Health Care Law and Legislation, Statistics Policies

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Health Care Ethics

Chapter 14

LEARNING OBJECTIVES

Describe the concepts of ethics & morality.

Describe how an understanding of ethical theories, principles, virtues, & values are helpful in resolving ethical dilemmas.

Explain the relationship between spirituality & religion.

Discuss situational ethics & how one’s moral character can change as circumstances change.

Explain how one’s reasoning skills influence the decision-making process.

I expect to pass through this world but once. Any good therefore that I can do, or any kindness I can show to any creature, let me do it now. Let me not defer it, for I shall not pass this way again

−Stephen Grellet

Ethics

Branch of philosophy that deals with values relating to human conduct with respect to rightness & wrongness of actions & goodness & badness of motives & ends.

Focus on rightness & wrongness of actions.

Concerned with what is morally good & bad, right & wrong.

Ethics – II

Microethics

individual’s view of right & wrong.

Macroethics

global view of right & wrong.

Ethics – III

Philosophical Ethics

involves inquiry into

ways of life

rules of conduct

Religious Ethics

a general pattern or“Way of Life”

Professional Ethics

a set of rules or moral code

Morality

Code of conduct

Guide to behavior

Describes class of rules held by society to govern conduct

Moral dilemmas occur

when moral ideas of right & wrong conflict

Morality Legislated

Law is distinguished from morality in that

law has explicit rules, penalties, & officials who interpret laws & apply penalties.

Laws created to set boundaries for societal behavior.

laws are enforced to ensure expected behavior happens.

Moral Judgments

Judgments are concerned with

what an individual or group believes to be the right or proper behavior in a given situation

No Universal Morality

right varies from nation to nation, culture to culture, religion to religion, as well as from one person to the next

Code of Conduct

Prescribe standards of conduct

States principles

Expresses responsibilities

Defines rules expressing duties of professionals to whom they apply

Ethical Theories

Normative Ethics

attempt to determine what moral standards should be followed so that human behavior & conduct may be morally right

General Normative Ethics

Applied Ethics

Descriptive Ethics

Meta-ethics

Ethical Theories II

Consequential Ethics

theory of ethics that emphasizes morally right action is whatever action leads to maximum balance of good over evil

Utilitarian Ethics

concept that moral worth of an action is solely determined by its contribution to overall usefulness

Ethical Theories III

Nonconsequential Ethics

Denies consequences of an action are only criteria for determining morality of an action

Deontology

doing right thing is good

might not always lead to or increase the good & right thing sought after

Ethical Theories IV

Ethical Relativism

morality is relative to the norms of one’s culture

whether an action is right or wrong depends on the moral norms of the society in which it is practiced

Ethics Theories - V

Virtue Based Ethics

focuses on inherent character of a person

not on the specific actions that he or she performs.

a morally virtuous person is one who does the good & right thing by habit.

Principles of Ethics – I

Ethical principles

universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, & motives are valued.

Autonomy

Life or Death: the Right to Choose

Principles of Ethics – II

Beneficence

Nonmaleficence

Justice

Distributive Justice

Virtues & Values

Virtue

normally defined as some sort of moral excellence or beneficial quality.

Moral value

relative worth placed on some virtuous behavior

What has value to one person may not have value to another.

A value is a standard of conduct.

Values used for judging goodness or badness of an action

Pillars of Moral Strength

Courage

Wisdom

Temperance

Commitment

Compassion

Detachment

Pillars of Moral Strength - II

Conscientious

Discernment

Fairness

Fidelity

Freedom

Honesty/Trustworthiness/Truth-Telling

Pillars of Moral Strength - III

Integrity

Kindness

Respect

Hopefulness

Tolerance

Forgiveness

Spirituality & Religion

Spirituality

in the religious sense implies that there is purpose & meaning to life; spirituality generally refers to faith in a higher being

Religion

serves a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source

Religions

Judaism

Hinduism

Buddhism

Taoism

Religions - II

Zen

Christianity

Jehovah’s Witnesses

Islam

Religious Beliefs and Duty Conflict

Secular Ethics

Based on codes developed by societies that have relied on customs to formulate their codes

Code of Hammurabi

Situational Ethics - I

Outcome or consequences of an action in which ends can justify the means

Moral values & moral character can be compromised when faced with difficult choices

Situational Ethics - II

Good people behave differently in different situations.

Good people sometimes do bad things

Beliefs can sometimes change as circumstances change

thus the term situational ethics

Sustaining Life Situational Ethics

Decision not to use extraordinary means to sustain life of an unknown 97 year old “may” result in a different decision if the 97 year old is one’s mother.

Reasoning Decision-Making

Reason includes the capacity for logical inference and the ability to conduct inquiry, solve problems, evaluate, criticize, and deliberate about how we should act and to reach an understanding of other people, the world, and ourselves.

Reasoning & Decision-Making – II

Partial reasoning involves bias for or against a person based on one’s relationship with that person.

Circular reasoning describes a person who has already made up his or her mind on a particular issue and sees no need for deliberation.

Reasoning Decision-Making – III

Ethics in decision-making involves the process of deciding the right thing to do when facing a moral dilemma.

Ethical dilemmas occur when ideas of right and wrong conﬂict.

Healthcare Dilemmas

Occur when there are alternative choices, limited resources, & differing values among patients, family members, & caregivers.

Coming to an agreement may mean sacrificing one’s personal wishes & following the road where there is consensus.

Consensus building can happen only when the parties involved can sit and reason together.

Professional Ethics

Standards or codes of conduct established by the membership of a specific profession.

Professionals are expected to follow ethical guidelines in the practice of their profession.

Content of the various codes of ethics vary depending on the risks associated with a particular profession.

Ethics Committee

Committee offering objective counsel when facing difficult health care issues & decisions resource to patients, families, & staff.

Analyzes ethical dilemmas, advise & educate health care providers, patients, & families.

Assists patients & family in coming to consensus with options that best meet the patient's care needs.

Ethics Committee Structure

Membership should include:

Ethicist

Clinicians

Legal counsel

Clergy

Quality Improvement Manager

Ethics Committee Function

Policy & Procedure Development

Educational Role

Hospital Staff

Community Education

Consultation & Conflict Resolution

Review Questions

1. Discuss the concept of morality.

2. Describes the various theories of ethics.

3. Describe the various principles of healthcare ethics.

4. Describe desirable virtues and values in the healthcare setting.

Review Questions - II

5. Given an example of situational ethics.

6. Discuss the importance of reasoning in the decision-making process.

7. Describe the purpose and function of a hospital ethics committee.