Ethics and the Family Medicine Resident

From the beginning of life to the end and everything in between

Ethics and the Family

Medicine Resident

•Brief History of Bioethics as a field

•Framework for Ethics

•Tools and Processes for Decision

Making

•Review of topics in Bioethics

•Case examples

•Small Group Exercise

Frameworks for Ethics

Principle Based Framework for

Ethical Decision Making

Beauchamp & Childress:

Autonomy

Beneficence

Non-maleficence

Justice

Frameworks for Ethics

Values & Virtues Based Framework for Ethical Decision Making

Nel Noddings: Ethics of caring

John Rawls: Veil of ignorance

Martha Nussbaum: Capabilities approach

Reciprocity

Religious Directives for decision making are often based on the values held highest within that community

Frameworks for Ethics

Cultural and Religious Norms

Social Contracts, Laws

Professional Codes of Ethic

Religious Traditions & Scriptures

Personal experiences

Framework for Ethics

Causistry

Case – based approach to ethical decision making

Most common way for Hospital ethics committees to

work through cases and consultations

Potter‟s Boxes

Facts Values

Principles Loyalties

Framework for Ethics Deontology

Duties

Ex: Immanuel Kant‟s Categorical Imperative

Teleology

Consequences

Ex: John Stuart Mill, “Greatest Good for the Greatest Number”- Utilitarianism

Both: Worth of persons

Stanford Encyclopedia of Philosophy plato.stanford.edu

• Categorical Imperative

• Utilitarianism

• Worth of Persons

• Traditions

• Beliefs

• Experiences

• Social Contracts & Laws

• Reciprocity

• Honesty

• Integrity

• Worth of persons

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

Principles Values

Teleology vs.

Deontology

Cultural and

Religious

Cases

Principles Values

Teleology vs.

Deontology

Cultural and

Religious

Decision

Making

Topics Consent

Capacity

Disclosure

Voluntariness/Autonomy

Truth Telling

Confidentiality

Surrogate decision making

Genetics

Research & IRBs

Institutional Ethics

Conflicts of Interest in

education and in patient care

Just distribution of scarce

resources

Infectious disease ethics

Transplantation ethics

Differences in Cultural

Norms

Topics Before birth

Personhood

Contraception

Donation and storing of Eggs and sperm

Care of Embryos

Mother vs. Fetus

Assisted reproduction

Population issues

Genetic Screening and Counseling

Prenatal Screening

Sex Selection

Cloning

Eugenics

End of Life

Advanced Directives

Futility

Brain Death vs. Cardiac Death

Organ Donation

Physician Assisted Death

Palliative Sedation

Withodingvs.Withdrawaling

Artificial Hydration and Nutrition

Ventilation

Surrogate Decision making

Every Age In-between

Allocation of Scarce Resources

Money/Insurance

Access to care

Urban vs. Rural

Organ Transplantation

Infectious Disease –HIV & STIs

Elective Procedures

Psychiatric Care

Opioid Prescribing

Research & trials

Informed consent

Blood transfusions

Famous Landmark Cases

Baby M- anencephaly

Helga Wanglie- When families disagree

Terri Shiavo, Nancy Cruzan- Withdrawling vs.

Witholding Life Support: Artificial Nutrition and

Hydration & Ventilator

Tuskeegee Syphillis Study

Local Cases

Mr. K

21 yo near drowning in 2009, with brain damage and recurrent sepsis. Mr. K was an exchange student from Ghana, planning to study and play soccer at Whitworth

Mr. C

Conscientious objection of Medtronic technologist to turn off dual ICD and Pacer in a gentleman who has chosen to allow natural death

Ms. N

Bipolar clinic patient in active mania who refuses to go to SMH for Psychiatric evaluation. Due to her insurance, this is currently her only option for Psychiatric care.

Things we encounter in FMS Daily

In the Clinic

Opioid prescribing

Care of the Difficult patient

Reproductive topics:

Contraception- daily OCPs and emergency contraception

IUDs, Tubals, Vasectomies

Discussing Advanced Directives & POLST forms

What to Do When Families Disagree

In the hospital:

Withholding and Withdrawaling life support

The Role of Conscience in Medical Decisions

Daniel Sulmasy, OFM, MD, PhD

University of Chicago

Does conscience ever clash with professional duties? What do we

mean by terms such as „conscience‟ and „conscientious objection‟?

How should one approach a request from a patient that conflicts with

one‟s individual conscience? Exploring how medical professionals can

strive to preserve their moral integrity while also respecting and

serving patients with whom they might have deep moral

disagreements.