Transcript document

IFMSA Ireland
International Conference 2004
Windows Into Medicine
Medical ethics: Beginning of life issues
Dr T Everett Julyan
Glasgow, UK
Saturday 16th October 2004, Dublin
The Scottish Council on Human Bioethics
www.schb.org.uk
There is nothing good or bad,
but thinking makes it so
Hamlet
Overview
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Why do we need medical ethics?
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What are medical ethics?
How can we decide what is ethical
and what is not?
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Abortion: A worked example
Why do we need medical ethics?
Examples:
HIV
● Leprosy
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CAN versus OUGHT
The END cannot justify the MEANS
Why do we need medical ethics?
The reality of morality
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c.f. mind versus brain
c.f. colour, colour-blindness and the
electromagnetic spectrum
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What are medical ethics?
eth-ic
noun
1. a. A set of principles of right conduct.
b. A theory or a system of moral values.
2. ethics (used with a sing. verb)
The study of the general nature of morals and of
the specific moral choices to be made by a person.
3. ethics (used with a sing. or pl. verb)
The rules or standards governing the conduct of a
person or the members of a profession.
What are medical ethics?
A definition:
The systematic study or practice
of moral behaviour within medicine
How can we decide what is ethical
and what is not?
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Gut-feeling?
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Reason?
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Conscience?
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Consensus?
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Consequences?
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Relativism?
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Authority?
Different approaches
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Deontological
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Teleological
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Consequentialist
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Others
Different approaches
Deontological
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Rule-based
e.g. Hippocratic Oath
Different approaches
Teleological
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Purpose-based
e.g. Natural Law
Different approaches
Consequentialist
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Results-based
e.g. Utilitarianism
Different approaches
Others
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Mixed approaches
e.g. Principlism
(autonomy,
beneficence,
nonmaleficence, justice, veracity, privacy,
confidentiality, fidelity)
Areas of ethical relevance
MOTIVES
ACTIONS
CONSEQUENCES
Different approaches
Discuss strengths and weaknesses of:
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deontology (rules)
teleology (purpose)
consequentialism (results)
principlism (autonomy, etc)
with respect to:
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motives
actions
consequences
Different approaches
Deontological (rules)
Strengths:
Weaknesses:
Different approaches
Teleological (purpose)
Strengths:
Weaknesses:
Different approaches
Consequentialist (results)
Strengths:
Weaknesses:
Different approaches
Principlism (autonomy, etc)
Strengths:
Weaknesses:
Differences in common
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There is an OUGHT
There is an ought IN REFERENCE TO
SOMETHING
We don't agree
SOMETHING IS
on
WHAT
THAT
God? Nature (evolution)?
or what?
A combined approach?
MOTIVES
RULES
PURPOSE
HAPPINESS
ACTIONS
PRINCIPLES
SURVIVAL
CONSEQUENCES
Abortion: A worked example
Some facts:
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One of the most commonly performed
gynaecological procedures in the UK
At least 1 in 3 UK women have an abortion
by age 45
~50 million deaths annually worldwide
~50
million
worldwide
abortions
annually
Abortion: A worked example
Any action which is taken
with the intention of ending the life
of a conceptus
(zygote,
fetus)
morula,
blastocyst,
embryo
or
Abortion: A worked example
1. 15 Prim, raped by father 6 weeks ago
2. 38 Para2, screening=”high risk of Down's”
3. 31 Para3, previous eclampsia, C-section and
subsequent puerperal psychosis
4. 22 Prim, going on holiday next year
Motives | actions | consequences
Rules | purpose | results | principles
Abortion: A worked example
Facts
● When does life begin?
Values
● Actual values
Is killing wrong? What is a person?
Balance between values
“Right to choose” versus “Right to life”
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Conclusions
Medical ethics
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Necessary
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Integral
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Ubiquitous
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Principled
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Generalisable
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Multifactorial
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Complex
Do to others what you would
have them do to you
Jesus Christ