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2. terminology.pptx

  1. 1. Considerations of ethics and brief terminology Amita K.C. (BPH, MPH) amita2013hope@gmail.com
  2. 2. Ethics and brief terminology • Defining the Good, Virtue Ethics, Situation Ethics, Care Ethics • Moral worth, types of moral worth • Paternalism, Plagiarism, Patent right, Autonomy, Competence and Decisional Capacity, Truth-Telling , Pluralism and Healthcare Professionals
  3. 3. Virtue Ethics • Virtue: excellence of intellect or character, good quality, good value, good worth • Character: certain inborn moral virtue • What sort of person must I be to achieve my life purposes ? • What makes one a good or excellent person? • Rather than “what is right or good to be based on my duty or to achieve good consequences
  4. 4. Virtue Ethics • Virtues are intellectual or character traits or habits that are developed throughout one’s life through Personal effort, training, and practice • eg: Wisdom, courage, hope justice, faith, love, charity, • Temperance : also known as restraint, the practice of self-control, abstention and moderation tempering the appetition ; especially sexually • Honesty, compassion, caring, responsibility, integrity, trustworthiness, carefulness.
  5. 5. Virtue Ethics • Moral virtue is a character trait that is morally valued • A person with moral virtue has both consistent moral action and morally appropriate desire • Practice of virtuous behavior • Rather than virtuous acts being the end result of good character
  6. 6. Virtue Ethics • Virtues are tendencies to act, feel, and judge that are developed from nature capacity by proper training and exercise • Practice creates habit of acting in a virtuous way • Virtue can be learned and improved • Excellence of character depends on motivation, care, clear judgment, self control and practice • Fruit of intelligent search • Possession of the simple person, not the gift of innocent intent (Aristotle)
  7. 7. Virtue Ethics • Virtuous acts must be chosen for their own sake • Virtuous character is created repeatedly acting in a virtuous manner • Virtuous acts must be chosen for their own sake • Choice must proceed from a solid and unchangeable character • Virtue is disposition to choose the mean • Human wellbeing is the highest aim of morality
  8. 8. • Golden mean of virtuous behavior • Golden Virtue: Practicing moderation • Avoiding both excess and deficiency • No list of moral principles • Basic Moral question is not “What should one do?” but “What should one be?” • Virtue lies not only engaging in virtuous acts, but also in Will ( Phillipa Foot) • Will is defined as “which is wished for as well as what is sought.” • Positive will is sometimes the necessary ingredient in success
  9. 9. Examples • Sometimes one man succeeds where another fails not because there is some specific difference in their previous conduct but rather because his heart lies in different place; and disposition of heart is part of virtue. • A man’s virtue is judged by his inner most desires as well as by his intentions. This fits with idea that a virtue such as generosity lies as much as someone’s attitudes as in his actions. -( Phillipa foot, 1997)
  10. 10. According to foot • Virtue is not a skill or an art • Can’t be merely a practiced or perfected act • It must engage in will • An act can’t be considered virtuous, if the intention is not good • Virtue is one of hope (every one has capacity to learn virtuous acts but • Road to virtuous character is less easily traveled
  11. 11. • Deep sympathy and discomfort at the other person’s suffering. • Sympathetic / empathetic and caring presence outweigh need for technical care • Discernment: wisdom, sensitive insights, acute judgment, understanding, appropriate action in given situations • It results in influencial actions • Requires sensitivity and attention
  12. 12. • Helps in developing relationships • Integrity: soundness, reliability, wholeness, and a coherent integration • Continue over time, reasonable stable, justified in action and judgment, • A person of integrity has a consistency of conventions, actions, emotions, and is trustworthy • Deficiency may include hypocrisy, insincerity, and bad faith
  13. 13. Situation Ethics
  14. 14. Situation ethics (contextualism) • In situation ethics, right and wrong depend upon the situation. • There are no universal moral rules or rights - each case is unique and deserves a unique solution. • Situational Ethics was pioneered by Joseph Fletcher (1905-1991).
  15. 15. Situational Ethics: Fletcher's Model • Situational Ethics, according to Fletcher's model, states that decision-making should be based upon the circumstances of a particular situation, and not upon fixed Law. • The only absolute is Love. Love should be the motive behind every decision. As long as Love is your intention, the end justifies the means. Justice is not in the letter of the Law, it is in the distribution of Love. • Fletcher founded his model upon a statement found in the New Testament of the Bible that reads, "God is Love”
  16. 16. Situation ethics (contextualism) • In situation ethics, within each context, it is not a universal law that is to be followed, but the law of love. • A Greek word used to describe love in the Bible is "agape". • Agape love is conceived as having no strings attached to it and seeking nothing in return; it is a totally unconditional love.
  17. 17. Situation ethics (Contextualism) • Situation ethics rejects 'prefabricated decisions and prescriptive rules'. • It teaches that ethical decisions should follow flexible guidelines rather than absolute rules, and be taken on a case by case basis. • Situation ethics was originally devised in a Christian context, but it can easily be applied in a non-religious way.
  18. 18. Elements of situation ethics • The elements of situation ethics were described by Joseph Fletcher, its leading modern proponent, like this: • Moral judgments are decisions, not conclusions • Decisions ought to be made situationally, not prescriptively • We should seek the well-being of people, rather than love principles.
  19. 19. • Love "wills the neighbour's good" [desires the best for our neighbour] whether we like them or not The ultimate norm of Christian decisions is love: nothing else • The radical obligation of the Christian ethic to love even the enemy implies unmistakably that every neighbour is not a friend and that some are just the opposite.
  20. 20. • Love and justice are the same, for justice is love distributedLove and justice both require acts of will • Love and justice are not properties of actions, they are things that people either do or don't do • Love and justice are essentially the same • Justice is Christian love using its head--calculating its duties. The Christian love ethic, searching seriously for a social policy, forms a coalition with the utilitarian principle of the 'greatest good of the greatest number.'
  21. 21. Ethics of care • The ethics of care (alternatively care ethics or EoC) is a theory about what makes actions morally right or wrong. • It is one of a cluster of normative ethical theories that were developed by feminists in the second half of the twentieth century.
  22. 22. Ethics of Care as a feminist ethic • Care-focused feminism is a branch of feminist thought, informed primarily by ethics of care as developed by Carol Gilligan and Nel Noddings in mid 1980s. • This body of theory is critical of how caring is socially engendered to women and consequently devalued. • “Care-focused feminists regard women’s capacity for care as a human strength” • which can and should be taught to and expected of men as well as women.
  23. 23. Ethics of care • The moral theory known as “ the ethics of care” implies that there is moral significance in the fundamental elements of relationships and dependencies in human life. • Normatively, care ethics seeks to maintain relationships by contextualizing and promoting the well-being of care-givers and care-receivers in a network of social relations.
  24. 24. Ethics of Care as a feminist ethic • Ethics of care is also a basis for care-focused feminist theorizing on maternal ethics. • It builds on the motivation to care for those who are dependent and vulnerable, and it is inspired by both memories of being cared for and the idealizations of self.
  25. 25. Ethics of care • Although care ethics is not synonymous with feminist ethics, much has been written about care ethics as a feminine and feminist ethic, in relation to motherhood, international relations, and political theory. • Care ethics is widely applied to a number of moral issues and ethical fields, including caring for animals and the environment, bioethics, and more recently public policy.
  26. 26. Moral • Morals are the rules that govern which actions are right and which are wrong. • A morals can be for all of society or an individual’s beliefs. • Sometimes a moral can be from a story or experience.
  27. 27. Examples of Morals in Society • Do not gossip • Tell the truth • Have courage • Do not have sex before marriage • Keep your promises • Do not cheat • Be trustworthy • Respect others • Keep your self control • Have humility • Serve mankind
  28. 28. Moral worth • Moral worth can be defined as a particular way in which an action or an agent are valuable, or deserve credit (or deserve discredit). • A central thought about moral worth is that it involves the agent's motives for acting
  29. 29. Moral worth • The moral worth of an action then should not be identified with its value in producing good consequences or preventing bad ones (including the very performance of the act). • A central task for moral philosophy is to establish what counts as the right moral reasons for performing an action, and particularly whether these include the thought that 'the action is right', even when that is true.
  30. 30. • An act has moral worth (i.e., is morally good) if and only if it • 1. is in accordance with the moral law (right- morally permissible or obligatory); • 2. it is not performed merely from inclination, regardless of whether or not the inclination be selfish or caring and; • 3. is performed from respect for the moral law.
  31. 31. Truth-Telling • Truth-telling in medicine is a broad area and often encompasses several ethical issues. • These issues include the right of patients or their families to receive information about their diagnosis and illness. • The physician, on the other hand, must balance his or her obligation to tell the truth against the imperative of “do no harm”.
  32. 32. Truth-Telling • Questions often arise concerning how much truth to tell. • When, if ever, is a physician justified in withholding information? • Can too much information be harmful?
  33. 33. Paternalism • Paternalism involves acting without consent or even overriding a person’s wishes, wants, or actions in order to benefit the patient or at least to prevent harm to the patient.
  34. 34. 34 Paternalism cont.. There are 2 elements in this definition: 1. the absence of consent 2. the beneficent motive (the welfare of the patient)
  35. 35. 35 Paternalism cont… • Paternalism exists when the health care worker intervenes to prevent patients from harming themselves in some serious way • e.g they can intervene in the case of those who are attempting suicide
  36. 36. 36 Paternalism cont… • From an ethical point of view, writers generally reject the right of health care providers to use strong paternalism • The courts have sometimes allowed treatment without informed consent to relieve serious pain or suffering • This treatment may remove doubts about competency of the person and allow informed consent • Here the treatment is directly in the service of autonomy
  37. 37. Plagiarism • is the use or close imitation of the language and thoughts of another author and the representation of them as one's own original work • Within academia, plagiarism by students, professors, or researchers is considered academic dishonesty or academic fraud
  38. 38. Patent right • A patent is an exclusive right given by law to inventors to make use of, and exploit, their inventions for a limited period of time. • By granting the inventor a temporary monopoly in exchange for a full description of how to perform the invention, patents play a key role in developing industry around the world.
  39. 39. Patent right • Once the owner of an invention has been granted a patent in any particular country, they then have the legal authority to exclude others from making, using, or selling the claimed invention in that country without their consent, for a fixed period of time. • Patent s are time bound monopoly right.
  40. 40. TRIPS • Trade Related Aspects of Intellectual Property (TRIPS) on the right to health, particularly the debate regarding the impact of global patent rules on the prices of essential medicines. • It also addresses the arguments for and against patent regimes in the drug field. • TRIPS helps to ensure that patents are not undermined by the sale of competing pirated copies.
  41. 41. Arguments in Favour of Patents right • The rationale for granting patents is the need to reward an inventor • Patents reward people for their inventions, thus encouraging creativity and innovation • the money raised from patent protection is said to be necessary to fund the considerable costs of research and development (R&D).
  42. 42. impact of patent rights on the price of medicines • TRIPS requires Member States of the WTO to provide protection for patent rights for 20 years • impact of patent rights on the price of medicines. Prices will be artificially too high for the prescribed 20-year period as patent-holders seek to maximize returns on their investment. • For example, the costs of patented drugs which combat the HIV virus are enormous.
  43. 43. impact of patent rights on the price of medicines • Such prices are only affordable in industrialized countries due to government benefits, which are not available in the developing world. • Clearly, it is impossible for most people in the developing world, where most HIV cases arise, to pay such prices.
  44. 44. impact of patent rights on human health • Similar problems, which have received far less attention than issues regarding access to AIDS drugs, arise with regard to access to drugs and vaccines for other treatable killer diseases. • For example, most women in the developing world cannot afford the new vaccine for cervical cancer, which is widely available to women in the North America, Latin America and Europe .
  45. 45. Autonomy • 1. Respect for autonomy/ Respect for person • Respect for persons recognizes the capacity and rights of all individuals to make their own choices and decisions. • There is a need to provide special protection to vulnerable persons. • Examples of vulnerable groups • Children, prisoners, mentally ill • people with limited education, living in poverty, limited access to health care services • Women (in some cultures)
  46. 46. 46 Respect for autonomy cont… • Respect for persons is embodied in the informed consent process. • Informed consent is designed to empower the individual to make a voluntary informed decision. • Potential research participants must fully comprehend all elements of the informed consent process.
  47. 47. Respect for autonomy cont… • A person of diminished autonomy is in some respect controlled by others or incapable of deliberating or acting on the basis of his/her desires and plans • E.g prisoners and mentally retarded individuals • Mental incapacitation limits the autonomy of the retarded person 47
  48. 48. Competence and Decisional Capacity • We often use the terms "competence" and "capacity" (short for "decision-making capacity") interchangeably. • However, they are not exactly the same. • Competence is a legal term. • Competence is presumed unless a court has determined that an individual is incompetent. A judicial declaration of incompetence may be global, or it may be limited (e.g., to financial matters, personal care, or medical decisions).
  49. 49. Competence and Decisional Capacity • Decision-making capacity, on the other hand, is a clinical term that is task-specific. • A physician may determine that a patient does not have the capacity to make a decision for or against surgery for a hip fracture, but she may have the capacity to decide if she wants a sleeping pill or a laxative.
  50. 50. Pluralism and Healthcare Professionals • The existence of multiple healing systems and options within a society. • Pluralism has always existed in health care systems; • there have always been multiple practitioners to choose from and multiple ways of understanding health and healing. • While the ideal pluralism suggests multiple healing options competing on a level playing field, in modern societies this is often not the case.