Ethics

A system of ethics according to which the rightness or wrongness of an action should be judged by its consequences. The goal of utilitarian ethics is to promote the greatest happiness for the greatest number.

the right action is the one which produces the greatest amount of happiness or pleasure for the greatest number of beings

Actions are moral when they conform to the rules that lead to the greatest good, or "the rightness or wrongness of a particular action is a function of the correctness of the rule of which it is an instance."

*dealing with duty, moral obligation, andright action

*Duties and obligations must be determined objectively and absolutely, not subjectively

• *apply universally
• *You tell the truth because it is morally right

• *is hyothetical
• = if _____then______

• Act as though the maxim of your action were by your will to become a universal law.
• *emphasis on universal
• *could you imagine a universe that everybody adopted the same maxim (ex. making promises that nobody could make. Then a promise becomes meaningless. Can not universalize the maxim)

Act in a way you always treat humanity

*treat someone mearly (a person can reasonably accept) as it means

*Can a person reasonably agree to being lied to? No

Distributing scarce medical resources

*using the resources to the group of people that ned it the most and could die without it.

*Maximize Aggregate Utility

• *legal and morally right
• *legal and morally wrong

• *legal and morally wrong
• *illegal and morally right
• -permissible
• -obligatory
• -heroic

a matter of an opinion

there is no distinction between what a person approves/disapproves of and what is morally right

ex- abortion is wrong, this just shows that a person does not agree with abortion but it is not morally right or wrong.

Meaning of moral statements

*moral judgments are just reports or expressions of personal attitudes or feelings

are those claims that are justified by moral reasons

The meta-ethical view that moral judgments are objectively correct(or incorrect) and that the task of moral theory and moral reasoning is to achieve correct moral understanding and make correct moral judgments.

it means that there IS a distinction between what people BELIEVE is morally right (or wrong) and what is morally right (or wrong)

• *Linguistic
• *Metaphysical
• *Epistemological

Regarding the reality of moral values

*There are no moral facts (as there are scientific facts); no moral order independent of people's responses of approval/disapproval.

*Moral right and wrong is just a matter of what people feel is right or wrong

Regarding moral knowledge

• *Moral judgments are neither true nor false;
• *They cannot be either confirmed/ disconfirmed
• *They cannot be either correct/ incorrect
• *Feelings or attitudes are not the sort of thing that can be assessed as true or false

• *Simple Subjectivism
• *Emotivism

A moral judgment means nothing more than that the speaker approves/disapproves of the object of moral evaluation. It is simple a report of the speakers attitude.

• X is morally right (permissible, obligatory, heroic)
• X is good, virtuous
• X ought to be done

• X is morally wrong (impermissible)
• X is bad, vicious
• X ought not to be done

Moral judgments are nothing other than expressions of approval or disapproval. This is different from the claim that moral judgments are reports of personal attitudes.

*"Stem cell research is immoral" means: Stem cell research------boo! (or other expression of disapproval)

*"Stem cell research is permissible" means: Stem cell research-------okay! (or other expression of approval)

*Discretionary

The manner and occasion of fulfilling the duty is left to each person to decide. They are not owed "to any definite person, nor at any prescribed time."

• *Non-discretionary
• *Fiduciary obligations

are owed to definite persons, who have a corresponding moral claim on my conduct.

*are perfect moral duties

*In professional ethics a fiduciary obligation is the obligation to act in the best interest of a client or stakeholder

The goal of medicine is to promote the patient best interest understood from the perspective of medicine

*the primary obligation of providers of health care is to avoid harm as medicine defines harm

*Do no Harm, Duty of non-Maleficence

*Duty not to inflict harm; not to impose risks of harm

*Prevent harm, remove harm, promote good

*To prevent/ remove pain, suffering, handicapping conditions of disease/injury

*To seek cure of disease/injury where there is reasonable hope of cure

*To prolong life/ prevent premature death

Health of the patient-(narrow) absence of disease, absence of infirmity

a) pain

b) impaired function

Psychological, social, aesthetic, economic, religious, cultural

mind set of provider: intentions/willingness to benefit; to relieve distress for the patient.

Skill set of provider: technical competence used to achieve a specifically defined benefit for the patient.

Duty of non-maleficence

X harmed Y= X caused an adverse effect on Y's interests

X harmed Y = X wronged Y or treated Y unjustly

FAILURE to exercise "Due Care" violates the principle of non- Maleficence

*A professional level of training and skill, adequate knowledge and skill for the proper discharge of particular duties, diligence, thoughtfulness, carefulness, and patience in discharging clinical duties.

• *Intentional
• *Unintentional

Knowingly imposing harm and risks that are unacceptable by professional standards

unknowingly, but carelessly imposing harm and risks below professional standards

responsible

*forgetfulness, inattention, poor motivation, carelessness, recklessness

responsible

• *Multiple failures of large systems
• *Poor design of equipment

Physician takes the role of the parent. Physician has complete authority to make decisions for the patient. Physician gives orders and will be obeyed.

Patient autonomy- patient may be able to refues

the physician treats the patient as a consumer. It is the physician's obligation to provide all of the facts, and the patient's values then determine what treatments are to be given. In the informative model, the physician provides the patient the means to exercise control and to make an informed decision as to the course of treatment

Patient autonomy- up to the patient to figure out the significance what they are receiving

A violation of another person's autonomy for the sake of that person's welfare

interference is justified only when the other person is not competent to make his own decisions

interference is justified even when another person is competent to make his own decisions: in order to promote that person's own good

paternalism s never justified; even when other person is not competent and at risk of harming himself

• *Minimal Standard
• *Outcome Standard
• *Status Test
• *Function/Process Standard

Patient is able to express a preference; show evidence of a choice

Patient is judged competent or not on the basis of the content of her choice; judged not fully competent if choice is unreasonable

Assessment of competence is made according to status indicators: age, diagnosis, pain, medication.

Assessment of competence is based on the decision-makeing functioning of the patient, the process of reasoning that leads to the decision

• * Independence from the will of others
• *Independence from irrational, unreasonable motivation

The ability of a person to be the author of her own life; the ability to design one's own life plan, to control the course of one's life

The capacity for conscious, deliberate, reasoned choice about one's actions

• *Freedom from coercion
• *Freedom from Psychological impairment
• *Choice must be informed

• Physical coercion
• Coercive options
• Coercive influence

• Needs relevant comprehension of circumstances
• Needs reasonable motivational response
• -Sources of motivational impairment: addiction, phobia, physical illness, mental distress

Autonomous choice requires that a person possess adequate information, that is comprehensible

works with the patient and their goals and tries to clarify the patients values are. The patients values include medical and non-medical values. Just the medical values are at stake and include them to make the best medical decision possible. Accomadate their values.

The physician acts like a teacher or friend. engaging the patient in dialogue on what course of action would be best. Not only does the physician indicate what the patient could do, but, knowing the patient and wishing what is best the physician indicates what the patient should do,what decision regarding medical therapy would be admirable.

Patient Autonomy- moral self development, the patient is empowered