Medethics Midterm

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Examples of Deontological Ethics: -Legal positivism
-Traditional Religion
-Formalism
Examples of Teleological Ethics: -Utilitarianism
-Proportionalism
Formalism: DEONTOLOGICAL; Kant
-Morality is a matter of obeying the moral law.
-Did not posit any content for that moral law. Only a formalistic procedure for decision making - Universal Rules exist, common to all, found in human nature. Without religion
Utilitarianism: -Teleological Ethics
-Ethical Choices made for the greatest good, for the greatest # of people.
-Evil can be done for a greater good.
Positivism: Ethics/Morals resulting from positive code of civil law.
Why not?
-Ethics change with laws. Abortion was immoral before legal, then became moral.
-Some laws require immoral actions - Hitler's Third Reich
Religious legalism: Laws that are basis of Moral Norms are derived from religion.
-God is ultimate authority, determines what is right/wrong.
-Guideline is God revealed in Bible or Quran.
Catholic Moral/Ethical System: -Combination of Truths accepted on Divine Faith revealed by God, and natural law reasoning.
-Catholic church has the right/responsibility to teach Gospel truths and natural law.
Natural Law: TELEOLOGICAL
Natural: goals/major values human beings seek are innate.
Law: By reasoning about innate goals/values, we determine actions that are norms/laws for achieving goals.
Deontological: Norms of law that are based on obedience to law.
Teleology: The Norms of law are based on the choice of means suitable to achieve the true goals of human life.
-Consequences/goals define the means as ethical or not.
Natural Law Method of Reasoning: 1. Humans should be dedicated to achieving happiness, ultimate goal.
-Happiness is friendship w/ God and neighbor.
2. Use natural law to determine if particular actions are proper means toward fulfilling ultimate goal.
finis operis: moral object of an action.
-the most important element of natural law reasoning about goodness of action.
"the object chosen rationally by the will determines the morality of human action."
Moral object: finis operis
-the purpose that the act accomplishes in the moral order.
-the inherent intention in the action one is actually performing.
WHY: a circumstance present in every moral action - the Human motivation.
-plays a significant role in determining the morality of an act.
finis operantis: secondary motivation - circumstantial intention. Qualifies the primary intent.
-Can make the finis operis, primary intention, more good or worse, but cannot make an immoral act moral.
What determines the morality of an ACT?: -The intention of the ACTION.
-Not the intention of the AGENT.
Dimensions of Moral Actions: Moral Object - finis operis
Most Important Determiner
Circumstances - WHY
Always present as a determiner, makes an action more or less moral.
Agent's Intention - finis operantis
Proportionalism: no act is judged simply by moral object.
take the moral object, circumstances, and secondary intention TOGETHER.
-If premoral goods outweigh bads, the action is judged good.
-an arbitrary system open to abuse and rationalization. NOT teleological, but teleogism.
Theological virtues: Faith, hope, and charity.
Priorities of Christians.
primarily concerned with pursuing intimate friendship w/ God and neighbor.
Moral Virtues: Prudence, Justice, Fortitude, Temperance.
-Support pursuit and practice of theological virtues (faith hope charity)
Ethical Principles: Norms and statements that aid in reaching conclusions of how to pursue our primary goals in life. Guides to human happiness. Based on the theological and moral virtues.
Principles of Christian Faith: -Well-informed Conscience
-Informed Consent
-Double Effect
-Cooperation
-Professional Communication
Principles of Christian Love: -Human Dignity
-Common Good and Subsidiarity
-Totality and Integrity
Principles of Christian Hope: -Stewardship and Creativity
-Inner Freedom
-Personalized Sexuality
Model for Decision Making: Virtues - Spirituality
Principles
Values (deontological, teleological)
Lifestyle and Behaviors

Each manifested in next item.
Principles of Medical Ethics: Christian Faith: WEll-informed conscience, informed consent, double effect, cooperation, professional commnication.
Christian Love: Human Dignity, Common good/subsidiarity, Totality/Integrity.
Christian Hope: Stewardship/Creativity, Inner freedom, Personalized Sexuality
Principle of Well-Formed Conscience: Involves 4 determinations:
1. Fundamental commitment to God and authentic dignity of all persons.
2. Exclude all that contradicts loving God and neighbor as oneself - all intrinsically evil actions.
3.Analyze moral object of actions, circumstantial motives, and other circumstances, to assure accordance w/ striving for friendship with God.
4. Act in accord with this wellformed conscience. Follow through.
Principle of Informed Consent: If I feel a well-formed conscience is necessary, it is unethical to ask for cooperation of others without allowing them to have well-formed consciences as well. Share relevant info required.
3 Necessary Things for Informed Consent:: 1. Liberty - lack of coercive influence.
2. Agency - capacity to make intentional choice; Freewill.
3. Respect/Acknowledgement - for any choice that is made, even if not preferable.
Principle of Double Effect: An act can have two effects, even if only one is INTENDED. The intention determines the morality of the action.

E.g., remove a cancerous uterus, at the same time a fetus; but can't kill the fetus first to remove the uterus.
Cooperation: Cooperating with an evil action, freely or under duress.
Formal
Material - Immediate/Mediate Material
Formal cooperation: Freely cooperating/joining with another person in an evil action.
e.g., robbing a bank
Duress: physical or moral coercion
Material cooperation: Cooperation in an unethical act when duress is present. two kinds:
Mediate
Immediate
Mediate Material Cooperation: cooperation in an accidental, nonessential manner in an evil action.
e.g., cutting the grass or nursing people after an abortion. Not essential to the act of abortion.
Immediate Material Cooperation: Cooperation with an evil action by performing an essential part of the act. Running the vaccum machine for aborting fetuses.
Application of Double Effect: Mediate Material Cooperation
-The actual intention, moral object, is not inherently evil; a secondary circumstance is.
Professional Communication: 1. Strive to establish/preserve trust at emotional/rational levels.
2. Share informatione legitimately needed for informed conscience.
3. Don't lie/mislead.
4. Keep info secret if not legitimately needed by others or might harm if revealed.
Principle of Human Dignity: -Being a Person - Human Dignity - is not based on physical/mental health.
-Human Person is made in image of God.
-All are equal, have same human rights, claim to justice/dignity.
Principle of Common good and subsidiarity: Aka, ppl of Participation in Community.
-Human communities are for promotion of common good of members; each person has a right/responsibility to participate in this effort.
Subsidiarity: aspect of the principle of common good
-calls on each person or lower social unit to be given the opportunity to exercise responsibility to achieve goals proper to it. Also lower units depend on higher ones for support.
Totality and Integrity: -Care for and develop one's own natural functions in 2 ways:
-Bodily and Psychic lower functions never sacrificed except for better overall functioning.
-Basic person-defining capacities never sacrificed unless to preserve life.
4 basic needs; sacrifice the lower ones for highest priority.
Stewardship and Creativity: God created all for a purpose; use life wisely to achieve it.
2 great gifts: the earth/natl resources,
human nature with 4 basic needs.
Both are wonderfully constructed; prevent defects, but respect what is already there. (limits to innovation, reckless wasting)
Inner Freedom: -Self control re: pain and pleasure.
-When pursuit of pleasure/ flight from pain are obsessive, person is an addict or phobic. Reduced freedom, ability to make informed consent, rationally control behavior.
Personalized Sexuality: Sexuality is a gift that must be kept in accordance with its teleologic goal.
Growth through Suffering: Suffering and death, joined to the suffering and death of Christ, represent growth, fulfillment, and joy.
An ethics consultation might be considered for:: 1. Clarification of issues re: decisional capacity, informed consent, advance directives.
2. Provide recomm. re: DNR, withdrawal of treatment.
3. To resolve ethical issues btwn family/caregivers, patient/family, or among staff members.
4 Most Important Things To Look for in making an ETHICAL DECISION: 1. Patient Preference/Autonomy
2. Medical Issues
3. Socioeconomic issues/factors
4. Quality of Life
What is LYING and what is NOT lying?: Lying: telling fiction to someone entitled to the truth.

NOT lying: telling fiction to someone that is not entitled to the truth.
Key Characteristic of Lying vs. Truth:: ENTITLEMENT
backdoor to a cultural opposition to telling a dying patient the truth: Get them to say "tell me the truth". They're entitled to the truth, so you can tell them the truth, and tell the family "the patient asked me".
Characteristics of Catholic Moral System: 1. Inherent belief that church can teach in faith (concepts) and morals (practice).
2. Humans have purpose to exist; goals are innate and cultureally based.
3. Natural law based - deont and teleo.
4. Dimensions of moral action - Moral object, circumstance (why) motive - intention.
embodied intelligent freedom: the freedom by which we create some needs and choose the ways to satisfy needs - defines us as human.
4 needs of human person: Psychological - sense, imagination, feelings.
Social: self-control, social relationships.
Biological: maintain physical functioning in homeostatic dynamic relationship.
Spiritual - Creative
How do you fulfill the four needs of a human person: through values
What is the purpose of Values: To give meaning and purpose to our human endeavors of fulfilling our needs. (pychological, social, biological, and spiritual)
Ethics - purpose of them: An organized way of structuring our values. Choices and actions of value help to achieve our 4 needs.
How do you define personhood?: Something innate, or something derived from society?

-We are made in the image of God. Personhood is not an achieved capacity; we are all still developing.
Bioethical Model for Decision making (personhood expanded): Patient H.C. Provider
Values Values
ABC BC
B and C are common to both
point of reference, allows for better decision-making when values are shared.
Can the world develop common values? (hint: appendix 2): Univrsal Declaration of Human Rights
United Nations

the world an agree on ethics, even between different cultures.
How does one fulfill their values: through communication and sharing with community; no person exists apart from a community.
2 components of sharing values w/ community: Shared Needs - the common good of society; we share our values in an intellectual process.
Individualism - we have personal freedom and responsibility for our values.
Health: optimal functioning of the four needs. Not simply biological health; holistic too. ALL 4 DIMENSIONS.
2 conceptions of disease: ontological
physiological
Ontological conception of disease: disease is an invader that disturbs the homeostasis of the human.
Due to: devils, contagions, defects, neurosis.
Remedy: drugs, surgery, etc.
Physiological Conception of Disease: disease is a breakdown of the internal harmony of the organic system.
Remedy/Cure: Regimented lifestyle change.
Scientific Medical view of disease: Ontological; factors outside the patient are responsible for the disease. A breakdown in the the body's defense of attacking diseases.
RESPONSIBILITY for healing: Physician
Who's responsible for healing in the ontological view of disease?: PHYSICIAN.
Alternative Care's view of disease: the root cause lies deep within the patient.
RESPONSIBILITY for healing: PATIENT; therapists are facilitators of patient SELF-HEALING.
According to the physiological view of disease, who is responsible for healing?: THE PATIENT!!!
Therapists are only FACILITATORS of patient self-healing.
2 things one's health ultimately depends on:: Conscience and Spiritual Discernment
2 things help us make choices: Conscience
Church Teaching
Judgement: a capacity to make a choice; a judgement re: a way of acting on what is worthy in pursuit of your goals.
Conscience: Affective, Instinctive. Judgement - capacity to make a choiceregarding acting on what is wrothy in pursuit of goals..
Can you make a mistake in good conscience?: YES. Conscience is not a guarantor of right choices.
morality involves choices; how do we make choices?: By informing our consciences as best as possible.
By studying church teaching that is available on the subject.
Need for conscience, acc. to Vatican 2: Church admits inadequecy to have solution to all problems;
Even though conscience can be mistaken, it is PRIMARY.
Extraordinary Teaching: Pope-Dogma
Bishops-Definition
Role of Pope in teaching - what kind: Pope declares a dogma - this is infallible teaching.
EXTRAORDINARY. Never changes, flawless. e.g., the trinity has 3 persons.
The role of Bishops in church teaching; what kind?: Bishops define teaching in Councils i.e., Vatican.
Define Dogma, Proclaim the Gospel, or Pastoral Councils. This is extraordinary teaching.
Pope's role in ORDINARY teaching: papal encylicals/letters.
-Changeable, purifiable/perfectable.
Z-quality diamonds.
Bishop's role in ORDINARY teaching: Nonuniversal/universal
revelation-interpretation.
disciplinary matters.
Is church teaching re: birth control INFALLIBLE?: no! - there's no church teaching re: medethics that is infallible. it's all ORDINARY.
as long as church teaching is __________ rely on conscience: ORDINARY
obsequium religiosum: honestly listen to ordinary church teaching with respect of intellect and will.
Have a primary right to listen to conscience over ordinary teaching, but at least listen first.
moral certitude: I'm as sure of my moral decision as I can be, but I could be wrong.

-How to make decisions based on conscience when no extraordinary teaching exists.
why do we need a well-formed conscience?: -because the church offers little extraordinary teaching on ethical issues in medicine.
-have to rely on conscience for the rest.
freewill -definition -who has it?: the capacity to make a choice related to the goal being pursued.

Who has it: those who understand the goal being pursued; requires capacity to abstract; kids can't do algebra.
Legal Autonomy -2 ways patients participate in legal decisions:: -Give informed consent, or
-Refuse to give informed consent.
Definition of Legal Autonomy: -The capacity to make a choice based on 2 laws:
1. Common Law Right to be free from invasion of bodily integrity.
2. Constitutional Right to Liberty
Is refusal of treatment incompetence? What are the grounds of the answer?: No. Persons with well-formed consciences and freewill (the ability to abstract from their goals in life) can give informed consent OR refusal.
4 Types of Patients who participate in medical decisions:: 1. Patients w/ Current dec'nal capacity
2. Patients w/ previous capacity who told someone their wishes and lost cap.
3. Patients w/ prev. capacity that did not express wishes.
4. PAtients who never had capacity (infants or severely disabled)
How does one express their wishes: 1. By expressing them in written format. Long-term desires.
2. By making them known.
3. Substituted Judgements by others.
4. Allowing other healthcare professionals to make decisions in their 'BEST INTEREST'.
2 Ways to give weight to a patient's wishes, based on the circle:: -Work from out - in. My values supercede the patients = I'm deciding in their best interest.

-Work from out in. Patient's values supercede mine.
2 Ways to express one's will/desires: -Durable Power of Attorney (DPA)
-Living Will
Living Will: direct communication/letter/document to a physician regarding ones wishes
WI caveat to Living Will: -If the physician perceives that the living will will "create discomfort" he can deny any request within it.
Power of Attorney: -A person is designated by the patient to make substituted judgements.
Health Care Agent: the person designated to make medical decisions in a Durable Power of Attorney.
Caveats to DPA: DPA - power of attorney; subst. judgmnts
-The Agent can prevent your placement in a healthcare setting without your verbal consent.
-Can prevent your receival of tube-feeding.
Difference between a Guardian and an Agent: Guardian = appointed by the courts.
Agent = chosen by you to make substituted.
Patient Self-determination Act: Upon entrance into a healthcare institution, patients are informed re: rights to decide medical action to be taken.
-Attached to Medicare Autonomous Bill.. saves healthcare dollars when elderly say STOP the treatment.
What did "PROFESSIONAL IDENTITY" used to be based on?: -Personal counselor-client relationships.
-improving interpersonal communication.
Identity of Professionalism in the information age is based on:: What you know, your ability to communicate it.
Why do patients go to the doctor? Does the power to prescribe make us more valuable?: Patients go for medicine/cure.
If we did not have the power to prescribe, we would still be valuable because we have the KNOWLEDGE of medicine.
Old Paradigm of Healthcare Professional: the POWER of the PAD - power to prescribe medications
New Paradigm of Healthcare Profession: The INTERNET. Everything doctors provide can now be provided via internet.
6 Positive effects of the NEW paradigm: 1. Reduced healthcare costs
2. Increased access to healthcare in underserved areas.
3. Decreased travel time/costs.
4. Faster timelier treatment.
5. Improved commun. between providers.
6. Keep patient's healthcare $$ in the local community.
Biggest Roadblock to the New Paradigm: (internet era)
GOVERNMENT won't provide the funding for internet care and telecommunication.
New role of professionals in light of the new paradigm:: Empowerment model; healthcare counselors; Facilitators of self awareness, aid the patient in making wise choices re; their own health.
The FUTURE of healthcare profession:: MINISTERS. holistic medicine.

NOT controllers of knowledge.

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