Introduction to Medical Ethics youtube / watch ?v=yiZt79UKUFQ

1. Ethics, too, are nothing but reverence for life. This is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life is evil. Albert Schweitzer 2012 Marek Vácha Introduction to Medical Ethicshttp://www.youtube.com/watch?v=yiZt79UKUFQ

2. Gyges´ ring Plato in The Republic has one of his characters ask us to engage in a though experiment. He tells the story of Gyges´ring, whose effect was to make its wearer invisible. What would prevent the possessor of the ring from commiting any crime he felt like committing? He could never be caught. Would we not all be tempted, if we had such a ring, to do whatever our heart desired, knowing we would not, could not, be found out?

3. Tottenham, august 2011 • there are two ways how to createorder: • by use of power • by use of self-restraint • when only police or armystandbetweenorder nad riots, freedom itself is at risk

4. Science x Ethics • science investigates what is • ethics investigates what ought to be

5. Science • The composition of mammalian blood is plasma 55% and cellular elements 45 % • leukocytes are: basophils, eosinophyls, neutrophils, lymphocytes, monocytes • IgE antibodies are produced in response to initial exposure to an alergen bind to receptors an mast cells • blood glucose level is about 90mg/100ml

6. Ethics • when, if ever, is possible to take a gift or gratuity from a patient? • Is it permissible to lie to a patient if it is for his or her good? • what obligations do I have to a colleague and fellow practitioner when I suspect that the colleague I am working with is abusing alcohol or appears chemically impaired while on duty?

7. Ethics • …and what about the Bodies exhibition? • Is this show ethically neutral? • …or good? • …or bad?

8. "Friendlyembryos" http://www.cuni.cz/IFORUM-9834.html

10. There are more complicated questions... • Is there any sort of pursuit of knowledge that might be forbidden? • is there a category of a "forbiddenknowledge"? • Is there any sort of research that should not be publiclyfunded? • Is there any sort of genetic knowledge that it might be better not to know? • Is any basic research ethicallymandatory in some way? • http://www.youtube.com/watch?v=HkW0C-NyNtQ

11. There are more complicated questions... should the use of cloning by somatic cell nuclear transfer (the technique used to produceDolly) be allowed in order to help as infertilecouple have a child? should the entire UK population and all visitors to Britain be compelled to provide DNA samples as a means of enabling the police to detect the perpetrators of criminalacts? (Mepham, B., (2008) Bioethics. An Introduction for the Biosciences. 2nd ed- Oxford University Press, Oxford. p. 3)

12. There are more complicated questions... • Is it possible to say that • future benefits justify the present practices? • future abuses do not disqualify present uses?

13. There are more complicated questions... Is a goal of the medicine painless, suffering-free and, finally, immortal existence?

14. Science and ethics

15. Science x Ethics • Methodological Naturalism: • what natural world contains • how it arrived at its current state • laws that regulate its behavior • Ontological Naturalism: • nothing else exists

16. Science and Philosophy Philosophy Science

17. The aim of the medicine: to elongate the life of the patient

18. „the art of living“ the ethics according to Aristote the lenght of life biological medicine The aim of the medicine: to elongate the life of the patient, „a horizontal“ of his/her life The aim of the moral philosophy: to give a meaningfulness of the life of the patient, „a vertical“ of his/her life

19. Ethics and Morality • Ethics is primarily a matter of knowing • Morality is a matter of doing • morality is what people believe to be right and good • ethics is the critical reflections about morality and the rational analysis of it.

20. Good ethics start with good facts! • Defining the problem • Descriptive – defining what is going on, description of who the patient is, who the family is, what is their moral world; what the options are in terms of diagnosis, therapy, prognosis, goals, what can be done, weighting the risks and benefits. • Normative – ethics arises from valueconflict – concerns itself with the „should“ questions

21. Descriptive Ethics and Normative Ethics • Descriptive Ethics • What do people think is right? • philosophical schools, religions etc. • Normative Ethics • identification of values • what behavior is good and why • supported by arguments • what should I do and why?

22. Whereas descriptive ethics attempts to describe and explain those moral views that in fact are accepted, normative ethics attempts to establish which moral views are justifiable and thus ought to be accepted.

23. Normative Ethics • Normative ethics is the attempt to determine what moral standards should be followed so that human behaviour and conduct may be morally right. • Normative ethics is concerned with establishing standards for conduct and is commonly associated with theories about how one ought to live.

24. The position of the teacher • the teacher is not in „God-like position“ • the teacher is not • a harbinger of an ultimate truth • a opinion-maker • the teacher doesn´t say „how things are“ • his/her task is more complicated • to tell to the students what is known about the problem • and then he/she try to moderate the discussion

25. The Scandal of Philososphy • We have movedforward in medicineduring the past 2 000 years • we now know much better the human body than Hippocratesknew • ..but have we moveforward in philosophy? • is our contemporaryphilosophybetter than the philosophy of Aristote? • maybe not! • the philosophymight be somewhere between art and science

26. The Problems of teachingPhilosophy • the notions are generally not so clear as in science • there is no such thing like „hard data“ • different people could have differentopinions • „there is only one science but many philosophies“ • everyone has his/her own philosophy • a philosophy is joint to the person of the philosopher and his/her epoch • …but is it true?

27. What is the difference between a postmodernist and a member of the Mafia? The Mafia makes you an offer you can´t refuse. A posmodernist makes you an offer you can´t understand.

28. Ethicalrelativism „Well..... well.... we will think about it.“

29. Ethicalrelativism • there is no goodness or badness • there is no rightness or wrongness • ....there are only opinions • Dostojevskij: if God does not exists, all is permitted.

30. Why to start with Philosophy? • In the history of the human spirit I distinguishbetweenepochs of habitation and epochs of homelessness. In the former, man lives in the world as in the house, as in a home. In the latter, man lives in the world as in an open field and at times does not even have fourpegs with which to set up a tent. • In the formerepochsanthropologicalthoughtexist only as a part of cosmologicalthought. In the latter, anthropologicalthoughtgainsdepth and with it, independence. • (Martin Buber: Between Man and Man)

31. A Problem of Personhood…what does it mean to be a human?

32. E.O. Wilson • the organism is only DNA´s way of making more DNA • the hypothalamus and limbic system are engineered to perpetuate DNA • these centers flood our consciousnessn with all the emotions – hate, love, guilt, fear, and others – that are consulted by ethical philosophers who wish to intuit the standards of good and evil • (Wilson, E.O., (2000) Sociobiology. The New Synthesis. Twenty-Fifth Anniversary Edition. The Belknap Press of Harward University Press. Cambridge, Massachusetts, and London, England. p. 3)

33. E.O. Wilson • The hypothalamic-limbic complex of a highly social species, such as man, „knows“, or more precisly it has been programmed to perform as if it knows, that its underlying genes will be proliferated maximally only if it orchestrates behavioral responses that bring into play an efficient mixture of personal survival, reproduction, and altruism • (Wilson, E.O., (2000) Sociobiology. The New Synthesis. Twenty-Fifth Anniversary Edition. The Belknap Press of Harward University Press. Cambridge, Massachusetts, and London, England. p. 4)

34. Common Morality • is a product of human experience and history and is a universaly shared product • is found in all cultures • is not relative to cultures and individuals, because it transcends both • (Beauchamp, T.L., Childress, J.F., (2009) Principles of Biomedical Ethics. 6th ed. Oxford University Press, New York, Oxford, p. 4)

35. Herodotus (5th century BC): DuringDarius´s reign, he invited some Greeks who were present to a conference, and ask them how much money it would take for them to be prepared to eat the corpses of their fathers; they replied that they would not do that for anyamount of money. Next, Dariussummoned some members of the Indian tribeknown as Callatiae, who eat their parents, and asked them in the presence of the Greeks, with an interpreterpresent so that they could understand what was being said, how much money it would take for them to be willing to cremate their fathers´ corpses; they cried out in horror and told him not to say such appallingthings. So these practises have become enshrined as customs just as they are, and I thinkPindar was right to have said in his poem that custom is king of all. • (Blackburn, S., (2001) Ethics. A Very Short Introduction. Oxford University Press, Oxford, p. 18)

36. animals? women nationalities (nazism) colour of skin (American Civil War) people in the same geographical locality tribe family

37. The UniversalDeclaration of Human Rights • Article 7 • All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

40. (Nash, R.F., (1989) The Rights of Nature. A History of Environmental Ethics. The University of Wisconsin Press, Madison, London. p. 5)

41. What does it mean to be a human person…?

42. What is a person…? • human eggs? • embryos or fetuses? • newborns? • the brain dead? • nonhuman animals? • cybrids? • enemies in war • different races • women and children

43. A Theory Based on • biological species • cognitive capacity • moral agency • sentience • communal relationship

44. A Theory based on CognitiveProperties • a person has to have : • self-consciousness • freedom to act and capacity to engage in purposeful actions • ability to give and to appreciate reasons for acting • capacity to communicate with other persons using a language • rationality and higher order volition

45. A Theory Based on Sentience • person = a being capable of feeling pain a pleasure • having the capacity of sentience is a sufficient condition of moral status • pain is an evil, pleasure a good • to cause pain to any entity is to harm it • even if you were not cognitively capable, morally capable, or biologically human, pain and suffering would be real to you

46. A Theory Based on Sentience • in this theory a fetus does have moral status at some point after several weeks of development, and thus abortions at that point would be prima facie impermissible • this point is prior to the stage of development at which some legal abortions now occur.

47. A Theory Based on Sentiencecritique • anyindividuallacking the capacity for sentiencelacks moral status • this theory disallows moral status for early-stagedfetuses as well as for all who have irreversiblylost the capacity for sentience, such as patients with severe brain damage • the degree of moral status and the level of moral protection can vary according to conditions such as the quality, richness, or complexity of life • as loss of capacityoccurs, humans (and nonhumans) will have a decreased moral status • In this way, the most vulnerable beings can become the most vulnerable to abuse and exploitation. No theory is morally acceptable that yields this conditions

48. A Theory Based on Moral Agency • a person… • is capable of making moral judgments about the rightness or wrongness of actions • has the motives that can be judged morally • = capacity for moral agency gives an individual moral respect and dignity

49. A Theory Based on Relationships • relationshipsbetweenpartiesaccount for moral status • the less the degree to which the fetus can be said to be part of a social matrix, the weaker the argument for regarding her/him as having the same moral status as persons • oncefetuses are detected in utero by stethoscope or sonogram, they become in significantrespects part of a social matrix

50. A Theory Based on Relationshipscritique • is it true, that only socialbonds and attitudesalonedetermine moral status? • the differentdegrees of moral status, such as moral agents having a higher degree of status than individualslacking such agency • no matter how much we love a favorite plant or institution, neither the plant nor the institution gains status by virtue of this relationship