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Ethics
| Question | Answer |
|---|---|
| What is Ethics? | -Moral philosophy helps us to distinguish right from wrong & good from bad |
| What is Ethics? | -Involves the study of morality, virtues, & values & how they affect one’s character -Involves how individuals decide to live within accepted boundaries & how we live in harmony with one another & nature |
| Micro-ethics | Individuals view of what's right and wrong |
| Macro-ethics | Global view of right and wrong |
| Philosophical Ethics | Involves inquiry about ways of life and rules of conduct |
| Religious Ethics | General pattern or way of life |
| Professional Ethics | set of rules of conduct or moral codes, involves ethical and unethical behavior |
| Bioethics | nature of life and death, what sort of life is worth living |
| Why study ethics? | -Recognize healthcare dilemmas -Provide tools for constructive deliberation & conflict resolution -Make "right" or better judgments, decisions, and choices -To serve as gap filler |
| What is morality? | -code of conduct -implies quality of being in accord with standards of right and good conduct -describes class of rules held by society to govern the conduct of individual members -an action/verb |
| Morals | -ideas about what is right and wrong -ingrained in culture and religion -not to be confused with cultural habits or customs |
| Morality vs. Morals | Morals are the ideas about where morality is a code of conduct (verb) |
| Codes of Ethics | -moral statement written into a formal document |
| Code of Ethics: Standards | -desirable trait |
| Code of Ethics: principles | -describe responsibility (i.e. zealous advocate) |
| Code of Ethics: Rules | -specify specific conduct |
| Principles vs.Rules | Principles allow for professional judgment, rules do not |
| Moral Judgments | -judgments concerned with what and individual or group believes to be right or proper behavior in a give situation -Involves assessment of another person's character -lack of conformity typically results in: moral censure, condemnation |
| Morality Legislated | -Law is distinguished from morality in that -law has explicit rules, penalties -laws are created to set boundaries for societal behavior -laws are enforced to ensure that expected behavior happens |
| Moral Dilemmas | -arise when values, rights, duties, and loyalties conflict -caregivers must not only examine what they consider the right thing to do, but what are the alternative and what are the patient's known wishes |
| Theories of Ethics | -Present varying viewpoints that aid in difficult decision making -predict the outcome of alternative choices (reach an ethically correct decision) |
| Theory of Ethics: Normative Ethics | -the attempt to determine what moral standards should be followed to produce morally right behavior -General: determination of correct moral principles -Applied ethics: applies normative theories to moral dilemmas (e.g. justify euthanasia) |
| Normative Ethics: Descriptive or Comparative Ethics | what people believe to be right and wrong |
| Normative Ethics: Meta-ethics | seek to understand ethical theories and their applications |
| Theory of Ethics: Consequential Ethics | -right or wrongness of an action is based on the consequences or effects of the action -goal is to achieve the greatest good for the greatest number of people -the morally right action involves one that leads to the maximum balance of good over evil |
| Theory of Ethics: Utilitarian Ethics (a form of consequential ethics) | -moral worth of an action is determined solely by its contribution to overall usefulness -philosophy that advocates greatest good for the greatest number -everyone is obligated to do whatever will achieve the greatest good for greatest number |
| Theory of Ethics: Deontological Ethics | -Duty based ethics -Focuses on: duty to others, rights of others -Consequences are not a determinant of what is right (doing the right thing may not always lead to an increase in what is good) |
| Theory of Ethics: Non-Consequential Ethics | -Rightness or wrongness of an action is based on properties intrinsic to the action (denies consequence of action is the only criteria for determining the morality) -Values in one situation may conflict with the same values given a different situation |
| Ethical Relativism | -morality is relative to the norms of one's culture -actions can be considered right or wrong depending on the accepted norms of society in which they are practiced |
| Ethical Principles | Universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued |
| Principles of Ethics: Beneficence | -Principle of doing good -Demonstrating kindness -Showing compassion -Helping others -Paternalism is a form of beneficence (making decisions for others) |
| Principles of Ethics: Non Maleficence | -avoid causing harm -not concerned with improving others' wellbeing, but with avoiding the infliction of harm |
| Principles of ethics: Autonomy | -right to make one's own decisions |
| Principles of Ethics: Justice | -Obligation to be fair in distribution of benefits and risks -Distributive justice: requires all individuals to be treated equally and fairly -Raises issues: how to we ration the healthcare system? |
| Scarce Resources | -What happens when resources are scarce and only one of two patients can be treated -What should be determining factors: age, position in life, patient wishes |
| Virtue Ethics | -focuses on the inherent character of a person rather than on the specific actions he or she performs |
| Virtue | -describes ideals of moral excellence and than has beneficial quality -distinguish good people from bad people -morally virtuous people does the right thing because of habit |
| Virtue vs. Value | -not antonyms, not synonyms -virtues are the ideas, values are the action |
| Values | -represent a standard of conduct -used for judging goodness or badness of an action -value to one person may not have value to another -change as needs change |
| Moral Value | -relative worth placed on some virtuous behavior |
| Pillars of Moral Strength Virtues and Vales | -courage, wisdom, temperance, commitment, compassion, conscientiousness, cooperativeness, discernment, fairness, fidelity, integrity, freedom, honesty/trustworthiness/truth-telling, kindness, respect, hopefulness, tolerance |
| Pillars of Moral Strength: Courage | -the mental or moral strength to preserve and withstand danger -balancing fear, self-confidence, and values -the greatest of all virtues |
| The Courageous Person | Has good judgment, a clear sense of his or her strengths, correctly evaluates danger and perseveres until a decision is made and the right goal that is being sought has been achieved |
| Pillars of Moral Strength: Wisdom | the judicious application of knowledge |
| Pillars of Moral Strength: Temperance | orderliness and moderation |
| Pillars of Moral Strength: Commitment | agreement or pledge to do something |
| Pillars of Moral Strength: Compassion | sympathy for another's suffering (vs detachment-lack of concern for pt's needs) |
| Pillars of Moral Strength: Conscientiousness | one who has moral integrity and a strict regard for doing what is considered the right thing to do |
| Pillars of Moral Strength: Cooperativeness | the process of working with others |
| Pillars of Moral Strength: Discernment | ability to make a good decision without personal biases, fears, or undue influence from others (decide the best action among many possible actions) |
| Pillars of Moral Strength: Fairness | the ability to make judgments free from discrimination, dishonesty, or personal biases |
| Pillars of Moral Strength: Fidelity | being true to out commitments and obligations to others |
| Pillars of Moral Strength: Integrity | steadfast adherence to strict moral or ethical code and a commitment to not compromise this code |
| Pillars of Moral Strength: Freedom | free to make choices for oneself within the boundaries of law |
| Pillars of Moral Strength: Honesty/Trustworthiness/Truth-telling | confidence a person will act with right motives |
| Pillars of Moral Strength: Kindness | considerate and sympathetic to another's needs |
| Pillars of Moral Strength: Respect | showing special regard to someone or something |
| Pillars of Moral Strength: Hopefulness | involves looking forward to something with the confidence of success |
| Pillars of Moral Strength: Tolerance | -Positive tolerance: implies that a person accepts differences in others (generally free of prejudice and discrimination) -Negative tolerance: implies that one will reluctantly put up with another's beliefs (simply tolerating the views of others) |
| Tolerance | Not all tolerance is virtuous, not all intolerance is wrong (persecution for religious beliefs vs. concentration camps) |
| Religious Ethics | -Religion provides a moral code for appropriate behavior -Prospect of divine justice helps us tolerate the injustices of life -Need to better understand cultural diversity and the importance of religion in the healing process |
| Secular Ethics | -based on codes developed by societies that have relied on customs to formulate their codes (e.g. Code of Hammurabi-Babylon) |
| Situational Ethics | - view of ethics where absolute standards are considered less important, concerned w/ outcome of consequences of action -Importance of a particular value may vary as one's situation changes (moral character compromised when faced with difficult choices) |
| Ethical Decision Making | the process of deciding, what the right thing to do is in the event of a moral dilemma |
| Ethics Committee | an advisory body with multidisciplinary membership from the hospital and the community whose purpose is to facilitate the discussion and resolution of ethical issues arising in the patient care setting |
| Committee Composition | Ethicist, educator, caregiver, legal advisor, political leaders, religious leader, corporate leader |
| Ethic Committee Goals: Support | Providing guidance to patients, families and the decision makers |
| Ethic Committee Goals: Review of Cases | as requested, when conflict in basic values |
| Ethic Committee Goals: Provide assistance in clarifying situations | ethical, legal, or religious in nature that extend beyond the scope of daily practice |
| Ethic Committee Goals: Help in clarifying the issues | Discuss the alternatives and compromises |
| Ethic Committee Goals: Promote the rights of patients | Promote patient rights |
| Ethic Committee Goals: Assist the patient and family to reach a consensus | options that best meet the patient's care needs |
| Ethic Committee Goals: Promote fair policies and procedures | -maximize the likelihood of achieving good, patient-centered outcomes |
| Ethic Committee Goals: Enhance the ethical tenor of both healthcare organizations and professionals | |
| Ethic Committee Functions | -policy and procedure development -ethical education -Consultation and conflict resolution |
| Ethic Committee: Policies and Procedure Development | -guidance to healthcare professions when addressing ethical dilemmas -the goals and responsibilities of the ethics committee (what types of cases with be heard) -consultation process: how to access consult services, develop consultation guidelines |
| Ethic Committee: Education | -educate committee members, community, patient and family, and staff -develop educational resources (addressing ethical, legal & spiritual issues) -include training in philosopy, religion, medicine, & law -promote pt rights: right to self-determination |
| Ethic Committee: Consultation and Conflict Resolution | -aid in resolving uncertainty and disagreement over health care dilemmas -options and suggestions for resolution (pts, family, and caregivers can request) -provide guidance, not decisions |
| Ethic Committee: Request for consultation | -Clarification of the issues: determining decision-making capacity, informed consent, advance directives, withdrawal treatment -Should be conducted in a timely manner |
| Ethics Committee: Conducting a Consultation | -identify the dilemma -identify relevant facts -identify stakeholders -identify moral issues -consider alternative options -conduct consultation -review and follow-up |
| Expanding Role of Ethics Committees Internal Issues | -dilemma of blind drug trials (who gets placebo) -physician responsibility (must the physician inform pt of their education, training, qualification, & skill) -Privacy & confidentiality (what med info should be shared w/ pt's family & other caregivers) |
| Convening the Ethics Committee Rules to Follow | -Serve as a resource when there are no clear choices -Be sensitive to pt and family values -Search for the best path to conflict resolution -Educate and guide the process without personal biases |
| Facing Ethical Dilemmas Guidelines | -seek to diagnose before you prescribe -not sure what to do-discuss you dilemma w/ other committee members -do not impose your beliefs on others -help guide other to make choices -ask patient how you might help |
| Reasoning and Decision Making | -process of deciding the right thing to do when facing a moral dilemma -Reason: capacity for logical inference; ability to conduct inquiry, evaluate, criticize, deliberate, and solve problems; reach an understanding of self-others |
| Partial Reasoning | -bias for or against a person based on relationship with that person |
| Circular reasoning | -premise is the conclusion and the conclusion is the premise of the argument -person sees no need for deliberation |
| Abortion | -the termination of pregnancy-by removal or expulsion -spontaneous vs. elective -controversy: fetal rights vs. rights of the mother |
| Abortion: Ethical and Legal Issues | -Rights of the woman: autonomy -Rights of the fetus: to be born -Rights of the spouse: paternal rights -Rights of the state: protecting life |
| Abortion: Ethical and Legal Issues | -When does life begin (who decides?) -Who protects the unborn fetus -What are the rights of the child or woman who has been raped? -Should abortion be considered murder? (a form of killing by preventing a birth that might have otherwise occurred) |
| Abortion: Ethical and Legal Issues | -what are the religious implications -what role should education play in the woman's decision to undergo an abortion |
| Woman's Right to Privacy: Roe vs. Wade (1973) | -Woman's right to privacy -State's Rights in protecting the unborn -1st trimester: decision between woman and doctor -2nd trimester: state may regulate procedure -3rd trimester: state may prohibit all abortion (except those deemed necessary) |
| Undue Burden Rule 1992: Planned Parenthood vs. Casey | -Supreme court reaffirmed: -constitutional right of women to have abortion -state can restrict abortions after fetal viability (exceptions for woman's health in danger) -state has a legitimate interest (protecting health of woman & life of fetus) |
| Undue Burden Rule 1992: Planned Parenthood vs. Casey | -how does the court evaluate state abortion rules? -based on whether they unduly burden woman's ability to obtain an abortion (purchase to place substantial obstacle in the path of women) -Undue burden: notify the husband |
| Undue Burden Rule 1992: Planned Parenthood vs. Casey | -Not undue burdens: -to inform woman of nature of procedures & risks -to offer info on fetus and alternatives -for woman to give informed consent -to require parental consent for minor -require 24 hr waiting period prior to abortion |
| Morality of Abortion | -not a legal or constitutional issue (matter of philosophy, ethics, and theology) -abortion dilemma arises because individual difference in life (experience, culture, beliefs, religion, and education) -reasonable people have divergent convictions |
| AIDS | -deadliest epidemic in human history -1st case appeared in 1981 (more than 21 million people have died) -Spread by direct contact with affected blood and body fluids |
| AIDS: Confidentiality Ethical Issues | -physician's right to privacy vs. pts right to know -MD- 4th amendment rights -Utilitarianism-greatest good for greatest # -Conscientiousness-moral integrity & strict regard for doing right thing -disclosure can lead to criminal/civil penalties |
| Artificial Insemination | -process of injection seminal fluid into a woman to induce pregnancy -sperm placed into the reproductive tract -sources of sperm: -homologous: semen of spouse used -heterologous: semen from donor other than human |
| Artificial Insemination | -Consent (Oklahoma) -Required in writing from executing MD, local judge, husband and wife -Confidentiality: consent form not a matter of public record |
| Organ Donation | -treats patients w end-stage organ dx facing organ failure -Fed regulations require: protocol regarding an organization's organ procurement responsibilities, specific notification duties, informing families of donor, educating hospital staff on donation, |
| Uniform Anatomical Gift Act | -statute enacted by all 50 states -Allows: persons to make a decision to donate, potential donors to carry an anatomical donor card -Who: sound mind, 18 years of age -How: will, other written instrument |
| Research, Experimentation, and Clinical Trials | -answers specific question about a drug's safety (pt vs being in the study) -Ethical principles: respect for person, beneficence, justice, autonomy |
| Institutional Review Board | -Federal regulations require hospital-based IRB -mechanism approving & overseeing use of investigative protocols (protecting rights & welfare human subjects) -IRB Functions: review proposed research studies, approve protocols research, conduct oversight |
| Clinical Trials: Informed Consent | -Physicians must disclose: risks, benefits, & treatment alternatives (legal obligation=duty) -Obtain written consent from patient -risks, benefits, and treatment alternatives -cannot contain: coercive language forcing pt to waive certain rights |
| Clinical Trials: Informed Consent | -Organizations conducting trials must: disclose treatment costs, determine competency of patient consent -Educate staff: potential side effects of treatments, implementation of protocols, monitoring of protocols |
| Sterilization | -the termination of the ability to produce offspring -vasectomy -tubal ligation -reasons: economic, therapeutic, genetics -Elective sterilization: voluntary, requires proper consent, individual is competent |
| Sterilization | -Therapeutic sterilization: performed to preserve life or health -Eugenic sterilization of certain categories of individuals (without need for consent, individuals such as mentally deficient, feeble-minded, habitual crimes) |
| Surrogacy | -Method of reproduction -Surrogate may be: child's genetic mother, gestational carrier -Ethical and legal issues: legal right to enter a surrogacy? long-term effect of surrogacy contracts? psychological impact on child -Ct decisions are split |
| Stem Cell Research | -use of embryonic stem cells -to create organs and various body tissues -Highly controversial issue generally -Involving religious beliefs -Fears as to how far scientists might go (another human being, Dolly the sheep in 1996) |
| Human Struggle to Survive | -dreams of immortality -race to prevent and cure illness -advances in medicine prolongs life -process of dying period prolonged -artificial body organs -exotic machines -medications |
| Euthanasia | -Greek: euthanatos, euthanasia, meaning "good death" or "easy death" -The mercy killing of the hopelessly ill, injured, or incapacitated |
| Active or Passive Euthanasia | -Active euthanasia: intentional commission of an act, which results in death (administration of a lethal dose of medication) -Passive euthanasia: when life-saving treatment (e.g. respirator) is: withdrawn or withheld |
| Voluntary or Involuntary Euthanasia | -Voluntary: suffering person makes decision to die -Involuntary: person other than the incurable makes decision to terminate the life |
| Value Questions Courts Face in Involuntary Euthanasia | -Who should decide (withhold or withdrawal treatment) -Factors on which decision should be based? -Viable standards to guide courts? -Criminal sanctions be imposed on a person assisting in ending a life? -When does death occur? |
| Constitutional Considerations: Autonomy | Shloendorff vs Society of NY Hospital: Every human being of adult years has a right to determine what shall be done with his own body; & the surgeon who performs an operation without his pt's consent commits an assault for which he is liable for damages. |
| In Re Storar | Every human being of adult years and sound mind has the right to determine what shall by done with his or her body |
| In re Quinlan | -Constitutional right to privacy protects pt's right to self-determination -A state's interest: not a justified interference with one's right to refuse treatment |
| In re Dinnerstein | -"No Code" orders are valid -prevent the use of artificial resuscitative measure on incompetent terminally ill patients |
| Court Involvement when: | -family members disagree as to the incompetent's wishes -physicians disagree on the prognosis -a pt's wishes are unknown because pt has always been incompetent -evidence exists of wrongful motive of malpractice |
| Defining Death | -irreversible cessation of brain function -AMA in 1974: when there is irreversible cessation of all brain functions including the brain stem |
| Prolongation of life | -Factors determine pt's intention to reject prolongation of life include: -persistence of statements regarding pt's beliefs -commitment to beliefs -seriousness of the statements were made -inference drawn from surrounding circumstances |
| Patient Self-Determination Act of 1990 | -Patients have the right: to formulate advanced directives, make decisions about their care, accept or refuse medical treatment -Healthcare providers receiving federal funds under Medicare must comply with the act to get reimbursement |
| Legislative Response | -After Cruzan decision, states began to draft new legislation -living wills -durable powers of attorney -healthcare proxies -surrogate decision making |
| Living will | -Instrument or legal document -describes treatments an individual wishes or does not whish to receive should he or she become incapacitated & unable to communicate treatment decisions -should be signed and dated by individual (and 2 unrelated witnesses) |
| Durable Power of Attorney | -legal device -permits individual known as "principal" to give to another person "attorney in fact" authority to act on their behalf -is authorized to handle banking, incur expenses, pay bills (expires if principal dies/becomes mentally incapacitated) |
| Durable Power of Attorney for Health Care | -legal instrument -designates and grants authority to an agent to make health and personal care decision for the patient (event the pt becomes unable to make their own decisions) |
| Healthcare Proxy | -legal document -allows a person to appoint a health care agent to make treatment decisions in the event he or she becomes incompetent and is unable to make decision |
| Surrogate decision maker | an agent who acts on behalf of a patient who lacks the capacity to participate in a particular decision |
| Substituted Judgment | -form of surrogate decision-making -surrogate attempts to establish what decision the patient would have made if that patient were competent to do so |
| Advanced Directives | -a form of living will or durable power of attorney -pts make decisions about their health care with their physician in advance of incapacity (may agree to a proposed treatment, choose among treatments, or say no to a treatment option |
| Guardianship | -legal mechanism by which a court declares a person incompetent and appoints a guardian |
| Physician assisted suicide | US Supreme Court rejected Kevorkian's argument that assisted suicide is constitutional right -Supreme Court Ruled -WA and NY laws prohibiting assisted suicide are constitutional -States can allow doctors to assist in suicide of their terminally ill pts |
| Criminalizing assisted suicide | -Quill v. Vacco, distinguished between refusing treatment and assisting suicide -State's interest -prohibiting intention killing &preserving life -prevent suicide -maintaining MD's role as healer -protect vulnerable ppl from indifference, predjudice. |
| Oregon's Death With Dignity Act | -Allows terminally ill Oregon resident to obtain lethal dose of medication for their physician -Legalizes physician assisted suicide -Prohibits physician or other person directly administers medication to end another's life |
Created by:
courtneyjustine