Part A - Situations Raising Ethical Questions

1. Consider whether overriding refusals of treatment by patients (e.g. Jehovah's Witness patient's refusal, on religious grounds, of a blood transfusion) constitutes a violation or an infringement of a right.Consider an opposing argument: whether or not this action would constitute medical paternalism. (See Picture Attached "Rights-Based Ethics.")

Rights-Based Ethics The language of rights permeates the law: the right to life, the right to die, the right to privacy, the right to reproduce, etc. A legal right of access to our publicly funded health system is granted to all Canadians under the Canada Health Act, R.S.C. 1985, c. C-6 [CHA]. However, legal rights and ethical rights are not necessarily the same and may conict with one another. Ethical rights may be promoted whether or not legislation supports them. The rights- based ethical theory reflects our intuition that we have certain things as a matter of right and this cannot be violated. Rights can be either negative or positive. Negative rights correlate with duties to refrain from doing something. For instance, most privacy rights are negative rights. Positive rights correlate with duties to help in some manner. For example, healthcare professionals are bound to help someone who claims a right to healthcare. Consider a "Patients Bill of Rights," a document which recognizes patients' rights of autonomy. This can be a revolutionary departure from Hippocratic benevolence because the healthcare professional is required, by claim of right, to consider patients' authority to decide for themselves. Rights, then, arejustified claims that people can make on others or on society. Legal rights arejustified by legal principles and/or rules, moral rights by moral rules. A violation of rights occurs when there is an unjustied action against a right. An infringement of rights occurs when there is a justified action which overrides a right. .41. Winnipeg Child and Family v. G. Winnipeg Child and Family Services (Northwest Area) v. G. (D.F.) In this 1997 case, a woman, five months pregnant with her fourth child, was addicted to glue sniffing. Two previous children were born permanently disabled as a result of her addiction and were permanent wards of the state. A judge of the Superior Court (the court of first instance) had ordered the woman into the custody of the Director of Child and Family Services, detained in a healthcare facility for treatment until the birth of her child. That order was appealed. The Court of Appeal overturned the decision, and said that the existing law did not support the order made and, given the difficulty and complexity entailed in extending the law to permit such an order, the task was more appropriate for legislature than the courts. There was a further appeal to the SCC by the family services department. The appeal was dismissed, with the Court ruling that an unborn child was not a person possessing rights. In effect, it could have no existence apart from the mother at that point.Major Ethical Theories There are two dominant trends of thought: consequentialist (of which utilitarianism is the most well-known) and deontological ethics. These are often used to justify or explain the duties involved in, for example, informed consent. There is a trend in medical ethics to examine issues in context and to avoid dependence on general abstract rules and rights. Consequentialist Ethics This theory of ethics focuses on the consequences of actions. In effect, the duty is \"right\" (i.e., it is the \"right\" thing to do) if the consequences are \"right.\" Utilitarianism is the most well-known form of consequentialist ethics. According to this theory, one should act in order to maximize the greatest good or happiness for the greatest number of people. The strengths of this position include the fact that how people are actually affected by what occurs reects our intuition that people should be treated as being of equal moral worth. Its weaknesses include the fact that there seems to be no consideration for the particularities of individuals, for their special relationships or personal projects. As one example, consequentialism would allow one individual to be permitted to cease to live if the act of the cessation of life were assessed to have greater utility for society than would the lack of such action. Critics of this ethical theory often focus on what they consider the hedonistic quality of equating utility with pleasure. Utilitarianism would have the relevant utility values for all people affected by an action calculated, and then action would proceed according to a calculation of the relevant balances. Deontological Ethics Deontological ethics originate in the Greek word \"W' meaning \"duty\": a duty which one thinks should be universally applied to all is mandatory regardless of the consequences. This theory does not direct us to assess particular details of people or situations. Deontological rules hold unless good reason exists to act otherwise. Critics say this theory seems to produce some counterintuitive results