Mario Malički

University of SplitSchool of Medicine

Farmaceutska ETIKA

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 y1. Obedience and punishment2. Self-interest orientationLevel 2 (Conventional) highschool3. Interpersonal conformity4. Authority and social-order Level 3 (Post-Conventional) college5. Social contract orientation6. Universal ethical principles

“I would cheat if I knew I wouldn't get caught”

“I’ll let you copy my work, if you give me something in return”

“I wont do it, cause I wont her to like me”

“You cant do it as teacher said no”

“There may be an exception to the rule”“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 y1. Obedience and punishment2. Self-interest orientationLevel 2 (Conventional) highschool3. Interpersonal conformity4. Authority and social-order Level 3 (Post-Conventional) college5. Social contract orientation6. Universal ethical principles

“I would cheat if I knew I wouldn't get caught”

“I’ll let you copy my work, if you give me something in return”

“I wont do it, cause I wont her to like me”

“You cant do it as teacher said no”

“There may be an exception to the rule”“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

JITENDRA GANDHI

Bristol-Myers Squibb

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

MEENAKSHI PATEL

Janssen Research &

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!