Accounting assignments
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finallesson5.pptxChapter 15
Healthcare Ethics
Learning Objectives (1 of 2)
Describe the concepts of ethics and morality.
Describe how an understanding of ethical theories, principles, virtues, and values is helpful in resolving ethical dilemmas.
Explain the relationship between spirituality and religion.
Learning Objectives (2 of 2)
Discuss situational ethics and how one’s moral character can change as circumstances change.
Explain how one’s reasoning skills influence the decision-making process.
Discuss the purpose of an ethics committee and its consultative role in the delivery of patient care.
Any Good I Can Do
I expect to pass through the 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, French-American Religious Leader (1773–1855)
Words Are “Tools of Thought”
The following is true of the study of any new subject:
New vocabulary and an understanding of abstract theories and principles of ethics will be necessary.
Such knowledge will arm the decision maker with the information necessary to help make difficult care decisions.
Ethics
Ethics is the branch of philosophy that deals with values relating to human conduct with respect to rightness and wrongness of actions and goodness and badness of motives and ends.
It involves the study of morality, virtues, and values, and how they affect one’s character.
It involves how individuals decide to live within accepted boundaries and how we live in harmony with one another and nature.
Scope of Ethics
Micro-ethics: Individual’s view of right and wrong
Macro-ethics: Global view of right and wrong
Ethics from Various Perspectives
Ethics is used in different but related ways.
Philosophical ethics involves inquiry about ways of life and rules of conduct.
Ethics may also be a general pattern or way of life (e.g., religious ethics).
Ethics may refer to moral codes.
Why Study Ethics?
To recognize healthcare dilemmas
To provide tools for constructive deliberation and conflict resolution
To make sound judgments
To better understand the goodness and badness of motives and ends
Morality
Aim above Morality.
Be not simply good;
be good for something.
—Henry David Thoreau
What Is Morality?
Morality is a code of conduct.
It implies the quality of being in accord with standards of right and good conduct.
It describes a class of rules held by society to govern the conduct of its individual members.
Morals
Ideas about what is right and wrong
Guides to behavior that rational persons put forward for governing their behavior
Moral Judgments (1 of 3)
Judgments concerned with what an individual or group believes to be right or proper behavior in a given situation
Involve assessment of another person’s moral character based on how he or she conforms to moral convictions established by the individual and/or group
Moral Judgments (2 of 3)
Lack of conformity typically results in:
Moral censure
Condemnation
Possible derision of the violator’s character
What is considered right varies from nation to nation, culture to culture, religion to religion, and person to person.
Moral Judgments (3 of 3)
There is no “universal morality.”
Whatever guide to behavior an individual regards as overriding and wants to be universally adopted is considered that individual’s morality.
Codes of Ethics
Codes of ethics provide for:
Standards: As guides to human conduct
Principles: Describe responsibilities
Rules of expected conduct: No allowance for individual judgment
Morality Legislated
Law is distinguished from morality.
Law has explicit rules, penalties, and officials who interpret laws and apply penalties.
Laws are created to set boundaries for societal behavior.
Laws are enforced to ensure expected behavior happens.
Ethical Theories
Ethical Theories
Attempt to introduce order into the way people think about life and action
Are the foundation of ethical analysis and provide guidance in the decision-making process
Present varying viewpoints that assist caregivers in making difficult decisions that impact the lives of others
Ethics, too, are nothing but reverence for life. This is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil.
—Albert Schweitzer
Normative Ethics (1 of 2)
Attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right
General normative ethics is the study of major moral precepts of what things are right.
Applied ethics is the application of normative theories to practical moral problems.
Normative Ethics (2 of 2)
Descriptive ethics, also known as comparative ethics, deals with what people believe to be right and wrong.
Meta-ethics seeks to understand ethical terms and theories and their application.
Consequential Ethics (1 of 2)
Morally right action involves:
Maximum balance of good over evil
The greatest good for the greatest number
Rightness or wrongness of an action is based on the consequences or effects of the action.
Consequential Ethics (2 of 2)
Questions to be asked
What will be the effects of each course of action?
Will the effects be positive or negative?
Who will benefit?
What will do the least harm?
Utilitarian Ethics
Form of consequentialism
Philosophy that advocates the greatest good for the greatest number
Nonconsequential Ethics
The rightness or wrongness of an action is based on properties intrinsic to the action, not on its consequences.
Situational Ethics (1 of 3)
Refers to a particular view of ethics in which absolute standards are considered less important than the requirements of a particular situation
The importance of a particular value may vary as one’s situation changes.
Situational Ethics (2 of 3)
Moral character can be compromised when someone is faced with difficult choices.
Good people behave differently in different situations.
Situational Ethics (3 of 3)
Good people sometimes do bad things.
One’s moral character can sometimes change as circumstances change (thus, the term situational ethics).
Situational Ethics: The Creation of Ignorance
How Common is the Creation of Ignorance?
It’s pretty common. I mean in terms of sowing doubt, certainly global warming denialists who for years have managed to say, “well the case is not proven. We need more research.” And what’s interesting is that a lot of the people working on that were also the people working on Big Tobacco.
—Interview with Robert Proctor
Professor, Stanford University
Discover, 2008
Situational Ethics: Discussion
Why do people who do bad things in one job repeat their pattern of doing bad in another? What is their motive?
Why do people watch bad things happen and then deny they are happening? Explain.
What is often referred to as being the “root of all evil?” How does it apply in this case?
Situational Ethics: Sustaining Life
A decision not to use extraordinary means to sustain the life of an unknown 84-year-old may result in a different decision if the 84-year-old is one’s mother.
Situational Ethics: Ethical Decision Making
Ethical decision making is the process of deciding what the right thing to do is in the event of a moral dilemma.
Situational Ethics: Case: High in the Andes (1 of 2)
Those who survived the plane crash high in the Andes Mountains were faced with some difficult survival decisions.
Their need to survive illustrates to what lengths one may go in certain situations in order to survive (see text for details).
Situational Ethics: Case: High in the Andes (2 of 2)
How might you change as circumstances change?
Describe how your consultative advice might change based on the patient’s needs, beliefs, and family influences.
Deontological Ethics
Focuses on
Duty to others
Rights of others
Forms
Religious ethics
Based on religious beliefs
Secular ethics
Based on codes developed by societies that have relied on customs
Ethical Relativism (1 of 2)
The theory that holds that morality is relative to the norms of one’s culture; that is, whether an action is right or wrong depends on the moral norms of the society in which it is practiced
Ethical Relativism (2 of 2)
What is morally correct behavior in one society may be morally wrong and another.
An action can be considered right or wrong depending on the accepted norms of the society in which it is practiced.
For example, slavery may be considered an acceptable practice in one society and an unacceptable practice in another.
Virtue-Based Ethics
Focuses on the inherent character of a person rather than on the specific actions that he or she performs
A virtue is normally defined as some sort of moral excellence or beneficial quality.
Virtues are those characteristics that differentiate good people from bad people.
A morally virtuous person is one who does the good and right thing by habit.
Principles of Healthcare Ethics
Autonomy
Right of a person to make one’s own decisions.
Patient has the right to accept or refuse care even if it is beneficial to saving his or her life.
May be inapplicable in certain cases
Affected by one’s disabilities, mental status, maturity, or incapacity to make decisions
Beneficence and Justice
Beneficence
Principle of doing good
Paternalism
Medical paternalism
Nonmaleficence
Avoid causing harm
Tuskegee Syphilis Experiment
National Research Act of 1974
Justice
Obligation to be fair in the distribution of benefits and risks
Distributive justice
Requires that all individuals be treated equally
Injustice for the Insured
Even if you’re insured, getting ill could bankrupt you.
Hospitals are garnishing wages, putting liens on homes, and having patients who can’t pay arrested.
It’s enough to make you sick.
—Sara Austin, SELF, October 2004, p. 247
Justice and Age (1 of 2)
Should an 89-year-old patient get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a 10-year-old girl?
Justice and Age (2 of 2)
Should a pregnant 39-year-old single parent get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a 10-year-old boy?
Justice: Disaster Patients: Who Gets Treated First?
Room #1: Severely injured patients not expected to live
Room #2: Severely injured patients most likely to live if treated
Room #3: Injured patients who will live but will suffer varying degrees of disability if not treated promptly
Justice: Emergency Care
Two patients are in critical condition. Who gets treated first?
First patient who walks through the door
Younger patient
Patient most likely to survive
Patient who can pay for services
Patient with most serious condition
Justice: Scarce Resources
What happens when resources are scarce and only one of two patients can be treated?
What should be the determining factors?
Age
Position in life
Patient wishes
Values
Moral value is the 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 are used for judging goodness or badness of some action.
Values give purpose to each life; they describe one’s moral character.
Intrinsic and Instrumental Values
Intrinsic value
Something that has value in and of itself
Instrumental value
Something that helps to give value to something else
Money is valuable for what it can buy.
Values Can Change
People make value judgments and choices among alternatives.
Values one so dearly proclaims may change as needs change.
If one’s basic needs for food, water, clothing, and housing have not been met, one’s values may change in such a way that a friendship, for example, might be sacrificed if one’s basic needs can be better met as a result of the sacrifice.
The motivating power of a person’s actions is a necessity for survival.
Differing Values
If mom’s estate is being squandered at the end of life, a family member financially well-off may want to hold on to mom despite the financial drain on her estate.
Another family member financially struggling to survive may more readily see the futility of expensive medical care and find it easier to let go.
Courage
Courage is the greatest of all virtues,
because if you haven’t courage,
you may not have an opportunity
to use any of the others.
—Samuel Johnson
Virtues and Values: What is Courage?
Courage is the mental or moral strength to persevere and withstand danger.
Courage is the ladder on which all the other virtues mount.
Courage involves balancing fear, self-confidence, and values.
Without courage, we are unable to take the risks necessary to achieve the things most valued.
Virtues and Values: The Courageous Person
A courageous person has good judgment and 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.
Virtues and Values (1 of 4)
Wisdom
Temperance
Commitment
Detachment
Virtues and Values (2 of 4)
Compassion
Conscientiousness
Discernment
Fairness
Virtues and Values (3 of 4)
Fidelity
Freedom
Honesty/Trustworthiness/Truth-Telling
Integrity
Virtues and Values (4 of 4)
Kindness
Respect
Hopefulness
Tolerance
Forgiveness
Religious Ethics
Religion provides a moral code for appropriate behavior.
The prospect of divine justice helps us tolerate the injustices in life.
There is a need to better understand cultural diversity and the importance of religion in the healing process.
Spirituality
Spirituality in the religious sense implies that there is purpose and meaning to life.
Spirituality generally refers to faith in a higher being.
Religious Beliefs (1 of 2)
Judaism
Monotheistic religion
Hinduism
Buddhism
Falun Gong
Zen
Taoism
Religious Beliefs (2 of 2)
Christianity
Based on Jesus Christ as Savior
Jehovah’s Witnesses
Anointing of the sick for healing
Islam
Religious Beliefs and Duty Conflict
Belief that it is a sin to accept a blood transfusion
Right to refuse
Necessity to work within the law and judicial system when states’ rights and the rights of a minor are involved
Secular Ethics
Based on codes developed by societies that have relied on customs to formulate their codes
Code of Hammurabi
Professional Ethics (1 of 2)
Standards or codes of conduct established by the membership of a specific profession.
Healthcare professionals are governed by ethical codes.
Codes of ethics are created in response to actual or anticipated ethical conflicts.
Professional Ethics (2 of 2)
Documentation falsified
Psychologist’s sexual misconduct
Attorney–minister misconduct
Ethics Committee: Objectives
Support and guidance
Analyze ethical dilemmas, advise and educate healthcare providers, patients, and families.
Assist patient and family in coming to consensus with options that best meet patient’s goal for care.
Ethics Committee: Functions
Policy and procedure development
Educational role
Consultation and conflict resolution
Requests for consultations
Expanding role of the ethics committee
Internal role: Organizational and patient care issues
External role: Political advocacy
Reasoning and Decision Making (1 of 4)
Reason guides our attempt to understand the world about us. Both reason and compassion guide our efforts to apply that knowledge ethically, to understand other people, and have ethical relationships with other people.
—Molleen Matsummura
Reasoning and Decision Making (2 of 2)
Reasoning is the process of forming conclusions, judgments, or inferences based on one’s interpretation of facts or premises that help support a conclusion.
Reasoning and Decision Making (3 of 4)
Partial reasoning
Involves bias for or against a person based on one’s relationship with that person
Circular reasoning
Describes a person who’s already made up his or her mind on a particular issue and sees no need for deliberation
Reasoning and Decision Making (4 of 4)
Ethical decision making is the process of deciding what the right thing to do is in the event of a moral dilemma.
Patients have an obligation to make medical preferences known to their treating physician.
Any glimmer of uncertainty as to a patient’s desires in an emergency situation should be resolved in favor of preserving life.
Ethical Dilemmas
Ethical dilemmas arise when ethical principles, values, rights, duties, and loyalties conflict.
A caregiver must not only examine what he or she considers the right thing to do, but what are the alternatives, and what are the patient’s known wishes.
Moral Compass Gone Astray (1 of 3)
The world is a dangerous place.
Not because of the people who are evil;
but because of the people who don’t do anything about it.
—Albert Einstein
Moral Compass Gone Astray (2 of 3)
Hartford Police Chief questions the city’s “moral compass” a week after bystanders and drivers maneuvered around the motionless body of the 78-year-old victim of a hit-and-run crash.
Moral Compass Gone Astray (3 of 3)
The continuing trend of awareness of declining value systems, coupled with increased governmental regulations, mandates that caregivers understand ethics and the law and the relationships.
Moral Compass Gone Astray: Discussion
What moral principles might the sheriff have been referring to when he questioned the city’s lack of a moral compass? Explain.
Discuss your thoughts as to why society in general is losing its moral compass.
Practical Suggestions (1 of 2)
Be a good listener.
Listen with the intent to learn, not to find fault or argue.
Listen to contribute and resolve ethical dilemmas.
Practical Suggestions (2 of 2)
Believe in good values.
Become virtuous by practicing good values until they become habits.
Summary Thoughts
Be careful of your thoughts, for your thoughts inspire your words.
Be careful of your words, for your words precede your actions.
Be careful of your actions, for your actions become your habits.
Be careful of your habits, for your habits build your character.
Be careful of your character, for your character decides your destiny.
What Can You Control?
Although you cannot control the amount of time you have in this life, you can control your behavior by adopting the virtues and values that will define who you are and what you will become and how you will be remembered or forgotten.
Helpful Hints (1 of 2)
Be aware of how everyday life is full of ethical decisions and that numerous ethical issues can arise when caring for patients.
Help guide others to make choices.
Ask your patient how you might help him or her.
Be aware of why you think the way you do. Do not impose your beliefs on others.
Helpful Hints (2 of 2)
Ask yourself whether you agree with the things you do. If the answer is no, ask yourself how you should change.
When you are not sure what to do, the wise thing to do is to talk it over with someone whose opinion you trust.
Do not sacrifice happiness for devotion to others.
Do not lie to avoid hurting someone’s feelings.
Review Questions (1 of 2)
Describe how ethical theories differ and how ethical principles are helpful to caregivers and the ethics committee in resolving ethical dilemmas.
Describe how spirituality and religion help to shape one’s healthcare choices.
Review Questions (2 of 2)
Describe why healthcare decisions can change as circumstances change.
Describe the consultative role of the ethics committee when addressing ethical dilemmas.
