1. Medical Ethics Introduction

3. The Origins of the Field and Its Current Status Current Status of Medical Ethics 1) Number of Courses Required 2) Medical Ethics programs in medical schools, nursing schools, HRP, etc. 3) Journals, e.g. Hastings Center Report , Journal of Medicine and Philosophy 4) Centers, e.g. Hastings Center, Kennedy Center at Georgetown University, Midwest Bioethics Center, K.C. 5) Rise of Hospital Ethics Committees 6) Massive Media Coverage

4. The Social Context: Why Is Medical Ethics So Prevalent? Some factors: 1) Federal Government support, e.g. IRBs, national commissions, publications 2) Rise of Medical Technology 3) Rise of 3rd Party Payers 4) American Distrust of the Professions 5) Rise of Professional Ethics 6) Critics of Medicine, e.g. Ivan Illych and Norman Cousins 7) Rise of Team Health Care

5. The Social Context: Why Is Medical Ethics So Prevalent? Some factors: 8) Women's Movement: * male dominance of medicine * focus on cure rather than care and prevention 9) Legalization, legislation, and litigation 10) Social interest in freedom and autonomy - decline in the status of medicine 11) Media Interest, e.g. Cruzan. Busalacchi, Siamese twins 12) Rise in the Cost of Medicine: how much can we afford?

6. Some Historical Points: 1940's and 1950's Human subjects research IRB's Doctor-patient relationship: a) buyer and seller b) child and parent c) individual and agent of society d) client and professional e) passive recipient and active provider f) the powerless and the powerful g) friend and friend

7. Some Historical Points: 1940's and 1950's (cont.) Doctor-patient relationship (cont.): h) contractual relationship: a legal agreement based on mistrust i) covenant relationship: a mutual agreement based on trust j) gatekeeper relationship informed consent informed refusal proxy consent/refusal competence death/dying

8. Some Historical Points: 1960's and 1970's privacy and confidentiality abortion/status of the fetus allocation of scarce resources definition of death

9. Some Historical Points: 1980's genetics issues nursing ethics professional ethics reproductive issues AIDS animal rights

10. Some Historical Points: 1990's human genome project right to health care/health care reform managed care/professionalism fetal neural tissue transplantation cloning

17. Some Basic Concepts in Medical Ethics Quality of Life: 1) Who defines? 2) An external definition? Same for everyone? 3) Internal definition Normal vs. Abnormal Natural vs. Artificial Health vs. Disease

18. Some Basic Concepts in Medical Ethics Quality of Life: Ordinary vs. Extraordinary Rights vs. Responsibilities Life vs. Quality of Life Person vs. Living Thing/Thing