Chapter 3 MEthods of health care ethics, part I

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Chapter 3: Methods of health care ethics, part I List and briefly describe the four central principles of the principlism approach to ethics. 1. _respect for autonomy 2. _nonmaleficence 3. _beneficence 4. _justice Support for the principle of autonomy comes from the German philosopher ___Immanuel Kant__. True or False. The principle of autonomy appears in the Hippocratic Oath. False Autonomy might also be limited in several ways and isn’t always clear. Describe one of the main limitations to autonomy. One of the main limitations to autonomy is informed consent as even if the person has the capacity to make their own choices, this principle recognizes several reasons for constraining that persons actions. Even if we do ultimately determine that someone has the capacity to make decisions, health care professionals are nonetheless able to constrain someone’s autonomy in two ways : 1. _act to prevent a person from inflicting harm on a third party. 2. _ are not required to honor a person’s request to use resources to which that person is not entitled. True or False. The principle of nonmaleficence or “do no harm” appears in the ancient Greek sources. True Reflection “Do not harm” might seem straightforward at first, but like most of the principles, it’s applications raises more questions than answers. For example, the practices of euthanasia and assisted suicide are condemned by many medical professional associations and individual practitioners, presumably because killing is viewed as a type of harm. But patients who request euthanasia or assistance in dying presumably do so because they view these practices not as harmful, but rather as clearly beneficial in their particular circumstances. How do you think the principle of “do no harm” should be interpreted with respect to assisted suicide? Are doctors who refuse to participate on grounds that this harms—quite

literally kills—the patient? Or are the patients right that this is actually beneficial to them? The principle of “do no harm” should be interpreted differently from case to case with respect to assisted suicide. As there are cases where it is more beneficial to the patient to go down the path of assisted suicide where there will be less harm done to them based on their situation. However, there are some cases where assisted suicide is an easy way out that would do more harm in the long run to some patients rendering the doctor to be right to want a course of care. True or False. The principle of beneficence is not in the Hippocratic Oath. False True or False. Professionals can override the refusal of treatment by patients who have decision-making capacity on grounds that the treatment would be extremely beneficial. False True or False. Even though the principle of beneficence suggests that we promote the well-being of others, health care professionals may refuse to provide certain treatments they judge to be ineffective, harmful, or morally unjustified, despite patient requests for those treatments. True The formal principle of justice , generally attributed to Aristotle, can be expressed as follows: “ _Treat equals equally, and unequal’s unequally_______.” In your own words, briefly describe what it means to be consistent in our decisions (thus acting justly). To be consistent in our decisions means to act the same for certain circumstances so the same for people who are equal and the same for those who are unequal. True or False. There are competing definitions and theories of justice that lead to very different outcomes when applied to the same situation, for example, in the distribution of health care resources (i.e. who should get health care). True What is the main problem with the principlism approach to doing ethics? The main problem with the principlism approach is that the principles conclusions about specific allocation problems will also often be different and in conflict with one another. What is a prima facie obligation ?

That is obligations that must be fulfilled unless they conflict with an obligation of equal or greater moral force. In contrast to the “___top-down_____” approach that moves from very general principles to the examination of moral problems in specific health care situations , theologian Albert Jonsen and philosopher Stephen Toulmin have articulated and defended a “___bottom-up_____” approach that begins with moral judgments about ___specific cases_____. What does the case-based approach say about our most confident and most widely shared moral judgments about right and wrong? That our most confident and most widely shared moral judgments are about the right or best course of action in specific cases, not about general principles. Briefly describe the case-based approach . The case-based approach requires careful description of the case at issue, identification of similarities of that case to paradigm cases, and use of those paradigm cases as moral precedents for the resolution of the current case. Describe one major problem with the case-based approach. Critics also question whether case-based reasoning by analogy can completely exclude the use of principles meaning this approach is not best understood as mutually exclusive. What does Bernard Gert think is the main issue with the principlist approach? Gert argues that the principles proposed by Beauchamp and Childress do little more than identify general topics in health care ethics and do not provide usable guides to moral choice and action. What does Gert argue that “ the hardcore foundation of morality ” is? The avoidance or lessening of the evils or harms of death, pain, disability, loss of freedom, and loss of pleasure. Gert maintains that the common morality consists of: 1. _rules prohibiting actions that cause harm. 2. _ideals encouraging the prevention or relief of harm. 3. _a procedure for determining when it is justifiable to violate a moral rule. In contrast to the previous ethical approaches, the virtue-based approach to health care ethics asserts that the most important moral task is what? Is becoming a particular type of person, namely, a person of good moral character, or a person of virtue.

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