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BIOMEDICAL

ETHICS

HENKY

Department of Forensic Medicine


Faculty of Medicine Udayana University

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Module for teaching medical ethics


to undergraduate students in
medical colleges in the South-East
Asia Region

Responsible units/departments
The responsible/leading unit/department may be
forensic medicine, or the medical education unit
or department of medical ethics

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Value, Ethics, Moral


Value

Value is fundamental beliefs


[or
principles, used] to define that which is
right, good and just.

MOTIVATE

Ethics
...ethics is the study of morality careful
and systematic reflection on and analysis
of moral decisions and behaviour (WMA)

Moral

CONSTRAIN
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PATERNALISTIC

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COOPERATIVE

Patients Expectation
High quality, clever, and skillful healthcare
Friendly and honest in answering patient
questions
Provide sufficient time (to communicate, check
out-thorough, treat, give an explanation)
Able to hear and respect for the patient as a
whole person
Trustworthy, able to keep a secret

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TRUST
TRUST
PROFESSIONALISM

BIOMEDICAL ETHICS

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Goals of Education
Develop Knowledge: Scientific concepts,
generalization & ethical principle, Understanding
complexity, questions that are posed by science
& technology
Develop Skills: Cognitive challenge, critical
thinking, decision making, informed-choice,
self reflection
Personal Moral Development: diversity, moral
obligation, values and responsibility, holistic
appraisal, values clarification and analysis
Making
MakingEthical
Ethical
Decisions
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Decisions

STEPS
1) Moral perception (seeing the ethical
problem)
2) Moral reasoning (resolving the problem
analytically)
3) Moral action (implementing the chosen
solution)

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MORAL
PERCEPTION

Seeing the ethical problem

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Improving Moral Perception


Futility?
1. Physiological
2. Quantitative
3. Qualitative

Best Interest?
1. Capacity
2. Advance
Directives
3. Value & Others

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Asking the Right Questions

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The Ethics Checklist


Patients wishes unclear / refusal of Tx/?
Questionable capacity to consent
Disagreeing relatives
End of life issues (DNR, Adv. dir)
Goal of care / appropriate Tx/
Confidentiality or disclosure issue
Resource or fairness issue
Other (please note)
No notable ethical issue
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MORAL
REASONING

Answer the question...


2+2

7+7

3+3

8+8

4+4

More than 1 right answer


Hasty Decision (-)
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Four Principles Approach


1) Beneficence
The best interest, altruism, golden rule, CPD

2) Nonmaleficence
Primum non plus nocere quam succurrere
Above all, do not harm more than succor

3) Respect for Autonomy


Respect patients choices based on their own values

4) Justice
Act fairly, distribute resources, whistleblowing,
legal issues, respect human right
Beauchamp & Childress, 2008

Derivative Principles

Veracity (Truth telling)


Fidelity (Keep promise)
Privacy
Confidentiality
Respect the contract
Honesty
Avoid killing
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Prima Facie

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Prima Facie

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Four Quadrant Approach


(1) Medical Indication
(2) Patient Preferences
(3) Quality of Life
(4) Contextual Features
Jonsen, Sigler & Winslade, 2010

Ethical Theory

Teleological/Utilitarian/Consequentialism
Deontological/Kantianism
Casuistry Principlism - Relativism
Virtue ethics (Moral Behaviour)
Compassion,
discernment,
trustworthiness,
integrity,
conscientiousness, courage, benevolence and nonmalevolence

Double effect
The act must be good or at least morally neutral
The moral agent must intend only the good effect
The bad effect must not be the means of bringing about the
good effect
The good and the bad effect must be proportional
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Making Decisions...

Consequences (risks, burdens, benefits)


Patients value and wishes
Professional codes
Legal duties
COMMON SENSE

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MORAL
ACTION

5W + 1H

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Research Ethics
1.
2.
3.
4.
5.

Clinical Trial
Stem Cell
NAMRU
Publications
etc

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A Doctors Become....
When patients seek help
When patients cured
When patients asked to
pay 50,000 USD
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A Doctors Become....
When patients seek help
When patients cured
When patients asked to
pay 50,000 Rp
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THANK YOU

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