Part I

Medical Ethics for PA Medical Ethics for PA StudentsStudents

Charles Walker, PA-C, PhDCharles Walker, PA-C, PhDDepartment of Orthopaedic SurgeryDepartment of Orthopaedic Surgery

LSU Health Sciences CenterLSU Health Sciences Center Shreveport, LA.Shreveport, LA.

July 2005July 2005

Medical Ethics Issues:Medical Ethics Issues: A Quick LookA Quick Look

Human StudiesHuman Studies


Allocation of Scare ResourcesAllocation of Scare Resources


Karen Ann QuinlenKaren Ann Quinlen


AbortionAbortion


EuthanasiaEuthanasia


Cost Benefit AnalysisCost Benefit Analysis


Transplant IssuesTransplant Issues


Fertility IssuesFertility Issues


Stem Cell / Cloning/ GeneticsStem Cell / Cloning/ Genetics


Ownership of Private Property / Ownership of Private Property / PatentsPatents


What Does It Mean To Be Human?What Does It Mean To Be Human?

Systematic Ways to Think About Systematic Ways to Think About Medical Ethics IssuesMedical Ethics Issues

Ethical Theories of Medical EthicsEthical Theories of Medical Ethics

Deontological EthicsDeontological Ethics

Teleological EthicsTeleological Ethics


Immanuel Kant described Immanuel Kant described Deontological Ethics in 18Deontological Ethics in 18thth Century Century



Deon Deon Gr. for dutyGr. for duty Duty OrientedDuty Oriented certain acts can be judged to be right certain acts can be judged to be right

or wrong in themselvesor wrong in themselves


Kant’s Categorical Imperative:Kant’s Categorical Imperative:

Always act in such a way that you Always act in such a way that you can also will that the maxim of your can also will that the maxim of your action should become a universal action should become a universal law.law.

Act so that you treat humanity, Act so that you treat humanity, both in your own person and in that both in your own person and in that of another, always as an end and of another, always as an end and never merely as a means.never merely as a means.


In an ethics of duty, the ends can In an ethics of duty, the ends can never justify the means. never justify the means.

Individual Individual human rights human rights are are acknowledged and inviolable. acknowledged and inviolable.

Deontological EthicsDeontological Ethics Kant's ethics poses two great problems that lead Kant's ethics poses two great problems that lead

many to reject it: many to reject it:

1. Unlike the proportionality that comes out of the utility 1. Unlike the proportionality that comes out of the utility principle, the categorical imperative yields principle, the categorical imperative yields only only absolutes absolutes . Actions either pass or fail with no allowance . Actions either pass or fail with no allowance for a "gray area." Moreover, the rigid lines are often for a "gray area." Moreover, the rigid lines are often drawn in unlikely places. For example, lying is always drawn in unlikely places. For example, lying is always wrong--even the "polite lie." wrong--even the "polite lie."

2. 2. Moral dilemmas Moral dilemmas are created when duties come in are created when duties come in conflict, and there is no mechanism for solving them. conflict, and there is no mechanism for solving them. Utilitarianism permits a ready comparison of all actions, Utilitarianism permits a ready comparison of all actions, and if a set of alternatives have the same expected and if a set of alternatives have the same expected utility, they are equally good. Conflicting duties, utility, they are equally good. Conflicting duties, however, may require that I perform logically or however, may require that I perform logically or physically incompatible actions, and my failure to do any physically incompatible actions, and my failure to do any one is itself a moral wrong.one is itself a moral wrong.


Jeremy Bentham and J S Mill Jeremy Bentham and J S Mill described Teleological or described Teleological or Consequentialist Ethics Consequentialist Ethics


Teleological or Consequentialist Teleological or Consequentialist EthicsEthics

TeleosTeleos Gr. for goal or end Gr. for goal or end Goal OrientedGoal Oriented rightness or wrongness of an act is to be rightness or wrongness of an act is to be

judged in terms of the consequences it judged in terms of the consequences it producesproduces


Actions are right to the degree that Actions are right to the degree that they tend to promote the greatest they tend to promote the greatest good for the greatest number good for the greatest number

Utilitarianism is a simple theory and Utilitarianism is a simple theory and its results are easy to apply its results are easy to apply


““The good" is defined in terms of The good" is defined in terms of well-well-being being (Aristotle's (Aristotle's eudaimoniaeudaimonia), and ), and distinguished not just distinguished not just quantitatively quantitatively but but also also qualitatively qualitatively between various forms of between various forms of pleasurepleasure. .

The principle defines the moral right in The principle defines the moral right in terms of an objective, material good. terms of an objective, material good.

Bridge gap between empirical facts and a Bridge gap between empirical facts and a normative conclusion--cost/benefit normative conclusion--cost/benefit analysisanalysis

Teleological EthicsTeleological Ethics It is not always clear what the outcome of an action will be, nor is it always It is not always clear what the outcome of an action will be, nor is it always

possible to determine who will be affected by it. Judging an action by the possible to determine who will be affected by it. Judging an action by the outcome is therefore hard to do beforehand. outcome is therefore hard to do beforehand.

It is very difficult to quantify pleasures for cost/benefit analysis (but since It is very difficult to quantify pleasures for cost/benefit analysis (but since this only has to be done on a comparative scale, this may not be as serious this only has to be done on a comparative scale, this may not be as serious an objection as it at first seems). an objection as it at first seems).

The calculation required to determine the right is both complicated and The calculation required to determine the right is both complicated and time consuming. Many occasions will not permit the time and many time consuming. Many occasions will not permit the time and many individuals may not even be capable of the calculations. individuals may not even be capable of the calculations.

Since the greatest good for the greatest number is described in aggregate Since the greatest good for the greatest number is described in aggregate terms, that good may be achieved under conditions that are harmful to terms, that good may be achieved under conditions that are harmful to some, so long as that harm is balanced by a greater good. some, so long as that harm is balanced by a greater good.

The theory fails to acknowledge any individual rights that could not be The theory fails to acknowledge any individual rights that could not be violated for the sake of the greatest good. Indeed, even the murder of an violated for the sake of the greatest good. Indeed, even the murder of an innocent person would seem to be condoned if it served the greater innocent person would seem to be condoned if it served the greater numbernumber

Case StudiesCase Studies Mr Wilkinson is a 77-year-old who lives with his wife and son. He is terminally ill Mr Wilkinson is a 77-year-old who lives with his wife and son. He is terminally ill

with cancer of the lung with liver secondaries. Over the last few months he has with cancer of the lung with liver secondaries. Over the last few months he has deteriorated, he has also lost a lot of weight. It has now been decided that Mr deteriorated, he has also lost a lot of weight. It has now been decided that Mr Wilkinson should be admitted for assessment and pain control.Wilkinson should be admitted for assessment and pain control.

He is currently taking co-codamol for pain relief but it is felt by the nursing staff He is currently taking co-codamol for pain relief but it is felt by the nursing staff that his pain relief would be better met through use of morphine. However, Mr that his pain relief would be better met through use of morphine. However, Mr Wilkinson has stressed that he does not want to start taking morphine having Wilkinson has stressed that he does not want to start taking morphine having heard terrible stories about people who have taken it. heard terrible stories about people who have taken it.

The ward staff express their concerns to you that they feel Mr Wilkinson is in pain The ward staff express their concerns to you that they feel Mr Wilkinson is in pain and that he looks uncomfortable. The staff have asked him on several occasions and that he looks uncomfortable. The staff have asked him on several occasions but he always says he's ok. During previous respite admissions, Mr Wilkinson has but he always says he's ok. During previous respite admissions, Mr Wilkinson has told nursing staff that he does not want to be drugged to death, He feels the Lord told nursing staff that he does not want to be drugged to death, He feels the Lord will receive him when he is ready.will receive him when he is ready.

One week after his admission, he deteriorates. He becomes semi-conscious - he is One week after his admission, he deteriorates. He becomes semi-conscious - he is dying. During periods of consciousness he becomes very agitated, screaming at dying. During periods of consciousness he becomes very agitated, screaming at times - especially when moved.times - especially when moved.

The nursing staff on the ward are very distressed by this. The wife and son are The nursing staff on the ward are very distressed by this. The wife and son are asked if they would agree to morphine or sedation being given to the patient. asked if they would agree to morphine or sedation being given to the patient. They refuse.They refuse.

The next day the son appears ambivalent about the decision to withhold The next day the son appears ambivalent about the decision to withhold morphine.morphine.

Both the Consultant and nursing staff feel that morphine should be given. The Both the Consultant and nursing staff feel that morphine should be given. The junior doctors and staff feel that the wishes of the family should be observed as junior doctors and staff feel that the wishes of the family should be observed as they are worried about a complaint.they are worried about a complaint.

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Part I

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