So what do you think about when you
think about ethics or morality?
Are those terms that
come easy to you?
When I think about ethics, I think it's things
that we learned all the way back in kindergarten.
How to be a good person?
How to be kind?
How to be fair? How to
treat people nicely?
You know core things that all of us
should have learned along the way.
But now we're going to take those general
principles and apply those to medicine.
How to take care of patients, patients who
are sick, who are ill and need our help.
We have to take those
general concepts of ethics
and now apply it to
the person before us.
So what is ethics?
It's a branch of moral philosophy which
systematically investigates human actions.
So when we're thinking about
human beings performing actions,
we can consider them
actors or moral agents.
They have the agency, the ability to
choose how to perform their actions,
how they're going to conduct
themselves in the world.
And we can think about those
actions in terms of good or bad,
right or wrong, what should
or should not be done.
And when we're thinking about ethical
inquiry, we can think about it at three levels.
There is first of all
the descriptive level.
So what is actually being done?
How are people behaving?
What are their actions?
What do they believe?
Those are the descriptive
levels of ethics.
There is the normative level of inquiry.
So what ought to be done.
What are the justifications
for an action?
Are there cultural norms that might speak to
how to be normatively, ethically correct?
And then lastly there
is the analytic.
So, this is what philosophers
might think about.
Not in terms of as an action
good or bad, or right or wrong.
But what are the actual
terms, the concepts?
What do they mean? What does
it mean to be good or right?
Now, I want to point out that
we're generally a medicine
thinking about descriptive and
normative levels of inquiry.
And there's something called
the is-ought phenomenon.
You might say that this is how
things are being done in the world,
but that does not necessarily imply
that that's how it ought to be done.
So there may be a different level
of understanding of what it means
to be normatively
There are various ways
to think about actions
of especially human actions,
how we evaluate those.
First level is going
to be the motivation.
So, the actor or the moral agent.
What motivates them to act?
You might think of, you know,
clinicians being motivated
out of compassion to help the
patient who is suffering.
You then might go to the
level of the intentions.
What is the intent
of the action?
What are you trying to
achieve through the action?
If it's a thief coming
upon you and stabbing you,
their intention is to cause harm, you know
to injure you so they can take your money.
Whereas the surgeon who
is taking their scalpel
and doing an incision in the abdomen
for patient with appendicitis,
their intention is a healing act to
try to take care of the appendicitis.
Next level of inquiry for evaluating actions
is going to be the character of the agent.
Is this is a good person?
You know, are there traits or character traits
that we think about for that moral agent
when we assess their
actions in the world.
Next, we might think
about "Are there rules?
Are there cultural norms by which
we should perform actions?
Is it following the rules when
we're performing these actions?"
The next level of inquiry
might be the action itself.
Are there core principles that
everyone should pay attention to?
And we'll get to those in future
lectures about respect or justice.
Are those sort of core element features that
we then have to apply to specific actions?
Or are there values that are important to
people in how they perform their actions?
And then lastly, we might think about
the consequence of the action.
What's the end result? Is it a
good result or a bad result?
A term called consequentialist and that
we'll get into in future lectures.
All of those ways are going to
be ways to think about actions.
And they're all important when
we're trying to assess, again,
for the clinician in how they're
performing these actions.
So now, let's apply those general principle
about what ethics is to medical ethics.
So this is an interdisciplinary field, which
is studying morality in the medical context.
And it's going to be primarily concerned
with what should be done with patient care?
How do we take care of patients?
And are we upholding certain
ethical principles in doing that?
At its core feature, medical
ethics is practical.
At the end of the day, you
have to make a decision,
you have to perform an
action to help that patient.
So you're going to take those
core ethical principles,
apply those to the delivery
of care by the clinician.
That is what medical
ethics is all about.
It maybe that there's a critical evaluation
of the assumptions or the arguments
for which you're basing your
medical decisions or your actions.
So, there's also going to be, you know,
an opportunity to step back and say
"Was that a good action or right
action in helping this patient?"
And then lastly, there may be
situations that create conflict
or are very challenging in the
delivery of care to patients.
And so you need a systematic approach
in how to recognize those situations,
but also how to address them because
again it's going to be practical.
At the end of the day, you're going to
have to do something for that patient.
The way I think about ethics, especially medical
ethics, is medicine has an internal morality.
It starts with the idea that a patient
who comes to us seeking help is ill.
They're vulnerable. They
have an existential crisis.
You know, their
health is affected.
They don't know what's going to
happen in the future to them.
That vulnerability, that factive illness cause upon
them to then seek care from someone they can trust.
When a clinician says, you know, for each
individual patient, "How can I help you?"
Or at the beginning of our profession, it
may be throughout our professional careers,
we profess, we say "You know,
I'm here to help other people."
So I'm applying this to the physician, but this also
applies to nurses that have their code of ethics.
This idea of profession that I'm here to help you is
the second step in this internal morality of medicine.
And then lastly, you know, when
you enter into this relationship,
the vulnerable patient where the person
who is saying they are here to help you,
that healing act is going to be accomplished for
me as a physician in taking care of a patient,
for a nurse same way
taking care of a patient,
that relationship creates this internal morality
that then is going to serve the patient's interest.
For medicine, specifically
I think about it as a Greek
term called tekne iatrike.
So, tekne meaning technical. So
this is a technical discipline.
You know, we have the skills, knowledge
that we have developed thru medical school,
thru our training that we get this confidence to
practice the science and the art of medicine.
Iatreke, you may be familiar
with the term iatrogenic.
So that involving, you know, the study of medicine or the
practice of physicians with diagnosing and treating patients.
And then the important part is that medicine
is neither solely an art or solely a science.
It is a combination
of both things.
There is an inextricable link
between both science and art.
Think of it as a craftsman, a
master craftsman building a house.
Now, anybody can take a hammer or nail, and
you know hammer that nail into a wall.
But a craftsman, you know,
creates a work of art.
So they have both the technical
discipline, they've learned their craft.
But there's also an art to it, that experience
that then comes with building something.
The same way in medicine. We take our skills,
we take our knowledge, and then we apply it
and over time with our experience with other patients
how to take care of this patient in front of us.
So, it's a moral enterprise combining
both scientific reasoning with judgment.
You need to have the judgment about how to take care of this
particular patient in this clinical experience right now.
And the ultimate goal is a right and good
healing action for a particular patient.
So we're going to think about ethics
in a variety of different ways.
We're going to have different
approaches to ethics.
First of all, virtue theory. Looking
at the character of the moral agent,
you know the clinician and the virtues that
they should espouse in taking care of patients.
We're going to think
So, applying those general principles
now to the medical context.
And there are going to be some core principles
that we need to think about in that regard.
Next, the ethic of care. So, this
is thinking about relationships.
I talked about the
So now, we're going to think about "What
are the contexts of a relationship
that are important in determining how we should
behave and how we should act towards the patient?"
And then lastly, casuistry. So this is case-based
reasoning where we're thinking about previous cases,
how did you solve the dilemma that
might have happened in that case
and now applying it to this
new case in front of us?
Are there any general rules that we should
follow in terms of that case-based reasoning?