Transcript Medicina utemeljena na dokazima

University of Split
School of Medicine
Ethics
Mario Malički
MORAL
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principle of
conduct
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good vs. bad
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"reaction“
Virtue – moral excellence
A virtuous doctor is a good doctor
Morality has exceptions – the LAW does not
Human behavior – attempt to preserve
consistency between image of self and ones
actions
There is a difference between moral expert and
moral superiority
Ethical approaches:
1. Metaethics
2. Normative ethics
3. Applied ethics
Deontology
duty
(normative ethics)
WMA International Code of Medical Ethics
• A physican shall:
always exercise his/her independent professional judgment and maintain the highest
standards of professional conduct.
respect a competent patient's right to accept or refuse treatment.
not allow his/her judgment to be influenced by personal profit or unfair
discrimination.
be dedicated to providing competent medical service in full professional and moral
independence, with compassion and respect for human dignity.
deal honestly with patients and colleagues, and report to the appropriate authorities
those physicians who practice unethically or incompetently or who engage in fraud
or deception.
not receive any financial benefits or other incentives solely for referring patients or
prescribing specific products.
recognize his/her important role in educating the public but should use due caution in
divulging discoveries or new techniques or treatment through non-professional
channels.
respect the local and national codes of ethics.
KODEKS
MEDICINSKE ETIKE I
DEONTOLOGIJE
10. lipnja 2006. Hrvatska liječnička
komora
School of Medicine
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all types of plagiarism, falsification and other ways of breaking the academic
integrity
attending the educational process under the influence of alcohol or narcotics
deliberately disturbing or interrupting lectures, research or other academic
activities
cheating with the usage or intention of usage of notes and data during exams,
except if explicitly allowed
helping other students during knowledge assessment if student is expected to
solve the problem alone
intentional misrepresentation of somebody else’s work as one’s own
abuse of information systems, technological equipment, email, or internet-based
programs for intolerable purposes
any kind of assault, maltreatment, disruption, blackmail, threat, harassment,
degradation, intimidation, mocking, insulting and similar.
Croatian Laws
• Physican’s Act
• Health Care Act
• Act on Protection of Population from
Infectious Diseases
• Blood and Blood Products Act
• Medically Assisted Fertilization Act
• Sex Change Act
• Rules for Examination of the Dead and
Establishing the Cause of Death
Trolley problem
Phillipa Foot 1967
The New York Times; Illustration by Frank O’Connell
Solving dillemas
Irrational approaches :
• obedience
• imitation
• feelings
• intuition
• habit
Rational approaches
• Deontology
• Consequentialism (Utilitarianism)
• Virtue ethics
• Principalism
BIOETHICAL PRINCIPLES
(Beauchamp and Childress)
1. Autonomy - respect the right of individuals
2. Non maleficence - avoid causing harm
3. Beneficence - help others
4. Justice - fair distribution
Autonomy
competent patient's right to accept
or refuse treatment
Non maleficence
Do no harm
Beneficence
Doing best for the patient
Justice
cost effectiveness and fair
distribution
Moral Development
Lawrence Kohlberg's stages of moral development
Level 1 (Pre-Conventional) 3-7 y “I would cheat if I knew I wouldn't get
caught”
1. Obedience and punishment
“I’ll let you copy my work, if you give me
2. Self-interest orientation
something in return”
Level 2 (Conventional) highschool
3. Interpersonal conformity
“I wont do it, cause I wont her to like
me”
4. Authority and social-order
Level 3 (Post-Conventional) college “You cant do it as teacher said no”
5. Social contract orientation
“There may be an exception to the rule”
6. Universal ethical principles
“You shouldn't lie as it violates the
principle”
Hamlin – Social evaluation by preverbal infants
2007 – helpers and hinderes
Kanakogi 2013 - Rudimentary Sympathy in
Preverbal Infants
Warneken 2006-7 Altruistic helping in human
infants and young chimpanzees
Frans De Waal – empathy in animals
Cruelty in animals
chimpanzee civil war - Kibale national park in Uganda
Tanzaina's Gombe Stream national park – split to two tribes
http://www.pbs.org - Hominidae Family Tree
Make love not war - Bonobos
Immanuel Kant -"Perpetual Peace" 1795
democracy, trade and an international
community are pacifying forces
Bruce Russett and John Oneal. 2001.
Triangulating Peace
Steven Pinker
The surprising decline of violence
Lawrence Kohlberg's stages of moral development
Level 1 (Pre-Conventional) 3-7 y “I would cheat if I knew I wouldn't get
caught”
1. Obedience and punishment
“I’ll let you copy my work, if you give me
2. Self-interest orientation
something in return”
Level 2 (Conventional) highschool
3. Interpersonal conformity
“I wont do it, cause I wont her to like
me”
4. Authority and social-order
Level 3 (Post-Conventional) college “You cant do it as teacher said no”
5. Social contract orientation
“There may be an exception to the rule”
6. Universal ethical principles
“You shouldn't lie as it violates the
principle”
Thorndike – 1930s
How much would you have to be paid to undergo
the following experiences?
1. to have one upper front tooth pulled out?
2. to have one little toe cutoff?
3. to eat a live earthworm six inches long?
4. to live the rest of your life on a farm in Kansas?
5. to choke a stray cat to death with your bare
hands?
Utilitarianism
revisited
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1. 74 000 $
2. 4,500 $
3. 100,000 $
4. 300 000 $
5. 164 000 $
Reason is weaker then situation
• David Hume 1738: “Reason is,
and ought only to be the slave of
the passions, and can never
pretend to any other office than
to serve and obey them.”
Stanely Milgram experiment
1961 -1963
The bystander effect
blog.lib.umn.edu
Disgust as Embodied Moral Judgment
• fart spray experisments (2005; 2008):
• legalization of marriage between first cousins
(Marriage), approval of sex between first
cousins (Sex), moral judgments of driving
rather than walking to work (Driving), and
approval of a studio’s decision to release a
morally controversial film (Film).
• abortion, pornography, premarital seks,
homosexual relationship or sex
Moral Universals/Foundations theory
– Johnathan Haidt
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Care/harm
Fairness/cheating – Reciprocity - The Golden Rule,
Liberty/oppression
Loyalty/betrayal - Ingroup community
Authority/subversion - hierarchy
Sanctity/degradation - Purity – sex, food,
23,684 subjects
Trolley problem
Phillipa Foot 1967
The New York Times; Illustration by Frank O’Connell
SOLVING MORAL DILEMMAS
Consequentialism - Utilitarianism– based on outcome or result.
Deontology – rules
Casuistry – according to known cases and solutions
Virtue ethics – internal motif for action
Ethics of care – interdependence, relationships and empathy
Physician Payment Sunshine Act
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Consulting fees
Honoraria
Gift
Entertainment
Food
Travel
Education
Research
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Charitable contribution
Royalty or license
Grant
Compensation for services
other than consulting
• Current or prospective
ownership or investment
interest
Bristol-Myers Squibb
JITENDRA
GANDHI
Company
$270717,70
PATRICIA
LORUSSO
Eli Lilly and Company
$115103,17
DONALD
ANDERSON
Forest Laboratories, Inc.
$75848,00
LAURA
CHOW
Eli Lilly and Company
$60865,00
Janssen Research &
MEENAKSHI
PATEL
Development, LLC
$55872,94
MISAL
KHAN
Daiichi Sankyo Inc.
$55866,00
DONALD
ANDERSON
Forest Laboratories, Inc.
$55290,00
MARTIN
ROCHE
DePuy Synthes Sales Inc.
$54490,00
ARAKEL
DAVTIAN
Forest Laboratories, Inc.
$51352,25
THOMAS
SHIOVITZ
Forest Laboratories, Inc.
$45842,25