Foundation in theory

HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit I Upon completion of this unit, students should be able to:

7. Discuss common ethical principles applied to critical bioethical issues. 7.1 Evaluate common principles and theories of health care ethics.

Course/Unit

Learning Outcomes Learning Activity

7.1

Unit Lesson Chapter 1 Chapter 2 Unit I Assessment

Required Unit Resources Chapter 1: Theory of Healthcare Ethics Chapter 2: Principles of Healthcare Ethics Unit Lesson In this unit, we will discuss foundations in theory. Particularly, we will learn about different theories and principles of health care ethics. Having a solid foundation of the theories and principles of health care ethics will allow you to have greater clarity when it comes to ethical decision-making in health care. Change, particularly in health care, is not new. More specifically, it is a driving force and theme of the current health care arena. Health care ethics are the moral principles that govern the U.S. health care delivery system. They provide a framework for which health care products and services are delivered. The 21st century promises individual, societal, and organizational health care ethical challenges (Morrison & Furlong, 2014). Before discussing the current state of health care ethics (in future units), it is important to understand the history behind health care ethics and the theories and principles. Ancient Greek philosophers sought to understand and apply reasoning in determining the correct course of action for a situation and how to explain why it was correct (Morrison & Furlong, 2019). Thomas Percival wrote Percival’s Medical Ethics in 1803, and the American Medical Association (AMA) first met and established the AMA Principle in 1847. These codes of ethics were established in accordance with the trends of medicine at the time (AMA, 2017). Recognition and acknowledgement of the rights and needs of patients receiving highly technical care grew as technology advanced (Mastrian & McGonigle, 2017). Medical decisions are made based on sound facts and ethical values. Historically, health care decision- making and patient privacy have been kept by health care professionals using codes of ethics, laws, principles, and regulations. Ethics codes consist of a list of principles. Several organizations have developed codes of ethics for patients as well as health care professionals. Developed by professional organizations, examples of health care codes of ethics include the following:

• American Nurses Association Code of Ethics for Nurses, • American Association of Medical Assistants (AAMA) Code of Ethics for Medical Assistants, • AMA Code of Medical Ethics, and • American Health Information Management Association Code of Ethics.

UNIT I STUDY GUIDE Foundations in Theory

HCA 3302, Critical Issues in Health Care 2

UNIT x STUDY GUIDE Title

Normative Ethical Theories Normative ethics use reasoning as a means of determining the right course of action that should be taken in certain situations. Normative ethics is the examination of right and wrong. There are six types of normative theories.

• Authority-based theories are typically faith-based and can be purely ideological. An example of this type of theory would be the works of Karl Marx (1818–1883) or capitalism (Morrison & Furlong, 2019). These theories determine the right thing to do based on an understanding of what an authority has said. Most often, religion-based ethics are avoided in health care because they lack the evidence to support them.

• Natural law theory is the traditional interpretations and works of St. Thomas Aquinas (1224–1274). Both rationally and in accordance with God’s providence and wisdom, nature has order (Morrison & Furlong, 2019). This is a moral theory and a legal theory. It is believed that natural law is an inherent part of nature. This type of theory is important in health care because of the influence of the Roman Catholic Church and the teachings of St. Thomas Aquinas as an early writer of ethics. Debates about abortion and social justice are rooted in the natural law theory (Morrison & Furlong, 2014).

• Teleological theories, called consequentialism, advocate that decisions are made from outcomes or consequences. The idea is to maximize the good of a situation. Consequentialism includes classical utilitarianism that consist of actions that are dependent on net benefit. It also includes rule utilitarianism, which are rules that have the greatest net benefit (Morrison & Furlong, 2014). An action’s consequence is the focus rather than the moral duties (Dixon, n.d.). The originators of this theory were Jeremy Bentham (1748–1832) and Stuart Mill (1806–1873).

• Deontological theories originated from the work of Immanuel Kant (1724–1804). This theory is the science of determining duties. It suggests that taking the right action does not always lead to a better outcome (Morrison & Furlong, 2019). Deontological ethical theories focus on moral obligations and duties and not so much on the action’s consequences or end. Moral duties are more important that moral value (Dixon, n.d.).

• Virtue ethics aim to find the proper end for human beings and then to look for that end. This can be where people seek excellence or perfection. It is used when training health care professionals (Morrison & Furlong, 2014). The goal of virtue ethics is to build character. It places less weight on learning rules and strains the importance of developing respectable habits of character (Fieser, n.d.). It is used as an avenue to assist health professionals with finding their highest good with an intent of improving health care outcomes. Virtue ethics are used most often in health care and are the premise for holding medical clinicians to a set of moral standards. Virtue ethics can be traced back to Plato (427–347 BCE) and Aristotle (384–322 BCE; Morrison & Furlong, 2019).

• Egoistic theories argue that what is correct is what maximizes a person’s self-interest (Morrison & Furlong, 2019). Egoistic theories are rooted in self-interest and do not take into account the benefit decisions may have on others outside of oneself. Egoism is a less popular ethical theory because self-interest supersedes the interest of patients. In health care, the ethical approach of the health care providers is to put the patient and his or her preferences above the preferences of the care team. In other words, these types of theories are not ideal in health care because patient interest is deemed to be the priority.

Principles of Health Care Ethics

The principles of ethics are based on theory and provide a foundation for responding to unforeseen health care issues, such as the uncertainty that existed with the implementation of the Patient Protection and Affordable Care Act or ACA of 2010, also known as Obamacare. Although the ACA has been in place for nearly a decade, ethical issues remain a public concern.

• Nonmaleficence means to do no harm. There is no debate over whether to avoid doing harm in health care ethics, but a debate does arise as to what the term harm means (Morrison & Furlong, 2014). This is the first part of the Hippocratic ethical teaching, “first do no harm . . . .”

• Beneficence means to avoid harm and suggest a level of altruism. In health care, it is a common morality. This is the second part of the Hippocratic ethical teaching, “. . . benefit only.” In all situations, health care organizations must do all they can do to benefit a patient (Saint Joseph’s University, 2017).

HCA 3302, Critical Issues in Health Care 3

UNIT x STUDY GUIDE Title

• Autonomy means self-ruling. In health care, it can be unclear as to whether or not a patient possesses the conditions required for autonomy (Morrison & Furlong, 2014). Is a patient competent to make decisions? A patient has the right to control his or her body and make his or her own decisions independently and in accordance with personal beliefs and values (Saint Joseph’s University, 2017).

• Theories of justice consist of two main theories: procedural justice and distributive justice. Procedural justice is due process. In health care, procedural injustices do occur. Distributive justice relates to what is fair when decision makers are determining how to separate benefits and burdens (Morrison & Furlong, 2014). Resource allocation has a lot to do with distributive justice. There should be fairness in all health care decisions; this includes decisions of benefits and burdens and equal distribution of new treatments or scarce resources. Health care providers must follow all regulations and laws when treating a patient and making decisions (Saint Joseph’s University, 2017).

Health Care Equilibrium

Principles of ethics take part in the necessary elements for health care equilibrium. Health care equilibrium is grounded in ethical principles. Justice is complex because what is right is subjective and can always be disputed. An awareness of rights and justice is essential for the allocation of health care resources (Morrison & Furlong, 2014). Ethical principles used in health care have helped shape how other industries practice. Despite the number of ethical principles that exist, not one theory alone will satisfy every complex issue, which is why more than one is often needed to make health care decisions. The reflective equilibrium decision-making model can be applied to issues at hand by going through the ethical theories, principles, morality, and judgments. Typically, in health care, an ethics panel or committee is trained in applying this model to decision-making.

Conclusion Ethics is a complex arena. In the 21st century and beyond, the scarcity of health care resources and the continuous spread of infectious diseases globally will increase the demand for health care professionals and stakeholders to use ethical concepts and reasoning to improve health care outcomes. An awareness of the ethical principles that exist is essential for policy makers and health professionals when working with patients and their families as well as implementing health care reform (Morrison & Furlong, 2014). The cornerstone of decision-making in health care is ethics. However, health care as a whole has embraced the concept of a patient-centered mode.

References American Medical Association. (2017). History of the code. https://www.ama-

assn.org/sites/default/files/media-browser/public/ethics/ama-code-ethics-history.pdf Dixon, M. (n.d.). Normative ethical theories: A closer examination. Ohio Northern University.

www2.onu.edu/~m-dixon/handouts/ethical%20theories.html

Fieser, J. (n.d.). Ethics. In J. Fieser, & B. Dowden (Eds.), Internet encyclopedia of philosophy. https://www.iep.utm.edu/ethics/#SSH2c.ii

Mastrian, K. G., & McGonigle, D. (2017). Informatics for health professionals. Jones & Bartlett Learning. Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning. Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning. Saint Joseph’s University. (2017). How the four principles of health care ethics improve patient care.

https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of- health-care-ethics-improve-patient-care