an introduction to bioethics
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An introduction to bioethics. Ma. Cristina S. Sombilon , M.D., F.P.S.P. Department of Medical Humanities UERMMMC College of Medicine. ETHICS. a branch of philosophy Practical science of MORALITY of human acts - PowerPoint PPT PresentationTRANSCRIPT
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Ma. Cristina S. Sombilon, M.D., Ma. Cristina S. Sombilon, M.D., F.P.S.P.F.P.S.P.
Department of Medical HumanitiesDepartment of Medical HumanitiesUERMMMC College of MedicineUERMMMC College of Medicine
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a branch of philosophy
Practical science of MORALITY of human acts
Teaches us how to judge accurately the moral GOODNESS or BADNESS of any human action
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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1. BENEFICENCE – ONE OUGHT TO DO GOOD
Seek the patient’s well-beingProvide standards of due care and
risk/benefit assessment 2. NON-MALEFICENCE – DO NO HARM
Avoid unnecessary expense, consult, procedures and medications
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
3. INFORMED CONSENT Provide the patient with a COMPLETE,
ADEQUATEDISCLOSURE of his illness and OPTIONS in a language he understands for the patient to be able to make a rational and free decision
4. AUTONOMY (RESPECT FOR PERSONS)
Respect the patient’s rational decision as long as he is aware of the consequences
The patient has a right to refuse
5. JUSTICEAllocating scarce resources fairly and
according to medical needs
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“life ethics” – philosophical
More encompassing than medical ethics, includes additional issues not necessarily a part of medical ethics
Medical ethics Business ethics Sexual ethics Social ethics Environmental policy and ethics
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Medical ethics is a “subset” of bioethics
Clinical or case-based approach
Used interchangeably “BIOETHICS”
“MEDICAL ETHICS”“BIOMEDICAL ETHICS”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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MEDICAL ETHICSMEDICAL ETHICS abortion euthanasia confidentiality truth telling fair distribution of
resources informed consent research involving
human subjects
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
HIV/AIDS issues organ
transplantation genetic engineering reproductive rights
and assisted reproductive techniques
stem cell research human cloning
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Corporate responsibility Rights and obligations of employees Diversity and discrimination in the
workplace Care for the environment from industry
and business Minimum wage vs. Living wage Age discrimination School discrimination
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
BUSINESS ETHICSBUSINESS ETHICS
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Homosexuality and gender sensitivity issues
Prostitution Adultery
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
SEXUAL ETHICSSEXUAL ETHICS
SOCIAL ETHICSSOCIAL ETHICS Family responsibility Distribution of social resources Society’s obligation to the poor
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The application of the GENERAL PRINCIPLES of ethics to the moral problems of the medical profession
CORE: ethics of a physician-patient relationship (TRUST)
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
Specific RULES OF CONDUCT of physician
What the physician PROVIDES for the patient
What the physician’s DUTIES are to the patient and VICE-VERSA
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TRADITIONAL MEDICAL ETHICSTRADITIONAL MEDICAL ETHICS
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
Equality of health care professionals and patients
• stewardship• autonomy
Purpose of health care is TOTAL PATIENT CARE (value based ethics)
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Duty to help the patient: BENEFICENCE
Duty not to harm the patient: NON-MALEFICENCE
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Coined to cover PHILOSOPHICAL, LITERARY, HUMANISTIC approaches to problems in medicine
Ethics is an area of study in philosophy and philosophy is a part of the humanities
Contemporary use of the term includes LITERATURE, POETRY, FILM, MUSIC to increase appreciation for the HUMANISTIC, INTERPERSONAL, and EMPATHETIC aspects of medicine
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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THE HEARTOF
MEDICINE
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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When and where was bioethics born?
ANCIENT HISTORY HIPPOCRATIC OATH – first code of medical ethics
“first do no harm”
A promise to respect a patient’s personal dignity and privacy
A promise to use medical knowledge FOR THE GOOD OF THE PATIENT
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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The oath and prayer of MAIMOINIDES (c. 1200)Rabbi Moshe Ben Maimon, a Jewish
philosopher
a meditative piece which implores physicians to look at the sick with respect and dignity
OATH“The eternal providence has appointed me to watch
over the life and health of Thy creatures. May the love for my art actuate me at all times: may neither avarice nor miserliness; nor thirst for glory or for a great reputation engage my mind... ”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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OATH OF MAIMOINIDES
“May I never see in the patient anything but a fellow creature in pain.”
“...God, thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto Thy calling.”
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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PERCIVAL’S CODE (1794) – first code of medical ethics adopted by a professional group of physicians.
AMERICAN MEDICAL ASSOCIATION (AMA) – first code of ethics was adopted in 1847 in Philadelphia
Duties and obligations of physicians to their patients and vice-versa
Duties of physicians to society and medicine itself
Revised and updated over time
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
MODERN DAY BIOETHICS Emerged from the atrocities and
scandals in human experimentation
Horrific experiments performed on prisoners by doctors in Nazi concentration camps
NUREMBURG MILITARY TRIBUNAL TRIALS (Nov. 14, 1945 – Oct. 1, 1946)
NUREMBURG CODE – influenced the direction of research ethics and policy
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NUREMBURG CODE Code of ethics on human
experimentation
Ten point statement delimiting permissible medical experimentation on human subjects
First line emphasizes that VOLUNTARY CONSENT of human subject is absolutely essential in any experiment
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
MODERN DAY BIOETHICS A new discipline which tries to reconcile the
discrepancies between the 2400 year old Hippocratic Code with today’s medico-moral issues
FROM AN ETHICAL POINT OF VIEW, MEDICINE IS
THE VICTIM OF ITS OWN SUCCESS
Today in medicine, the CRITERION OF WHAT IS GOOD (ethical or moral) is being replaced by WHAT IS USEFUL (Utilitarianism)
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
1966 article by Dr. Henry Beecher, Harvard Univ., in the New England Journal of Medicine (NEJM)
Several unethical and experimental research programs in clinical research in the U.S.
Used unknowing human subjects exposed to extreme health risks
“moral basis” or purpose is to advance scientific knowledge
Other well publicized events in health care and research questioned the norms of medical ethics
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
WILLOWBROOK STUDY/EXPERIMENT
Infecting mentally retarded school children of the Willowbrook State School in New York with HEPATITIS
To study the course of the disease
Consent to the study became a “prerequisite” for enrolment
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
TUSKEGEE EXPERIMENT
1930s U.S. Government study
400 Black American men with SYPHILIS were signed up to observe the course of the disease
1949- discovery of a cure PENICILLIN
Treatment was DELIBERATELY WITHELD from the subjects in order to observe the progress of the disease and its complications until death
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
TUSKEGEE EXPERIMENT
“bad blood”
Patients lived with the disease until their death, some in the 1970s
U.S. Gov’t. reparations and recognition of these men did little to regain the trust of the public in human experimentation
Only in the last term of Pres. W. Clinton was a FORMAL APOLOGY to the families of the Tuskegee victims given
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
MODERN DAY BIOETHICS CANDIDATES
1962: LIFE magazine article by Shana Alexander on the Seattle Artificial Kidney Program
1967: Dr.Christiaan Barnard, South Africa, first successful heart transplant
1973: Roe vs. Wade – U.S. Supreme Court decision on abortion
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
1974: exposure of Tuskegee Syphilis study
1974: The National Commission for the Protection of Human Subjects in Biomedical and Behavioural Research
1976: Quinlan case – U.S. Supreme Court decision on end-of-life
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
1978: Drs. Patrick Steptoe and Robert Edwards – first test tube baby (IVF) and embryo transplant baby Louise Brown
1980s – present: HIV/AIDS
1991: the Patient Self-determination Act (advanced directives, living will, ethics committees)
MODERN DAY BIOETHICS RECENT EVENTS
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Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
1996: Dolly, the first cloned sheep; stem cell technology
2002: legalization of euthanasia in the Netherlands, emergence of Right to Die advocates and movement, Oregon Death with Dignity Act
2007: Terri Schiavo – end of life case, termination of feeding
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BIOETHICS AS A FIELD MORE DEFINED
Bioethics institutes 1969 Hastings Center 1971 Kennedy Institute for Ethics (Georgetown
Univ.)
1977 Tom Beauchamp and James Childress The Principles of Biomedical Ethics (a synthesis of
approaches and methods in biomedical decision making)
1995 – 2001 National Bioethics Advisory Committee; President’s Council on Bioethics
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
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HOSPITAL ETHICS COMMITTEESS
ETHICS REVIEW BOARD
Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC
THE FUTURE OF BIOETHICS
Brain mapping and highly precise imagine technology – neuroethical issues to determine personality traits and disease and behavior predisposition: accessing a person’s memories for legal or forensic purposes
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