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IFMSA Ireland International Conference 2004 Windows Into Medicine Medical ethics: Beginning of life issues Dr T Everett Julyan Glasgow, UK Saturday 16th October 2004, Dublin The Scottish Council on Human Bioethics www.schb.org.uk
There is nothing good or bad, but thinking makes it so Hamlet
Why do we need medical ethics? What are medical ethics? How can we decide what is ethical and what is not? Abortion: A worked example Overview
Examples: HIV Leprosy CANversusOUGHT TheENDcannot justify theMEANS Why do we need medical ethics?
The reality of morality c.f.mindversusbrain c.f.colour, colour-blindness and theelectromagnetic spectrum Why do we need medical ethics?
eth-icnoun 1. a. A set of principles of right conduct. b. A theory or a system of moral values. 2. ethics (used with a sing. verb) The study of the general nature of morals and of the specific moral choices to be made by a person. 3. ethics (used with a sing. or pl. verb) The rules or standards governing the conduct of a person or the members of a profession. What are medical ethics?
A definition: Thesystematic study or practice of moral behaviour withinmedicine What are medical ethics?
Gut-feeling? Reason? Conscience? Consensus? Consequences? Relativism? Authority? How can we decide what is ethicaland what is not?
Deontological Teleological Consequentialist Others Different approaches
Deontological Rule-based e.g.Hippocratic Oath Different approaches
Teleological Purpose-based e.g.Natural Law Different approaches
Consequentialist Results-based e.g.Utilitarianism Different approaches
Others Mixed approaches e.g.Principlism (autonomy, beneficence, non-maleficence, justice, veracity, privacy, confidentiality, fidelity) Different approaches
Areas of ethical relevance MOTIVES ACTIONS CONSEQUENCES
Discussstrengthsandweaknessesof: deontology(rules) teleology(purpose) consequentialism(results) principlism(autonomy, etc) with respect to: motives actions consequences Different approaches
Deontological(rules) Strengths: Weaknesses: Different approaches
Teleological(purpose) Strengths: Weaknesses: Different approaches
Consequentialist (results) Strengths: Weaknesses: Different approaches
Principlism(autonomy, etc) Strengths: Weaknesses: Different approaches
There is anOUGHT There is an oughtIN REFERENCE TO SOMETHING We don't agree onWHAT THAT SOMETHING IS God? Nature (evolution)? or what? Differences in common
A combined approach? MOTIVES PURPOSE RULES HAPPINESS ACTIONS SURVIVAL PRINCIPLES CONSEQUENCES
Some facts: One of the most commonly performed gynaecological procedures in the UK At least1 in 3UK women have an abortion by age 45 ~50 million deathsannually worldwide ~50 million abortionsannually worldwide Abortion: A worked example
Any action which is taken with the intention of ending the life of a conceptus (zygote, morula, blastocyst, embryo or fetus) Abortion: A worked example
1. 15 Prim, raped by father 6 weeks ago 2. 38 Para2, screening=”high risk of Down's” 3. 31 Para3, previous eclampsia, C-section and subsequent puerperal psychosis 4. 22 Prim, going on holiday next year Motives|actions|consequences Rules|purpose|results| principles Abortion: A worked example
Facts When does life begin? Values Actual values Is killing wrong? What is a person? Balance between values “Right to choose” versus “Right to life” Abortion: A worked example
Medical ethics Necessary Integral Ubiquitous Principled Generalisable Multifactorial Complex Conclusions
Do to others what you would have them do to you Jesus Christ