2. Ethical dilemma.

Medical Ethical dilemma

Teacher: George Cristian Curca

Professor of Legal Medicine and Medical Ethics, MD, Ph.D. Dept. of Legal Medicine and Bioethics, UMPh CD

Dilemma
Dilemma = a double proposition (gr.), a double solution. Attention; a (moral) dilemma is a (moral) choice between 2 solutions. No one could have a dilemma choosing between good and bad. Step away from false dilemmas (immoral dilemma, valid solutions, different type of dilemmas mixed together), false dichotomy, false solutions. In a dilemma both solutions are equal inacceptable or at least contradictory or they do not respect all imperatives or moral normatives However one must be applied: therefore the agent who take the decission must make a choice. A personal choice. And this is moral frustration. A moral dilemma is when people facing a moral choice have different views based on opposite arguments, still valid, and when the agent who has to make the final decision has a moral frustration not knowing what arguments to chose in order to make all people content and without generating injustice. Possible solutions: general interest (equality), priority (the weakest, the strongest, his own interest), abandon, sacrifice (obligation, honor)

Model of ethical decision

1. 2. Observation of the moral flow (observation) Identify the presence of an ethical dilemma: ethical values which are in contradiction which bring in contradiction people generating debates about right and wrong (we have no dilemma in unanimity whatever the case); (identifying an ethical dilemma) Identify moral values, principles, imperatives at stack in that ethical dilemma and separate them from others values such as legal values, professional values, normative values (identifying moral values). Do not mix legal values with moral values, etc. Constructing the ethical balance with the moral values already identified : bring together on each plate the moral values, arguments/imperatives of the same kind etc. Look carefully to avoid false dilemmas, etc. (deliberating facts): ascertain all dilemma types in that case and offer correct solutions for each type (professional dilemma, ethical dilemma, deontological dilemma, legal dilemma, etc) (deliberating moral values)

3.

4.

5. Affiliate on each plate the action which coagulate the morale values of that kind (deliberating facts and actions) 6. Solving the dilemma: making your moral choice which is moral for all the people (deliberation of the good choice) 7. Argumentation: arguments to explain the moral choice for all the people (argumentation) 8. Sustain and promote the chosen moral option: verify the consistency/validity of the choice throughout time, people ideas, cases (assuming responsibility) 9. Observation of the moral flow (observation)

DILEMMA IN THE DOCTOR-PATIENT RELATIONSHIP

Doctor

Types of dilem ma

PATIENT

 HEINZ DILEMMA (Lawrence Kohlberg, 1927-1987) A woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to produce. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: No, I discovered the drug and I'm going to make money from it. So Heinz got desperate and broke into the man's store to steal the drug for his wife. Should Heinz have broken into the laboratory to steal the drug for his wife? Why or why not?

Heinz should steal the medicine because it is only worth $200 and not how much the druggist wanted for it; Heinz had even offered to pay for it and was not stealing anything else. Heinz should not steal the medicine because he will consequently be put in prison which will mean he is a bad person Heinz should steal the medicine because he will be much happier if he saves his wife, even if he will have to serve a prison sentence Heinz should not steal the medicine because prison is an awful place, and he would more likely languish in a jail cell than over his wife's death. Heinz should steal the medicine because his wife expects it; he wants to be a good husband Heinz should not steal the drug because stealing is bad and he is not a criminal; he has tried to do everything he can without breaking the law, you cannot blame him. Heinz should not steal the medicine because the law prohibits stealing, making it illegal. Heinz should steal but he must accept consequences and he must take responsibilities if he is caught

Heinz should steal the medicine because everyone has a right to choose life, regardless of the law Heinz should not steal the medicine because the scientist has a right to fair compensation. Even if his wife is sick, it does not make his actions right.
Heinz should steal the medicine, because saving a human life is a more fundamental value than the property rights of another person Heinz should not steal the medicine, because others may need the medicine just as badly, and their lives are equally significant.

[Kohlberg, Lawrence (1981). Essays on Moral Development, Vol. I: The Philosophy of Moral Development. San Francisco, CA: Harper & Row. ISBN 0-06-064760-4.], [http://en.wikipedia.org/wiki/Heinz_dilemma]

Lawrence Kohlberg's stages of moral development

Level 1 preconventional (4-10 years):
Stage 1 of obedience/punishment Stage 2 of moral instruments and motivations, self-interest, egoism

Level 2 conventional (10-13)

Stage 3 wish to social compatibility, acceptance, conformity Stage 4 rules, law-and-order

Level 3 postconventional (14-adult)

Stage 5 respect for social order, for human rights Stage 6 ethics, morality, universal human ethics

What would ethical theories of good would answer in Heinz case?

What would Platon have said? Virtues standpoint What would Locke have said? Rights standpoint What would Kant have said? Duty standpoint What would Ross have said? Main duty-prima facie- standpoint What would Bentham or Mill have said? Results and consequences standpoint What would bioethics have said? Bioethical principles standpoint

Ethical dilemmas
Circle friends dilemma Emergency doctor dilemma Personal interest vs. a third person (public interest) dilemma: (i.e. Tarasoff case) Personal interest vs. organization interest Personal interest vs. community interest (concentration camp dilemma) Personal interest vs. society interest: fat man, pregnant woman and the cave, Heinz dilemma

Medical ethical dilemma

A medical ethical dilemma is a complex dilemma bringing together 2 dilemmas: an ethical dilemma (searching for good and bad) and a moral professional dilemma (normative dilemma).