Morality and ethics: foundational concepts and distinctions

Morality and Ethics

Over the last several decades the issues of morality and ethics has been continually brought to the forefront. Part of the reason for this is the advances that have take place in medical research. This has caused a whole host of ethical and moral dilemmas to develop. A good example of this can be seen with the use of social networking, chatting and emailing as part of modern day medicine. These different advances have allowed physicians to be able to most effectively communicate with patients and colleagues about a whole host of issues. This can include everything for providing routine follow ups with patients, to utilizing this technology to communicate with other doctors about the latest procedures. In general this was touted as a cost effective way to provide even better health care services. However, like many new breakthroughs a number of moral as well as ethical issues have developed the most notable would include: liability issues, reimbursement / time issues and the confidentiality of the physician patient relationship. Liability issues are created with instructions provided by a patient to a physician in an email. Where, there are no ethical or moral guidelines for following such instructions. This is problematic for reimbursement / time issues, because this could interrupt the time that physicians are spending with patients and it could be an unwelcome distraction, by forcing them to constantly monitor incoming emails / instant messages. When a doctor is performing follow up with clients through the use of chatting or email, this could affect patient - physician confidentiality. As this information could be seized illicitly and then used to exert influence upon the physician or patient. What this shows, is how with nearly every single medical breakthrough or technological innovation there are a number of moral and ethical issues that must be grappled with. ("Privacy and Security," 2010) To fully understand how the rules of morality would apply to a variety of situations in the future; requires that you carefully examine what factors have influenced medical ethics and the different rules governing morality. This will provide the greatest insights, as to how the various moral and ethical standards can be updated to reflect the rapid changes that are occurring.

The Different Factors that have Influenced Medical Ethics

To fully understand the how various factors have affected medical ethics requires providing a definition of both ethics and morals. At which point, an evaluation will be undertaken to see the overall scope of how various events of the past have formed the modern day standard of ethics that all health care professionals practice. Morals are when a person has a sense of right and wrong about the various situations that they will encounter in daily life. Ethics is when you are examining how various views and behaviors will influence a particular situation. In this aspect, the greatest amount of good that can be achieved is desirable for all situations. Where, in the real world health care professionals are seeking to focus on achieving greatest amounts of good, through their actions and thoughts about various issues that may arise. In field of health care a number of different ethical issue have arose over the last several decades. To include: right to life issues, assisted suicide along with how and when these various ethics would be relevant to different patients. (Pozgar, n.d.)

There were a number of events throughout the 20th century and early 21st century that have shaped how various medical ethics are applied the most notable would include: the Tuskegee study, the Nuremberg trial and advances in technology / medicine. The Tuskegee study took place from 1932 to 1972, where researchers wanted to see the full effects of Syphilis. The problem was: that the researchers would seek out those people who were most vulnerable to the disease or were already affected by it. They would then watch the effects over the course of time. This is despite the fact that Syphilis could be treated with anti-biotics. Then, all of the different subjects were African-American men, who were poor, uneducated and came from rural areas. The fact that these people were not informed about a possible cure and the way they were selected; brought into question the overall morals / ethics of researchers. Where, scientists were interested in seeing the long-term effects of the disease, but not the well being of their subjects. (Pozgar, n.d.) This would help to play a role in shaping how various medical standards would be applied when any kind of medical research or procedure is being conducted. In many ways one could argue that the Supreme Court case Canterbury v Spence is tied directly to the Tuskegee study. This case is relevant because the court ruled that physicians are required to disclose the possible risks associated with any kind of medical procedure or study. The disclosure must take place at such a time, that the subject / patient can be able to make an accurate determination of the overall risks involved. ("Canterbury v Spence," n.d.) In the case of the Tuskegee study, the researchers clearly violated this ethical principal by not disclosing the dangers of their research and the fact that their subjects could be treated.

A second event that would influence medical ethics would be Nuremberg Trials. In this particular case, a military tribunal was conducted for 23 doctors and Nazi officials that allowed various kinds of medical experiments to take place in the concentration camps. This was significant because it would create the first ethical standards for modern day medicine (the Nuremberg Code). This required that voluntary consent must be received from the subject prior to conducting any kind of medical research. Then, the benefits of the research must outweigh any kinds of possible risks involved. As a result, an ethical standard would be developed that would help guide health care professionals on the most morally correct way to work with patients. This would lead to a number of increased ethical standards that would continue to be applied, based off of the Nuremberg Code. (Pozgar, n.d.) The most notable would include: the creation of the World Medical Association guidelines for doctors in 1964 and the National Research Act. The National Research Act is a specific law that was enacted to prevent the obvious abuses that occurred because of the Tuskegee study. Where, it would create a commission that would regulate and apply different ethical standards to the medical industry (the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research). ("Regulations and Ethical Guidelines," n.d.)

A third event that would influence medical ethics would be the changes in technology / advances in medicine. During the late part of the 20th century and early part of the 21st century, the point that life would begin and when it would end became two hotly debated ethical issues. At the heart of the debate was abortion and assisted suicide, these two are related because for the first time it was easy for life to be destroyed. (Pozgar, n.d.) The overall issue was when life began / ended and how would medical ethics apply to each situation. In the case of abortion, the Supreme Court ruled in Rowe v Wade that abortion was a legal medical procedure. Yet, there were attempts to limit / restrict access to abortions. ("Rowe v. Wade," 2010) As medical science evolved, an abortion pill was developed that could be purchased by women without a prescription (the morning after pill). This is causing an ethical conflict in defining what someone is allowed to do with their body and at what point does life actually begin. The introduction of the morning after pill only makes these issues more complicated, as women can be able to safely conduct their own abortions.

The way that the issues of advances in technology / medicine have helped to shape medical ethics is by allowing life to be extended. Where, someone could fall into a deep coma or they could suffer in agony from a debilitating condition. These points are tied together because they both involve when someone is allowed to die. What's occurring is modern medicine has advanced enough that someone can be kept alive in a vegetative state (such as a coma) for years. This has caused many in the medical community to claim that it is unethical to let someone to continue to live in such a state for prolonged periods of time. While, others will claim that ending any kind of assistance is effectively committing murder. In the case of assisted suicides a similar argument takes place, where proponents do not want to see someone suffer unnecessarily form debilitating conditions such as Alzheimer's disease. While, the opponents claim that assisting them with ending their lives is effectively committing manslaughter. An example of this can be seen with a 2006 incident, where the Supreme Court prevented the White House from punishing doctors who were assisting critically ill patients with suicide. (Pozgar, n.d.) This is significant because it would highlight the overall ethical conflicts that exist in medical ethics. What both these issues show is how advances technology / medicine are changing the overall scope of the ethical debate within the medical and legal communities.

Together all of these events have helped to shape the way various ethical standards for medicine would evolve. This is important because they would clearly define the most appropriate conduct for medical research and how to interact with patients in the health care industry. As they would form the backbone of creating professional standards that the industry currently enjoys. However, as a number of breakthroughs in medicine and technology are taking place, this means that the overall issues of morals / ethics are evolving. Where, ethical issues are becoming more ambiguous or new ones are arising.

Rules Governing Morality

Over the decades a number of different codes and principals have been adopted, as way to provide various health care professionals with ethical standards in the different situations they will encounter. The AMA Code of Medical Ethics is one guideline that creates moral standards for everyone to follow. Where, it will address a number of different principals the most notable would include: when providing care the physician will show respect / treat all patients with dignity, all physicians will maintain high principals of honesty, follow the various laws, respect the rights of patients / other health care professionals, continuously learning new procedures / techniques and to support / care for all people. ("AMA Code of Medical Ethics," n.d.) These different principals establish a basic outline that physicians will follow. However, over the years the way various ethics are applied can to cause the codes can be vastly different. A good example of this can be seen during the 1950's and 1960's, when the AMA was opposed to creation of Medicare. Since that time, they have reversed positions and are now opposed to any kind of cuts in the program. (Rapaport, 2009) What this shows is the overall role of ethics is changing. Where, the AMA was opposed to expanding the program based on ethical / moral considerations. Yet, once the program was enacted they were opposed to any cuts because of the potential harm that would take place. This ethical shift was created based upon the changes in moral and ethics that the organization would have. In the case of the AMA Code of Medical Ethics, it is seeking to identify the most ethical procedures when practicing medicine. Over the years, as the different views of society and the members of the AMA change, so will the code of ethics. To effectively enforce the different provisions, the AMA has the Council on Ethical and Judicial Affairs. Their responsibility is to examine different ethical issues and provide guidance to physicians about what the most correct response would be under the code. They also have powers of enforcing the various provisions of the code of ethics, to include: imposing fines and censuring those who are determined to be in violation. ("Council of Ethical and Judicial Affairs," 2010)

A second set of codes that were developed to provide different moral / ethical guidelines includes: the ICN Code of Ethics and the American Nurses Association Code of Ethics. The ICN Code of Ethics provides nurses with a number of ethically-based principals that should be used at all times to include: respecting human life and treating everyone with respect. At which point, it will clearly spell out four relevant areas that pertain to the practice of nursing such as: the relationship that nurse have with patients / the general public, the most ethical behavior of nurses in the practice, the relationship of nursing with the profession itself and the relationship of nurses interacting with other colleagues. The code then goes one step further by: supporting nurses who refuse to participate in activities that will not sustain effective healing and caring. ("ICN Code of Ethics for Nurses," n.d.)

The American Medical Association of Nurses Code of Ethics is: a second code that guides nurses in the most morally correct actions. This code would include a number of distinct principals the most notable would include: protecting the patients confidentiality, protecting the public against unethical practices / procedures, taking responsibility for all decisions / actions, participating in the continuous development of modern medicine, protect the public / the field of nursing from disinformation / misrepresentation and working with other members of the health care industry to meet the needs of the general public. ("American Nurses Association Code of Ethics, " n.d.) What this shows, is how in the field of nursing the two different codes of ethics can be applied to the industry. This is significant because they provide nurses with two guidelines that they can follow, when various situations arise during the course of treating patients. When you have two different sets of codes in place, this helps provide moral clarity by giving everyone a variety of issues and how to most effectively respond. Over the course of time, this is helping to improve the various ethical issues and how they are applied, by providing nurses with a number of interpretations on moral situations.

In the field of medical research there are number of different codes that establish a variety of ethical standards the most notable would include: the Helsinki Declaration, the Nuremberg Code and the National Research Act. The Nuremberg Code and the National Research Act have had an impact on other codes of ethics within the health care industry. However, their greatest impacts have been felt within the field of medical research, as they would establish the basic procedures for conducting any kind of experiment (from an ethically acceptable view point). These two are important because they would require that all experiments must outweigh any kind of perceived harm to the subjects, they must be informed of the effects prior to engaging in the project and they must set standards for enforcing different provisions. This is significant because it is forcing medical researchers to act in the most morally and ethically correct way at all times. Where, various experiments that are taking place for the sole benefit of the researchers are no longer accepted as legitimate scientific experiments. Then, with various ways of enforcing the different provisions, is saying that any kind of actions or behavior beyond the various ethical codes will be punished. This is effectively forcing all medical researchers to follow the various provisions of the code.

The Helsinki Declaration was another set of codes that were adopted to provide even greater standards within the field of medical research. Where, the overall objective was to be to have some clearly definable scientific purpose that will benefit humanity or the environment in some way. Special attention must be given to how the research is conducted and the overall effects that it will have on subjects (including animals). There are several basic principals that are addressed to include: all research must conform to scientifically accepted standards, if human subjects are involved an independent committee must review the project / research being conducted, there must be clearly defined objectives of the study, the subject has the right to confidentiality, all hazards involving human research subjects should be predictable, all research on humans must spell out how it will be used along with the objectives and all research should contain ethical principals that are outlined as a part of the declaration. ("Declaration of Helsinki," 1996) This is significant because it takes the ideas presented in the Nuremberg Code and expands upon them in relation to how medical research is conducted. Over the course of time, the different principals outlined would help to clearly and define the most acceptable ethical standards within the field.

What Nuremberg Code, the National Research Declaration and the Helsinki Declaration highlight is how the overall nature of ethics is evolving. Where, the obvious abuses that were occurring in the past have been addressed to help curb the abuses that were taking place. Each one of the different codes / regulations provides specific guidance to various abuses that are occurring. This is significant, because as the world of medical research is evolving something must be done to address the changes that are taking place. A good example of this occurred in with the first break through in conducting a kidney transplant in 1954. Where, this medical advancement would bring up a number of different ethical issues that must be grappled with. The most notable would include: how various organs were harvested, who would be determined to receive such organs and how would the various organ transplants be regulated. (Pozgar, n.d.) This is significant because it underscores how with one advancement (the ability to conduct kidney transplants) opened up a number of different issues that could affect the ways medical research was conducted. As a result, the various codes of ethics were intended to provide specific guidance to the changes that are occurring in the field of medicine.