What is ethics?

1

• What is ethics?
• What is autonomy?
• Models of the health-professional-patient
  relationship

2
What ought to be done in a given situation, all
things considered?
--Benjamin and Curtis
3
What ought to be done...

• Action oriented
• Implies personal ownership and responsibility
• Implies choice
• Implies reasonable control

4
in a given situation...

• All ethics is situation ethics
• Concrete facts matter
• What makes one situation like another situation
  in ethically relevant ways?

5
all things considered?

• There is no ethical point of view distinct from
  other (practical) points of view
• Good ethical reasoning is not a new viewpoint but
  an integration (and critical analysis) of all
  existing viewpoints
• Can we ever in practice consider all things
  finally and irrevocably? (Provisional nature of
  ethical conclusion)

6
What ought to be done in a given situation, all
things considered?
Is this the only ethical question?
7
Snapshot ethics vs. Videotape ethics
8
Snapshot vs. videotape

• What does it mean to do the right thing now?
• What does it mean to live a morally good life?

9
Snapshot vs. videotape

• What does it mean to do the right thing now?
• Rules, principles, case study
• What does it mean to live a morally good life?
• Virtue

10
(Respect for) Autonomy

• Not interfering in anothers wishes and choices
• Treat others as ends-in-themselves and not as
  means only (Kant)
• Self-determination
• Assumes adult capacities

11
Paternalism

• Refusing to acquiesce in another persons wishes
  or choices for that persons own benefit.

--Childress
12
Paternalism and Principles

• Paternalism principle of benefit/harm takes
  priority over principle of autonomy
• Other, non-benefit-based reasons to reject
  autonomy not paternalism
• Is it really paternalism if principle of
  autonomy does not apply due to lack of capacity?

13
Why paternalism and not parentalism?

• Is concept gender-specific?
• Does it derive from a gender-specific role?
• Father Knows Best (TV show, 1950s)

14
Paternalism and the history of U.S. medical ethics

• Hippocratic ethic no challenge to physician
  paternalism
• 1960s traditional authority questioned
• Veatch Contractual vs. priestly model of
  physician-patient relationship, 1972
• Veatch, generalization of expertise, 1973

15
Paternalism and the history of U.S. medical ethics

• Much of U.S. medical ethics since the 1960s
  amounts to the refutation of physician paternalism

16
Autonomy Problems to flag

• Is autonomy culturally specific?
• Is autonomy gender biased?
• Does autonomy favor some life stages over others?
• Does autonomy focus on individual in isolation
  rather than as member of family and community?

17
Models of P-patient relationship

• Veatch, 1972 Priestly vs. Contractual models
• Miller, 1981 4 senses of autonomy
• Emanuels, 1992 Paternalistic vs. Informative
  models-- and more

18
Miller, 4 senses of autonomy

• Free action
• Authenticity
• Effective deliberation
• Moral reflection

--Miller, Hastings Cen Rep 1981
19
Autonomy and Relationship
20
Emanuels Models
21
If you went to your physician for medical care,
what role would you want him or her to play, and
why? Would it matter what the medical problem
was?