history of medical ethics ph 350 norwich university spring 2010
TRANSCRIPT
Learning Objectives
• To understand early medicinal thought, especially the concept of paternalism
• To highlight some of the major events in history that developed patient autonomy
• To review the goals of medicine• To understand the major principles of
modern-day medical ethics
Early Medicinal Thought
• Paternalism
-Medical treatment as a father/child relationship
-Guiding principle: physician decides what is best for the patient and tries to follow that course of action
-Focus: patient care and outcomes, not the patient’s needs or rights
-Argument: maximum patient benefit can only be achieved when the doctor makes the final decision
Paternalism…Continued
• Types of Paternalism-Positive vs. Negative
Positive = promotes the patient’s goodNegative = seeks to prevent an existing harm
-Soft vs. HardSoft = appeals to the patient’s valuesHard = applies another’s values over the patient
-Direct vs. IndirectDirect = benefits the patient who has been restrictedIndirect = benefits a person other than the one restricted
The Father of Medicine
• Hippocrates -Rejected medical views of his time
-Based his medical practice on observations and study of the human body
-Believed that illness has a rational explanation
-Treated body as a whole unit, not just parts
-Founded a medical school on the island of Cos, Greece to teach his beliefs
Hippocratic Oath
• Original vs. Contemporary
-language and content has been updated to fit modern beliefs about medicine
-spells out physician responsibilities to both the patient and the medical profession
Evolution to Autonomy
• Making the shift from paternalism
-Patient given opportunity to determine benefit vs. harm- The Patient’s Bill of Rights
-Questions being raised regarding the patient’s wishes as to what is ethical
-How much do you tell the patient?-Do they even want to know?
Notable Cases in History
• Nuremberg Code: 1946
-Limits on medical research following Nazi testing of hypothermia & antimicrobialagents
-Subjects were put in ice tanksfor 3 hours, wounds were inflicted& purposely infected with bacteria
-Concepts of informed consent, avoiding all unnecessary physical & mental suffering, proper preparation & facilities, ability for subjects to
opt out, basing human experiments on results of animal testing
Notable Cases…Continued
• Tuskegee Syphilis Study: 1929
-Use of placebos in studies
-Participants were illiterate, black sharecroppers thoughtto have “bad blood”
-Deaths, chronic illness, andtransmission to wives & childrenresulted
Notable Cases…Continued
• Nancy Cruzan: 1983
-Was maintained in a persistent vegetative state for several years -Parents requested that artificial hydration and nutrition be withdrawn
-Courts rule in their favor, but healthcare team appeals the decision
-Incompetent patients need to be protected by law
-Encouraged the development of advance directives and appointmentof a health care proxy to carry out patient’s wishes
Goals of Medicine
• Relieve suffering- Example: The use of Chloroform and Ether
Chloroform was used more often because it was faster acting, less was needed to put someone under, and it was non-flammable. However, it was more dangerous than using Ether. The risk of drug overdose was greater with Chloroform.
Goals…Continued
• To cure disease and preserve life1900 – Average life expectancy was 492003 – Average Life expectancy is 78
• Vaccinations Definition: “A preparation of a weakened or killed pathogen, such as a bacterium or
virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.”-Swine Flu
• Cures- Breast Cancer
Principles of Medical Ethics
• Confidentiality-HIPAA (Health Insurance Portability & Accountability Act)
• Honesty-Telling patients what they need to know
• Justice-Treating all patients without discrimination
• Gatekeeping-Patients access to medicine through doctors
• Report impaired colleagues
Principles…Continued
• Avoid sexual relations with patients
• Conflicts of interest
• Scope of practice-Range of responsibility, abilities
• Gaming the system-Using patients to make more money