publicHealthEthics-course_Outline&Introduction
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publicHealthEthics-course_Outline&Introduction
- 2. CONTACT INFORMATION [email_address] 0567995290 Office hours by appointment Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 12. ISSUE OF ETHICAL CONCERN IN PUBLIC HEALTH Why ethics in public health? Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 14. Figure 10.1 Changes leading to altered interaction between microbes, animals, and plants Genetic changes in microbes, plants, animals and humans Social change in human populations - in material circumstances, and behavior Human interventions, discoveries and manipulations of the environment Natural environmental change Influence on individuals and families - varies by place Over time population differences host, agent or environment factors Population variations in health and disease patterns Analysis and interpretation of differences to gain insight into the evolution of these patterns, and hence the causes Demonstrate population differences in disease rates by time, place and person/population Use information to improve health The phenomena underlying population variations Epidemiology tries to understand above phenomena
- 21. AN ISSUE IS AN ETHICAL ISSUE WHEN… … we encounter conflicting values, beliefs, goals, or responsibilities … we are concerned that persons or their rights are not being respected … we are concerned about fairness and justice … we are unsure what we should do or why we should do it, morally speaking Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 25. Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 29. ETHICAL JUSTIFICATION Ethical theories and principles as lenses: “ Doing bioethics well requires appeal to the insights provided by multiple theories…the metaphor of lenses provides a more accurate and a more productive understanding of the role of theories in bioethics…” (Sherwin, The Politics of Women’s Health , 205). Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 45. CLASSROOM APPLICATION Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 46. FACTS & VALUES
- 47. WHAT ARE YOUR THOUGHTS ON: “ He killed her.” Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 48. “ Treatment is futile.” Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 52. THE FACT-VALUE DISTINCTION Science is the century-old endeavour to bring together by means of systematic thought the perceptible phenomena of this world into as thorough-going an association as possible. To put it boldly, it is the attempt at a posteriori reconstruction of existence by the process of conceptualisation. Science can only ascertain what is, but not what should be, and outside of its domain value judgements of all kinds remain necessary. -- Albert Einstein Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 58. “ HUMAN” VS. “PERSON” Ghaiath Ethics in Public Health (JPCMFM) Jan.2010 humans persons human persons
- 59. FURRY PERSONS (?) Ghaiath Ethics in Public Health (JPCMFM) Jan.2010 Matti Hali Fellini
- 63. ETHICAL THEORIES PURPOSES AND APPROACHES
- 67. ETHICAL REASONING Critical reflection Ghaiath Ethics in Public Health (JPCMFM) Jan.2010 Jonathan Breslin, 2006 To give careful consideration To question assumptions, both our own and others’ Critical reflection is important to avoid knee-jerk emotional responses and “jumping to conclusions,” as well as failing to take other perspectives into account…
- 68. ETHICAL JUSTIFICATION “ Ethics focuses on the reasons why an action is considered right or wrong. It asks people to justify their positions and beliefs by rational arguments that can persuade others.” -- Bernard Lo. Resolving Ethical Dilemmas , 3rd ed. (2005) Ghaiath Ethics in Public Health (JPCMFM) Jan.2010 Jonathan Breslin, 2006
- 73. ETHICAL JUSTIFICATION Ethical theories and principles as lenses: “ Doing bioethics well requires appeal to the insights provided by multiple theories…the metaphor of lenses provides a more accurate and a more productive understanding of the role of theories in bioethics…” (Sherwin, The Politics of Women’s Health , 205). Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 77. UTILITARIANISM Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 87. DEONTOLOGY Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 88. THE ETHICS OF DUTY More than any other philosopher, Kant emphasized the way in which the moral life was centered on duty. Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
- 95. CATEGORICAL IMPERATIVE: Ghaiath Ethics in Public Health (JPCMFM) Jan.2010
Notes de l'éditeur
- about readings/content assignments office hours by appointment
- hand these out
- - also known as "moral philosophy" and "philosophical ethics" - refers to philosophical reflection on the nature and function of morality (that is, philosophical reflection on social conventions about right and wrong human conduct--on social principles about doing good, avoiding harm, respecting others, observing rules of justice, etc.) descriptive ethics: more social science, empirical; attempts to describe and explain moral views that are held A systematic understanding of right and wrong as it relates to: - rules or standards of right conduct - good character, virtuous behaviour
- metaethics: philosophical study of the nature of moral judgments, methods of justification re: ethical theory and particular ethical judgments; conceptual analysis kinds of ethical theory that concern us most are: (1) general normative ethics --where the task is to advance and provide a reasoned justification of an overall theory of moral obligation, thereby establishing an ethical theory that provides a general answer to the question: what is morally right and what is morally wrong? * normative ethics concerned with questions of what is right/wrong, good/bad; whereas *metaethics* concerned with the meaning or significance of calling something right or wrong, good or bad, for example, and whether moral judgments about good or bad are objective or subjective and (2) applied normative ethics (and bioethics is one branch of applied ethics) where the task is to resolve particular moral problems by appealing to or applying general normative ethics (e.g., Can maintaining patient confidentiality in the face of harm to third parties be morally justifiable; if so, under what conditions?)
- When there is conflict of moral values , beliefs, and objectives e.g. between the health care providers and the patients. For instance, the classical example of blood transfusion to a severely bleeding Jehovah Witness who refuses to take blood, even this refusal can lead to severe life threat and eventually death. When there is conflict of commitments and responsibilities : for example at one hand there is the commitment of the health care provider to preserve his/her patients' lives, however there is the responsibility to "rationally" use the resources available to him/her on the other hand. The classical example of which is "one ICU bed, and two patients: whom to choose?" When there is the concern that our patients rights/values are not respected . When the issue in focus is related to justice in allocating the available resources . A classical example is which of the cancer drugs should be funded publicly. Should we choose a drug which efficiently improves the quality of life of few patients? Or a drug that makes little improvement for a larger number of patients. Finally, when we, as care providers feel that we are not sure what we should do .
- lenses: readily switched for a different view, can be layered; some provide clearer perceptions of problems than others, but can gain different understandings by trying different options; challenge = seeking out best lenses for problem at hand
- e.g., where you see this kind of thinking operating? (e.g., duty to get free and informed consent…doesn’t depend on consequences) From the Greek word deon , meaning duty Pure deontological theory (e.g., Kant) holds that consequences are morally irrelevant and focuses, instead, on the essential nature of actions, motives, and moral agents Mixed deontological theory (e.g., Ross, Rawls) which incorporates aspects of Kantianism and aspects of Utilitarianism Claims that consequences may be morally relevant, although it is not the consequences of an action taken alone that determine its morality
- e.g., where you see this kind of thinking in action? (e.g., policy-making, public health, sometimes resource allocation) A kind of teleological ethical theory (from the Greek word telos , meaning goal- or result-oriented) Described as consequentialist because they hold that no action or rule is morally right in itself—something is morally right because it produces certain consequences, e.g., it maximizes the intrinsic value of happiness/pleasure
- e.g., of this kind of approach? kind of person a practitioner—or ethicist—is…not just concerned that your family doctor, e.g., gets good results or respect your rights…probably want to have the sense that he/she is a good person, really cares about you, etc.
- . see if response is value judgment . what do you need to know before you can make a value judgment (e.g., who is she? (e.g., person? rabid pitbull attaching him? wounded bird? fly?) who is he (child? cat? person?) why did he kill her (instinct? accident? self-defense? murder? other?) .e.g., of how we sometimes bring value judgments to a statement that is merely descriptive = fact/value, inferential leap . other side of coin—sometimes we think a concept or statement is merely descriptive when in fact it is a value judgment (i.e., value laden)…>>>>
- i.e., medically impossible? (e.g., reattaching a completely severed head) . not likely to achieve medical goals (whose?) (e.g., certain survival rate, certain quality of life) . not like to achieve the patient’s goals . not worth it, given the costs (to whom?)
- definitions? examples of persons? examples of non-persons?
- any thoughts/questions? if not, ask what some of these criteria mean and what degree must be present/demonstrated
- person = philosophical concept human being = biological label—refers to homo sapiens
- Category within personhood?
- Category within personhood? or can a moral patient be considered a non-person--will depend on philosophical view
- Ok, let’s turn now to ethical assessment and reasoning...Module 1 helpful re: necessary awareness and imagination in particular; let’s focus first on knowledge…what knowledge is required in the assessment stage…kinds of information to gather and quality of that information
- Some of the questions you likely have as facilitators….
- - principles meant to guide action for all in similar circumstances—e.g., principle of respect for autonomy directs us to act in ways that honour the free and informed decisions and actions of others
- Although a thorough assessment is on-going until the issue is resolved, the next focus is on ethical reasoning…what do we do with all the information gathered in the assessment? This is where we need to polish our critical reflection skill. critical = ; reflection = So, critical reflection is the integration of questioning assumptions as part of what is means to give careful consideration
- deductive, top-down approach : conclusion follows logically from general principles or rules plus relevant facts of situation; applying general rule to situation falling under the rule inductive, bottom-up: reason from particular instances to general rules, principles, theories; “meanings, functions and weight of a principle derive from previous moral struggles and reflection in particular circumstances” (B&C 392); e.g., causistry, use of case studies, comparisons and analogies to reach moral conclusions; practical knowledge takes priority over theoretical RE: effort to make beliefs, principles, and theories as coherent as possible; when considered judgments conflict with some aspect of a moral theory, must modify one or other to bring into equilibrium
- lenses: readily switched for a different view, can be layered; some provide clearer perceptions of problems than others, but can gain different understandings by trying different options; challenge = seeking out best lenses for problem at hand
- Rachels on similarity between use of theory in ethics and use of theory in science, psychology, etc. Without ethical theories, frameworks, etc.—chaos
- Responsibility: are we responsible for others’ actions if we know that they will cause more harm than good? Integrity: Utilitarianism often demands that we put aside self-interest. Sometimes this means putting aside our own moral convictions Intentions: Utilitarianism is concerned almost exclusively about consequences, not intentions. Moral Luck: By concentrating exclusively on consequences, utilitarianism makes the moral worth of our actions a matter of luck. We must await the final consequences before we find out if our action was good or bad. Who does the calculating? Example of English in India, then wanted the best for india! Who is included? When we consider the issue of consequences, we must ask who is included within that circle. Those in our own group (group egoism) Those in our own country (nationalism) Those who share our skin color (racism) All human beings (humanism or speciesism?) All sentient beings
- e.g., where you see this kind of thinking operating? (e.g., duty to get free and informed consent…doesn’t depend on consequences) From the Greek word deon , meaning duty Pure deontological theory (e.g., Kant) holds that consequences are morally irrelevant and focuses, instead, on the essential nature of actions, motives, and moral agents Mixed deontological theory (e.g., Ross, Rawls) which incorporates aspects of Kantianism and aspects of Utilitarianism Claims that consequences may be morally relevant, although it is not the consequences of an action taken alone that determine its morality
- e.g., of this kind of approach? kind of person a practitioner—or ethicist—is…not just concerned that your family doctor, e.g., gets good results or respect your rights…probably want to have the sense that he/she is a good person, really cares about you, etc.
- cf. case law
- view is that ethics develops from social consensus formed around cases, but isn’t ethics about more than consensus— why do we agree? go back to previous slide—how do we know this guy got it right? * tie in to Schiavo by mentioning number of people who would say re: Schiavo “I just don’t get it—this was decided in law long ago…”