Clinical Skills – Ethics/Humanities/Health Law

Tutorial Notes for Aug. 30, 2002

"Playing God"

Thanks for agreeing to do this.

I'm hoping we can use this story as a set-up for a general introduction to ethics that I'll be giving in the couple of classes that follow the small group discussion. The story is clear and vivid. As such, I expect most of the students will have a fairly clear intuition as to whether the physician's conduct in the story is justifiable (although I expect there will be some variance in which way their intuitions go). I'd suggest just canvassing reactions as a first step. After that, the main thing I'd like to focus on is getting the students to justify their reactions and, in the process, to think about how to go about doing this.

In the following couple of lectures to this session, I'll be trying to get them to approach ethical decision making by drawing a distinction between facts, principles and concepts. Roughly, here's what the distinction amounts to. By 'facts' we mean just what you'd expect: the concrete details of the case. By 'principles' we mean the moral rules that are relevant to the particular case (e.g., 'don't kill except in self-defence'). By 'concepts' we mean the categories that have to be applied when considering what the principles tell us about the particular case (e.g., what does the concept of self-defence mean?). They won't have encountered these distinctions yet, so it probably doesn't make sense to formally introduce them during the small group discussions. Nonetheless, if you could steer them toward thinking about what the relevant details in the case are and how to decide what those details tell us about the status of the physician's actions, that would be helpful.

I'd also like to use the story as a way of driving home to them the distinction between law and morality. Clearly, what the physician does in the story is illegal. No plausible argument suggests otherwise. But I expect most students will be willing to at least entertain the possibility that the physician's actions aren't immoral (even if they're not ultimately convinced). It might be helpful to emphasize this difference in the moral and legal status of the action as way of separating the concepts of the law and morality.

More briefly, here are the questions I'd like us to focus on:

1. Were the physician's actions morally right?

2. What would you do in this situation? (They may think the first question already answers this one. If so, ask them whether their actions are always morally right.)

3. What principles are relevant to thinking about the moral status of the physician's action? Are there reasons on both sides of this issue?

4. Would having further details about the situation make it easier to assess the physician's actions? If so, what are these details?

5. Are there any circumstances under which it is morally OK for a physician to break the law?

6. To what extent should a physician's personal values influence his actions as a physician?

Don't feel, however, that it's necessary to get through all these questions. If the discussion takes a turn away from the issues I've identified here and you think it's a useful direction, then don't feel the need to force them back to the above questions.

Andrew