Transcript Document

Introduction to Medical Law,
Ethics, and Bioethics
Chapter 1
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Why Study Law, Ethics, and
Bioethics?
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Illegal is almost always unethical
Basic understanding of law as it applies to medical
practice is essential
Helps protect employee and employer from lawsuits
Assists medical professional in making decisions
based on reason and logic rather than on just emotion
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Medical Law
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Addresses legal rights and obligations that
affect patients and protect individuals, including
health care employees
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Provides yardstick to measure actions
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Punishes unlawful actions
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Medical Practice Acts
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Apply to how medicine is practiced in individual
states
Define meaning of the practice of medicine in
that state
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List requirements and methods for licensure
Define what constitutes unprofessional conduct
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
What Ethics Is Not
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Not about how you feel
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Not about sincerity of beliefs
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Not about emotional response
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Not only about religious beliefs
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Ethics
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Branch of philosophy related to morals, moral
principles, and moral judgment
Uses reason and logic to analyze problems
and find solutions
Concerned with actions and practices that
improve welfare of people in a moral way
4 Mainstream Theories:
Rights-based, Duty-based, Utility-based, Virtuebased
Medical Law and Ethics, Third Edition
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Bonnie F. Fremgen
Medical Ethics
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Concerns issues related to practice of
medicine
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Explores and promotes principles regulating
conduct of health care professionals
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Involves consideration of others in deciding
how to act
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Utilitarianism
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Greatest good for the greatest number
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Impact of actions on welfare of society as a
whole
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Utilitarianism is forward looking – choose the option that
brings about the overall better consequences.
Each individual has equal worth (1/the number of people)
Ends justify the means
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When a course of action will lead to overall better results
(the ends), how you get there will not be relevant (the
means).
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Duty-Based Ethics
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Focuses on performing duty
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Explores conflicts among duties
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A duty is not what one ought to do because someone else
says you ought to do it.
A duty is what one ought to do because reason dictates
that you ought to do it in such and such circumstances.
(respect persons vs respect yourself)
Example: We respect patient’s wishes to honor
their human dignity not because of the overall
consequences.
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Virtue-Based Ethics
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Emphasis on character traits, not on decisions
or principles involved
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Seeking the “good life” or how one ought to be
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Examples: being fair, honest, …
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Rights-Based Ethics
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Emphasis on individuals’ rights
Rights belong to all people
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
A SIDE NOTE ON “RIGHTS”
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Rights talk often disguises as other kinds of
ethical theories
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Look to the reasons why we ought to have such a right to
reveal the kind of ethical theory supporting it: For example,
we have a right to privacy because
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Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
it will lead to a better democracy (utilitarian)
that would respect persons and promote human dignity
(duty-based)
it is an entitlement from the constitution (social-based
theory of ethics that is not discussed in the textbook)
Because it is the fabric of the universe (rights based
theory)
Values That Drive Ethical Behavior
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Beneficence
Fidelity
Gentleness
Humility
Justice
Do No Harm
Trust
Further Science
…..
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
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Perseverance
Responsibility
Sanctity of life
Tolerance
Work
Non-Judgmental Regard
Professional
Competence
Interpersonal Ethics
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Respect
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Empathy
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Integrity
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Sympathy
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Honesty
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Compassion
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Fairness
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Loyalty
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Health care professional demonstrating
empathy
Figure 1-1
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
All patients are entitled to compassionate care
Figure 1-2
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Workplace Issues
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Privacy, or confidentiality
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Due process
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Sexual harassment
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Comparable worth
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Three-Step Ethics Model
1. Is it legal?
2. Is it balanced?
3. How does it make me feel?
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Think of your gut reaction not as evidence that something
is wrong but as an initial prompt to pursue a concern further
The other models then serve as a further guide.
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Dr. Bernard Lo’s Clinical Model
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Gather information
Clarify the ethical issues
Resolve the dilemma
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
Seven-Step Model for Examining
Ethical Dilemmas
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Determine the facts
Define the precise ethical issue
Identify the major principles, rules, and values
Specify the alternatives
Compare values and alternatives
Assess the consequences
Make a decision
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen
QUESTIONS?
Medical Law and Ethics, Third Edition
Bonnie F. Fremgen