Ethical Issues in Neurology
Jeffrey S. Nicholl, M.D.
1. "The rules or principles which govern right conduct."
The analysis of moral decision making.
2. Ethical models:
1. Agent--virtue theories the nature of the agent and his motivation determine the morality of an act.
2. Acts deontology some acts are inherently wrong.
3. Ends teleology the intent justifies the means.
4. Consequences utilitarianism the actual effects determine the morality of the act.
3. Principles in medical ethics:
1. Respect for the individual (autonomy)
2. Beneficence (nonmaleficence)
3. Justice (distribution)
5. Utility (greatest good)
6. Fidelity (to the individual patient’s best interest.)
8. Universality (The Golden Rule)
Medical ethics involves the balancing of conflicting principles in a particular case.
4. Codes of medical ethics:
2. AMA (varies from country to country)
3. Religious (varies among religions)
5. Death and dying:
1. Definition of death
a. Whole body (death of the organism)
b. Brain death (Uniform Brain Death Act)
c. Irreversible coma (PVS)
d. Loss of higher cortical function (death of the person)
2. Benefit v. Burden
3. Withholding v. withdrawing treatment
4. Ordinary v extraordinary treatment
5. Killing v. allowing to die
6. Physician-assisted suicide v. euthanasia
7. Futile care
9. Double effect
10. Substituted judgment v. explicit wishes of the patient (advance directives)
6. Persistent Vegetative State -- Quinlan, Cruzon, Barber
8. Amyotrophic Lateral Sclerosis
10. Medical economics
11. The "slippery slope"
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