semmelweis university 2 0 1 2 / 2 0 1 3
semmelweis university 2 0 1 2 / 2 0 1 3 semmelweis university 2 0 1 2 / 2 0 1 3
MEDICAL ETHICS (BIOETHICS) Institute of Behavioral Sciences Tutor: Prof. Dr. József Kovács Code: AOMAGOET_1A Course Syllabus (28 hours) SEMMELWEIS UNIVERSITY / FACULTY OF MEDICINE Course objectives: a.) To enable students to recognize ethical issues when encountered in everyday clinical practice and research b.) To provide students with a conceptual-logical system, which helps them to address ethical questions and to resolve ethical dilemmas in an efficient way c.) To introduce students to a body of knowledge, which helps them to understand, respect and protect the rights of patients research subjects and fellow health care professionals d.) To help the would be health care professional to understand the responsibility of the individual, of the health care system and of the society as a whole in maintaining health Lectures 1. week Basic concepts of ethics. Descriptive ethics, normative ethics, metaethics. General ethics and applied ethics. Bioethics, medical ethics, health care ethics. Similarities and differences. The role of bioethics in a pluralistic society. The relationship between law and ethics. Reasoning in ethics. The most common mistakes. 2. week Normative theories of ethics. Deontological theories of ethics. (The Golden Rule, Kant and the categorical imperative, the principle of double effect, W.D. Ross and the prima facie duties,) Teleological theories of ethics. (Act and rule utilitarianism.) Theories of natural law. Contractarian theories of ethics. (The theory of justice of John Rawls) 3. week The basic principles of medical ethics. The principle of respect for autonomy. The principle of non-maleficience. The principle of beneficience. The principle of justice. Arguments against „principalism”. 4. week The concept of health and disease. Naturalistic definitions of health. The medical model of defining health. Normativist definitions of health. Some questions of psychiatric ethics. Faculty of Medicine 159
160 SEMMELWEIS UNIVERSITY / FACULTY OF MEDICINE 5. week Informed consent. Simple consent and paternalism in medicine. The emergence of the doctrine of informed consent. Standards for information disclosure for patients. When is informed consent not necessary? Standards of competence and incompetence. The right to refuse medical treatment. Some psychological and communicational aspects of informed consent. 6. week Information disclosure to terminally ill patients. Telling the truth to patients. The history of information disclosure to terminally ill patients. Pros and cons for lying to terminally ill patients. The weaknesses of the arguments in favour of lying. The dying process according to E. Kübler-Ross. How to communicate the bad news to terminally ill patients. The physician’s relationship with the relatives of the deceased patient. 7. week Justice in Health Care I. Ethical questions of macroallocation. Higher and lower level macroallocational problems. The role of personal responsibility in maintaining health. The principles and practice of rationing in contemporary health care systems. (Soft and hard rationing.) Medical ethics and medical economics. Ethical questions of cost-benefit and cost effectiveness analyisis. The QALY. The problem of right to health care. (The libertarian, the liberal and the socialist views about the right to health care.) The role of the market and that of the state in the health care system. Ethical problems of financing health care. (Fee-for-service, capitation, fixed salary, DRG-system, stc.) Setting health care priorities in Oregon. Attempts to define a just health care system. 8. week Ethical questions of reproductive medicine. Abortion. Arteficial insemination from donor. In vitro fertilization, surrogate motherhood. Ethical questions of genetic counseling. Ethical questions of embryo experimentation. 9. week Justice in Health Care II. Ethical questions of microallocation. Moral dilemmas in the allocation of scarce medical resources. The concept of microallocation. Ethical analysis of various selection criteria. (Medical benefit, psychological ability, supportive environment, social value criterion, resources required criterion, age, ability to pay, random selection, personal responsibility for the illness, etc.)
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160<br />
SEMMELWEIS UNIVERSITY / FACULTY OF MEDICINE<br />
5. week<br />
Informed consent.<br />
Simple consent and paternalism in medicine.<br />
The emergence of the doctrine of informed consent.<br />
Standards for information disclosure for patients.<br />
When is informed consent not necessary?<br />
Standards of competence and incompetence.<br />
The right to refuse medical treatment.<br />
Some psychological and communicational aspects of informed consent.<br />
6. week<br />
Information disclosure to terminally ill patients. Telling the truth to patients.<br />
The history of information disclosure to terminally ill patients.<br />
Pros and cons for lying to terminally ill patients.<br />
The weaknesses of the arguments in favour of lying.<br />
The dying process according to E. Kübler-Ross.<br />
How to communicate the bad news to terminally ill patients.<br />
The physician’s relationship with the relatives of the deceased patient.<br />
7. week<br />
Justice in Health Care I. Ethical questions of macroallocation.<br />
Higher and lower level macroallocational problems.<br />
The role of personal responsibility in maintaining health.<br />
The principles and practice of rationing in contemporary health care systems. (Soft and hard<br />
rationing.)<br />
Medical ethics and medical economics. Ethical questions of cost-benefit and cost effectiveness<br />
analyisis. The QALY.<br />
The problem of right to health care. (The libertarian, the liberal and the socialist views about the<br />
right to health care.)<br />
The role of the market and that of the state in the health care system.<br />
Ethical problems of financing health care. (Fee-for-service, capitation, fixed salary, DRG-system,<br />
stc.)<br />
Setting health care priorities in Oregon.<br />
Attempts to define a just health care system.<br />
8. week<br />
Ethical questions of reproductive medicine.<br />
Abortion.<br />
Arteficial insemination from donor.<br />
In vitro fertilization, surrogate motherhood.<br />
Ethical questions of genetic counseling.<br />
Ethical questions of embryo experimentation.<br />
9. week<br />
Justice in Health Care II. Ethical questions of microallocation. Moral dilemmas in the allocation of<br />
scarce medical resources.<br />
The concept of microallocation.<br />
Ethical analysis of various selection criteria. (Medical benefit, psychological ability, supportive<br />
environment, social value criterion, resources required criterion, age, ability to pay, random<br />
selection, personal responsibility for the illness, etc.)
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