Bioethics Notes (Term 1)

Session 1
The major elements of discovery are: Interrogatory, Deposition and Document request

Common law emanates from judicial decisions. It is a set of principles that have evolved from the decisions of past court
cases and continue to evolve and expand from the judicial decisions that arise from the new court cases.
Administrative law flows from the rules and regulations and decisions of administrative agencies.
Statutory law arises from legislative bodies

Fiduciary relationship in which one party places special trust, confidence and reliance in and influenced by another wha
has a fiduciary duty to act for the benefit of the other party.

The four essential characteristics of a profession include:

– Competence in specialized body of knowledge and skill
– Provision of particular service to society
– Standards of education and practice
– Self-regulation

Stare decisis means “let the decision stand.” Courts use the principles developed in earlier similar cases and past
decisions to inform and decide current decisions.

Discovery often the longest part of the lawsuit and, in many instances ends the case when information discovered is
detrimental to one side. It is also a fact finding phase meant to eliminate surprises, clarify what the lawsuit is all about
and make the parties decide if they should settle or drop claims and/ or defenses.

Plaintiff is the one who brings a case against another in a court of law. Defendant is a person against whom an action is
brought.

Deposition is one of the major elements of Discovery; it is the opportunity for each side to question witnesses and
parties to a suit to elicit information about the case.

Session 2

Carol Gilligan believes that Kohlberg’s research for value development is gender biased. Gilligan describes
a separate value development pathway in her research where she describes values for each sex—―personal
responsibility ―for females and‖ legalistic equality‖ for males.

Abraham Maslow was an American psychologist who was best known for creating Maslow’s Hierarchy of
Needs, a theory of psychological health predicated on fulfilling innate human needs in priority, culminating in
self-actualization.

Pre conventional fall under ages 3-7 under Kohlberg’s theory of moral reasoning and one of their characteristics is
egotism which means they are self-centered and they just want to satisfy their own desire, they also think that they
are superior to others.

Cusp is the point at which two parts of a curve meet. In generational theory, individuals who fall into the overlap
between two generations are born in time between eras and are influenced by both eras.

Great Depression and World War 2 were trying times, when fiscal and personal survival required that all participate,
all work together, and all do their duty. As a result, they are conservative and serious with an ethic of hard work
and are comfortable with rules, order, and social structures.

The foremost theorist of value development is Kohlberg and Piaget. According to their models individuals can be seen
to grow through several stages of ever- increasing complex, value orientation from infant to adult.

Kohlberg’s orientation of stages:

Preconventional-3-7 years of age; Punishment/Obedience, Egotism
Conventional- 7-12 years of age; Respect rules, Please others
Postconventional- 12 and above; Social contract, Personal conscience

Generation Z are known to be techno savvy multitaskers because they grew up with advanced technologies like
computers, cellphones etc., they are master of multitasking; they can text, talk, read and eat at the same time
which amazes previous generation. They have adopted and mastered advances in technology faster than any
previous group. As a result of their techno savvy, some have suggested generation names such as iGeneration,
Gen Tech, Net Gen and Digitarians.

Value Cohorts are constructs from generational theory, which holds that generations occupy a 20-year span of
time during which individuals in their youth are value programmed as a group by historical events.

Morris Massey is known for his phrase ―who you are is where you were when‖ is his popular generational theory
during 1970-1980, in this theory it holds that the historical time period in which an individual is born shapes the
development of their world view.

Session 3
Unethical Acts according to most culture together and to include torture and slavery.

Slavery is a formed of human bondage; exhausting someone in labor

Nihilism is a philosophy that there are no moral truths, no moral rules, no moral knowledge or responsibilities. For those
that hold this position, nothing can truly be wrong or right in moral sense. For moral nihilist, morality, like religion is a
mere illusion

Private law deals with the relationship between citizen to citizen or that is concerned with the definition, regulation and
enforcement of rights in cases where both parties involved are private citizen.

Standpoint theory holds that in ethical decision making one should always try to take into account or listen to the
standpoint of the most marginalized and vulnerable persons involved.

Misdemeanor is a crime punishable by less than a year in a jail or house of correction. Examples of common
misdemeanor are the theft of small amount of money, disorderly conduct or breaking into an automobile. Felony is far
more serious breach of law and is punishable by death or imprisonment in a state or federal penitentiary and these
include kidnapping and rape.
Public Law deals with relationships between private parties and the government; concerned with the state in its political
or sovereign capacity. It consists constitutional, administrative, criminal and international law while Private law consist
of tort and contract law.

World view is system of thoughts, feelings, opinions, and beliefs with which we screen events occurring around us. It is
thesubjective screen, based on our culture and life experiences that we judge the rightness and wrongness of actions as
theypertain to what a person should do in a given situation.

Sexism is a prejudice or discrimination based on a person’s sex or gender but it primarily affects women and girls. It is
linked to gender roles and may include the belief that in sex or gender is intrinsically superior to another.

Ethical relativism is the theory hold morality is relative to the norms of one’s culture. Whether action is right or wrong
depends on moral norms of the society.

Session 4
Utilitarianism is the most common form of consequence-oriented reasoning, to a utilitarian good resides in the
promotion of happiness or the greatest net increase of pleasure over pain.

Utilitarianism is the most common form of consequence-oriented reasoning, to a utilitarian good resides in the
promotion of happiness or the greatest net increase of pleasure over pain.

Rule utilitarianism seeks to avoid the hedonic calculus of act of utilitarianism in which each option must by measured by
the principle of utility. Rule utilitarianism holds that action can be right if it conforms to a rule that has been previously
validated by the principle of utility.

Bentham and Mill are considered the fathers of utilitarianism, which is the most common form of consequence oriented
reasoning.

Kant based his moral philosophy on the crucial fact that we are rational beings, and a central feature of this rationality
was that principles derived from reason are universal.

Golden rule is not a part of categorical imperative; this is the famous rule that states “Don’t do unto others what others
don’t want to do unto you.”

Duty oriented ethicists feel the basic rightness and wrongness of act depends on its intrinsic nature rather than on the
situation or the consequences. This position is often called deontological theory, taken the Greek word for duty.

Categorical imperative is an action could be known to be right when ii was in accordance with rule that satisfied a
principle and this is a part of duty oriented reasoning.

In the classic work of Kant “Groundwork of the Metaphysic of Morals” he held that consequences of action were
essentially irrelevant.
The above mention was the admonition of J.M Barrie and it is wise to follow this admonition when you are trying to
come to mutual understanding regarding value agreements.

Session 5
Aristotle’s traits of virtuous character :
Choice must proceed from a firm character
Virtue is a disposition to choose the mean
Virtuous acts must be chosen for their own sakes.

Libel is known as written defamation, harming others reputation

Virtue ethics is primarily about personal character and moral habit development rather than a particular action.

One of the elements of a torte is the existence of a legal duty owing from defendant to plaintiff not from plaintiff
to defendant

Negligence is charge when something just happens, when there is no intent, when the outcome is unexpected, but
injury occurs.

Respondeat superior means let the master answer. Liability assessment against employer for negligent act
committed by their employees during the course of their work.

Libel and slander are part of the defamation of character, invasion of privacy, false imprisonment, assault and battery.

One of the forms of negligence is malfeasance it’s the execution of an unlawful or improper act. E.g. In healthcare,
malfeasance occurs when people are injured or die because of poor treatment or negligent care. Also known as medical
malpractice.

In divine theory a divine being sets down finite rule, example is the rules known as the Ten Commandments taken from
Judeo- Christian traditions. It includes key moral prohibitions common to most culture, as well as some specific rules set
down to exact adherence of a particular religion.

Session 6
Golden Rule across Religion:
Islam-No one of you is a believer until he desires for his brother that which he desires for himself.
Judaism- What is hateful to you, do not to your fellow man.
Buddhism- Hurt not others which you would find hurtful.
Brahmanism- Do naught unto others which would cause you pain if done to you.
Confucianism- Do not unto others that which you would not have them unto you.
Taoism- Regard your neighbor’s gain as your gain, and your neighbor’s loss as your own loss.
Christianity- All things whatsoever ye would that men should do to you, do ye even to them.
Non maleficence means ought not to inflict evil or harm to one person

Veracity is being truthful. This binds health practitioner and the patient. The patient must tell the truth so that
appropriate care can be provided. The practitioner needs to disclose information so that the patient can exercise
personal autonomy.

All patient has their right to privacy, we cannot disclose their information to the public as part of ethical principle of
confidentiality. With this important aspect the patient places his or her trust to the health care professional.

We you make use of a placebo you are engaging yourself in a nondisclosure and deception for your practice of work
even if it is for therapeutic purposes, you are still deceiving the patient or lying to the patient which makes it a conflict
with one of the universal principle which is veracity.

Role fidelity is to do your role within your scope of practice. E.g. Role of nurse is to provide competent care to patients
and to do in a way that is honest, responsible and fair.

It is commonly held view that rights imply correlative obligations. That is, if someone has a right to x, then someone else
(some person, group of people, institutions, etc.) bears some obligation, or duty with respect to that right. Sorting out
the nature of obligations implied by rights, however, turns out to be a contentious matter.

Perhaps a more useful contractarian model for the development of justified claims for individual rights is the moralized
initial situation as described by John Rawls. Rawls offers a kinder and gentler arrangement the context for the social
contract and envisions an initial situation known as the original position.

Natural rights were generally equated to the law of God and found their most succinct expressions in forms such as the
Golden Rule.

Thomas Hobbes is known for his Hobbesian model, For Hobbes, nature did not teach lessons to innate human rights, but
rather that human nature itself created the need for something with sufficient power to crush individual will and bring
about acceptable behavior of chaos.

Session 7

List of negative legal rights that have been afforded by the sanction of law.
- Equal opportunity in employment
- Freedom of Religion
- Right to bear arms
- Right to personal property
- No taxation without representation
- Right to an abortion

Positive rights or also known as welfare rights is about provision of goods and services.
Only legal persons can receive legal rights. The characteristics commonly attributed to a legal person include that.
- Person can be injured
- Person can be thought to have interest
- Person can be benefitted

Legal Rights are clearly, rights which exist under the rules of legal systems or by virtue of decisions suitably authoritative
bodies within them. Legal rights are created through constitutional guarantees, legislative statutes, judicial review and
government agencies.

Positive rights examples (US based)

Indigent right to health care
Licensed driver’s right to use of public roads
Right to a public education
American veterans right to health care
Citizen of Ballwin, Michigan, to garbage collection

Session 8
Invading of patient’s privacy will result in breach of confidentiality. It can create distrust between patient and
practitioner.

Misappropriation usually deals with the unpermitted use of other person’s identity or name for another’s benefit.

Intrusion is the act of intruding or act of wrongfully entering upon, seizing, or talking possession of the property of
another.

Presenting someone in a false light to the public usually involves the publication of information that leads to the
public regarding the plaintiff falsely. An example would be the use of a stock photo of a surgical team in an article about
Medicare fraud. The intent was to show a generic picture of practitioners: however, the implication of associating
them with the article would place them in a false light.

Utilization review is the use of managed care techniques such as prior authorization that allow payers, particular health
insurance companies to manage cost of health care benefits by assessing its appropriateness before it is provided using
evidence-based criteria

Patient’s information and this record is considered confidential and it should be limited to patient, authorized
representatives of the patient. The attending physician and hospital staff members who have a legitimate interest.

In medical records mistake should not be erased or unreadable. If you enter an incorrect word all you need to do is draw
single line, enter correction, error initiated and dated.

One of the minimum standards of IRB is to safeguard to protect the patient’s privacy will be part of the research
protocol. Confidentiality must be maintained.