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Dat SH exam ಠ_ಠ

Ethics program - recap

  • Examine the aims and the graduate capabilities
  • Think about the perspectives:
    • Principles-based ethics
    • Human rights
    • Social justice
    • Virtue ethics
  • She wants us to look at the ethics wheel for not-normal ethics perspectives
  • Begin to think about new issues in the lectures and take this further in the tutorials
  • Preparation for portfolio
  • Support you in examining your own moral commitments and values and considering these in relation to others
  • Ethics wheel - don't forget about it, it's a good summary, try to see if you can use the perspectives in a practical sense

What are some of the things you look for in a doctor?

  • Honesty
  • Communication skills
  • Integrity
  • Empathy
  • Confidentiality, trust
  • Confidence
  • Best interests (not expensive)
  • Intelligence

Everyone's looking for virtuous doctors

Virtues and vices

Virtues:

  • Generosity
  • Honesty
  • Compassion
  • Courage
  • Temperance (not at either extreme - a moderate character)
  • Kindness
  • Integrity
  • Practical wisdom

Vices:

  • Greed
  • Gluttony
  • Cowardice

etc

Hippocrates

  • ..."abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slvaes"
  • "With purity and with holiness I will pass my life and practice my Art"
  • Means: "I will be focused on my patient, honest and respectful and act with integrity"

Virtue ethics

  • Plato/Aristotle
  • Ancient Chinese philosophy
  • Emphasises virtues, or moral character --> human flourishing
  • In contrast to emphasising rules or consequences of actions
    • Rules e.g. "Never lie, never kill etc"
  • Greek epic poets and playwrights such as Homer and Sophocles, paint the morality of their heroes and antiheroes in terms of their respective virtues and vices
  • Moral virtues are desire-regulating character traits which are between more extreme character traits (vices)
  • E.g. honesty lies between rudeness and deception
    • Courage is in between cowardice and stupidity
    • Compassion is between entrenchment and indifference
    • Trust is between dependency and unreliability
  • By the late middle ages Aristotle's virtue theory was the definitive account of morality
  • The particular virtues described were called the Cardinal virtues
  • Medieval ethicists added to these: faith, charity, hope

Re-emergence of Virtue ethics?

  • What kind of person should we be?
  • According to virtue ethics there are certain ideals such as excellence or dedication we should try for
  • These ideals are discovered through thoughtful reflection on what we have learned to maximise growth potential

Upshot: Virtues are still important

AMA code of ethics

  • Consider first the well-being of your patient (consideration)
  • Treat your patient with compassion and respect (compassion and respect)
  • Practise the science and art of medicine to the best of your ability (dedication)
  • Humility

Doctor quizzed over detox death

  • Has a diploma in Swedish massage, no PhD or ND (Naturopathic Degree)
  • Just a massage therapist, came up with a program for lifestyle modification, but this isn't enough to cure disease
  • He claims he was acting in the person's best interests, but he was deceptive and didn't have the right knowledge to help the man
  • What he did wrong?
    • Lied about qualifications
    • Made up an institute
    • Probably should have realised his diet wasn't right for this man
    • Took advantage of desperation of person who was dying, exploited him
    • Virtue: given the benefit of the doubt, he said he was doing the best he could to try to help the patient
  • Even though he was virtuous in a sense, all the horrible and deceptive things he did resulted in a bad situation

Sex with patient caused no harm, doctor says

  • Suit alleges negligence, violations of consumer law
  • Dr Henry Smith had sex with one of his patients as a psychiatrist, but claims he did the patient no harm
  • Patient was undergoing psychoanalysis with Smith
  • She and her husband went to sue him
  • Having sex with a patient is not a crime in Massachusetts, but it is grounds for revocation of physician's license
  • Tried to dissuade her from reporting him, but when she wouldn't, he resigned all his positions (he was a heavyweight in psychiatry)
  • McNally said she lacked the ability to recognise that she was being harmed as a result of what is known as transference - the unconscious attribution of feelings about someone from the past onto a therapist
  • The patient is never in a position where they can give real consent
  • In 23 states in USA, it is criminal to have sex with a patient, but not in all states
  • Abuse of power - doctor-patient relationships are never equal (they're never on an equal footing)
  • Apparently transference happens all the time
  • It is not illegal for you to have sex with a patient in Australia, but you can be deregistered
    • If you want a relationship with a patient, you have to stop being their treating doctor (at least a year timeframe before having a relationship)
  • It's unethical to treat your wife or your own family
    • Imagine something goes wrong - a fatal complication, or wrong diagnosis
  • Discipline by the board can occur depending on whether there is a complaint
  • Is what he did wrong?
  • Why is it wrong?
  • Is it excusable?
  • Was he virtuous?
    • All he did is fall in love with her
    • His vice might have been lust, the virtue he was lacking was self-restraing

Doctors selling medical records

  • Secretly selling confidential medical records to a marketing firm with links to the pharmaceutical industry
  • Information is de-identified
  • Are these doctors doing anything wrong?
    • Yes - greed is a vice. Breach of confidentiality - you only expect your personal information to be used for your own benefit, not for other purposes
    • You need consent for everything

Complaints against doctors up by 10%

  • Doctors were accused of being rude, arrogant, aggressive and abusive towards patients, their families or staff
  • People accept doctors to behave in a particular manner. Society expects virtuous doctors
  • AMA president said the rise in complaints should not be interpreted as evidence that doctors were behaving badly, but that the community is standing up more to doctors, more aware of the process

Child sex charge GP still working

  • Melbourne doctor charged with many cases of indecent assault over 30 years
  • Should he be stood down pending the hearing?
  • Can people change or do they carry the burden of their mistakes fully?
  • Can he be given "a fair go"?
  • Should he be punished for a vice that was expressed 30 years earlier?
  • Can we control our vices?
  • What makes us control our vices?

Problems of Virtue ethics

  • No codifyable principles (could argue that some of these people were being virtuous -- they're not functional, even though you may not be doing harm)
  • Not functional/operational
  • Not grounded either in rules or outcomes
  • Do not always guide actions
  • Character is a complex mix
  • Should we be held accountable for past vices?
  • The application problem. No rules/different interpretations:
    • There isn't a deicion procedure for determining what the right action was in any particular case
    • Rule(s) need to be stated in such terms that any non-virtuous person could understand
  • Conflict problem - doesn't help you resolve conflicts (although I may think something is best for a patient, the patient's family doesn't think this)
  • We still look for virtuous doctors
    • But Virtue ethics doesn't work
    • Need Principle based ethics