Midterm Vocab

criteria of a moral theory

A theory, qua theory, needs to be: 1. categorical 2. impartial 3. fair 4. consistent 5. practical (i.e. utility)

Normative ethical theory

the concept of the good, (virtue, deontological, Consequentialist, caring) Aristotle's virtue theory is one of the most important. set of questions that arrive when considering how a person should act

Hippocratic Oath

"I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." Central to the Hippocratic Oath is the concept of non-maleficence or the principle that, above all else, do no harm (i.e. primum non nocere).

care

"Prior to 1982 scarcely anyone spoke of an "ethic of care." The word "care" had never emerged as a major concept in the history of mainstream Western ethics as compared, say, with the concepts of freedom, justice, and love. Yet, starting with the 1982 publication of a book by Carol Gilligan that spoke of a care perspective in women's moral development and throughout the 1980s and into the 1990s, an ethic of care emerged very rapidly, questioning earlier assumptions and setting new directions for bioethics." In defining care, care ethicists argue that care invokes an intertwining of emotions and attitudes such as sympathy, empathy, solicitude, concern, compassion, sensitivity and respect. The focus is on the interdependence of relations and the contexts within which the patient and healer occupy. The good is that which achieves a contextual holism.

disclosure

(sufficient information) 1/7 key components to informed consent A patient has a clear moral right to know the potential costs, outcomes, effects and harms of any medical treatment or procedure. Moreover, the professional has a clear moral duty to inform the patient of all of the above. Minimally, disclosure should include: Accessible and easily understood information; Benefits and risks of the procedure; Nature of the procedure; Costs and alternatives; Qualifications of the professional.

informed consent,

. In the U.S., a strong version called INFORMED CONSENT is typically practiced. The standard of INFORMED CONSENT is understood as "what any reasonable patient would want to know about their treatment and what the particular patient needs to know." According to Beauchamp, there are 7 key elements to I.C. 1. Competence (compos mentis) 2. Voluntariness 3. Disclosure (sufficient information) 4. Recommendation 5. Decision 6. Authorization

aristotle

. Keep in mind that medicine, law, ethics, philosophy all arose in Aristotle's time and he was a major contributor to all those fields. Aristotle's virtue theory is one of the most important normative theories, has wielded enormous influence over the past 2,000 years and is undergoing a kind of renaissance today. Aristotle (384-322). He introduces us to Virtue Theory in his major work, The Nichomachean Ethics, where he develops a truly character-based ethical theory. Frequently called Aretaic ethics after the ancient Greek word for excellence, άρέτέ. Aristotle thought to be moral was to practice human excellence, or to be truly human, The way of being of a courageous person is best exemplified by Achilles the great warrior from Homer's poem, The Iliad. Aristotle sees Achilles as someone who is practicing the way of being of courage to a tee. It is Achilles' character that functions as the centre to his action. Aristotle's Great-souled person or 'megalopsuchos'

golden rule

. Kung-fu-tzu (Confucius) (551-479) and his "golden rule" offered the first version of a deontological ethic. Image result for confucius golden rule "Do not impose on others what you do not wish for yourself."

fiduciary

A healthcare professional has chosen to dedicate his or her professional life to a caring profession build on trust. Trust is the essential underpinnings of any medical relationship. This kind of relationship is known as a FIDUCIARY relationship and it rests on several important aspects including empathy, confidentiality, compassion, dependability, honesty, truth-telling, fairness, patience and open-mindedness.

moral heroes

Aristotle held that an intelligent and truly wise and virtuous person—a person with an active and well-developed phronesis and the proper moral habits from emulating moral heroes-- would always choose the mean between extremes and that, in turn, would be the highest virtue. A Moral Hero is not a hero of accident or impulse. A Moral Hero must have intentionally, and selflessly upheld a moral virtue, such as kindness, patience, justice, compassion, love, or peace, knowing of the risks and consequences of their actions. We learn, according to Aristotle, by imitation (Mimesis). We learn language and proper ethical behavior by emulating others who have previously learned and developed phronesis.

4 principles approach: autonomy, beneficence, non-maleficence, respect

Autonomy (Self-rule) Justice (Fairness) Beneficence (Helping) Non-maleficence ( Not harming) Hippocrates (460-370): Primum Non Nocere justice

autonomy

Autonomy is the concept of self-rule or sovereignty that we understand rational agents to possess. We respect people's choices and decisions when there are no mitigating circumstances that cloud their judgment. When we over-ride a person's autonomy because of some mitigating factor, we call it Paternalism Kant- categorical imperative- deontological

felicific or hedonic calculus,

Bentham argues that all we need to do is tally up the units of pleasure compare them with the units of pain and we should be able to determine a moral act. In short, when we use his FELICIFIC CALCULUS. We are adding pain and pleasure... Their approach views the good as a calculus maximizing pleasures over pains for the greatest numbers of persons involved. An ethical ends justifies the means approach.

Gilligan

Carol Gilligan- another cofounder of care ethics Pre conventional stage- principle of care: individual survival conventional stage-self sacrifice for the greater good post conventional stage- principle of nonviolence(do not hurt others or oneself)

primum non nocere

Central to the Hippocratic Oath is the concept of non-maleficence or the principle that, above all else, do no harm (i.e. primum non nocere).

confidentiality

Confidentiality is present in all professional codes and is when one person (patient) voluntarily discloses information to another (care provider) with the expectation that it will not be divulged to any third party without the patient's permission. The expectation is that the medical professional will safeguard this private information. Historically confidentiality originally derives from the Hippocratic oath where the oath swore physicians to... "Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret." Confidentiality may be viewed as the practice of keeping personal and medical information protected from the public purview.

consequentialism

Consequentialism: (Outcome-based) Bentham&Mill This theory postulates that the good is achieved when you produce more beneficial outcomes for a larger percentage of individuals than any other alternative. The good becomes, then, a maximizing of the consequences. The English political philosopher, Jeremy Bentham and his godson, the polymath, John Stuart Mill, are the two best spokesmen for this ethical theory, a theory they ultimately tagged utilitarianism. Their approach views the good as a calculus maximizing pleasures over pains for the greatest numbers of persons involved. An ethical ends justifies the means approach.

HIPAA

Health Insurance Portability and Accountability Act (2003). A Federal law protecting a patient's medical records. This information may only be shared: When the law requires Upon Patient's authorization To facilitate treatment To prevent harm from occurring Patients may restrict information; Providers must provide clear, written explanations of the condition; Patients may see and obtain copies of their records; Providers must get permission from a patient or their legal proxy before sharing information; Patients have the right to file a complaint and seek redress when they feel a breach has been committed.

applied ethics

Healthcare ethics, as applied ethics, seeks to develop the healthcare professional's understanding of ethical decision-making. In so doing, the goal is to develop the healthcare professional's ability to identify, analyze and offer possible solutions to ethical dilemmas that may arise within medicine and healthcare. is the philosophical examination, from a moral standpoint, of particular issues in private and public life which are matters of moral judgment. It is thus the attempts to use philosophical methods to identify the morally correct course of action in various fields of everyday life.

Kant

Immanuel Kant (1724-1804), German Philosopher, was the best known and most influential deontologist. In his The Critique Of Practical Reason and The Grounding For Any Future Metaphysics of Morals, he presented a thorough examination of reason and morality and a deontological ethic. So the courage to understand underscores Kant's ethics. To that end, Kant argued that the only thing unqualifiedly good was a good will. thought of categorical imperative

great-souled person

In his Posterior Analytics and Nichomachean Ethics, Aristotle talks of the ideally virtuous or ethical human as the great-souled human. This ethical ideal is frequently embodied in the person of his teacher's (Plato) teacher Socrates. Aristotle's Great-souled person or 'megalopsuchos' is "someone of excellence, who esteems his or her own worth, but not with exaggeration (or false modesty); who is not over-excited by success nor much grieved by failure; who is generous and serves others, but not given to admiration, for nothing is particularly great. Above all, those large of soul are honourable, proud of their own virtue in the practical sense of not allowing any act to compromise it. In modern terms, Aristotle is speaking of a great, self-actualized ego, where 'great' is not simply large, but also high-minded and good" (from John Carroll's, Ego and Soul.) Think also of Wordsworth's "plain living and high thinking, " Thoreau's life of simplicity or Maslow's self-actualized hierarchy of needs.

Bentham

Jeremy Bentham (1748-1832) developed Consequentialism by arguing that "humans serve two sovereign masters, pain and pleasure. A good act, then, is one that ends with more pleasure than pain. godfather of mill Bentham argues that all we need to do is tally up the units of pleasure compare them with the units of pain and we should be able to determine a moral act. In short, when we use his FELICIFIC CALCULUS. We are adding pain and pleasure...

Rawls:

John Rawls: contractarianism John Rawls ( 1921-2002) was perhaps the most influential and important ethicist of the latter half of the 20th century. A deontologist in the tradition of Kant, he almost single-handedly re-invigorated ethical discourse and the concept of justice. "justice is fairness" "justice is the first virtue of a social institution." In his monumental A Theory of Justice, he claims that each person should have an equal right to the most extensive total system of equal basic liberties compatible with all, arranged such that: It is to the greatest benefit to the least advantaged, and; Attached to offices and positions open to all.I veil of ignorance how to solve economic problems with fairness

utilitarianism

John Stuart Mill (1806-1873), Bentham's godson, agreed with Bentham in his major work, Utilitarianism, but qualified the concept of pleasure to focus on intellectual and moral pleasure rather than merely physical or sensual ones. Two versions of utilitarianism have emerged in contemporary ethical thought: Act Utilitarianism: Where we determine social utility act by act. The act is preferable when it produces the most amount of pleasure. Rule Utilitarianism: Where we use a rule that produces the greatest good across several individual cases or acts.

Mill

John Stuart Mill (1806-1873), Bentham's godson, agreed with Bentham in his major work, Utilitarianism, but qualified the concept of pleasure to focus on intellectual and moral pleasure rather than merely physical or sensual ones. Mill accepted Bentham's reasoning but argued that we need to consider a broader set of pleasures and pains in our calculations. After all, how do we measure pain, pleasure? We need to consider the preferential pleasures rather than purely physical ones. Rather be Socrates dissatisfied than a fool satisfied" Mill's quote illustrates his notion that we need to construe pleasures in terms or quality rather than quantity. Further, we need to think of pains and pleasures according to : Intensity Duration Purity Fecundity And then gauge their total effects on the whole of society. Mill argued that we should try to maximize the pleasures—sum of total happiness-- for the greatest number of people. This is his concept of SOCIAL UTILITY.

categorical imperative ( 2 formulations),

Kant argued that there was a knowable universal principle in ethics. He called it the Categorical Imperative. It was universal (i.e. categorical) and rational command (i.e. an imperative). Kant offered two versions of the Categorical Imperative: 1. Act only according to that maxim whereby you can at the same time will that it should become a universal law;" and, 2.Act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end." also 3 act as though you are a member of a law making kingdom of ends The C.I. illustrates a central principle to deontological ethics and that is the concept of AUTONOMY

medical uncertainty

Medical Uncertainty. Medicine does not always know the full effects of a proposed treatment ( e.g. genetics) and may not always make the correct diagnosis. (vide Bursztajn and Duncan and Weston Smith). Medicine is as much an art as a science. Factors contributing to uncertainty include "biological variability of patients, patient and physician bias, error in test interpretation, differing values and opinions of patients and physicians, and uncertainty surrounding decision-making. Physicians differ in their ability to tolerate uncertainty, and this varying tolerance has been linked with choice of specialty, increased test ordering, personal anxiety.

medical ethics

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, and sociology.

Noddings

Nel Noddings(1929-) caring model We put great emphasis on moral interdependence—our shared responsibility for the moral strength or weakness of each member of our society. In 'educating the [caring] response,' caring parents and teachers provide the conditions in which it is possible and attractive for children to respond as carers to others. We show them how to care. carer and person receiving the care on dependent on each other, relation/receptivity

Tarasoff v. Regents,

Tarasoff v. Regents of The University of California" In 1968, college student Prosenjit Poddar met Tatiana Tarasoff at a dance class in California. They dated briefly but she rejected him. Poddar then told his therapist about wanting to kill her. His therapist wanted to commit him to hospital, but Poddar convinced campus police he was not dangerous. In the summer of 1969, after she returned from a vacation, Poddar stabbed Tarasoff to death with a kitchen knife. Poddar was convicted and deported back to India after conviction was overturned. Her parents sued the campus police for failing to warn that their daughter was in danger. This led to the famous Tarasoff decision, which ruled physicians now must warn potential victims of a psychiatric patient.

social utility

The Greatest Happiness Principle or Social Utility. Mill argued that we should try to maximize the pleasures—sum of total happiness-- for the greatest number of people. This is his concept of SOCIAL UTILITY. So a right act is one in which the pleasures outweigh the pains for the greatest number of people. "Act in such a way that you maximize the greatest happiness for the greatest number of people."

Nuremburg code

The aftermath of the Nazi experiments resulted in the Nuremberg Trials where 23 Nazi doctors would be charged with crimes against humanity. 15 were convicted. This led the international community to adopt the Nuremberg Code which rests on the principle of informed consent.

doctrine of the mean

The doctrine of the mean is a central concept in Aristotle's virtue ethics. According to the doctrine of the mean, virtue is a mean state between extremes of excess and deficiency. Aristotle describes this mean state as an "intermediate relative to us." Thus, courage exists as the mean between cowardliness and foolhardiness.

social construction model

depends on circumstances that a person is in, if they are truly disabled or ill. VP Biden, talking about war on cancer flipped from medical model, person centered language.

veil of ignorance,

The veil is a theoretical starting point advanced by Rawls in his "Theory of Justice" where one determines a just society ignorant of where one would belong in that society. As Rawls says: "no one knows his place in society, his class position or social status; nor does he know his fortune in the distribution of natural assets and abilities, his intelligence and strength, and the like." In short, one imagines what a just society would be like without knowledge of one's class, race, gender, education, ability or status. It causes you to consider the "other" in your allocation of justice. What would such a healthcare system look like? What are the minimal conditions of healthcare you would accept as just be? Spend some quality time listing what these basics would be. - Rawls

versions of justice

Versions of Justice: Compensatory( reimbursement for past wrongs) Retributive (punitive) Distributive (Allocation of goods and services)

Held

Virginia Held - cofounder of care ethics(The ethics of caring focus on the whole person and the person's contexts Interdependence Most Vulnerable prioritized) Virginia Held (1990) reveals that...care ethicists are focused on the issue of reality. She believes there is something about justice ethics that doesn't account for our lived in the world experience, where we are creatures in social-emotional context. In addition, She holds that women have a special moral access because of their cultural role as caregivers to children. This role makes them sensitive to the emotional, interpersonal elements of ethics. It makes them sensitive to the emotional and self-constituting element of relationships in ethical decisions. Men may not be as sensitive to this, according to Held. And possibly as a result of Justice ethic's lack of perspectival privilege

virtue theory

Virtue (Aretaic) character-based Aristotle thought to be moral was to practice human excellence, or to be truly human, those large of soul are honourable, proud of their own virtue in the practical sense of not allowing any act to compromise it to be virtuous, people need to be brought up within an ethical and politically just community. Aristotle argued that humans should strive for excellence in all that they do and that meant for Aristotle living a "life in accordance with reason."

W.D. Ross

W.D. Ross (1877-1971) argued from a deontological perspective that an act is right not because of the consequences it may bring about but only insofar as the duties we fulfill in doing that act. Accordingly, Ross held that there are seven (7) Prima Facie duties:

prima facie duty

W.D. Ross (1877-1971) argued from a deontological perspective that an act is right not because of the consequences it may bring about but only insofar as the duties we fulfill in doing that act. Accordingly, Ross held that there are seven (7) Prima Facie duties: a. Reparation: Making amends for previous wrongs b. Gratitude: Being thankful c. Fidelity: Loyalty d. Non-maleficence: Avoiding harm e. Justice: Being fair f. Beneficence: Doing good g. Self-improvement: Building one's character It may be helpful to memorize these and make them your daily ethical practice. modern deontological, helpful in healthcare

kinds of consent,

Written Oral Implied (usu. In emergency medical situations) General Special Consent (high risk or experimental procedures)

will

as a moral agent, will need to choose to do a certain thing for the reason, you have a duty to it rather than giving you please. ability to ration and make a good decision, will should be governed by reason , Kant argued that the only thing unqualifiedly good was a good will. (deontology)

utilitarianism: rules

certain rules are made to provide certain outcomes with the best circumstances . articulates a policy in the medical field and says everyone with a certain illness needs a certain treatment because it has worked in the past.

deontology

concerned not with the moral agent's character nor the consequences of the act, but solely with the very action or duty itself. Deontologists believe in acts that are intrinsically right or wrong. (e.g. Killing is always wrong). IT frames ethics in terms of duty, responsibility and articulates transparent sets of guides or principles. It is not positive human law but may be conceived as a higher, moral law. . Kung-fu-tzu (Confucius) (551-479) and his "golden rule" offered the first version of a deontological ethic. The chief criticism of the deontological model is that following a rule or principle is too rigid and inflexible in ordinary circumstances.

question 4:

eugenics, belief we can produce a better race by changing how we breed, 38 states passed eugenic laws to sterilize thousands of people. UVM directly implicated in this, perkins is the head of the American Eugenics Society. with hospital and the state, vermont had a successful program with sterilization of around sterilization of around 300 native americans. fully unjust, not respecting autonomy, not asking for confidentiality, special populations (alertly, poor, prisoners, - do they have a special standing in medicine'?)

care ethics

importance on the caring agent and seeks to develop reciprocity, authenticity and concern over rational agency, rights and a disengaged moral analysis. Typically contrasted against deontological and utilitarian ethics, care ethics has affinities with moral perspectives such as African ethics, feminism and Confucian ethics. [and] the desirable moral response is attached attentiveness to needs, not detached respect for rights*** Emphasizing the roles of Mutual Interdependence and Emotional Response changes our moral approaches to a model similar to the mother-child relationship of mutual interdependency.

arête

meaning virtue or excellence- character in homers odyssey (part of virtue ethics)

care ethics

not focused on the outcome itself, but on the set of relationships that usually have a positive outcome. really about individual patients.

phronesis

practical wisdom and ultimately derives from the habit of emulating one's moral exemplars (heroes) : For the virtuous character, the next step is to gain valuable life experience. The quality of one's experience informs one's moral development, one's choices, one's character. Phronesis—a kind of practical wisdom-- comes only from actually lived experience and is the ability to learn from that experience, integrate it, and understand the consequences of one's choices. It is something that requires accumulated life experience and is often seen in mature individuals we would consider wise.

reason

requires a universal principle to justify action- should only act when our action can be universalized. To universalize an act, simply ask yourself if everyone else should do the same thing in similar circumstances. If there is no conflict, then the act is universal.

medical model

sees a persons disability as a loss of function flaw: focus on impairment (the deaf person, for example)

greatest happiness principle

social utility

utilitarianism: acting

you can't make rules that provide the best outcomes, rather, you have to go act by act, but still want the best outcomes. in the medical field, they would determine the outcome by each patient. more flexible with therapy