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Groups and individuals
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
In medical ethics, there is a strong norm of non-maleficence—more colloquially, “do no harm” (Beauchamp and Childress 2001). Interpreting this norm is tricky; for example, it is clear that it is permissible for a surgeon to cut the patient with a scalpel, “harming” her, as part of the operation of removing the tumor. However, one thing the principle does seem to imply is a strong default norm against harming some patients for the sake of helping other patients (John and Wu, 2022). Consider a standard case in introductions to medical ethics, where we could kill one person and redistribute her organs to save five lives. Even if cutting up friendless loners who wander too close to hospitals would do more “good” than “harm” overall, doing so would be wrong. Cancer screening or mass vaccination seems structurally similar to the organ redistribution case, as they involve knowingly harming some to help others, apparently violating this non-maleficence concern. How, then, might they be justified?
Evidence-Based Medicine and Resource Allocation
Published in Rui Nunes, Healthcare as a Universal Human Right, 2022
Nevertheless, in the global environment of resource allocation, EBM’s usage to restrict apparently useful clinical treatments, on the grounds of both a lack of scientific evidence and a distributive justice requirement, can be a useful tool to facilitate the access of all citizens to a reasonable level of healthcare and to promote the system’s efficiency (Taylor 1998). Moreover, from a medical ethics perspective, it may be in accordance with the long-standing tradition of beneficence in clinical practice. In fact, there is a clear distinction between resource allocation and a saving money policy. EBM implementation may even increase healthcare expenditure, but scarce resources will be then allocated more fairly to treatments of proven benefit (Figure 5.1).
A Fatal Attraction to Normalizing
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
In positing justice as the regulatory ideal of health care, macro-(bio)medical ethics initially proposed a deductive model on which principles of justice would inform our picking out and prioritizing those medical interventions that further equality. Interventions that qualify as treatments because they aim effectively at restoring normal function were, on this model, to take precedence in the allocation of resources. As we have seen, however, endorsing maintenance or restoration of normal functioning as the standard for allocation can itself, all too readily, prolong disadvantage. Macro-(bio) medical ethics must therefore overcome its fatal attraction to normalizing in order to open itself to other strategies for advancing justice.
Teaching compassion for social accountability: A parallaxic investigation
Published in Medical Teacher, 2023
Hoi F. Cheu, Pauline Sameshima, Roger Strasser, Amy R. Clithero-Eridon, Brian Ross, Erin Cameron, Robyn Preston, Jill Allison, Connie Hu
By convention, compassion is one of the defining characteristics of a good physician. The first principle of medical ethics in the American Medical Association’s Code of Medical Ethics states that ‘A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights’ (American Medical Association 2016, 2022). The Canadian Medical Association puts compassion on top of its list of ‘virtues exemplified by the ethical physician’ (Canadian Medical Association 2018). The Medical Board of Australia’s revised code indicates that physicians should ‘display qualities such as integrity, truthfulness, dependability and compassion’ (Medical Board of Australia 2020). While compassion is a conventional ethical virtue, social accountability (SA) appears as a newer idea that emerged around the latter part of the twentieth century, reinforced by numerous defining documents. They include the Edinburgh Declaration (World Federation for Medical Education (World Federation for Medical Education (WFME) 2021) 1988), the 2010 Global Consensus on Social Accountability (published in Boelen 2011), and the Tunis Declaration at the World Summit on Social Accountability (Network-Towards Unity for Health (TUFH) 2017). It is also now a Canadian Medical School accreditation standard (CACMS 2019) with a global movement toward being embedded in other health professional schools worldwide.
“It is very difficult in this business if you want to have a good conscience”: pharmaceutical governance and on-the-ground ethical labour in Ghana
Published in Global Bioethics, 2022
Kate Hampshire, Simon Mariwah, Daniel Amoako-Sakyi, Heather Hamill
In LMICs, such decisions and associated trade-offs may come into play at far lower thresholds, as governments struggle to provide even basic essential medicines for their populations. Pisani (2019) has recently suggested that pressures to meet Universal Health Coverage targets could result in a lowering of drug quality, as governments seek to source cheap medicines, driving down effective quality assurance. In a recent discussion piece, Ravinetto et al. (2018, p. 83) asked “whether it could ever be ethically justified to compromise on the quality assurance of medicines depending on what individuals, communities, or societies can afford”. This is an uncomfortable question because it poses a direct challenge to the four widely-accepted and supposedly “universal” principles of medical ethics (Beauchamp & Childress, 2013): respect for autonomy, beneficence (doing good), non-maleficence (avoiding harm), and justice. As such, it raises the deeply problematic possibility that we should accept “different [ethical] standards for the advantaged and the disadvantaged”, as Farmer and Gastineau (2004, p. 246) put it.
The Hippocratic Oath across the interfaith spectrum
Published in Baylor University Medical Center Proceedings, 2022
Many graduating medical students or professionals take the contemporary Hippocratic Oath, which states their intentions to conduct medicine justly and ethically. The Hippocratic Oath is ceremonial and optional, similar to the oath made by a judge, president, or other politician when sworn into office. Nonetheless, many institutions see it as a rite of passage for physicians. Though this most famous treatise in Western medicine is credited to the Greek physician Hippocrates of Kos, the most well-known doctor of his day, the true author is uncertain, and there may have been many writers.1 The substance of the Hippocratic Oath has been altered and its authorship questioned in contemporary times, particularly throughout the 20th century. At the same time, the major world religions—Baha’i, Buddhism, Christianity, Confucianism, Hinduism, Islam, Jainism, Judaism, Shinto, Sikhism, Taoism, and Zoroastrianism—have versions of the Hippocratic Oath to emphasize the importance of beneficence, nonmaleficence, autonomy, and justice, which are essential components of modern medical ethics outlined in the Hippocratic Oath. By investigating these alternative versions, similarities between different faiths emerge.