healthcare ethics assignment

MEDICAL ETHICS  Written Assignments  

OBSERVE THE DUE DATES!!    Check on due dates:  Calendar

This Philosophy Class is a Writing Intensive (WI) Class. 

CRITERIA FOR WRITING INTENSIVE (WI) CLASSES

A.  Writing

All WI Classes shall meet all of the following criteria:

1.       Throughout a semester, students spend a portion of their class time writing in the service of learning course material.  This writing may be informal and un-graded .

The written assignments satisfy this criteria.  The last assignment is informal and low stakes.

2.       A minimum of 10 pages of formal writing will be assigned and will be achieved by assigning several short papers, one short paper plus a longer one, or one longer paper assigned in stages that are each guided and responded to by the faculty member.

This minimum is more than met by the written assignments.

3.       These 10 pages are responded to and returned to the student by the faculty member so that the student has the opportunity to revise before a final grade for the assignment is given. 

The instructor returns the formal written assignments indicating where they may have lost points. Students will have 48 hours to revise and resubmit.

4.       The faculty member regularly discusses student writing in class.

The instructor goes over the assignment and provides a sample of a submission that serves as a model.

5.       Each time a writing assignment is given, the faculty member discusses and clarifies the assignment and his or her expectations for it.     

The instructor goes over the assignment and provides a sample of a submission that serves as a model

Click on the module title below for the assignment for that module.

INSTRUCTIONS for PREPARING and SUBMITTING WRITTEN ASSIGNMENTS

MODULE  0 ORIENTATION

MODULE 1 INTRODUCTION TO THE COURSE

MODULE 2 ETHICS

MODULE 3 THE MORAL CLIMATE OF HEALTH CARE

MODULE 4 PROFESSIONALISM ELITISM AND HEALTH CARE

MODULE 5 ETHICS AND NURSING

MODULE 6 RIGHTS TRUTH AND CONSENT

MODULE 7 HUMAN EXPERIMENTATION

MODULE 8 ABORTION

MODULE : MID COURSE EVALUATIONS AND CHANGES

MODULE 9 SEVERELY IMPAIRED NEWBORNS, FUTILITY AND INFANTICIDE

MODULE 10 CARE OF THE DYING

MODULE 11  DELIBERATE TERMINATION OF LIFE AND PHYSICIAN ASSISTED SUICIDE

MODULE 12 REPRODUCTION , ASSISTANCE AND CONTROL

MODULE 13 ALLOCATION OF RESOURCES: SCARCITY AND TRIAGE

MODULE 14 A CLAIM OF A RIGHT TO HEALTH CARE

MODULE : CULMINATING ACTIVITY: BONUS EXERCISE

INSTRUCTIONS FOR PREPARING AND SUBMITTING : C ASE STUDIES

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MODULE  0 ORIENTATION ASSIGNMENTS: ORIENTATION WEEK

For this first module you are expected to COMPLETE ALL the TEN STEPS TO START OFF

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Written Assignment for MODULE 1 INTRODUCTION TO THE COURSE

Read the first chapter of the online textbook and then please answer each of the questions below.  Short answers are acceptable (100 - 300 words in total for all 4)   No correct or incorrect answers!  Low stakes writing assignment. Just your own thoughts.  No need to research or look up anything.

1. Why is it necessary for anyone to care about ethics?

2. Of what value would knowledge of the principles of ethics be to people confronted with moral problems or dilemmas?

3. How is a person any better off knowing about Biomedical Ethics when confronting moral problems ?

4. Why do you think that you have anything to gain beyond the credits for taking this course and coming to understand the issues and principles related to Ethics and Biomedical Ethics in particular?

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I suggest that you create your assignments using your word-processing program and spell checker , then copy and paste your text-answers into the message window of an email ,and send it to the instructor by email with the text inside the email message window. DO NOT send attachments .

Written Assignment for MODULE 2 ETHICS

I. Reading Comprehension

• Distinguish Descriptive Ethical Relativism from Normative Ethical Relativism (NER).  Copy and paste from the free online textbook providing the url for its location on the world wide web (www).
• How do people come to believe and act on normative ethical relativism (NER) ?
• State three objections to the theory of normative ethical relativism (NER), i.e., three criticisms or weaknesses.  How has NER been disproven? Copy and paste from the free online textbook providing the url for its location on the world wide web (www).
• Why is NER not useful as an ethical theory?
• For EACH of the following 5 theories:  consequential : A)  Ethical Egoism B)  Rule Utility ///  non-consequential:C)  Natural Law Theory D)  Kant E)  Rawls   Describe the basic principle: What is the concept of the "GOOD" involved with each?

II. Critical Thinking

Based on your reading and understanding of the materials in the Module on Ethics in this course answer what makes any act morally good?   Since no human action when witnessed by human beings has a sign hanging over it  indicating its moral status what is the source or how is it that actions are thought to be morally good or immoral?  This is asking you to think carefully and to think about what underlies every moral judgment people make about human conduct.  DO NOT answer with what you yourself think in particular makes a human action morally good.  DO NOT answer with some particular idea you have about about the moral good. Do answer with the general description of how human actions are thought to be morally good or not good, bad , incorrect or otherwise.  On what do such thoughts of moral appraisal rest? What is the basis for humans reaching a moral judgment about a human action?

When people think of some human action as being morally good or bad or incorrect or right or wrong they are making a moral judgment.  That judgment rests upon some idea (principle) of the moral GOOD.  Just what makes an action GOOD or not good is always a judgment made by some humans.  So what makes any human action morally good is a judgment and what makes the judgment is some idea of the moral GOOD and that would be some principle of the GOOD.  This module presented some of those principles.  You will be learning more of how they operate as the semester proceeds.

Let�s consider it this way.  A person (the judge) makes a moral judgment about some human action.  The judge declares the action to be wrong or bad or immoral.  Then that person is asked why make that judgment. Judge replies �Because it is wrong , that�s why.�  Then the judge is asked but �Why do you think so?� We attempt to get the judge to realize or reveal just what is the ultimate basis for the moral judgment made.  Now the reply of the judge can vary .  Let�s look at a few.

�it�s against God�s Law�  this reply could indicate that the judge is using Divine Command principle.  If asked �what is god�s law?�  The judge might reply � It is against nature as god made it.�  This might indicate that the judge is using Natural Law principle.

�I don� like it.  That�s why�  and this might indicate the judge is using Egoism as a basic ethical principle for moral judgments.

�it doesn�t please me� or It does not make me happy� and this might indicate the judge is using Egoism as a basic ethical principle for moral judgments.

�People are going to be upset about this� or �acting like that upsets people� or Acting like that will make lots of people upset or angry.�  This might indicate the principle of Utility is being used for making moral judgments.

�You just don�t treat people that way.  No one should be treated like that.� This might indicate the Kantian Categorical Imperative is being used to make the moral judgment.

� It is not fair, that�s why.�  Or Acting like that is not fair to those who are less fortunate �  �Acting that way does not help us to live together and treat others as equals .�  This reply might indicate that the Maxi Min principle is being used to make the moral judgment. 

I hope that you now realize what this part of the assignment is intended to have you realize and also one of the main points of Module 2 and this course.  Now put this into your own words as your response to this part of assignment for module 2. Based on your reading and understanding of the materials in the Module on Ethics in this course answer what makes any act morally good?

Written Assignment for MODULE 3 THE MORAL CLIMATE OF HEALTH CARE

NUMBER EACH PART of YOUR SUBMISSION

1. Reading Comprehension

In this module there has been discussion of values and conflicts in values. Institutional or Economic Values  vs Individual or  Human Values have been presented. 

What are those Institutional Values (list them) and what are the Individual Human Values (list them) and how do they clash? Copy and paste from the free online textbook providing the url for its location on the world wide web (www).

2. Critical Thinking

In health care, medicine and medical research there often occurs a clash in values. These conflicts exist amongst the providers and between the providers and the recipients of care.

Provide an example of one such conflict.

1. Describe the situation or case: the source of case for illustration may be from the textbook, any site on the Internet , a ny case reported in the media(print or electronic) or a case you witnessed or know about yourself. If it is a personal experience PLEASE do not use actual names of the persons involved.

2. state what the conflict is

3. state clearly and deliberately underline what the Institutional Values and the Individual Human Values   are that are in conflict. BE SURE that you do this.  State the values .  Be explicit and clear. Underline for emphasis the exact words describing the actions in the case that indicate the value.

If you choose to use a personal case please do not use names or identify yourself. Put it in the third person and use pseudonyms.

If you choose to have CHAT GPT do this portion just be sure to cite that source for your case.

Written Assignment for MODULE 4 PROFESSIONALISM ELITISM AND HEALTH CARE

A. What are the professional codes of physicians or medical societies based upon? Are they ethical codes? If not, what are they? If so, how are they ethical? What purpose (s) do such ethical codes serve?  Base your answer on the reading in the online textbook.  Show evidence of having done the reading by using quotations-cite your source. Copy and paste from the free online textbook providing the url for its location on the world wide web (www).

B. Describe the following models for the doctor-patient or scientist-subject relationship and discuss any problematic characteristics of each .

1. Code 2.Contract 3. Covenant and Consent as a Canon of Loyalty

What are the desirable and undesirable characteristics of each model for the doctor-patient or scientist-subject relationship , if any, and why do you think so? Include the ideas of philanthropy, proficiency, loyalty and responsive obligation in your answer.  BE SURE that you include each of these ideas philanthropy, proficiency, loyalty and responsive obligation i n your answer.  That is where the critical thinking comes in. 

Written Assignment for MODULE 5 ETHICS AND NURSING

A. What are the nurse's duties and responsibilities toward recipients of their care? < It is quite a list!! Copy and paste from the free online textbook providing the url for its location on the world wide web (www).

B. Discuss the nurse-physician conflict where ethical duties and rights are concerned. < They have different roles and operate out of different models!!!

C. How can nurses serve as advocates for the recipients of their care? What does that advocacy involve? Copy and paste from the free online textbook providing the url for its location on the world wide web (www).

D. Explain the notion of collective responsibility and the conditions under which it comes into being and how it might apply to nurses. This is given in the online textbook.   Copy and paste from the free online textbook providing the url for its location on the world wide web (www). After doing that you may offer an example of a case if you wish to do so.

Written Assignment for MODULE 6 RIGHTS TRUTH AND CONSENT

The basic ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles of health care are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

A. Do people have the ethical right to Informed Consent?  What ethical principle supports this "right" ? Explain how the principle supports the "right" as a "good" thing.  If not, why not?

Why? What are the difficulties with it? What limitations might exist?

B. Do people have the right to know their diagnosis and prognosis as well as anything else connected with their condition, their treatment and its consequences?  What ethical principle supports this "right" ? Explain how the principle supports the "right" as a "good" thing.  If not, why not?

C. Is it the right of people receiving health care to have the truth, the whole truth and nothing but the truth from their physicians insofar as their diagnosis, prognosis and treatment is concerned? If so, what is it based upon?  What e thical principle supports this "right"? Explain how the principle supports the "right" as a "good" thing.  If not, why not?

D. What are the limits on the autonomy of a person and then of a person reduced to the role of a  "patient"? Copy and paste from the free online textbook providing the url for its location on the world wide web (www).

E. Under what circumstances can confidentiality be breached? Provide an ethical justification (ethical principle+reasoning) for your position.

Written Assignment for MODULE 7 HUMAN EXPERIMENTATION

TWO Assignments to choose from-choose only one!  Choose only one (1) dilemma !

OPTION 1 Dilemma 1

Dr. Benton spoke directly and without affect to Melissa Canton.   �Ok you need to understand that this drug has some powerful effects.   One is to make a person more tranquil.  We do not as yet know how exactly it works and what else it might do to people.  We are looking for something that would work like Thorazine which we know you have heard about.  We want something that will work on people diagnosed as schizophrenics.�

Melissa Canton asked Dr. Benton  �Well, I wonder about side effects.  What are they?��

Dr. Benton  replied with: �Well we do know this so far and it�s that if someone were to take it for a few weeks it can produce consequences on the nervous system with muscular control.  It might lead to tremors in some muscles and difficulty in walking and maybe some signs of trouble with face muscles and the like. Not all of these possible side effects seem to be permanent.�  �We do not know the effects in all people and there is a chance you�ll have no changes at all and never develop any tremors.  Then again you might have some signs sooner and even more sever than most.   That�s what we need to find out.�

�So no chance I�m gonna die or anything like that?� Melissa Canton.

�Well all meds have risks of one kind or another.  In this case we don�t think the risks are great at all.  We are looking into any long-term nerve damage or possible brain damage but we honestly do not know.�

�So you need people like me with no schizo thing to take the drugs so you can compare with them?�said Melissa Canton.

 �That�s it alright,� said Dr. Benton .  �But I need to add that you may not get the drug at all.  You see that none  involved in this experiment as patients or experimenters will know who is getting what: either the tranquilizer we are testing or some sugar pill as a placebo.�

 �Oh, OK. Maybe then there may be no risk to me at all,� said Melissa Canton. .

 �Maybe not.  But we do need you and it is important.  This new drug might offer much to relieve the symptom of a great number of people who suffer from schizophrenia.� said Dr. Benton.

 �OK, Now I think I get it � said Melissa Canton. , � I�m gonna get paid for doing this, right?�

 �Correct.  A flat fee -half at the beginning of the study and the rest at the end.  But you must understand that you must waive your right to claim compensation due to any injury or ill effects that you may suffer as a result of the medication.� said Dr. Benton

�Yeah I get that and I�ve got to take a risk.  I really don�t like that at all but I don�t have a job and I need the money so I can go back to school next semester.� Melissa Canton. .

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ASSIGNMENT 7 OPTION 1 CRITICAL THINKING:

1. State what the ethical problems are in this case above involving Melissa Canton. .  There are several.  State at least three of them.

2. Use only ONE of either of these two articles!!!!!  Either the Hellman and Hellman article or the Hans Jonas article.   State what the author�s ethical position would be on this case of Melissa Canton if they were asked.  

(A) State what the ethical position (ethical principle used by) of Hellman and Hellman would be concerning this situation with Melissa Canton. and why you think so.  Summarize their thinking-use quotes.

The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING. OR

(B) State what the ethical position (ethical principle used by) Hans Jonas. What would Hans Jonas make of this case of Melissa Canton?  Would he think it was being handled in a manner that was morally correct or not? Summarize his thinking-use quotes.

READ Samuel Hellman and Deborah H. Hellman authors of "Of Mice but not Men: Problems of the randomized Clinical Trial" New England Journal of Medicine. Vol. 324 no 22 (1991) pp 1585-1589 http://digitalcommons.law.umaryland.edu/fac_pubs/1072/

READ  Title: Philosophical Reflections on Experimenting with Human Subjects   Author: Hans Jonas   Publication Information:  This essay is included, on pp.105-131, in a 1980 re-edition of Jonas' Philosophical Essays: From Current Creed to Technological Man, published by the University of Chicago Press available here https://www.sfu.ca/~andrewf/jonas.pdf    Summary and comments here: http://www.qcc.cuny.edu/SocialSciences/ppecorino/MEDICAL_ETHICS_TEXT/Chapter_7_Human_Experimentation/Readings.htm

NOTE:  A Case Study is due for this module at the same time the written assignment is due!

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ASSIGNMENT 7 OPTION 2 Dilemma 2: 

Human Experimentation:   Alternate Written Assignment on Experimentation in the time of Pandemic Covid-19

Topic:  Use of a drug/vaccine challenge test

A drug/vaccine challenge test is a test where the researchers gives subjects a small amount of a drug/vaccine while observing the subjects to watch for a reaction. In the case of a vaccine the subjects are given the vaccine and then actually exposed to / given the virus to observe the results.

In a few cases where such a test has been done there was available rescue/salvage therapy which is a treatment designed to suppress resistant virus following combination antiviral treatment. In other words there is a therapy to counter the consequences of contracting the virus and its symptoms and possible outcomes.

As of January 2023 there were no known rescue therapies for Covid-19.

RESOURCES:  (you need to acquire more than these three)

1.      COVID-19 human challenge studies: ethical issues  by Euzebiusz Jamrozik, FRACP  and Prof Michael J Selgelid, PhD  Published: May 29, 2020   https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30438-2/fulltext

2.      controversial ?human challenge? trials for covid-19 vaccines gain support   by jon cohen jul. 20, 2020 , 5:10 pm      https://www.sciencemag.org/news/2020/07/controversial-human-challenge-trials-covid-19-vaccines-gain-support.

July 20, 2020 - Researchers use human challenges to test vaccines for other ... drugs can help �rescue� study participants if the vaccine doesn't work. Human challenge trials intentionally place human subjects in harm�s way, so it is imperative that care be taken about when and how they are conducted. One prominent medical ethicist says challenge trials for COVID-19 vaccines might be the way to go, given the enormous morbidity and mortality associated with the infectious disease caused by SARS-CoV-2.

3.      Top ethicist makes the case for COVID-19 vaccine challenge trials   July 15, 2020   Timothy M. Smith   Senior News Writer    https://www.ama-assn.org/delivering-care/ethics/top-ethicist-makes-case-covid-19-vaccine-challenge-trials

Human challenge trials intentionally place human subjects in harm�s way, so it is imperative that care be taken about when and how they are conducted. One prominent medical ethicist, Arthur Caplan,  says challenge trials for COVID-19 vaccines might be the way to go, given the enormous morbidity and mortality associated with the infectious disease caused by SARS-CoV-2.

4. Britain Infected Volunteers With the Coronavirus. Why Won�t the U.S.? Oct. 14, 2021 By Kate Murphy    https://www.nytimes.com/2021/10/14/opinion/covid-human-challenge-trial.html?searchResultPosition=1

the Common Cold Unit established and refined a model for so-called human challenge studies that paved the way for the first Covid-19 human challenge study just completed in Britain, where young, healthy and unvaccinated volunteers were infected with the coronavirus that causes Covid while researchers carefully monitored how their bodies responded.

ASSIGNMENT  OPTION 2 Critical Thinking  -0.5 points for each of 6 parts total 3 points

1.       State what the ethical problems are in this case of the challenge testing.  There are several.  State at least three of them.

2.   Should there be an accelerated schedule for the testing (experimentation) of therapies for those inflicted with covid-19? Answer yes or no and provide an ethical principle to support your answer. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism .  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

3.       Should there be an accelerated schedule for the testing (experimentation) of vaccines to protect against infection by covid-19?Answer yes or no and provide an ethical principle to support your answer.

4.       Should there be the testing of drugs used for other purposes and the continued testing when it is noted that that the drug produces cardiovascular problems for some recipients? Answer yes or no and provide an ethical principle to support your answer.

5.   Should there be a Challenge test for the vaccine? Answer yes or no and provide an ethical principle to support your answer.

6.  State what the ethical position (ethical principle used by) of Arthur Caplan  (see video) or any other ethicist in an article you have read and provide the link to the article.

Written Assignment for MODULE 8 ABORTION

Based on  Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000

Amanda Watts was only 17 years old when she went to a concert with three of her friends.  They saw Drake perform at Barclay Center in Brooklyn.  After the concert it was easy to get separated from her friends as the crowd of over 18,000 exited. Amanda decided to just go to the car to meet up with them.  But when she got to the eight-story parking building, Amanda just wasn�t sure exactly where they had parked in the building.  She started looking on a middle floor.

While she searching two men, one white and the other black, appearing to be in their twenties, came over to her and asked if she needed help.  Amanda explained the situation to them, and one of the men suggested that they get his car and drive around inside the parking building.  Amanda hesitated, but both seemed so polite and genuinely concerned to help that she decided to go with them.  Once they were in the car, however, the situation changed.  They drove out of the building and toward Coney Island.  Amanda pleaded with them to let her out of the car.  Then, some seven miles from the auditorium, the driver stopped the car in the dark area behind a vacant building.  Amanda was then raped by both men.

Amanda was treated at the hospital and released into the custody of her parents.  She filed a complaint with the police, but her troubles were not yet over.  Two weeks after she missed her menstrual period, tests showed that Lucy was pregnant.

                �How do you feel about having this child?� asked Sarah Ruben, the Watts family physician. 

                �I hate the idea,� Amanda said.  �I feel guilty about it, though.  I mean, it�s not the child�s fault.�

                �Let me ask a delicate question,� said Dr. Ruben.  �I know from what you�ve told me before that you and your boyfriend have been having sex.  Can you be sure this pregnancy is not really the result of that?�                 Amanda shook her head.  �Not really.  I use my diaphragm, but I know it doesn�t give a hundred percent guarantee.�

                �That�s right.  Now, does it make any difference to you who the father might be, so far as a decision about terminating the pregnancy is concerned?�

                �If I were to be sure it was Bob, I guess the problem would be even harder,� Amanda said.

                �There are some tests we can use to give us that information,� Dr. Ruben said.  �But that would mean waiting for the embryo to develop into a fetus.  It would be easier and safer to terminate the pregnancy now.�

                Amanda started crying.  �I don�t want a child,� she said.  �I don�t want any child.  I don�t care who�s the father.  It was forced on me, and I want to get rid of it.�

                �I�ll make the arrangements,� said Dr. Ruben

 For this case of  Amanda's pregnancy what would each of the following authors hold on her obtaining an abortion and WHY :  Provide a paragraph on each explaining their positions and use some quotations.

• A.  Sarah Jones
• B.  Sidney Callahan,
• C.  Peter Alward

Find descriptions of their positions here:

http://www.qcc.cuny.edu/SocialSciences/ppecorino/MEDICAL_ETHICS_TEXT/Chapter_8_Abortion/Readings.htm

Using the DIALECTICAL PROCESS state what your ethical position would be on the Case of  Amanda Watts  and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.   Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism, virtue theory.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

Use this template or form to make certain that you include each part of the process-parts a to e

Label your parts with the letters a to e to make very clear that you have done each part.

Dialectical thinking: the 5 parts

• a. Take a position on this question or issue Be as exact as you can be.  Be precise in your use of language (ethical principles and values) .
• b.  Provide the reasons why you think this position is better defended by reason and evidence than are the alternative positions Position defended using reasoning (ethical principles and values) in support of the judgment (conclusion of the  argument).  You state the reasons why the position you take makes sense and has evidence and reasons (ethical principles and values) to support it other than your feelings or personal preference or your opinion or what you were brought up to believe or what just about everyone you know thinks or believes.   Philosophers have offered such reasons (ethical principles and values) . and evidence for the positions they have taken and you should consider them and if you agree you can and should so state them in support of your own position.
• c.  State the reasons why you found the other positions that use other (ethical principles and values) . flawed or less defensible than the one you are defending
• d.  State the criticisms of your position from those who use other (ethical principles and values) .
• e.   Respond to those criticisms from those using other (ethical principles and values) . -a  rebuttal- how do you defend your position in light of those criticisms?

VIDEO on Dialectical Process  https://www.youtube.com/watch?v=zziTWJPbYyU ______________________

Written Assignment for MODULE 9 SEVERELY IMPAIRED NEWBORNS, FUTILITY AND INFANTICIDE

Based on  Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000  . Page 185 Scenario #8

Not all babies are born without any health problems.  Here is a troubling case:

Mr. Robert Locke was in his early twenties and worked as clerk at a discount store called the Bargain Barn.  The Baby�s mother was Hilda Jules and she and Mr. Robert Locke were not married but did create a child born with defects. Several doctors were consulting on the case of the birth of their child. Dr. Savano, the attending obstetrician, asked the hospital bioethics advisor, Lynn White, to meet with him and Dr. Hinds, one of the staff surgeons, to talk with the father of a newborn girl born to Hilda Jules . 

In the consulting room Lynn White met with Mr. Robert Locke who was very nervous.  He knew that the baby had been born just three hours or so before and that Hilda Jules was in very good condition.  But Dr. Savano had not told him anything about the baby.  �I�m sorry to have to tell you this,� Dr. Savano said.  �But the baby was born with severe defects.�

�My God,� Robert Locke said.  �What�s the matter?�  �It�s a condition called spina bifida,� Dr. Savano said.  �There�s a hole in the baby�s back just below the shoulder blades, and some of the nerves from the spine are protruding through it.  The baby will have little or no control over her legs, and she won�t be able to control her bladder of bowels.�  Br. Savano paused to see if Mr. Sinclair was understanding him.  �The legs and feet are also deformed to some extent because of the defective spinal nerves.�  

Mr. Robert Locke was shaking his head, paying close attention but hardly able to accept what he was being told.

�There�s one more thing,� Dr. Savano said.  �The spinal defect is making the head fill up with liquid from the spinal canal.  That�s putting pressure on the brain.  We can be sure that the brain is already damaged, but if the pressure continues the child will die.�

�Is there anything that can be done?� Robert Locke asked.  �Anything at all?�

Dr. Savano nodded to Dr. Hinds.  �We can do a lot,� Dr. Hinds said.  �We can drain the fluid from the head, repair the opening in the spine, and later we can operate on the feet and legs.� 

�Then why aren�t you doing it?� Robert Locke asked.  �Do I have to agree to it?  If I do, then I agree. Please go ahead.�

�It�s not that simple,� said Dr. Hinds.  �You see, we can perform surgery, but that won�t turn your baby into a normal child.  She will always be paralyzed and mentally retarded.  To what extent, we can�t say now.  Her bodily wastes will have to be drained to the outside by means of artificial devices that we�ll have to connect surgically.  There will have to be several operations, probably, to get the drain from her head to work properly.  A number of operations on her feet will be necessary.�

�Oh, God,� Robert Locke said.  �Hilda and I can�t take it.  We don�t have enough money for the operations.  And even if we did, we would have to spend the rest of our lives taking care of the child.�

�The child could be put into a state institution, � Dr. Hinds said.

�That�s even worse,� Mr. Sincalir said.  �Just handling our problem to somebody else.  And what kind of life would she have?  A pitiful, miserable life.� 

None of the rest said anything.  �You said she would die without the operation to drain her head,� Mr. Sinclair said.  �How long would that take?�

�A few hours, perhaps,� Dr. Savano said.  �But we can�t be sure.  It may take several days, and conceivably she might not die at all.�

�Oh, God,� Mr. Robert Locke said again.  �I don�t want her to suffer.  Can she just be put to sleep painlessly?�

Dr. Savano didn�t answer the question.  He seemed not even to hear it. �We�ll have to talk to Hilda Jules also,� he said.  � And before you make up your mind for good, I want you to talk with the bioethics advisor.  You two discuss the matter, and the advisor will perhaps bring out some things you haven�t though about.  Dr. Hinds will leave you both together now.  Let me know when you�ve reached your final decision and we�ll talk again.�

ASSIGNMENT MODULE 9   Critical Thinking

Using the DIALECTICAL PROCESS  state what your ethical position would be concerning what the couple or Hilda Jules  should do and why. You are to take a position and defend it. How would you advise this couple of what would be morally correct or acceptable.  You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) y ou are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.    Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles of health care are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

____ VIDEO on Dialectical Process http://www.youtube.com/user/PhilipPecorino#play/uploads/21/zziTWJPbYyU __________________

Written Assignment for MODULE 10 CARE OF THE DYING

Based on Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000  . Page 243 Scenario #3

On April 8 th , 1984, Mr. Benjamin Wilkins was admitted to the Glendale Adventist Medical Center in Los Angeles. He was twenty-seven years old and suffered from five ordinarily fatal diseases: emphysema, diffuse arteriosclerosis, coronary arteriosclerosis, an abdominal aneurysm, and inoperable lung cancer. During the performance of a biopsy to diagnose the lung cancer, Mr. Benjamin Wilkins� left lung collapsed. He was placed in ICU, and a chest tube and mechanical respirator were used to assist his breathing.

Mr. Benjamin Wilkins complained about the pain the respirator caused him, and he repeatedly asked to have it removed. When his physician refused, he pulled out the chest tube himself. This happened so often that eventually Mr. Benjamin Wilkins' hands were tied to the bed to keep him from doing it. He had signed a living will in attempt to avoid such a situation.

                Although after discussions with Richard Scott, Mr. Benjamin Wilkins' attorney, Mr. Wilkins� physician in the hospital administration agreed to disconnect the respirator, the hospital�s attorney refused to permit it.  He argued that, since Mr. Benjamin Wilkins was not terminally ill, brain dead, or in a persistent vegetative state, the hospital might be open to legal action.

                Mr. Scott took the case to Los Angeles Superior Court. He argued that Mr. Benjamin Wilkins was legally competent to make a decision about his welfare and that, although he did not want to die, he understood that disconnecting the respirator might lead to his death. The hospital�s attorney took the position that Mr. Benjamin Wilkins was ambivalent on the question of his death. His statements �I don�t want to die� and �I don�t want to live on the respirator� were taken as inconsistent and so as evidence of ambivalence. Removing the respirator, the attorney argued, would be tantamount to aiding suicide or even committing homicide.

                The court refused to either allow the respirator to be removed or to order that Mr. Benjamin Wilkins� hands be freed.  To do so,  the court ruled, would be to take a positive step to end treatment, and the only precedents for doing os were in cases in which the patients were comatose, brain dead, or in a chronic state of vegetative state.

                The case was then taken to the California court of Appeal, which ruled:  �If the right of a patient to self-determination as to his own medical treatment is to have any meaning at all, it must be paramount to the right of a competent adult patient to refuse medical treatment is a constitutionally guaranteed right which must not be abridged.�

                The rule came too late for Mr. Benjamin Wilkins.  He died twenty-three hours before the court heard his appeal.

ASSIGNMENT MODULE 10  

PART 1 . Reading Comprehension

State what the Rule Utilitarian and Natural Law positions would be in this case above involving Mr. Benjamin Wilkins and why you think so for each position.

State what the Rule Utilitarian and Natural Law positions would be in this case abov e involving Mr. Benjamin Wilkins and why you think so for each position.

PART 2. Critical Thinking

Using the DIALECTICAL PROCESS state what your ethical posi tion would be on the case of Mr. Benjamin Wilkins and why. Y ou are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING .

Written Assignment for MODULE 11  DELIBERATE TERMINATION OF LIFE AND PHYSICIAN ASSISTED SUICIDE

In September 1995 Dr. Arnold Stang published an article in the  Southern Journal of medicine in which he described how he had prescribed barbiturates for Lydia Marie Jones, a forty-five-year-old woman suffering from leukemia.  In prescribing the medication, Dr. Stang also informed Ms. Jones, who had been his patient for a long time, how much of the drug constitute a lethal dose.

                Ms. Jones later killed herself by taking an overdose of the barbiturate, and Dr. Stang was investigated by a Tulsa Oklahoma Grand jury.  Although it is illegal in Oklahoma to assist someone in  committing suicide, the grand jury decided not to indict Dr. Stang on the charge.

                Dr. Stang�s actions were later reviewed by the three-member Oklahoma State Board for Professional Medical Conduct to consider whether he should be charged with professional misconduct.  The board arrived at the unanimous decision that �no charge of misconduct was warranted.�

                The board, in its report, distinguished between Dr. Stang�s actions and those of Dr. Jack Kevorkian. The board pointed to Dr. Stang�s long-term involvement in caring for Ms. Jones and contrasted it in Dr. Kevorkian�s lack of any prior involvement with those whom he assisted in killing themselves.

                Moreover, the board pointed out that Dr. Stang �did not directly participate in any taking of life� and this too made his actions different from those of Dr. Kevorkian.  �One is legal and ethically appropriate, and the other, as reported, is not�  the board concluded.

State whether James Rachels in Active and Passive Euthanasia   ( http://www.qcc.cuny.edu/SocialSciences/ppecorino/DeathandDying_TEXT/Rachels_Active_Passive.htm   would disagree with Daniel Callahan in  his article  When Self Determination Runs Amok ( http://www.qcc.cuny.edu/SocialSciences/ppecorino/MEDICAL_ETHICS_TEXT/Chapter_10_Care_of_the_Dying/READING_Callahan.htm in this case as to what to do in the case of  Lydia Marie Jones and defend your answer giving reasons for what you think their positions would be.

Alternate locations of texts:

 James Rachels in Active and Passive Euthanasia

 Daniel Callahan in  his article  When Self Determination Runs Amok

Using the DIALECTICAL PROCESS  state what your ethical position would be on the Case of Lydia Marie Jones and why. What should Dr. Stang do from an ethical viewpoint? You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

Written Assignment for MODULE 12 REPRODUCTION , ASSISTANCE AND CONTROL

From:  Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000  . Page 725 Scenario # 1

�You�ve got to help us,� Clarence Woody said. �Keith is � was � our only child, and he meant the world to us. When the police came and told us he was dead, all Sara and I could think of was how we could get him back.�

�But you can�t get him back,� Dr. Alma Lieu said. �Even if we prepared one of his cells and implanted it in your wife�s uterus, the baby wouldn�t be Keith.�

�But he would be his genetic twin,� Clarence said. �He would be as close as we can get to replacing our son.� His eyes filled with tears. �Won�t you help us?�

 ASSIGNMENT MODULE 12 Critical Thinking   Reproduction, Assistance and Control

 Provide ethical grounds for a policy with regard to cloning of a human being to replace a child with a duplicate .  Do NOT simply respond to this case. Focus on setting a policy for all women and all doctors to follow.

Provide ethical grounds for a judgment on buying and selling of embryos to those who want a designer child.

Label your parts with the letters a to e to make very clear that you have done each part

Written Assignment for MODULE 13 ALLOCATION OF RESOURCES: SCARCITY AND TRIAGE

Choose only one of the three options below- only one !!!

Option 1: CASE:  Lifestyle factors in the decision in allocating life saving resources, such as a transplant

From: Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 799, Decision Scenario #9

Dr. Sarah Brandywine hurried into Dr. Kline�s inner office. Dr. Kline was transplant coordinator at Mid-western General Hospital, and he was expecting her. She had called him for an appointment as soon as she had realized the dimension of the problem with Mr. Wardell.

"So tell me about Mr. Wardell," Dr.Kine said, nodding toward the chair beside his desk.

"He�s fifty-one-year-old man who came to the hospital two days ago because he was frightened by the jaundice and ascites he developed over the course of the last week," Dr. Brandywine said. "He have been experiencing fatigue and loss of appetite several weeks prior to the jaundice. His liver is swollen and lumpy."

"Sounds like cirrhosis," Dr. Kline said. "I�m sure you did liver function tests, but what about a biopsy?"

"We did both yesterday. And I called you right after the final results. There�s so much scarring that Mr. Wardell has little liver function left." She shook her head. "I want to put him on the transplant list."

"What�s the cause of his disease?"

"It�s alcohol induced."

"No way." Dr. Kline shook his head. "No livers for alcoholics. No ifs, ands, or buts about it."

"This is a man with two kids." Dr. Brandywine tried to keep her voice level. "One�s twelve, and the other is eight. Their mother died two years ago, and their dad is all they�ve got left."

"Oh, God, the kids make it particularly sad." Dr. Kline�s voice took on a pained expression. "But look, thirty thousand people a year from alcoholic cirrhosis, and we can�t treat them at all."

"I know we can�t, but can�t we treat some?" Dr. Brandy wine leaned forward. "Is being an alcoholic enough for an automatic turndown?"

"I�m afraid so." Dr. Kline nodded. "These are people who created their own problem. There are far being enough livers to go around, so it�s only fair for us to put folks with problems not of their own making on the list and to leave others off."

"But, look, this guy�s got two kids depending on him." Sarah squeezed her hands into fists. "If I can get him into a rehab program, can we promise him the chance at a liver then?" She quickly added. "Not a guaranteed liver, but a chance at one."

"The answer�s still no." Dr. Kline paused. "I�m not saying alcoholics can�t be reformed, but I am saying they�re bad risks. If we give a transplant to somebody whose liver was destroyed by biliary cirrhosis, we�re likely to get a good, long-term survival. But if we transplant somebody who�s been drinking for the last ten or twenty years, we�re not likely to get food, long term results. The guy may promise to stop drinking and maybe he�ll do it for a while. But chances are good that, within a few years, he�s going to be back in the hospital with liver failure again, and alcohol is going to be the cause."

"I admit the numbers are against me." Dr. Brandywine inhaled deeply, then let her breath out in a long whoosh. "There�s nothing I can say to convince you?"

"We can�t afford to risk wasting a liver," Dr. Kline said. "That�s what I�ve got to convince you of." He shook his head. "It breaks my heart to think about Mr. Wardell�s children, but I�ve got to think about the parents with cirrhosis who aren�t alcoholics."

Should lifestyle factors be considered in the allocation of scarce life saving medical resources ? Defend your position using ETHICAL principles.  Using the DIALECTICAL PROCESS  state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own.

Option 2:   CASE: ALLOCATION of VENTILATORS (COVID-19

How should it be determined who will receive the ventilators used to treat those in most dire condintions from the COVID-19 virus ? Defend your position using ETHICAL principles.  Using the DIALECTICAL PROCESS  state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

  RESOURCES: CASE: ALLOCATION of VENTILATORS (COVID-19

Option 3: CASE: VACCINE DISTRIBUTION

How should it be determined who will receive the vaccine to prevent infection from the COVID-19 virus ? Defend your position using ETHICAL principles.  Using the DIALECTICAL PROCESS  state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

  RESOURCES  CASE: VACCINE DISTRIBUTION

Written Assignment for MODULE 14 A CLAIM OF A RIGHT TO HEALTH CARE

From: Munson, Ronald. INTERVENTION AND REFLECTION .6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 863, Decision Scenario 6

"Let me explain it to you, Mr. Faust," Charles Young said. "Although your wife is covered by Medicare, we cannot pay for the care she is receiving in the nursing home. As an Alzheimer�s patient, she�s getting custodial care, and that is explicitly excluded from Medicare coverage. Do you have any insurance?"

"My wife and I both have coverage through my job. Bu the benefits office told me exactly the same thing. My policy doesn�t cover long-term, chronic, or custodial care."

"I�m sorry to hear that," Young said. "That means that you�ll have to pay the total cost of care yourself."

"Where can a sales rep get that kind of money?" Mr. Faust said. "A nursing home will cost me forty or fifty thousand dollars a year. If I sell our house and use all our savings, I could pay for maybe a year or two, but then I wouldn�t have anything to live on myself. Where could I live? How could I eat?"

"The only alternative is to divest yourself of your assets so that you cannot be held legally responsible for paying for your wife�s care. The you and she can both get assistance under the Medicaid program."

"Then I have to literally become a pauper before I can get any help?"

"I�m sorry to say that�s true."

 ASSIGNMENT Module 14 Critical Thinking

Use any single (one) ethical principle from the group we have covered to support your position on each of these three issues. Hopefully it is the principle that you have decided is closest to your values and will use in making moral choices. If you are tempted to use different ethical principles for each of the three issues then you are an ethical egoist and you should use that principle on all three issues. The ethical principles were presented in Module/Chapter  2 and include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  Refer to one or more of these as ethical principles when answering  assignments.  Do not use the Moral Principles of Health Care as Ethical Principles. The Moral Principles involved in Health Care include: Autonomy, Informed Consent, Truth Telling, Confidentiality, Privacy. These are NOT the basic ethical principles such as include Egoism, Utility, Natural Law, Categorical Imperative, Maxi-Min Principle, Existentialism, Feminism.  The moral principles are popular and recognized in several ways in health care including  in �codes� and in statements of �rights� because there are so many of the Basic Ethical Principles that support the moral judgment that these MORAL Principles of Health Care are a MORALLY GOOD THING.

1. Should a national health care program pay for the custodial care of the elderly? Defend your position using ETHICAL principles.

2. Should family members be required by law to help pay the health care expenses of the other family members? Defend your position using the same ETHICAL principles as with question #1.

3. Should people with incomes adequate to cover their health care expenses or to buy private health insurance be ineligible to participate in a national health insurance plan? Defend your position using the same ETHICAL principles as with question #1.

Use any single (one) ethical principle from the group we have covered to support your position on each of these three issues. Hopefully it is the principle that you have decided is closest to your values and will use in making moral choices. If you are tempted to use different ethical principles for each of the three issues then you are an ethical egoist and you should use that principle on all three issues.

_____________________

Written Assignment for MODULE:  CULMINATING ACTIVITY: BONUS EXERCISE

This is a BONUS ASSIGNMENT and is OPTIONAL You do not need to do it.  If you choose to do it you are required to do all FOUR (4)  Parts.

PART I  ABOUT THE SUBJECT MATTER: FINAL EXERCISE 

1. Which of the issues covered this semester has been the most important and why so?

2. Which of the issues covered this semester has meant anything to you personally and why so?

3. Why are not more people aware of these troublesome questions, issues or problems?

4. Now that you have been educated as to these issues in Biomedical Ethics in what way will they have any consequence in your life?

5. Are you in a better position now to think about and handle these issues using ethical principles?

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PART II ETHICAL DIALECTICAL THINKING

Place your best example of using ethical dialectical thinking into a submission to me. Copy and paste your best work from this semester.  No new work involved!! ! Send it to me by email in a separate email from all other messages or submissions.

Title it as : ETHICAL DIALECTICAL THINKING

Using the DIALECTICAL PROCESS  state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so.  In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own.

VIDEO on Dialectical Process http://www.youtube.com/user/PhilipPecorino#play/uploads/21/zziTWJPbYyU

PART III.  COURSE OBJECTIVES

This course has nine objectives on a scale of 0 to 5 with 5 as the highest level , how well do you think that you have achieved these objectives?

• a. Identify and comprehend traditional and current issues in Biomedical Ethics;
• b. Define the main areas of ethical discourse;
• c. Discuss theories of ethics: teleological and deontological
• d. Develop skills of critical ethical analysis of contemporary moral problems in medicine and health care.
• e. Analyze and respond to the comments of other students regarding philosophical issues.
• f. Identify some of the basic content in the field of BIOMEDICAL ETHICS, traditional and current Issues in Biomedical Ethics,

a. vocabulary

b. concepts

c. theories

• g. Communicate your awareness of and understanding of Biomedical Ethics .
• h. Demonstrate familiarity with the main areas of philosophic discourse related to these dilemmas in Biomedical Ethics ,
• i.  Develop skills of critical analysis and dialectical thinking used in (a) analyzing cases and dilemmas , (b) in forming and defending positions, (c) analyzing and responding to the comments of other students regarding Biomedical issues.

Score 0 to 5   a.____  b. ______ c._______  d.________ e.______ f._____ g. ____  h. ______ i.________

PART IV ABOUT THE COURSE: FINAL EXERCISE 

1: What did you like best about this course? 

2: What specific things do you think could be improved in the structure or design of the course and learning activities? 

3: How would you improve the quality and participation in course discussions/interactions?  

4:   What changes would you suggest be made to the pacing or sequence of the content and activities for this course? (e.g., were the due dates doable for you? Were the course materials sequenced well?)  

5:  What changes would you suggest be made to the quantity of work required for this course?  

6:  How could the course be improved in terms of my interaction, participation, and management of the course?  

7:  What other suggestions, comments, or recommendations would you have for the instructor?

8:  What advice do you offer to students who would be just entering the class at the very start of the semester?

I suggest that you create your assignments using your word-processing program and spell checker , then copy and paste your text-answers into the message window of an email and send it to the instructor by email with the text inside the email message window. DO NOT send attachments .

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CASE STUDIES

Each student must submit a case presentation on some incident or situation which relates to the topic and issues of this module. Such presentations consist of the following two(2) sections.

a. Materials concerning the case located on the internet

i. Newspaper articles

ii. Magazine articles

iii. Professional Journal articles , e.g., Philosophy, Law, Medicine Nursing, Public Health, etc..

iv. Other Internet items

MINIMUM of four (4) items

b. Viewpoints on the case by analysts, ethicists, commentators .

MINIMUM of four (4) items which MUST include commentary and/or analysis by people who use ethical principles. These would NOT be articles in newspapers or magazines but items found in professional journals or at the websites of academic and professional organizations.

This is basically an assignment where you will use a number of search engines to gather materials from the internet.

GOOGLE, Northernlights, yahoo, etc...

You will copy and paste the addresses(url's) of those materials into a single file or document and then send it (submit it) to the instructor. You do NOT need to and should not make any personal comments on the case . So, you are NOT required to do any original thinking or critical thinking on the case. You will be gathering the materials and hopefully reading them and in so doing you will learn more about the issues involved and in gathering materials that involve ethical analysis you will learn more about that as well.

case studies: Directions

To submit them you do the same as for the written assignment. If you do not have WORD just put the material right into the message window that opens when you click on the "create an new email" icon.

I suggest that you create your assignments using your word-processing program and spell checker , then SEND FILE to the instructor or by email with the text inside the email message window. DO NOT send attachments .

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Research in Philosophy on the Internet.

With search engine doing research in Philosophy on the Internet you would enter:

cloning + human + ethics

malpractice + stonybrook hospital

malpractice + ethics

kevorkian + ethics

mercy killing + ethics

confidentiality + law

confidentiality + ethics

CASE PRESENTATION FORMAT

CASE TITLE:

DESCRIPTION of the case by student:

url�s for the Articles Describing case:

url�s for Articles with Ethical Position: Philosophers, Theologians, Lawyers, Medical Doctors

SUBMISSION of the CASE STUDY

The student will make the submission by attaching a file that has the text and the links to the internet sites of articles and other related items.

The BEST of these submissions will be placed on a website with the student�s name as author. These will be used by future students of this course.

If any student feels able and willing to create a POWERPOINT presentation for the case study including live links and illustrations, images, photos, etc... contact me for permission and instructions on what would be required and how to submit the material.

When you are ready you simply go to the submission section of this module and open the submission document and then click on the link for submitting an assignment and then attach your file with the case study including the url's.

Fil e formats for submission must be limited to: WORD , html, webpage, dos

I shall make my comments on what you submit and assign a grade.

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Ethics Case Studies & Education Resources

ACP ethics education resources cover a broad range of issues in clinical ethics, professionalism, teaching, research, health care delivery, and other topics. Each resource can be used as a learning activity and completed for free CME/MOC credits as indicated or used as a teaching tool.

• Ethics Case Studies for CME/MOC
• Ethics Manual Activity for CME/MOC
• Position Paper Activities for CME/MOC

Additional Ethics Case Studies

Acp ethics case study series.

Each case study draws on an ethical challenge encountered by physicians in everyday practice, teaching or research. Free CME/MOC credits are available from ACP’s Online Learning Center. Free CME/MOC credits are available for completion of case studies on Medscape as indicated (a free Medscape login is required for access and completion).

• “Why Can’t I Be There?” Ethics Regarding Restrictions on Visitation/Family Caregiver Presence CME/MOC
• Pain Management Near the End-of-Life: What Would Mom Want? CME/MOC
• Ethics, Professionalism, Physician Employment and Health Care Business Practices CME/MOC
• Show Codes, Slow Codes, Full Codes, or No Codes: What Is a Doctor to Do? CME/MOC
• When Resources Are Limited During a Public Health Catastrophe: Nondiscrimination and Ethical Allocation Guidance CME/MOC
• Patient Prejudice? The Patient Said What?... and What Comes Next CME/MOC
• Lab Results Reporting, Ethics, and the 21st Century Cures Act Rule on Information Blocking CME/MOC
• Physician Suicide Prevention: The Ethics and Role of the Physician Colleague and the Healing Community CME/MOC
• Ethics, Electronic Health Record Integrity and the Patient-Physician Relationship CME/MOC
• Ethics, Professionalism, and the Physician Social Media Influencer CME/MOC
• Professional Attire and the Patient-Physician Relationship CME/MOC
• When the Family Caregiver Is a Physician: Negotiating the Ethical Boundaries CME/MOC
• ”Doctor, Can’t You Just Phone a Prescription In?” and Other Ethical Challenges of Telemedicine Encounters CME/MOC
• Serving as an Expert Witness: Is there a Duty? CME  

Ethics Manual (CME/MOC)

The ACP Ethics Manual is the core of College ethics policy. The seventh edition examines issues in medical ethics, reflecting on the ethical tenets of medicine and their application to emerging challenges while also revisiting older issues that are still very pertinent. It helps physicians be prepared to deal with ethical challenges: to identify and reaffirm the fundamentals of medical ethics—such as the patient-physician relationship—and apply principles and reasoned arguments in resolving dilemmas and in debate about ethics topics.

A 25-question quiz module on the seventh edition of the Ethics Manual is available for up to 10 AMA PRA Category 1 Credits TM and MOC Points. The activity is free for ACP members and Annals subscribers.

Annals of Internal Medicine offers the following CME/MOC activity for ACP members and Annals subscribers:

• Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices (Ann Intern Med. published online 15 March 2021) CME/MOC

Additional position papers cover a broad range of health care ethics issues and can be used as a teaching tool.

• Pandemic Treatment Resource Allocation Ethics and Nondiscrimination
• Confidentiality and Privacy: Beyond HIPAA to Honey, Can We Talk?  
• Secret Recordings of Office Visits by Patients  
• Addressing a Colleague's Unprofessional Behavior During Sign-Out  
• Patient Requests for Specific Care: 'Surely You Can Explain to My Insurer That I Need Boniva?'  
• Maintaining Medical Professionalism Online: Posting of Patient Information  
• Banning Harmful Health Behaviors as a Condition of Employment: Where There's Smoke There's Fired?  
• Addressing a Colleague's Sexually Explicit Facebook Post  
• Wellness Programs and Patient Goals of Care  
• Resident Duty Hours: To Hand Over or Gloss Over?
• When an Aging Colleague Seems Impaired  
• Preventive Health Screening, Ethics and the Cognitively Impaired Patient  
• Stewardship of Health Care Resources: Allocating Mechanical Ventilators During Pandemic Influenza  
• Copied and Pasted and Misdiagnosed (or Cloned Notes and Blind Alleys)  
• Stewardship of Health Care Resources: Responding to a Patient’s Request for Antibiotics
• Who Should Get What? Mammography and the Stewardship of Health Care Resources  
• Patient/Physician/Family Caregiver Relationships: When the Family Caregiver Is a Physician  
• Physician Work Stoppages and Political Demonstrations -- Economic Self-Interest or Patient Advocacy? Where Is the Line?  
• To Be or Not to Be: Should I Serve as an Expert Witness?  
• Author! Author! Who Should Be Named in a Published Study? An Ethics Case Study  
• The Difficult Patient: Should You End the Relationship? What Now? An Ethics Case Study  
• Dealing with the "Disruptive" Physician Colleague  
• Must You Disclose Mistakes Made by Other Physicians?
• Providing Care to Undocumented Immigrants
• Twenty-eight additional case studies are published in the book  Ethical Choices: Case Studies for Medical Practice (2nd edition)

For more information on these and other educational content, please contact Lois Snyder Sulmasy, JD, at  [email protected]  or at 215-351-2835.

Ethics Sessions at Internal Medicine Meeting 2020

April 23 – 25, 2020, Los Angeles, CA

Sponsored by the Ethics, Professionalism & Human Rights Committee (EPHRC)

• Ethical Case Challenges: Precision Medicine and Genetics in Primary Care
• Ethics Year in Review
• Spirituality in End-of-Life Care: What is the Physician’s Role?
• Practical Palliative Care: Managing Pain at the End of Life

Ethics education sessions on different topics are offered at the annual Internal Medicine Meeting each year. Information on past Internal Medicine Meeting ethics sessions is available upon request at [email protected] .

Attending the Internal Medicine Meeting is an excellent way to fulfill your state CME relicensure requirements. The ethics sessions may fulfill specific CME content requirements of your state’s licensure renewal. Letters of participation documenting attendance are available online .

For more information on these and other educational content, please contact Lois Snyder Sulmasy, JD, at [email protected] or at 215-351-2835.

7 Main Ethical Principles in Nursing + Why They’re Important

Are you a nurse with a genuine desire to give the best care possible to patients and their families and to become a strong member of your nursing team? Maybe you are a nursing student eager to learn as much as possible to help you succeed in nursing. If so, the most important lesson you can learn is how to establish ethical nursing practices. There are several ways to demonstrate strong ethics, and knowing the main ethical principles of nursing is a great place to start. Perhaps you are wondering, "What are the 7 main ethical principles in nursing, and why they are important?” In this article, you will learn about ethical nursing principles and how they apply to you. As you continue reading, you will find an in-depth look at the 7 main ethical principles in nursing, why they’re important, and examples of how they are applied in the four main areas of nursing.

What Exactly Is An Ethical Principle In Nursing?

What is the source of ethical principles in nursing, 7 reasons why ethical principles are so important in nursing, how many ethical principles are there in nursing.

1. Accountability 2. Justice 3. Nonmaleficence 4. Autonomy 5. Beneficence 6. Fidelity 7. Veracity

Are There Any Conflicting Ethical Principles In Nursing?

What are the 7 main ethical principles in nursing and why they are important, 5 most common challenges you will face while applying the 7 ethical principles in nursing and how to overcome them, challenge #1: knowing where to draw the line between autonomy and beneficence, what is it:, how to overcome:, challenge #2: deciding whether to withhold information or be honest about a patient’s status or prognosis, challenge #3: supporting autonomy related to informed consent, challenge #4: keeping promises when your circumstances change, challenge #5: determining if nonmaleficence overrules a patient’s right to privacy, my final thoughts.

An Introduction to Ethics in Healthcare

Over the past 30 years, the field of medical ethics has become increasingly important in both medical education and clinical practice. Manifestations of the increasing role and presence of medical ethics can be found not just in the escalating number of books and journal articles on this topic, but in the percentage of medical schools in which training in medical ethics is now part of the standard curriculum and the growing number of hospitals nationwide in which ethics committees regularly meet to help resolve perceived ethical dilemmas. Healthcare as a microcosm of society reacts and responds to societal events. The task of medical ethics is to analyze and hopefully resolve ethical dilemmas that arise in medical practice and biomedical research. Medical ethics is not a static, rigid entity; on the contrary, it is a field where disagreements among acknowledged experts are far from uncommon. Much of medical ethics has concerned itself with end-of-life issues and discussions related to medical decisions making in the case of incapacitated patients. Healthcare managers are usually acutely aware of their ethical responsibilities to patients, clients, the organization, and the community. For the most part, they are aware of what are considered ethical business practices. Too often, however, they may overlook their ethical responsibilities to the people they manage. Continual advances in technology, changes in healthcare financing, increasing consumer needs and expectations, the ever expanding public scrutiny and litigation all contribute to the significant complexity of healthcare. On a fundamental level, people need and want guidance and standards to help them “do the right thing.” Most of the time, unconsciously, the manager will make the right decisions and will “do the right thing.” Healthcare managers will be confronted with ethical dilemmas on a daily basis. For the most part, those involved in healthcare are decent, because they wish to contribute something of value to society.

The decision-making process in healthcare management has become more complicated and it is especially difficult for healthcare executives to feel confident that they are making ethically responsible decisions. Caution must be exercised, however, to avoid the assumption that if no law or rule or regulation or policy addresses an action, then the action must be ethical. This is not true. The healthcare manager is expected to know the answers, to make decisions quickly and authoritatively, and to lead the staff with a moral integrity.

Laura Nash in her article, “Ethics Without the Sermon”, offers the following twelve questions for examining the ethics of a business decisions:

• Have defined the problem accurately?
• How would you define the problem if you stood on the other side of the fence?
• How did the situation occur in the first place?
• To whom and to what do you give your loyalty as a person and as a member of the corporation?
• What is your intention in making this decision?
• How does your intention compare with the probable results?
• Whom could your decision or action injure?
• Can you discuss the problem with affected parties before you make your decision?
• Are you confident that your position will be as valid over a long period of time as it seems now?
• Could you disclose without qualm your decision or action to your boss, your CEO, the board of directors, your family, society as a whole?
• What is the symbolic potential of your action if understood? If misunderstood?
• Under what conditions would you allow exceptions to your stand?

The key to ethical decisions is an awareness on the part of the healthcare manager of the necessity of asking thoughtful questions and taking the time to formulate ethically sound answers. Regardless of which strategy the healthcare manager uses to arrive at a sound ethical decision, the manager must examine all of the consequences of each action considered. John Worthley offer the following ten ethical principles that can be used to help healthcare executives determine an ethical course of action:

• Never take any action that is not in the long-term self-interests of yourself and the healthcare organization to which you belong.
• Never take any action that is not honest, open, and truthful.
• Never take any action that is not kind, and that does not build a sense of community.
• Never take any action that violates the law.
• Never take any action that does not result in greater good than harm in your healthcare facility.
• Never take any action that you would be unwilling to see another healthcare professional take in similar situations.
• Never take any action that bridges the agreed upon rights of others.
• Always act to maximize profits subject to legal and market constraints and with full recognition of external costs.
• Never take any action in which the least among us are harmed in any way.
• Never take any action that will interfere with the rights of others for self-fulfillment.

Ethical dilemmas all have one thing in common-they all deal with the interrelationships of people and the different values, special interests, and goals that each person brings to the workplace. Above all, a wise manager never underestimates the power of example. The ethical manager will consistently practice the standards of conduct that the manager wishes all employees to emulate. And we always say that Ethics applies to all situations and to all relationships.

Related posts

The Ethics of Managing People

Medical errors, gender discrimination.

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Medical ethics.

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• Continuing Education Activity

Familiarity with ethical principles on a basic level is necessary to practice medicine. However, most healthcare providers are unable to explain how or why medical ethics principles have come to be and justify how they apply medical ethics principles in a systematic fashion. Many different medical ethics guidelines are available, such as from the American Medical Association (AMA), American Osteopathic Association (AOA), and the American College of Physicians (ACP). Given the lack of definitive ethical standards and premises, let alone a hierarchy or algorithm for prioritizing them, clinicians still face challenges in achieving satisfactory solutions to ethical challenges for themselves, their patients, and other parties involved. Because medical ethics issues are not limited to physicians, this article is written to be useful for both physicians and non-physicians. The neutral term "healthcare provider" is used in circumstances that apply to both physicians and non-physicians.

• Describe the formation and functions of medical ethics principles.
• Summarize how law, science, religion, and non-medical ethics disciplines affect the discipline of medical ethics.
• Explain how to apply medical ethics principles when attempting to resolve a medical ethics dilemma.
• Outline how the interprofessional team can work together to advance medical ethics and patient outcomes.
• Introduction

Medical ethics is a required element of American physicians' formal training. Familiarity with ethical principles on a basic level is necessary to pass initial medical licensing examinations. However, many healthcare providers (HCPs) are unfamiliar with the list of ethical principles relevant to modern medical practice, explain how or why medical ethics principles have come to be, or integrate and prioritize medical ethics principles systematically. 

Many different medical ethics guidelines are available, such as from the American Medical Association (AMA), American Osteopathic Association (AOA), and the American College of Physicians (ACP). The AMA code is of historical interest since it originates from the world's first medical ethics code (written in 1847) intended to serve as an authority at a national level. It was revised in detail in 2016 with some minor alterations in 2019.

Although the AMA advertised its 2016 code as "designed to meet the ethical challenges of medical practice" and as "the medical profession’s authoritative voice," the first page of the code stated that the code was "not intended to establish standards of clinical practice." That language has been removed, leaving language that serves as a more authoritative standard with a system of hierarchy in the appropriateness of actions involving degrees of obligation, such as  must ,  should , and  may , with the flexibility provided depending on circumstances.

Nevertheless, not all HCPs are held by other policy-making bodies to uphold the AMA code. Given a lack of definitive ethical standards and premises, let alone a hierarchy or algorithm for prioritizing or enforcing them, HCPs often still face great challenges in achieving satisfactory solutions to ethical challenges for themselves, their patients, and other parties involved. 

Goals for its practical application by physicians and other healthcare providers:

• To explain the formation and functions of medical ethics principles
• To demonstrate how law, science, religion, and non-medical ethics disciplines affect the discipline of medical ethics
• To illustrate how to apply medical ethics principles when attempting a resolution of a medical ethics dilemma
• Issues of Concern

Whereas moral instruction dates to Egyptian writings dating to before 2000 BCE, the first recorded systematic approach to defining a set of moral behaviors (ethics) derived from logic belongs to Aristotle (384-322 BCE). He referred to his work as the "ethikos," which means the "customs." The word denotes the concept of "habitual character and disposition." Multiple other Greek writers (such as Thucydides (c. 460-400 BCE), Plato (c. 426-347 BCE), and Luke (c. first century CE) also used this word.

Aristotle, an early authority on legal theory and biology, based his ethics system on a rational defense of what behavior was appropriate or inappropriate with practical intent, specifically to improve the quality of human lives. His principal concern was the nature of human well-being. 

Evolution of Ethics  

Concepts on the nature and function of ethics continue to evolve. Whereas the study of ethics (including Aristotle's) always attempts to distinguish good from bad, the concept of ethics among laypersons has become associated with the connotations of distinguishing right from wrong (and starting in the 1300s CE of distinguishing virtue from evil). Ethical evolution, like the evolution of many other disciplines, particularly the field of law, often starts as a reaction to a new event (a human action or inaction) that an author considers unacceptable. Although the action/inaction involves specific circumstances (such as time, place, and views of the people involved), the reaction attempts to establish that the action/inaction shall thenceforth become unacceptable for others in circumstances potentially very different from the original event.

Many factors, such as economics, affect a society's ethics in a manner akin to a feedback loop (or yin-yang), particularly with respect to laws and other forms of enforced policies. Ethicists' views that policymakers support eventually lead to the creation of a policy. The policy eventually leads to a dilemma, then a reaction to the dilemma, and then a new or revisited commentary by ethicists regarding what action or inaction is acceptable. The cycle repeats. Thus, ethical principles follow traceable lines of historical events and persons that have prevailed in influence. Looking at the history of an ethical principle (or law) can provide an understanding of why the ethical principle has risen to prominence (or why a law exists) and may enable a practical basis for accepting or rejecting it. This evolution of ethics and policy results in a potential source of HCP conflict, such as when a HCP trained in more current ethical concepts and policy disagrees with a HCP who believes in more dated ones (e.g., paternalism). Medical ethics principles evolve intertwined with principles in other fields of ethics.

Ethics as a Systematic Study

Ethics comprises numerous overlapping subdisciplines. Medical ethics can be classified as a subdivision of applied ethics, but it functions dependently on the following subdivisions of ethics as well (this list is not intended to be all-inclusive):

• Descriptive ethics: How do people behave?
• Normative ethics: How ought people to behave (to do good)?
• Meta-ethics: What is good behavior? How can we tell what is good from what is bad?
• Applied ethics: How do we apply descriptive, normative, and meta-ethics conclusions to real-life situations?
• Virtue ethics: How does a person gain the skills and knowledge to be virtuous and to do good?
• Group ethics: What factors enable and inhibit individuals from working together to do good? Is there one set of behaviors that yields the greatest likelihood of prosperity for a particular group?

Just as the application of knowledge in a branch of surgery can improve by understanding aspects of other surgical disciplines, the application of medical ethics can improve by understanding aspects of these other ethical subdivisions. Conversely, limited awareness of ethical principles and hierarchies can set up a HCP to conclude that "there is no right answer" for a situation in which a confident best answer could otherwise emerge. For example, it was a grasp of Aristotle's non-medical virtue ethics from the 300s BCE that enabled Thomas Aquinas (1225-1274; not a HCP) to propose the Principle of Double Effect, which is used by HCPs in clinical practice today.

When, where, who, and what are relatively easy questions to answer. How and why are the harder questions. Metaphysics, epistemology, history, and the "hard" sciences address how. In their most ambitious form, ethics, theology, and logic also attempt to address why.

Without the exploration of the why, a HCP has limited ability to apply ethical concepts to new, varied, and complex situations. HCPs who truly want to understand and apply ethics must be simultaneously like a child repeatedly asking the next why and a teacher continuing to supply an ever more cogent answer.

Authority in Ethics

An explanation for "why" that adults give children is "because I said so." This suffices only if the child holds the adult to have a satisfactory position of authority. It is practical when having a dialogue with yourself, with patients, or with others regarding what is or is not ethical to share and apply the written and unwritten opinions of all relevant authorities to reach a satisfactory consensus.

Thomas Hobbes (1588-1679), the "father of Western political philosophy." His ideas spurred the creation of lists of "inalienable rights" of persons, and he also discussed the functions of authority in society. However, America's founding fathers rejected Hobbes' idea that government can have absolute power, holding it to be "self-evident" truth that:

• Authority is not in and of itself adequate for establishing what is ethical.
• An ethical principle raised by a person in free speech may trump authority for authority's sake. 

As with scientific truth, where beliefs developed from "experience" are considered to be the worst level of evidence, deferring to "experience" or "years in the business" is not a reliable way to achieve the best decision in ethics. 

Nevertheless, a shortcut to not having to think through an ethical dilemma is to refer to what a common/shared authority has already said. From laws to policies, the following list serves as a relative weighting of authority on medical policy (in decreasing order) for American HCPs that may help a HCP determine a course of action.

• US law (statutory law, common laws, executive law)
• State law (same as above; potentially useful even from another state if one's state has no contradictory law)
• National policy issued for HCPs regardless of type (AMA/AOA policy)
• National policy issued for a specified type of HCP (board/society of practice or ACGME policy)
• Local policy issued for HCPs regardless of type (hospital policy)
• Local policy issued for a specified type of HCP (department or training program policy)

In a real ethical dilemma, if none of the authorities listed above provides what seems to be adequate guidance, then HCPs can turn to authorities from the Great Conversation. The Great Conversation refers to how voices of the past, like Aristotle and Hobbes, shared ideas that ring true across time and place and influence people of later generations, which includes practical matters affecting the health care of millions of people today. For example, Harry Blackmun (1908-1999), the justice writing the majority opinion in the 1973 Roe vs. Wade trial, justified his decision to all the world, not based primarily on prior American law, but based on the views of Aristotle, Plato, and Jewish and Christian non-scriptural/post-scriptural writers. Further demonstration that law is not always the highest authority in medical ethics: the ACP code of ethics committee, which attorney chairs, states, "Medical and professional ethics often establish positive duties (that is, what one should do) to a greater extent than the law."

Medical Ethics and Objectivity

On the one hand, Aristotle stipulated that an all-encompassing system of ethics cannot be condensed to precise proofs that demonstrate that action holds true in every situation. On the other hand, he stated that some actions should never be taken (exemplifying objective ethics, discussed below). Returning to the comparison of applied ethics with the law, a functional ideal for both systems is that decisions derived from meta-ethics and normative ethics are made and enforced while maintaining impartiality for persons with one particular characteristic versus another as much as possible.

Ethics and Science

On the one hand, science can "improve" understanding and use of ethics. Some hypotheses and patterns in ethics can be studied using the scientific method. The dependent variable of persons' moral decisions can be assessed after exposing them to an independent variable in a randomized fashion. To a degree, persons' beliefs and behaviors can be quantified. Objectivity is a goal shared by science and ethics (discussed below).

On the other hand, "science" can be a hindrance to the original goal of ethics (i.e., to improve quality of life). Scientific advances causing problems with the quality of life is a common theme that science fiction movies use and that many laws and policies (such as those of the AMA) battle against. Setting aside the intent of science and contemplating the method of science only, the latter also may be of no aid. Sometimes the scientific method explains a cause and effect relationship, but often it does not and results in more questions than answers, similar to what can occur when mulling over an ethical dilemma. Applying the scientific method may not prove that one theory or course of action is superior to another. How a scientist develops and conducts an experiment is subjective and variable. How scientists interpret and apply facts varies. Much of the work passed off by persons labeled as "scientists" are observational (i.e., it does not apply the actual scientific method at all) or violates David Hume's (1711-1776) is/ought problem, which warns against laying out observations using descriptive terms and then concluding with unsubstantiated prescriptive terms.

Objective Ethics

So-called objective ethics (also called ethical absolutism but distinct from "objectivist ethics" or "ethical objectivism") is the attempt to create a set of ethical rules that (almost) always holds true. For an ethical behavior to be truly objective, it must depend neither on values nor beliefs but must depend entirely on reason (logic) and observable true statements. An observable true statement is one that can be shown to be true in the way the concept in the sentence "the sun is larger than the earth" can be shown to be true. Epistemology is the study of how a person can know something is true and is beyond this article's scope.

Ways to improve objectivity in medical ethics:

• no self-interest in the outcome (is impartial) or
• no knowledge of the actual outcome of the decision (similar to "blinding" in a blinded experiment).
• Alternatively (or additionally), address the issue as if the decision-maker is the one who would be the one experiencing the primary outcome of the decision. The "father of duty ethics," Immanuel Kant (1724-1804), used both of these tactics.
• Decide in such a way that the choice does apply or could apply to many circumstances/persons over many time points or instances. This approach is in contrast to a more subjective alternative, which applies a decision only to one or several circumstances/persons or over a few time points or instances. This concept is akin to using a mathematical algorithm designed to increase the odds of achieving the desired outcome over many instances at the possible sacrifice of achieving the desired outcome for a particular instance.
• Define a marker/point of reference to serve as an objective standard. An example from science is how a unit for measuring temperature was defined as the difference between the temperate of freezing and boiling water at sea level divided into 100 equal parts. Once such a standard is chosen, based upon that standard, a behavior could be considered right or wrong in (almost) any situation, often regardless of the behavior's consequences, and thus (almost) always be an obligation to carry out. 

These methods (among others) can be used to formulate laws. The more real-world variables included and the less like a vacuum or a controlled laboratory environment an ethical dilemma is, the less the actual outcome may resemble the expected outcome. For an ethical system to be practical, it must be able to address variables and specific situations without a de novo analysis each time. It must also prevent extreme variety in outcomes by clinicians reaching different conclusions in identical situations.

Though it is not possible that normative ethics can be completely objective in the real world, attempts at maximizing an objective strategy for ethics can still be made, in an attempt at defying Hume's theory of emotivism, which is that ethics claims by their nature derive from emotion and not from fact. 

Ethical Spectra and Biases

It is important when evaluating the stance of an authority to understand both its biases and if it has one, its primary objective standard (as defined above). For example, think about how differently HCPs of different specialties might approach fever workup and treatment due to not sharing a reference standard:

• Surgery: First line is to image to find something to lance and leave to open drainage
• Rheumatology: First line is to look for serum inflammatory markers and treat with steroids
• Infectious disease: First line is to obtain tissues for culture to allow treatment with a specific drug
• Interventional radiology: The first line is to image to find something to put a catheter in
• Primary care: The first line is to treat empirically with broad-spectrum antibiotics
• Organ specialty/hematology: The first line is to think about what non-infectious problems could cause fever in their tissue of choice

The AMA Code of ethics originators themselves can serve as an example of bias in ethics. The formation of the AMA occurred, at least in part to (1) prevent economic competition from "less qualified" medical practitioners and (2) to define the obligations of the public to physicians. The founders of the AMA maintained the bias of preventing racial minorities and women from practicing medicine.

Listed below are the spectra (biases) of the different major Conversationalists in ethics (not intended to be all-inclusive). Awareness of these standards/reference points can help a HCP perceive the variety of ethical views that he or she will encounter from patients, colleagues, and others.

Theories of Ethical Standards

• Egoism: Serve yourself first.
• Subjective relativism: Each person decides for oneself what interest to serve.
• Cultural relativism: Serve your society’s (or other social groups') expectations of you first.
• Utilitarianism: Serve the greatest good for the most people. Something is "good" if it is useful.
• Act: Focus on the ends.
• Rule: Focus on means.
• Virtue ethics: Follow a defined list of virtues.
• Duty/deontological ethics: Whether or not your intentions/motives are good, act out of duty to the most relevant authority.

Medical ethics has included each of the above standards to different degrees in different times and places. A detailed discussion of these examples is beyond the scope of this article.

HCPs practicing medical ethics, from its ancient historical roots (in Egypt, Mesopotamia, and Greece) through the present day, have always primarily adhered to ethics of deontology, i.e., duty or obligation. The number of included duties is not magical or sacred; it differs depending on the source. Thomas Beauchamp (1939-) and James Childress (1940-) emphasized four, preferring to call them "principles" instead of "duties:"

• Nonmaleficence: "Not carrying badness," potentially the earliest written emphasis on ethics, can be traced particularly to the Egyptians.
• Beneficence: "Carrying good" can be traced to all early civilizations
• Respect for patient autonomy: "Self-rule," particularly stressed by Immanuel Kant; in some regards can be traced to the Greeks
• Distributive justice: Equality of rights among all persons; Equality in rights arguably may be traced to Guan Zhong (c. 650 BCE); in Western culture, it can be traced to the Stoics in thought, to first-century Christians in spiritual worth, and Thomas Hobbes in social rights.

Bernard Gert (1934-2011), Charles Culver (1934-2015), and Danner Clouser (1930-2000) provide a critical alternative to Beauchamp and Childress, both on a philosophical and on a practical level but also make many similar conclusions. They emphasize 10 duties for physicians:

• Do not kill.
• Do not cause pain.
• Do not disable.
• Do not deprive of freedom.
• Do not deprive of pleasure.
• Do not deceive.
• Keep your promises.
• Do not cheat.
• Obey the law.
• Do your duty.

Not altering Beauchamp and Childress' duties per se but also hoping to improve upon the practicality of their analysis, Albert Jonsen (1931-), Mark Siegler (1941-), and William Winslade (1941-) identified four topics intrinsic to every clinical encounter for organizing and prioritizing facts of a particular case:

• Medical indications: Diagnosis, prognosis, treatment options, physical treatment goals
• Patient preferences: Including patient values
• Patient quality of life: As experienced and determined by the patient
• Contextual features: Family, law, culture, hospital policy, insurance companies, other financial issues, among others.

The ACP ethics code includes Beauchamp and Childress's four principles by name. The 2016 AMA code defends all four principles to varying degrees. It does not address non-maleficence and beneficence using those terms but advises physicians to behave to maximize patient benefits and minimize harm. As mentioned previously, it emphasizes beneficence: "The practice of medicine... arises from the imperative... to alleviate suffering." The section on organ procurement supports distributive justice. 

Although the AMA code shifted from using the language of “duties of physicians” in 1847 to “principles of medical ethics” in 1957, the code still implies that medical ethics are by nature shaped predominantly by duty (as opposed to by virtue or by utilitarianism).

Conflicts in Medical Ethics

Conflicts of interest in carrying out these duties are inherent to the profession and are the norm, not the exception. Conflict can occur between essentially any two ethical principles or duties. Numerous medical ethics texts explore these conflicts for a given clinical scenario, particularly conflicts between autonomy and beneficence, between distributive justice and beneficence, and between the "lesser of two evils" application of non-maleficence. The rest of this section will examine a much less commonly addressed conflict between beneficence and non-maleficence: not which is the lesser of two evils, but which is the greater good and which is more fundamental to the practice of medicine.

Beneficence is a Greater Good than and Primary to Non-Maleficence

Although non-maleficence serves as "out-of-bounds lines" in medicine, beneficence should remain cemented as the goal. This view directly opposes that of Gert, who argued that a physician has no moral obligation to be beneficent other than to meet whatever minimum duty of beneficence is required of the physician to keep his or her job. He argued that non-maleficence is morally obligatory but that beneficence of any kind is not.   Gert was a very rational thinker but was neither a HCP nor a student of medical history, never delving into what HCPs of the past said in the Great Conversation. Gert's view contradicts thousands of years of medical practice, the current AMA position, and many people's moral compass as directed by their spiritual/religious convictions (discussed below).

The 2016 AMA code of ethics' opening line (i.e., its version of "Four score and seven years ago our fathers brought forth on this continent a new nation..." or "When, in the course of human events, it becomes necessary for one people to dissolve the political bonds which have connected them with another...") is:

"The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering." (AMA code 1.1.1).

The text continues in the same vein about putting patients' health above the physicians' needs. There is no mention of any notion pertaining to "do no harm" until Section 1.1.7, and the authors of chapter 1 never fully develop the idea of non-maleficence. That the primary purpose of doctoring is altruism is supported by the Hippocratic Oath, in which "I will use treatment to help the sick according to my ability and judgment" precedes a discussion of avoiding harm. The concept "first do no harm" dates to Auguste Francois Chomel (1788-1858).

The mainstream perspective of natural law theorists, psychologists, and the public is that humans normally are expected to exhibit some beneficence (altruism). The controversy in law, philosophy, and business are how to defend rationally the degree to which beneficence is required.

An attempt to create an objective formula for when some human attempt at beneficence should be expected is:

A person (or group of people) P has an obligation to perform an act of beneficence aB to some other person Op whenever:

• Op is at risk R of significant loss of or damage to some basic interest.
• aB is definitely necessary or likely necessary to prevent R.
• aB does not present a significant R to P. In other words, The expected benefit to Op outweighs the expected burden to P.

Contrary to Gert's assertion that such behavior is not morally rational, this kind of behavior is supported by moral teaching in the form of a command, e.g., the parable of the Good Samaritan (Luke 10:25-37)..."Go and do likewise."

The notion that business persons' economic motivation commonly trumps their altruism is testified, not only by anyone who has ever "been taken advantage of" or experienced a glaringly inadequate "quality of service" by a business but also in ethics philosophy literature. Adam Smith was Hume's successor and influenced the field of business ethics. Smith (1723-1790) argued that the well-being of persons depends on social cooperation but not on businesses' benevolence to customers and that it is nonsensical to expect businesses to show benevolence. However, William Nickels (1939-) and Kellie McElhaney (1966-) have provided contemporary arguments that "charity" and "social responsibility," both forms of beneficence, are usually good for business (i.e., financial gain and influence) in the long run (analogous to some observations supported by game theory). Bartlett reviewed cost-benefit analyses of patient education techniques in a variety of settings and concluded that certain techniques in educating patients result in cost savings on a systems level. [1]  However, many HCPs do not educate patients because they receive no direct financial reward. 

Persons like-minded to Gert believe that beneficence is nothing more than commendable. Some HCPs share this view or some version of it; their obligation is only to make some minimal effort to prevent harm but not even to attempt to relieve suffering. HCPs tend to exhibit this behavior/view as they evolve from their early days in medical training and obtain positions in which they are more concerned with money. Businesses and/or HCPs in authority that embrace the mantras of Smith and Gert not uncommonly go so far as directly to impede other HCPs from carrying out the very altruism that first inspired them to become HCPs.

Both the medical and military professions are also based on the ancient Greek virtue of "arete"- a commitment to excellence. Whereas the duty of the soldier is always foremost to protect his fellow soldiers, the duty of the HCP is always foremost to protect the patient. Persons who enter these professions often feel a "higher" calling to serve others that compels them to serve beyond meeting a minimum standard. Gert was married to his childhood sweetheart for over 50 years before being separated by death. Although a union of that sort can be achieved out of "duty," it usually requires and derives its meaning from another fundamental trait of humanity that can also be the driving force of a HCP's behavior: love (Greek "agape").

Gert convincingly argued that a person cannot impartially do good for all persons at all times. In this way, he unintentionally promoted distributive justice. Nevertheless, it is essentially unheard of to find a member of the Great Conversation, a statute of law, or an ethical code pertaining to the practice of medicine that argues that distributive justice dominates beneficence as a rule. Instead, the beneficence-justice dilemma is discussed only in the context of emergencies.

Unfortunately, Gert did not define how to carry out duty practically when there are opposing forces, specifically, a duty to the patient, to the nurse, to one's colleagues, to one's administrator, to one's medical student, and to one's risk manager. Codes of medical ethics indicate that the physician's duty to the patient supersedes the physician's duties to all others. Gert agreed that healthcare organization administrators should optimize physicians' time spent for beneficence while still meeting expectations of patients and policy requirements by using mid-level providers and/or assistants to, for example, reduce physician time spent on tasks not required for a physician to accomplish, such as patient education, data gathering, correspondence, procedure organization, and other logistics.

Proposed Hierarchy of Beneficence, Autonomy, Non-Maleficence, and Justice

Non-Emergency Setting

• Proceed to do what you believe good for the patient, assuming that the patient agrees there is not a better option (beneficence and respect for autonomy).
• If the patient does not agree that your plan is the best option, then stop (respect for autonomy).
• If you or someone else is contemplating that you proceed to act in a way that you know could harm the patient, then stop (non-maleficence). The exception to this is if 1) the intent of the action that could harm the patient is beneficence 2) the plan of action is the least threatening/most desirable means to an end available (beneficence), and 3) the patient agrees with the action after having informed consent (respect for autonomy). If these three conditions are met, then proceed.

Emergency Setting

Ration beneficence evenly among patients (distributive justice); otherwise, proceed as for non-emergency settings.

Although successfully performing each of these tasks to the satisfaction of every patient is impossible, the AMA states the physician must make a good-faith attempt.

Medical Ethics' Link to Theology and Religion

Whereas writings on morals extend historically to the Egyptians before 2000 BCE, approaches to normative ethics began to act independently from the field of theology only around the mid-1700s. In other words, only in the last 5% to 10% of history has the approach to the public dissemination of mainstream moral thought involved taking God out entirely of the equation; a similar mainstream approach in medical ethics dates to an even later time. The major Greek philosophers (Aristotle) and Hippocratic physicians believed in a higher power than humanity. The 1847 AMA code drafting committee chairperson Dr. John Bell (1796-1872) wrote that "medical ethics, as a branch of general ethics, must rest on the basis of religion..." Dr. George Wood (1797-1879), AMA president in 1853, advised every physician to have access to the AMA ethics code because "next to Holy Scripture and the grace of God, it would serve most effectually to guard him from evil."

In 2017, over 70% of Americans identified as belonging to an Abrahamic religion (Christianity, Islam, and Judaism). About 2% identified as belonging to one of the other two major world religions of Hinduism or Buddhism, and about 6% identified as atheist or agnostic. At least approximately 20% of American hospital beds remain in a religion-affiliated hospital.

None of the primary principles of medical ethics either began with or are unique to Abrahamic writers. The norm in the United States is now enforcement of moral principles by secular authorizing bodies (government, professional societies, places of business). Nevertheless, it is historically inaccurate and incomplete to neglect the influence of a belief in God on the establishment of these principles, as argued by Friedrich Nietzsche (1844-1900). An informed application of the imperatives that modern medical ethics codes prescribe cannot exclude concepts from monotheistic theology and theodicy when applied to many patients. American HCPs routinely encounter patients and family members who ascribe ethical authority to texts that they believe come with directives from God and often serve as their highest ethical authority.

• Clinical Significance

Aristotle envisioned ethics as a means for the improvement of human life in concert with the practice of medicine. He pointed out that without having a standard for knowing what the right reason is, a person cannot master ethics, just as a student of medicine cannot master medicine if the student can only say that the right treatment to administer is one that someone else told the student to administer but can name no standard other than this.

Medical ethics remains an evolving field. Its application using a system of principles with varying hierarchies is relatively recent. The first code of medical ethics was not written until after the inventions of antiseptic technique and the stethoscope and around the same time as the invention of general anesthetics. In 1980, the AMA reduced its code of ethics from its original four chapters extending for 20 pages to seven minimally elaborated principles. By this time, state legislatures and hospitals had taken over doctors' political agendas that were a significant part of the original concern of the AMA. Not yet had ethicists' reactions to the civil rights movement of the 1960s and 1970s and the medical technology revolution of the last half of the 20th century taken effect at the level of the AMA. In 1998, for the 150th anniversary of the original code, the AMA re-expanded the code to nine chapters over 150 pages. In 2016 the AMA further expanded the code to eleven chapters spanning over 200 pages.

Article IV of the 1980 AMA Code added the language of "patient rights:" 

"A physician shall respect the rights of patients, of colleagues, and of other health professionals."

The 2016 code expanded patient rights to a whole page. Patient rights are still not a national uniform doctrine [2] . The United States Congress proposed and then rejected the concept of making such a doctrine in 2002. It may still be an upcoming horizon that is crossed after following the lead of other countries or regional authorities.

Medical ethics continues to expand in terms of authorship and scope. By 2017, twelve journals indexed in PubMed that are devoted to medical ethics had reached a citation index factor of at least 1.0, such as The American Journal of Bioethics , BMC Medical Ethics , Journal of Medical Ethics , Bioethics , and The Hastings Center Report .

Primary research and review articles continue to discuss new concepts in the ethics of issues such as:

• Use of medical technology [3]
• Medical treatment of populations [4]
• Human reproduction [5]
• Mental health [6]
• Organ donation [7]
• Surrogate decision making [8]
• Suicide and assisted death [9]  and
• Limits in the extent of services of critical care medicine.  [10]

And as with Henry Beecher's reports in 1966  [11] [12] [13]  that marked a turning point in the United States' government's involvement in medical ethics, ethics applications in clinical trials also continue to evolve  [14] .

The field of medical ethics will continue to impact the fields of law (with new medical ethics-based laws passing yearly across the states) and science. In turn, these fields will continue to impact medical ethics. HCPs must not lose sight of changes that have occurred recently and that are yet occurring in order to practice medicine according to modern principles of medical ethics.

• Other Issues

Non-PubMed Indexed References In Order of Citation

• American Medical Association Council on Ethical and Judicial Affairs. AMA Code of Medical Ethics . Chicago, IL: American Medical Association; 2017. https://www.ama-assn.org/delivering-care/ama-code-medical-ethics. Accessed November 15, 2018.
• American Medical Association Council on Ethical and Judicial Affairs.  AMA Code of Medical Ethics . Chicago, IL: American Medical Association; 2019. https://www.ama-assn.org/about/publications-newsletters/code-medical-ethics-preface-preamble. Accessed November 6, 2020.
• American College of Physicians. ACP Ethics Manual 6th ed. https://www.acponline.org/clinical-information/ethics-and-professionalism/acp-ethics-manual-sixth-edition/acp-ethics-manual-sixth-edition. Accessed November 15, 2018.
• American Osteopathic Association. AOA code of ethics. https://osteopathic.org/about/leadership/aoa-governance-documents/code-of-ethics/. Accessed November 15, 2018.
• American Medical Association. https://www.ama-assn.org/delivering-care/ama-code-medical-ethics. Accessed November 15, 2018.
• American Medical Association. https://www.ama-assn.org/ama-publishes-updated-code-medical-ethics-contemporary-medicine. Accessed November 15, 2018.
• Aristotle. Politics . 1295a36.
• "Ethic." Merriam-Webster.com. Merriam-Webster, 2018. https://www.merriam-webster.com/dictionary/ethic. Accessed November 15, 2018.
• Kraut R. Aristotle's Ethics. The Stanford Encyclopedia of Philosophy , 2018 edition. Zalta E. (ed.), https://plato.stanford.edu/archives/sum2018/entries/aristotle-ethics/. Accessed November 15, 2018.
• Thomas Aquinas. Summa Theologiae . Part II-II, question 64, article 7.
• OCEBM Levels of Evidence Working Group*. “The Oxford Levels of Evidence 2”. Oxford Centre for Evidence-Based Medicine. https://www.cebm.net/index.aspx?o=5653. Accessed November 15, 2018.
• Thomas Hobbes. Leviathan . Part 2, chapters 17-31.
• Hutchins R. The great conversation: the substance of a liberal education. Encyclopædia Britannica. Chicago, IL; 1955.
• Roe v Wade, 410 U.S. 113 (1973).
• Aristotle. Nicomachean Ethics. I. III 1094b.
• David Hume. A Treatise on Human Nature. Book 3, part 1, section 1.
• Immanuel Kant. Groundwork of the Metaphysics of Morals . 4:428-9.
• Jonsen A. A Short History of Medical Ethics.  Oxford, England: Oxford University Press; 1999. ProQuest Ebook Central. Accessed November 15, 2018.
• Beauchamp T, Childress J. Principles of Medical Ethics . New York, NY: Oxford University Press; 1979.
• Gert B, Culver C, Clouser KD. Bioethics: A Return to Fundamentals . New York, NY: Oxford University Press; 1997.
• Jonsen A, Siegler M, Winslade W. Clinical Ethics . New York, NY: MacMillain; 1982.
• American Medical Association. Code of Ethics of the American Medical Association . Philadelphia, PA: Collins and Collins; 1848.
• American Medical Association. Principles of Medical Ethics. Appendix F. 1957:355–257. In: Baker RB ed. The American Medical Ethics Revolution . Baltimore, MD: Johns Hopkins University Press; 1999.
• Gert B. Common Morality . New York, NY: Oxford University Press; 2004.
• Hooker W. Physician and Patient . New York, NY: Baker and Scribner; 1847: 219.
• David Hume. An Enquiry Concerning the Principles of Morals. Section 4, part 1 .
• Adam Smith. Wealth of Nations . Book 1, chapter 2.
• Nickels W, McHugh J, McHugh S. Understanding Business , 11th Edition. New York, NY: McGraw-Hill; 2015.
• McElhaney K. Just Good Business: The Strategic Guide to Aligning Corporate Responsibility and Brand . Oakland, CA. Berrett-Koehler Publishers; 2008.
• Gert B. Bioethics: A Systematic Approach , 2nd Edition. Oxford University Press; 2006.
• Morenz S.  Egyptian Religion . Ithaca, NY: Cornell University Press; 1973.
• Bell J. Introduction to the Code of Medical Ethics. In: Baker RB, Porter R, Porter R. (eds.), The Codification of Medical Morality, vol. 2. London, England: Kluwer Academic Publishers; 1995: 65-72.
• Wood G. Editorial [letter]. Transactions of the AMA (9); 1856: 61.
• Cox D, Jones RP.  America’s Changing Religious Identity, 2016 American Values Atlas . Public Religion Research Institute; 9 June 2017.
• Kaye J, Amiri B Melling L, Dalven J. Health Care Denied . American Civil Liberties Union; 2016.
• Nietzsche F. On the Genealogy of Morality: A Polemic . Leipzig, Germany: CG Naumann; 1887.
• Aristotle. Nicomachean Ethics . VI. I 1138b18–34.
• Beauchamp T. The Principle of Beneficence in Applied Ethics. The Stanford Encyclopedia of Philosophy , 2013 edition. Zalta E. (ed.), https://plato.stanford.edu/entries/principle-beneficence/. Accessed November 15, 2018.
• American Medical Association. Code of Medical Ethics. Chicago, IL: American Medical Association; 1980. 
• American Medical Association. AMA Code of Ethics . Chicago, IL: American Medical Association; 1997.
• Bipartisan Patient Protection Act. S.1052 (2002) .
• Enhancing Healthcare Team Outcomes

Familiarity with ethical principles is necessary to practice medicine safely. Given the lack of definitive ethical standards and premises, clinical teams often still face great challenges in achieving satisfactory solutions to ethical challenges for themselves, their patients, and other parties involved. Working together as an interprofessional team to provide the best patient care in an ethical manner will result in the best outcomes. [Level 5]

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Disclosure: Michael Young declares no relevant financial relationships with ineligible companies.

Disclosure: Angela Wagner declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Young M, Wagner A. Medical Ethics. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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