Medical ethics: introduction

1. Medical ethics: introduction Janet Radcliffe Richards Professor of Practical Philosophy University of Oxford Oxford Uehiro Centre for Practical Ethics

2. Apprenticeship Clinical practice

3. Explanation Apprenticeship Clinical practice

4. Explanation Apprenticeship Current scientific beliefs Clinical practice

5. Explanation Apprenticeship Descriptions of cases Current scientific beliefs Clinical practice

10. Explanation Apprenticeship Descriptions of cases Current scientific beliefs Clinical practice

11. Enquiry Explanation Apprenticeship Descriptions of cases Current scientific beliefs Clinical practice

12. Enquiry Explanation Apprenticeship Descriptions of cases Current scientific beliefs Clinical practice

13. Enquiry Explanation Apprenticeship Descriptions of cases Current scientific beliefs Scientific reasoning and research Clinical practice

14. Enquiry Explanation Apprenticeship Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice

15. Enquiry Explanation Apprenticeship Descriptions of cases Current scientific beliefs Scientific reasoning and research Clinical practice

16. Enquiry Explanation Apprenticeship Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice

22. The elements of medical education Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice Current legal and professional standards VALUE ISSUES

23. The elements of medical education Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice Current legal and professional standards VALUE ISSUES

24. The elements of medical education Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice Current legal and professional standards Moral enquiry VALUE ISSUES

25. What is medical ethics? ‘Ethics’ has two quite different meanings: • A particular set of standards. In this sense ‘medical ethics’ is the set of standards accepted as appropriate for doctors. • Moral philosophy: an enquiry into questions about moral standards, including what standards we ought to have.

26. ‘Ethical’ is ambiguous • Sometimes it means ‘in line with accepted professional standards’ • Sometimes it means ‘morally right’

27. The elements of medical education Descriptions of cases FACTUAL ISSUES Current scientific beliefs Scientific reasoning and research Clinical practice Current legal and professional standards Moral enquiry VALUE ISSUES

28. Disagreements and difficulties can come from either source

29. The case of Dr Cox

30. How Dr Cox might have defended his action • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

31. Different ways of challenging Dr Cox • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

32. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

33. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was not right to kill her

34. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

35. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She was being put under pressure by the family • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

36. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She was being put under pressure by the family • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was not right to kill her

37. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

38. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • He could easily have controlled the pain by consulting an expert colleague • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

39. Different ways of challenging Dr Cox • She wasn’t in pain - just getting attention • She wanted to die • He could easily have controlled the pain by consulting an expert colleague • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was not right to kill her

40. Different ways of challenging Dr Cox • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

41. Different ways of challenging Dr Cox • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • Killing people or helping them to die is always wrong ------------- So it was right to kill her

42. Different ways of challenging Dr Cox • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • Killing people or helping them to die is always wrong ------------- So it wasnotright to kill her

43. The values determine which facts are even relevant

44. How Dr Cox might have defended his action • Mrs B was in terrible pain • She wanted to die • No available medication could have controlled the pain • People who are in uncontrollable pain and want to die should be helped to do so ------------- So it was right to kill her

45. The advance of science and technology increases the significance of value issues in practical reasoning.

46. Recent and current controversies • Conjoined twins • Time limit for abortion • Sustaining patients in PVS • Fertility matters • Organ donors and the dying process

48. The ‘best interests’ principle When a patient is not competent to consent to treatment, the doctor must act in the patient’s best interests

49. Treatment in the non-competent patient’s best interests • Length of life? • Absence of pain? • Mental abilities/ level of awareness? • Physical abilities? • Appearance to relatives and friends? • Patient’s former character and wishes? Which elements matter at all? e.g:

50. Treatment in the non-competent patient’s best interests