Christian Medical Ethics

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Christian Medical Ethics

• A basic exploration
• of fundamental concepts
• and a problem solving process

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Common approaches to medical ethics

• Virtue ethics (Existential)
• Good What a good person would do
• Look at motives and behaviour
• Consequence ethics (Teleological/ Utilitarian)
• Good Aiming at good goal / consequences
• Look at facts and consequences
• Duty ethics (Deontological)
• Good What the law says
• Look at laws, protocols, standards, creeds, norms

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What is Christian medical ethics?

• Theological basis Matthew 22 37-39
• Application How love our neighbour in
  healthcare?
• As a science Reverent,
• systematic,
• analytical and
• critical thinking about
• how medical professionals ought to behave.
• We consider virtues, consequences and duties in
  loving God and our neighbour

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Ethics problem solving flow-chart
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Case study Specialist in sex scandal

• Busy, 35yr, communication problems with his wife
• He flirts/touches just a game also with
  ?colleague
• Shares with her during breaks, she is good
  listener, gives sound advice ? platonic
  friendship ?romance
• Together at research conference
• Sudden animal-like hunger in lift ? he kisses her
  xxx!
• Colleague enters on next floor uncomfortable
  silence
• Later, ? colleague I love you you should marry
  me
• No? Then I accuse you of sexual harassment I
  will ruin your career!
• She files complaint via her friend on ethics
  committee for unprofessional behaviour and
  harassment

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In the groups

• Appoint persons in following roles
• One person specialist
• One person ?colleague
• One person colleague who saw them in lift
• Rest ethics committee members of clinic
• Define the problem
• Develop possible courses of action
• Determine preferred course of action

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1. Define moral problem

• What are the facts of the situation medical,
  nursing, legal, economic, social, organisational?
• Who is involved?
• What does each party think about the situation?
• What are their responsibilities in the situation?
• What interests do they have in the situation?
• What are the underlying world view perspectives?
• Is there a moral dilemma? If so, which? More than
  one dilemma?
• What is the scope of the problem? (Micro, meso,
  macro?)
• State the problem as a specific question

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2. Develop possible courses of action

• Which courses of action could be taken?
  (including those you would not agree with)
• What virtues / consequences / duties are relevant
  in each of the possible courses of action?
• Which virtues / consequences / duties are in
  danger of being neglected in each of the possible
  courses of action?
• What would each possible course of action mean
  for each of the key persons involved?
• If different underlying opinions / preferences /
  world view issues are evident, specify.

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2.1 Virtues A Christian perspective

• Seven Medical Virtues
• Compassion
• Mercy
• Professionalism
• Integrity
• Collegiality
• Justice
• Prudence

• Seven Virtues
• Faith
• Hope
• Love
• Fortitude
• Temperance
• Justice
• Prudence

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2.2 Consequences A Christian perspective

• Purpose promote health interests of patient
• What will consequences be for
• Ethical, religious, legal, economical, social and
  technical aspects? (? also aesthetic, linguistic
  and cultural aspects)
• Preventive, curative, palliative terminal care?
• Health and well-being of involved parties?
• Consider these rules regarding consequences
• Proportionality (benefit / burden analysis)
• Subsidiarity (least drastic / burdensome /
  expensive)
• Consider the scope of the consequences
• Micro (personal), meso (institutional) and macro
  (whole field)
• Short term, long term, eternal

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2.3 Duties A Christian perspective

• Christian duties
• Pro-shalom not kill on purpose
• Marriage as safe circle for intercourse,
  conception and raising children
• Respect responsibility and freedom of choice of
  patient
• Repair of disease as safe circle for genetic
  manipulation
• Respect property of another
• Respect created sexual identity
• The Law What does the Bible say?
• Ten / two commandments
• Law suited to humans
• Love is fulfilment of the law

• Medical Duties
• Care
• Respect for life
• Beneficence (do good)
• Non-maleficence (no harm)
• Justice
• Confidentiality
• Trustworthiness
• Informed consent
• Hippocratic Oath
• Medical ethical codes
• Protocols, standards
• Professional responsibilities position
  description

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3. Determine preferred course of action

• Dialogue with relevant parties regarding possible
  courses of action discuss virtues / consequences
  and duties of each possibility
• Use feedback to improve quality of problem
  solving
• Develop criteria for evaluating the possible
  courses of action what is acceptable / exemplary
  / unacceptable
• Which criteria will count the most?
• Build convincing argumentation for your choice
  refer to virtues, consequences and duties as well
  as the criteria for evaluating the courses of
  action
• Seek to reach consensus about the preferred
  course of action. Use negotiation / mediation if
  required
• What protocol to follow if no consensus is
  reached?

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4. Deploy planned course of action

• Plan Make a good plan re course of action
• Consider implications on care plans, treatment
  protocols, institutional plans and procedures
• Who does what by when?
• Who is responsible for supervision of which part
  of the planned course of action?
• How will the implementation of the planned course
  of action be evaluated?
• What will consequences be of the evaluation?
• Do Implement the plan

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5. Deployment evaluated and appropriately handled

• Check Evaluate the course of action as indicated
  in the plan
• Act Use information from evaluation to take
  appropriate steps towards a better future together

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What happened in the sex scandal?(Two
incidents combined into one)

• Ethics committee
• noted unprofessional behaviour specialist
  warning given
• considerate of sudden urge, not premeditated
• Specialist
• marriage counselling together with wife
• stopped unprofessional behaviour
• Female colleague
• No legal action (warning by ethics committee
  apology and changed behaviour of specialist
  appeased her)
• one year further studies overseas (which she was
  always wanting to do, but just did not get so
  far)
• found a better job elsewhere afterward