ON THE ETHICS OF HUMAN FLOURISHING: CAN AN OLD IDEA INFORM THE NEW MODEL OF HEALTHCARE? (PART 1)

1. ON THE ETHICS OF HUMAN FLOURISHING: CAN AN OLD IDEA INFORM THENEW MODEL OF HEALTHCARE? (PART 1) Brendan Leier PhD Clinical Ethicist UAH/Stollery Assistant Professor JDHEC

2. Case Mrs. Bright is 68yr old woman who has suffered a serious stoke and has been recovering on a stroke unit for six weeks. She is non-attentive and non alert in a minimally conscious state and is currently fed via peg tube. The direction of her care is discussed with her husband and two children. Her prognosis is for her condition to remain relatively the same. The family is presented with the option to either continue to treat Mrs. Bright and find her a long-term care placement, or to provide Mrs. Bright with compassionate care only. Mrs. Bright’s husband cannot bring himself to “give up” on his wife and opts for placement. The children do not seem to agree with their fathers decision, but support it. Mrs. Bright is placed into long-term care.

3. Traditional Principled Approach • Respect for Patient Autonomy • Beneficence • Non-Maleficence • Justice

4. A natural conflict? • Tension between “quality of life” and notions of “intrinsic value”, i.e. dignity, etc.

5. A natural conflict? • Tension between “quality of life” and notions of “intrinsic value”, i.e. dignity, etc. • In these cases, autonomy tends to be the “trump”, but what role does it really play.

6. Autonomy and eudaemonia • The principle of autonomy is a mechanism meant to insure that individuals have a right to express their own understanding of eudaemonia or the good life.

7. Two questions of Ethics • New Question: What makes right actions right? • Old Question: What is the good life?

8. The Greek Philosophical World-View in One Slide… • The Greek World-View as well as the Medical World-View are teleological.

9. The Greek Philosophical World-View in One Slide… • The Greek World-View as well as the Medical World-View are teleological. • Telos=goal, end, purpose.

10. The Greek Philosophical World-View in One Slide… • The Greek World-View as well as the Medical World-View are teleological. • Telos=goal, end, purpose. • “Goodness” is hence teleological and is related to the extent to which a thing fulfills its purpose or end.

11. The Greek Philosophical World-View in One Slide… • The Greek World-View as well as the Medical World-View are teleological. • Telos=goal, end, purpose. • “Goodness” is hence teleological and is related to the extent to which a thing fulfills its purpose or end. • To have a purpose is to also have the capacity to fulfill that purpose.

12. Capacity and Flourishing • Human beings are unique in that we have innumerable capacities.

13. Capacity and Flourishing • Human beings are unique in that we have innumerable capacities. • This begs that question: which of our capacities require fulfillment in order for us to realize a good life?

14. Assumptions of an ethic of human flourishing… • Assumption #1 Human life is meaningful with respect to its capacity to flourish. A good life is a life in which we flourish. • Assumption #2 Goodness, value, and quality are forms of flourishing in the form of fulfilling capacities. • Assumption #3 When we cease to flourish, and such capacities cannot be restored, the role of medicine has ceased.

15. What does an Ethic of Flourishing Entail? • That we understand treatment and care as purposeful, goal-based, behaviour. No form of care is appropriate “in and of itself”. • That the eudaemonistic question dwelling at the heart of care and can only be informed through dialogue. • That the “goodness” or “appropriateness” of treatment is relative to outcomes or goals.

16. Part 2 • Flourishing and the will • The flourishing model and end of life care, mental health, and risk. • Possible problems for an Ethics of Flourishing. Thanks! Brendan bleier@ualberta.ca