• A patients request for a possibly useless
  treatment (p. 698)
• Patient with flu requests antibiotics which are
  useless against flu
• Psychological comfort v.s. promotion of
  antibiotic-resistant bacteria
• Consider variety of appropriate approaches in
  your discussion