Transcript Medicina utemeljena na dokazima

University of Split
School of Medicine
Farmaceutska ETIKA
Mario Malički
MORAL
Ćudoređe
 oblik svijesti o:
normama
ponašanja, tj.
ispravnosti
ponašanja
 dobro vs. zlo
 "reakcija“ – pitanje
djelovanja

Vrlina – moralna izvrsnost
Pretpostavka je da farmaceut koji posjeduje vrline
– dobar farmaceut
Moralni stav ima iznimke – zakon nema
Ljudsko ponašanje – pokušaj očuvanja
konzistentnosti između slike o sebi i vlastitog
djelovanja
Ja ............ svečano izjavljujem:
- svoje znanje i umijeće, uvijek ću primjenjivati, u skladu s načelima ovog
Kodeksa, časno, savjesno i dostojanstveno;
- poštivat ću ljudski život od njegovog početka do smrti, promicati zdravlje,
sprečavati i liječiti bolesti;
- pomoć ću pružati svakome bez obzira na dob, spol, rasu, narodnost,
vjersko ili političko uvjerenje i društveni položaj, poštujući pri tome
ljudska prava i dostojanstvo čovjeka;
- prvenstvo ću uvijek davati interesu bolesnika pred osobnim interesom;
- skrbit ću se za pravilnu, učinkovitu i sigurnu uporabu lijekova;
- lijekove ću izrađivati i izdavati po najvišim standardima kakvoće;
- čuvat ću povjerenu mi tajnu;
- svojim učiteljima i kolegama iskazivat ću poštovanje i zahvalnost za
znanje, umijeće i odgoj koje sam od njih primio;
- svim svojim sposobnostima čuvat ću plemenite tradicije ljekarničkog
poziva.”
All human beings are born free and
equal in dignity and rights. They are
endowed with reason and conscience
and should act towards one another in
a spirit of brotherhood
Universal Declaration of Human Rights
Trolley problem
Phillipa Foot 1967
The New York Times; Illustration by Frank O’Connell
Lawrence Kohlberg's stages of moral development
Level 1 (Pre-Conventional) 3-7 y “I would cheat if I knew I wouldn't get
caught”
1. Obedience and punishment
“I’ll let you copy my work, if you give me
2. Self-interest orientation
something in return”
Level 2 (Conventional) highschool
3. Interpersonal conformity
“I wont do it, cause I wont her to like
me”
4. Authority and social-order
Level 3 (Post-Conventional) college “You cant do it as teacher said no”
5. Social contract orientation
“There may be an exception to the rule”
6. Universal ethical principles
“You shouldn't lie as it violates the
principle”
Hamlin – Social evaluation by preverbal infants
2007 – helpers and hinderes
Kanakogi 2013 - Rudimentary Sympathy in
Preverbal Infants
Warneken 2006-7 Altruistic helping in human
infants and young chimpanzees
Frans De Waal – empathy in animals
Cruelty in animals
chimpanzee civil war - Kibale national park in Uganda
Tanzaina's Gombe Stream national park – split to two tribes
http://www.pbs.org - Hominidae Family Tree
Make love not war - Bonobos
Immanuel Kant -"Perpetual Peace" 1795
democracy, trade and an international
community are pacifying forces
Bruce Russett and John Oneal. 2001.
Triangulating Peace
Steven Pinker
The surprising decline of violence
Lawrence Kohlberg's stages of moral development
Level 1 (Pre-Conventional) 3-7 y “I would cheat if I knew I wouldn't get
caught”
1. Obedience and punishment
“I’ll let you copy my work, if you give me
2. Self-interest orientation
something in return”
Level 2 (Conventional) highschool
3. Interpersonal conformity
“I wont do it, cause I wont her to like
me”
4. Authority and social-order
Level 3 (Post-Conventional) college “You cant do it as teacher said no”
5. Social contract orientation
“There may be an exception to the rule”
6. Universal ethical principles
“You shouldn't lie as it violates the
principle”
Thorndike – 1930s
How much would you have to be paid to undergo
the following experiences?
1. to have one upper front tooth pulled out?
2. to have one little toe cutoff?
3. to eat a live earthworm six inches long?
4. to live the rest of your life on a farm in Kansas?
5. to choke a stray cat to death with your bare
hands?
Utilitarianism
revisited
•
•
•
•
•
1. 74 000 $
2. 4,500 $
3. 100,000 $
4. 300 000 $
5. 164 000 $
Reason is weaker then situation
• David Hume 1738: “Reason is,
and ought only to be the slave of
the passions, and can never
pretend to any other office than
to serve and obey them.”
Stanely Milgram experiment
1961 -1963
The bystander effect
blog.lib.umn.edu
Disgust as Embodied Moral Judgment
• fart spray experisments (2005; 2008):
• legalization of marriage between first cousins
(Marriage), approval of sex between first
cousins (Sex), moral judgments of driving
rather than walking to work (Driving), and
approval of a studio’s decision to release a
morally controversial film (Film).
• abortion, pornography, premarital seks,
homosexual relationship or sex
Moral Universals/Foundations theory
– Johnathan Haidt
•
•
•
•
•
•
Care/harm
Fairness/cheating – Reciprocity - The Golden Rule,
Liberty/oppression
Loyalty/betrayal - Ingroup community
Authority/subversion - hierarchy
Sanctity/degradation - Purity – sex, food,
23,684 subjects
Trolley problem
Phillipa Foot 1967
The New York Times; Illustration by Frank O’Connell
PRISTUPI RJEŠAVANJA MORALNIH DVOJBI
UTILITARISTIČKI PRISTUP – korisnost tj. posljedice
DEONTOLOŠKI PRISTUP – pravila
KAZUISTIČKI PRISTUP – prema već postojećim slučajevima
PRISTUP PREMA VRLINAMA – unutarnji motiv za djelovanjem
PRISTUP SKRBI – Odnos pojedinaca
PRISTUP DRUŠTVA – Posljedice na društvo
BIOETIČKA NAČELA
1. Autonomija - Autonomy
2. Neškodljivost - Non maleficence
3. Dobročinstvo - Beneficence
4. Pravednost - Justice
1. Autonomija
• Poštivanje autonomije znači da osoba ima
sposobnost voljnog djelovanja, uz
razumijevanje okolnosti i informacija, a bez
utjecaja koji bi govorili protiv slobodnog i
dobrovoljnog čina.
Primjer:
• Na hitni prijem doveden je 35-godišnjak nakon
prometne nezgode. U prometnoj nezgodi mu
je amputirana noga. Pri svijesti je, i naglašava
liječniku kako je on Jehovin svjedok, te kako
odbija mogućnost transfuzije krvi, bez obzira
na posljedice.
2. Neškodljivost
• Nećemo namjerno stvoriti bespotrebnu štetu
ili ozljedu pacijenta, ni djelom ni propustom
3. Dobročinstvo
• Primjer: kod hitnih stanja; kad je pacijent
onesposobljen težinom ili prirodom ozljede ili
bolesti, pretpostavit ćemo da bi razumna
osoba željela da je se liječi energično, žurno
ćemo joj pružiti odgovarajuće liječenje i skrb.
4. Pravednost
• Pravedna raspodjela raspoloživoga.
Physician Payment Sunshine Act
•
•
•
•
•
•
•
•
Consulting fees
Honoraria
Gift
Entertainment
Food
Travel
Education
Research
•
•
•
•
Charitable contribution
Royalty or license
Grant
Compensation for services
other than consulting
• Current or prospective
ownership or investment
interest
Bristol-Myers Squibb
JITENDRA
GANDHI
Company
$270717,70
PATRICIA
LORUSSO
Eli Lilly and Company
$115103,17
DONALD
ANDERSON
Forest Laboratories, Inc.
$75848,00
LAURA
CHOW
Eli Lilly and Company
$60865,00
Janssen Research &
MEENAKSHI
PATEL
Development, LLC
$55872,94
MISAL
KHAN
Daiichi Sankyo Inc.
$55866,00
DONALD
ANDERSON
Forest Laboratories, Inc.
$55290,00
MARTIN
ROCHE
DePuy Synthes Sales Inc.
$54490,00
ARAKEL
DAVTIAN
Forest Laboratories, Inc.
$51352,25
THOMAS
SHIOVITZ
Forest Laboratories, Inc.
$45842,25
Ispovijest optuženih liječnika: 'Put u
Berlin nije mito’
• “Potpuno je normalno da farmaceutska tvrtka liječnicima
plaća seminare”
• 'Farmalovi lijekovi su jeftiniji i zato smo ih propisivali‘
• “Legalno je da plate kotizaciju jer je to način na koji
sudjelujemo na kongresima.”
• “Dođu i donesu bon za Uskrs ili Božić, kažu da će dati neku
opremu za ordinaciju... Ne smatram da je to mito. Jer svaki
lijek koji sam potpisala pacijentu je trebao, bio je strogo
indiciran.”
Ljekarnica iz Dugog Rata odbila izdati antibebi
pilule jer joj to brani katolička vjera!