100 cases in clinical ethics and law free download

100 cases in clinical ethics and law free download

London: Triangle, , p. It is society which handicaps me, far more seriously and completely than the fact I have spina bifida. Yousef and Maria, a couple in their mid-thirties, have a son aged 4 years and a daughter aged 2 years. It is characterized by profound anaemia and failure to thrive. Their son requires regular medication and blood transfusions every 3—4 weeks. In the long term, however, stem cell treatment represents his only hope of a cure. This treatment usually involves a bone marrow transplant from a tissue-matched donor but could also take the form of a stem cell transplant from the umbilical cord blood of a tissue-matched baby.

At present, there is no suitable donor for their son. His sister is only a 50 per cent tissue match and although Yousef and Maria are keen to have more children, there is. They are very excited about this and would like to. As an F2 doctor completing your general practice rotation at their local. In pre-implantation tissue typing, embryos that have been created in vitro are tested for the appropriate histocompatibility antigens before implantation.

Three recent cases merit par- ticular attention. The HFEA granted a licence for pre-implantation tissue typing to be. The House of Lords said that tissue typing was a practice which. Mrs Hashmi could regard an embryo as unsuitable. Although similar to the Hashmi case, there was one crucial. Pre-implantation testing of the embryo would therefore confer no direct. HFEA granted a licence to the Fletchers. The embryo being selected need not be at. In the absence of PGD to exclude serious genetic disease, tissue typing confers no immedi-.

Concerns have been raised about the long-term. Others argue that in creating a child for a specific purpose,. In contrast, others suggest that the child would derive psychological benefit from helping. Supporters of the technique argue that the new child would enjoy the same legal.

Others point out that children are conceived for a whole range of reasons e. Tilly and her husband come to see you, their GP, to ask for advice on fertility treatment.

She is 30 years old and has had five miscarriages. She does not have any problems con- ceiving but is unable to carry a pregnancy to term. Recent tests have diagnosed her with antiphospholipid syndrome — a condition which causes her blood to clot and disrupt the supply of blood to the placenta. Tilly and her husband are still desperate to have their own children.

She is 34 years old, married and has three children of her own and her husband has recently had a vasectomy as they felt their family was complete. She also wants to know who. Surrogacy is the practice by which a woman becomes pregnant with the intention of handing the baby to the commissioning couple after birth. Surrogacy can involve either implanting an embryo into another woman so that the child will be completely genetically related to the commissioning parents or artificially inseminating a woman so that the child is genetically related to the father but not to the commissioning mother.

The Act is unusual in that although it is not unlawful to enter into a surrogacy arrangement, it does not make it easy for surrogacy to occur. It is illegal to advertise for a surrogate mother and the birth.

Any surrogate contracts drawn up between the commis-. Therefore the surrogate can-. By law the birth mother is the legal mother of the child and her name will go on the birth. If the birth mother is married, her husband will be named as the father unless. If this happens, or if the birth mother. The Warnock Report and later the Brazier Report looked at the ethical. Carrying a child for another person can be seen as an act of. There is no evidence that any potential child would be harmed by being.

Parallels here can be drawn with chil-. The arguments against surrogacy are principally about the indignity of having a market. It is said to be an affront to the dignity of a woman and her marital. The virtue of carrying a baby for another woman is outweighed by any.

It also has the potential to take advan-. Relatives may also feel coerced into surrogacy by being unable to say no to a request. Some people feel that surrogacy can never be truly altruistic. A year-old lawyer, Charlotte, is happily married and has a good income. She has just discovered she is pregnant. She does want children at some point but has also just been nominated for promotion at work. She knows she would not get the promotion if she told her boss she was pregnant.

She decides that, at this time in her life, the promotion is more important to her than having this baby. She goes to see her general practitioner GP a few weeks later, having finally decided that she would like to have an abortion. She asks the GP about whether she has a right to an abortion.

To prevent the high levels of mortality and morbidity associated with illegal abortions the Abortion Act was introduced to provide limited defences to the criminal offences under the OAP. The Abortion Act was amended in and currently sets out four grounds for termination. Abortion is lawful only if it fulfils the criteria of the Abortion Act. The grounds for abortion. The most commonly used ground is that the pregnancy has not exceeded 24 weeks and.

There is no restriction based on the viability of the fetus and although most abortions take. There have. The second ground is that the termination is necessary to prevent grave permanent injury. This could include the situation. The third ground allows termination where the continuation of the pregnancy would involve. Approximately 1 per cent of all abortions in England and Wales are. There are two issues here — the likelihood of risk and the.

There will be some situations where antenatal tests show that the baby. However, when a positive diagnosis is not possible then the. London: RCOG,, paragraph 3. The RCOG has recommended that the follow- ing issues are considered: the availability of treatment for the condition, extent to which the disability will limit communication with others, the extent of possible physical pain and suffering and the extent to which that person would be reliant on others.

In Reverend Jepson, who herself had been born with a congenital jaw defect cor- rected by surgery , discovered that in Birmingham an abortion had been carried out at 28 weeks on a fetus with a cleft palate. She argued that terminations after 24 weeks should only be carried out for extremely serious conditions and therefore the doctors who author- ized the termination for fetal abnormality under the fourth ground were not justified in doing so.

Following an investigation by the Crown Prosecution Service, the doctors were. Rights of the father. The father-to-be has no right to insist that a woman continue with the pregnancy. This was clarified in the case of Paton v. Trustees of British Pregnancy Advisory Service Mr Paton tried to prevent his wife from having an abortion using both his right as a potential father and the right to life of the unborn child as justification.

He failed on both accounts. The only way in which a potential father could prevent a woman from under- going an abortion would be to argue that the abortion would be illegal and would not comply with the Abortion Act. Usually the two doctors signing the form would be the GP and a consultant gynaecolo-. It is not a legal requirement for the doctor performing the abortion to sign the form. All abortions must be notified and recorded. The information required includes the gesta-. If a fetus is being aborted on the grounds that it is at risk.

This recognizes a. When she. However, she was undecided at first and the conversation she had. Her husband, family and friends were all delighted. Charlotte has received antenatal care. Despite coun-. When a woman wants to terminate a pregnancy her reproductive autonomy is in direct conflict with the interests of the fetus. However, there are various ways in which abortion can be defended morally.

However, according to this definition, patients in a persistent vege-. A contrasting view is that an embryo is a human being with full moral status, and there-.

Rights are acquired by virtue of being human, and there-. This accords. The potentiality argument states that although an embryo is not yet a person it should. John Harris. So at what point of development would a fetus gain a right to life — conception, the. If such a right is acquired from conception. Even if fetuses are accorded full moral rights from conception then does this justify harm to.

A year-old lawyer, Charlotte, is 18 weeks pregnant. Despite counselling, Charlotte is now sure that she wants to terminate the pregnancy. She goes to see her GP to request a termination. However, the GP is a practising Roman Catholic with a strong faith, and she does not wish to participate in abortion services.

The onus is on the person claiming to rely on conscientious objection to prove it, on religious or ethical grounds. As there is no statutory definition of conscientious objection there may be practical difficulties in interpreting these grounds. Conscientious objection applies only to participation in treatment. The exemption does not extend to giving advice, performing the preparatory steps to arrange an abortion where the.

Doctors relying on the. Royal College of Midwives, Conscientious Objection ,. Position Paper No London: RCM, April Medical students can use the conscientious objection provisions to opt out of witnessing. London: BMA, In any event conscientious objection does not apply to necessary treatment in an emer-. Healthcare practitioners are obliged to.

In this. Other health professionals in the area may also object because the preg-. Other situations. The Human Fertilisation and Embryology Act provides conscientious objection to those participating in assisted conception.

Objecting to the treatment of lesbians or single women would not come within the exception. Those who conscientiously object to par- ticipating in withdrawing life-sustaining medical treatment should, where possible, be allowed to hand over the care of the patient to a colleague BMA, Withholding and Withdrawing Life-Prolonging Medical Treatment.

Josephine was 8 weeks pregnant when her 3-year-old daughter was covered with red spots and diagnosed as having German measles.

Josephine told her general practitioner GP that she would want a termination rather than risk giving birth to a disabled child. She had two blood tests but the results were contradictory. The GP did not check with the lab- oratory nor did he run new tests. Instead he reassured her that all was well. In fact, Josephine gave birth to a boy who was blind, deaf and severely brain damaged. James and Anna are planning to have children.

They inform their GP that a nephew of. James has a severe chromosomal abnormality and is profoundly disabled. They ask. However, the GP does not take a family history nor. She is now 2 years old and cannot walk, talk or recognize her parents. There are many ethical arguments that support the moral right of a fetus to be born.

But it could be argued that a damaged fetus has a right not to be born. If so, what is the threshold at which it could be said that it is better for a child never to have existed, because of the extent of their disabilities? Wrongful birth. This is a claim made by the parents of the child. It is alleged that a negligent act or omission, e. Had the mother received adequate and accurate medical information she would have had the choice to avoid the harm by requesting a termination although the woman is not obliged to have a termination even if she were properly informed.

Such actions are recognized in many. An award would be made for the costs. The healthcare professional acted negligently in failing. Wrongful life. The child claims it has been wronged by being born and should be compensated. The case of McKay v. Essex Area Health Authority. In the above two scenarios, failure to carry out genetic tests that were reasonably indicated.

However, the disabled child. To what extent is an unborn child entitled to protection? A woman cannot be sued for. She had severe respiratory fail- ure requiring ventilation for the first 3 months of her life, and now she has pulmonary hypertension resulting from the damage to her lungs.

She also has recurrent urinary tract infections and her renal function is worsening. She has not left hospital since her birth and 2 months ago she was transferred to the paediatric intensive care unit with a severe infection.

Since that time her respiratory and neurological functioning have profoundly and persistently deteriorated. Rebecca is now 8 months old and although her weight is increasing it is not matched by growth in head circumference which is indicative of brain damage and limited potential brain growth. She does not respond to stimulation although she does experience pain and distress and it is considered that she will be able to experi- ence pain of future treatment.

She will have minimal cognitive function and she is very. Justice Fair, equitable and appropriate decision-making. Distributive justice refers to considerations of fairness in the allocation of scarce resources. Narrative ethics Ethical issues explored through the values, experiences and perspectives of those involved. National Institute for Health and Clinical Excellence NICE NICE provides national guidance on the promotion of good health and the prevention and treatment of ill health and on new and existing medicines and treatments.

Negligence Conduct that falls below the standard reasonably expected in the circumstances. Damages can be awarded in compensation for harm caused. Parental responsibility The duties and rights which parents have in respect of their children. For example, turning off an artificial ventilator. Quality-adjusted life year QALY A measure of calculating the cost effectiveness of treatment, combining the quality and quantity of life achieved through a medical intervention.

Quality of life The value of life assessed by reference to certain attributes including mental and physical ablities, rather than its length. Sanctity of life All life has intrinsic value irrespective of the features or quality of a particular life. Saviour sibling A child created in order to treat brothers and sisters with genetic disorders. Suicide An act performed by an individual with the knowledge and intention that the action taken will result in their death.

Surrogacy An arrangement under which a woman carries a baby on behalf of another. Therapeutic privilege Deliberate withholding of information about risks of treatment in order to prevent harm to the patient. Utilitarianism A consequentialist moral theory which provides that the right course of action is that which promotes the greatest happiness for the greatest number.

Virtue ethics A moral theory which provides that an action is morally right if it is what a virtuous agent would do in those circumstances. She is extremely intelligent and having gained a first in history at Oxford University she is now halfway through her PhD. It is at times when her life is most stressful that she struggles with her anorexia.

The first time she was admitted to hospital was when she was She was being badly bullied at school and had stopped eating to try to become thin to prevent being teased about being overweight. Being able to lose so much weight gave her the sense that she had some control over at least one aspect of her life.

Ophelia has spent the past 14 years in and out of hospital. On two occasions she had to be admitted to intensive care as she had lost consciousness.

During these admissions she was fed by a nasogastric tube. She also has a history of obsessive-compulsive disorder and has been receiving cognitive behavioural therapy. A year ago she had managed to stabilize her weight at 50 kg — she is 1. With the stress of her PhD and the breakdown of her relationship with her boyfriend, when you initially see Ophelia, she weighs less than 35 kg.

Although you want to feed her by nasogastric tube to prevent her needing a third admission to intensive care, she adamantly refuses to have this. She tells you that she does not want to die, but nor does she want to be force fed. She is extremely frail and needs constant supervision by a healthcare assistant. Due to a shortage of beds on the psychiatric ward Ophelia is currently being nursed on a general ward. The older women in her bay are complaining about the amount of personal attention she is receiving, as when they need assistance to change position or to go to the bathroom there is often a long wait due to staff shortages.

Medical students are often taught this theory to demonstrate how to approach and solve medical dilemmas. The first step is to analyse how each principle may be relevant to the situation, i. The principles are non-hierarchical although respect for autonomy has gained in importance in the era of patient-centred care. Respect for autonomy requires that the decision-making capacities of the individual are acknowledged. A person may not be fully autonomous in all situations but increasingly the views of those with limited autonomy are being recognized and respected.

Just because a patient lacks capacity to make a particular decision does not mean that a doctor should override their wishes. When a patient voices an opinion, every effort should be made to respect that decision, unless it is contrary to their best interests. The moral obligation of beneficence is not owed to everyone in general.

However, there is a moral obligation for healthcare professionals to benefit their patients. In contrast, the prima facie obligation of non-maleficence is a general requirement to avoid causing harm. Most medical treatment incurs an element of potential harm. However, the risk of harm may be justified by balancing it against the anticipated benefits. The principle of justice often takes a back seat to the other principles.

It is used in ethical arguments to ensure that there is fair allocation of services and treatment within society. At an individual level, it is used to promote equality among patients from all walks of life, irrespective of nationality, culture or religion.

When there is conflict between the principles then a choice must be made to prioritize one over another. In the scenario, the doctor can only impose treatment on Ophelia if there is evidence that she lacks autonomy.

Anorexia nervosa is a complex illness. Affected individuals feel that they do not have control over their life and so use refusal of food to demonstrate that there is some aspect of their life that they can control. But does this mean that Ophelia lacks autonomy? It may be in her best interests to force feed her if she is at a critically low weight to avoid irreparable harm and restore her autonomy for future decision making. However, restraint and force feeding may destroy any trust she has built with her doctors.

The principles of beneficence and non-maleficence should be balanced to produce the outcome with overall net benefit. It could be claimed that the special nursing that Ophelia is receiving is an unfair allocation of limited health resources.

Her son had the triple measles, mumps, rubella MMR vaccination just over a year ago after Pippa had been reassured that it was extremely safe and would protect her son against dangerous childhood illnesses. Unfortunately he had a bad reaction to the injection, with a high temperature, a rash around the injection site and a fit. Although he seems fine now Pippa is worried that having a fit is an indication that he will become autistic or develop bowel problems.

She has read the contradictory evidence about the risks of the triple MMR vaccine in newspapers and recognizes that the evidence suggesting a link between MMR and autism has now been disproved. However, she is still concerned about having her daughter immunized against MMR, in case the same thing happens to her. The inherent wrongness or rightness of an act is not considered.

One example of consequentialist theory is utilitarianism, which was first proposed by Jeremy Bentham in the late eighteenth century and further established by John Stuart Mill in the nineteenth century. Utilitarianism is the most influential consequentialist theory. The principle of utility provides that the morally correct course of action is that which promotes the greatest happiness of the greatest number. So the right thing to do is determined by the action that will result in the greatest overall happiness.

Intuitively this seems an attractive and simple theory. But it does require impartiality since the theory does not allow room for the promotion of individual interests, nor do the interests of family and friends take priority in deciding the morally correct thing to do.

The consequences of an action must be considered across time. There is no preference for happiness now, and the consequences for both the present and future generations should be taken into account. The net happiness must be calculated taking into account any unhappiness that a course of action will cause. The theory not only considers the consequences of actions but also the consequences of failures to act. It is a hugely demanding theory because it requires us to constantly analyse the potential outcomes of everything that we do or do not do and thus allows insufficient moral breathing space.

Consequentialism can be considered to conflict with the demands of justice. Plucking a healthy person off the street and using his body parts to save the lives of six people who need organ transplants may produce the greatest happiness. But does this mean that we can do disagreeable things if the consequences are good enough? The theory is so obsessed with ends that it overlooks the importance of means, in contrast with deontological theory.

The main problem with consequentialism is that it is difficult to apply to real-life scenarios because accurately predicting the possible consequences of an action is impossible. In this case scenario there are several possible outcomes of Pippa having her daughter immunized against MMR. In theory, she may suffer immediate short-term harm fever but gain long-term benefits disease resistance. Although it is not possible to predict whether this child will benefit from vaccination there is scientific evidence to suggest that childhood vaccination schemes offer overall benefit to society.

This will protect future generations from the side-effects of disease and subsequently increase happiness. The future benefit of immunization outweighs the unhappiness caused by any potential side-effects to this child and other children receiving the vaccination.

His friend Carlos has had human immunodeficiency virus HIV infection for many years. He is now in the terminal stages of the disease and is in constant pain and suffering.

Carlos and Patrick have been friends for a long time and Patrick has always said that he would be there to support Carlos. Carlos now asks him to travel with him to Dignitas in Switzerland so that he can be assisted to end his life. Patrick wants to be there for his friend. Personally he does not have any ethical quandaries about whether he should prevent Carlos from making a decision to seek assistance to end his own life. However, he is worried that he now has professional responsibilities and duties, which would be compromised by travelling to Switzerland with Carlos.

Some acts are intrinsically wrong irrespective of the good consequences that may follow, for example torture, lying, murder. This may seem particularly harsh as it does not take into account either the consequences of an action or the emotions and needs of an individual. Would it be ethically justifiable for the police to shoot one terrorist to prevent him blowing up a train full of people?

Deontological theory can be criticized because it does not provide a definitive list of duties, nor does it state what should be done where two duties conflict. People can act freely so long as they do not violate moral constraints. In comparison consequentialist theory could be said to be far more demanding as it constantly requires an assessment of consequences. Deontological constraints are usually negatively formulated, e. What is outside these boundaries is not forbidden; it could be argued that withholding the truth is morally acceptable because it does not amount to lying.

It is also important to consider the nature of the constraint on action and how narrowly it is framed. For example, Kant considered that it is always wrong to deliberately end the life of an innocent human being. Therefore it does not preclude killing of animals or murderers. It is more concerned with action rather than inaction. It may be wrong to take life but what about not saving it? Does the application of deontological theory help in deciding whether it is morally permissible for Patrick to go with his friend to Dignitas?

According to the theory it is wrong to deliberately end the life of an innocent human being. If Carlos is injected with a lethal dose of barbiturates then the person doing this would breach the moral imperative, but what if Carlos is supplied with the drug to self-inject?

Patrick is not acting to kill his friend, he is merely enabling such an act to take place. A universalizable law may forbid assisting a suicide. She has had multiple courses of chemotherapy and a bone marrow transplant which have all failed. She is constantly in hospital and as such has had a disrupted education and little opportunity to make lasting friendships. She and her parents have accepted that further treatment is unlikely to be beneficial, and she wishes to return home to die in peace.

Her doctors are unwilling to accept her decision as she is only Scenario 2 Tasha, a year-old girl, was born with a congenital heart defect that was repaired at birth. She now needs a heart transplant to enable her to live an active life. The prognosis of recovery after the heart transplant is good. Her parents are prepared to accept whatever decision she makes as they believe she will have to live with the consequences.

Aristotle believed that to be virtuous is to be able to rationally analyse a specific characteristic virtue and then act on the decision, which would ultimately result in human flourishing.

Virtue theory does not comment on which particular virtues are important. The application of which virtues to consider in specific situations is highly subjective. This is both a strength and a weakness of the virtue ethics theory. Can virtue theory be used to assess whether Sara and Tasha should be allowed to refuse potentially life-saving treatment? The virtuous doctor should have a good knowledge of both the facts of the cases and the emotions of the patients. She should also consider her own emotional response and then reflect on which virtues should be applied in order to attempt to reach a moral conclusion.

Benevolence, compassion and discernment are three virtues which could be applied to the two scenarios. When applied to medicine, benevolence means to act in a way which best serves the interests of the patient. Sara is suffering and has little prospect of recovery. It is in her best interests to value the time she has left. Tasha, however, has a good chance of leading a normal life. It would not be in her best interests to die. She would perhaps understand that Tasha does not want to die but that she has fears surrounding the operation and the consequences of having a transplant.

These issues should be discussed with the patient to enable her to cope with her fear. Virtue theory does not give definitive answers to moral dilemmas, but it can help guide decision making after careful analysis.

It enables individuals to reflect on the dilemma in question and come up with workable solutions. He is wandering around and crying out. The nurses have tried persuading him to stay by his bed or at least in his bay, but he is refusing to listen to them. One female patient has become upset because he keeps going to stand at the end of her bed and stares at her. The nurses are worried that as well as upsetting other patients, Micky is very unsteady on his feet and they fear he may fall over and injure himself.

You read his notes to try to find a cause for his confusion. You learn that Micky, 76 years old, was an elective admission yesterday for a laparoscopic cholecystectomy.

Two weeks earlier he had been admitted to accident and emergency with shortness of breath and pleuritic chest pain. He was kept in for 3 days and treated with intravenous antibiotics. There are at least two possible causes for his confusion: a recurrence of his pneumonia or other sepsis or a reaction to the general anaesthetic.

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Nursing staff are reluctant to carry out CPR on a patient in a persistent vegetative state despite her mother's insistence and the physician's orders to do so. A nurse experiences moral distress with being told to continue monitoring a year-old patient's blood work as long as she remains on blood thinners. Mary Jo is diagnosed with bladder cancer but does not wish to have surgery. After refusing surgery twice, her doctor tells her that he cannot be her doctor any longer.

This case discusses the dilemmas that occur when a patient does not heed the advice of a doctor, and what obligations do the patient and doctor have in maintaining the patient-doctor relationship. A year-old male came into the cardiac care unit with an inferior wall myocardial infarction, and shortly thereafter coded. Resuscitation attempts succeeded; however, over the course of a few days he went into multi-system failures. Jennie is a year-old woman who had suffered from hypertension, diabetes and many strokes.

She had an advance directive, which indicated that she did not desire any surgery, antibiotics, resuscitation or tube feeding. When it becomes very difficult for her to eat, requiring an aide for a couple of hours each meal, her daughter decides that it is appropriate for a feeding tube to be placed as Jennie does not have a fatal illness, just simply requires adequate nutrition.

Karen Ann Quinlan, a twenty-two-year-old who ingested a harmful mix of drugs and alcohol, suffered two fifteen-minute periods of interrupted breathing which left her in a chronic vegetative state without any cognitive functions.

When the trial court refused the order to withdraw life-support, her father, who was her guardian, appealed. An year-old non-ambulatory nursing home patient was confined to semi-fetal condition with "sever organic brain syndrome. Her physician declines, and the courts are involved. A year-old accident victim suffered lack of oxygen to her brain for six to twenty minutes. She was in a persistently comatose and vegetative state, sustained by a gastronomy feeding tube.

What should happen to this patient when she is in a state of progressive spastic quadriplegia with irreversibly contracted extremities, but doctors say she could live another thirty years. On December 14, , Helga Wanglie, 86, fell in her Minneapolis home and broke her hip. After the fracture was successfully set, she was discharged to a nursing home. On January 1, , she was readmitted due to developing respiratory failure and place on a respirator.

During the next five months repeated attempts to wean Mrs. Wanglie from the respirator were unsuccessful; she was conscious, aware of her surroundings, and could recognize her family.

John is a year-old who was recently admitted to a long-term care facility after being discharged from the hospital after a stay for pneumonia.

He is nonverbally refusing meals, and with no obvious family members to relay his wishes, staff are finding it hard to determine what the next step should be in his care. Since the s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.

A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook Principles of biomedical ethics. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application.

The four principles are: [21]. The principle of autonomy , broken down into "autos" self and "nomos rule , views the rights of an individual to self-determination.

The definition of autonomy is the ability of an individual to make a rational, uninfluenced decision. Therefore, it can be said that autonomy is a general indicator of a healthy mind and body.

The progression of many terminal diseases are characterized by loss of autonomy, in various manners and extents. For example, dementia , a chronic and progressive disease that attacks the brain can induce memory loss and cause a decrease in rational thinking, almost always results in the loss of autonomy.

Psychiatrists and clinical psychologists are often asked to evaluate a patient's capacity for making life-and-death decisions at the end of life. Persons with a psychiatric condition such as delirium or clinical depression may lack capacity to make end-of-life decisions. For these persons, a request to refuse treatment may be taken in the context of their condition. Unless there is a clear advance directive to the contrary, persons lacking mental capacity are treated according to their best interests.

This will involve an assessment involving people who know the person best to what decisions the person would have made had they not lost capacity. Psychiatrists and psychologists may be involved to support decision making. The term beneficence refers to actions that promote the well being of others.

In the medical context, this means taking actions that serve the best interests of patients and their families. James Childress and Tom Beauchamp in Principle of Biomedical Ethics identify beneficence as one of the core values of healthcare ethics. Some scholars, such as Edmund Pellegrino , argue that beneficence is the only fundamental principle of medical ethics.

They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery and euthanasia are severely unethical and against the Hippocratic Oath. The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin, primum non nocere. Many consider that should be the main or primary consideration hence primum : that it is more important not to harm your patient, than to do them good, which is part of the Hippocratic oath that doctors take.

Much harm has been done to patients as a result, as in the saying, "The treatment was a success, but the patient died. In practice, however, many treatments carry some risk of harm. In some circumstances, e. So the principle of non-maleficence is not absolute, and balances against the principle of beneficence doing good , as the effects of the two principles together often give rise to a double effect further described in next section.

Even basic actions like taking a blood sample or an injection of a drug cause harm to the patient's body. Euthanasia also goes against the principle of beneficence because the patient dies as a result of the medical treatment by the doctor.

Double effect refers to two types of consequences that may be produced by a single action, [29] and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence. A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient while simultaneously having the maleficent effect of shortening the life of the patient through the deactivation of the respiratory system.

The human rights era started with the formation of the United Nations in , which was charged with the promotion of human rights. The Universal Declaration of Human Rights was the first major document to define human rights. Medical doctors have an ethical duty to protect the human rights and human dignity of the patient so the advent of a document that defines human rights has had its effect on medical ethics. The Council of Europe promotes the rule of law and observance of human rights in Europe.

The Council of Europe adopted the European Convention on Human Rights and Biomedicine to create a uniform code of medical ethics for its 47 member-states.

The Convention applies international human rights law to medical ethics. It provides special protection of physical integrity for those who are unable to consent, which includes children.

No organ or tissue removal may be carried out on a person who does not have the capacity to consent under Article 5. As of December , the Convention had been ratified or acceded to by twenty-nine member-states of the Council of Europe. Like recommendations, they set forth universal principles to which the community of States wished to attribute the greatest possible authority and to afford the broadest possible support.

The Declaration provides special protection of human rights for incompetent persons. In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account.

Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected. Individualistic standards of autonomy and personal human rights as they relate to social justice seen in the Anglo-Saxon community, clash with and can also supplement the concept of solidarity, which stands closer to a European healthcare perspective focused on community, universal welfare, and the unselfish wish to provide healthcare equally for all.

The concept of normality, that there is a human physiological standard contrasting with conditions of illness, abnormality and pain, leads to assumptions and bias that negatively affects health care practice. Autonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in the patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners.

In general, Western medicine defers to the wishes of a mentally competent patient to make their own decisions, even in cases where the medical team believes that they are not acting in their own best interests. However, many other societies prioritize beneficence over autonomy.

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