Discussion 9

HSA 515 Week 9 Lecture: Healthcare Ethics and Procreation and Ethical Dilemmas

Slide #

Scene/Interaction

Narration

Slide 1

Intro Slide

Slide 2

Scene 1

Professor Charles enters classroom and introduces the topics for today’s lesson and begins the lecture.

Prof Charles: Hello everyone. Welcome back to class. Today, we will discuss healthcare ethics, moral principles, and a variety of issues of procreation.

Ethics and morals are derivatives of the Greek and Latin terms for custom. Noting that words are the tools of thought, it is important to know some vocabulary in order to lay a foundation for applying abstract theories and principles of ethics and make practical use of them.

An ethical dilemma arises in situations where a choice must be made between unpleasant alternatives. It can occur whenever a choice involves giving up good and suffering something bad no matter what course of action is taken. In healthcare a caregiver may have to decide do I choose life knowing that an unborn child will be born with severe disabilities, or should I choose abortion and thus prevent pain for both child and mother?

Should I adhere to my spouse’s wishes not to be placed on a respirator, or should I choose life over death, disregarding her wishes and right to self-determination? Should I encourage the abortion of my daughter’s unborn child, which is the result of a gang rape, or do “no harm” to the unborn child? Such delimmas rise to conflicting answers.

Let’s first discuss ethics. What is the definition of ethics?

Casey: Ethics is that branch of philosophy that seeks to understand the nature, purposes, justification, and the founding principles of moral rules and the systems they comprise.

Donald: I would agree, but would also add that it focuses on the rightness and wrongness of actions, as well as goodness and badness of motives and ends. Ethics is the decision- making process determining the ultimate actions: What should I do, and is it the right thing to do?

Casey: In addition I would add that it involves how individuals decide to live, how they exist in harmony with the environment, and how they live with each other when so few have so much and so many have so little.

Prof. Charles: Absolutely… what are the three different but related ways ethics are used?

Casey: The three different ways ethics are used are philosophical ethics, which involves inquiry about ways of life and rules of conduct; the second is a general pattern or “way of life” such as religious ethics and the third is a set of rules of conduct or “moral code,” which involves professional ethics and unethical behavior.

Prof. Charles: What is bioethics?

Donald: Bioethics addresses such difficult issues as the nature of life, the nature of death, what sort of life is worth living, what constitutes murder, how we should treat people who are especially vulnerable, and the responsibilities we have to other human beings. It is about making the right judgments in difficult situations.

Prof. Charles: Great job Donald! Now let’s take a closer look at morality and ethical theories.

Slide 3

Check Your Understanding

Which of the following is not a principle of healthcare ethics?

A. Anything goes is not a principle

B. Demonstrates doing bad in the healthcare setting

C. Demonstrates good or compassion

Correct Feedback:

B. Demonstrates doing bad in the healthcare setting

Incorrect Feedback:

C. Demonstrates good

or compassion

Slide 4

Scene 2

Prof Charles: Morality is a code of conduct. It is a guide that all rational persons put forward for governing their behavior. Morality describes a class of rules held by society to govern the conduct of individual members. A moral dilemma occurs when moral ideas of right and wrong conflict.

Ethical theories and principles is an attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right.

The consequential theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. It is ethics that judge actions by their consequences.

Situational ethics is concerned with the outcome or consequence of an action in which the ends can justify the means. Why do good people sometimes do bad things? The answer is fairly simple: One’s moral character can sometimes change as circumstances change—thus the term situational ethics. Remember ethical decision-making is the process of determining the right thing to do in the event of a moral dilemma.

Slide 5

Scene 3

Discussion between Prof Charles and students.

Prof. Charles: Principles of healthcare ethics are universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Ethical principles assist caregivers in making choices based on moral principles that have been identified as standards considered worthwhile in addressing health-related dilemmas.

Prof Charles: Beneficence describes the principle of doing good, demonstrating kindness, showing compassion, and helping others. Doing good requires knowledge of the beliefs, culture, values, and preferences of the patient ---what one person may believe to be good for a patient may, in reality, be harmful. For example, a caregiver may decide that a patient should be told frankly, “There is nothing else that I can do for you.” This could be injurious to the patient if the patient really wants encouragement and information about care options from the caregiver.

Compassion here requires the caregiver to tell the patient, “I am not aware of new treatments for your illness; however, I have some ideas about how I can treat your symptoms and make you comfortable. In addition, I will keep you informed as to any significant research that may be helpful in treating your disease processes.”

Nonmaleficence is an ethical principle that requires caregivers to avoid patient harm. Nonmaleficence is not concerned with improving others’ well-being, but rather with avoiding the infliction of harm.

Justice is the obligation to be fair in the distribution of benefits and risks. Justice demands that persons in similar circumstance be treated similarly.

The principle of autonomy involves recognizing the right of a person to make one’s own decisions. Autonomy means recognizing an individual’s right to make his or her decisions about what is best for him or herself.

Casey: So, Professor Charles…can you tell us about virtues and values?

Prof. Charles: Absolutely! Virtue ethics focuses on the internal character of a person rather than on specific actions that he or she performs. Properly understood, virtues serve as indispensable guides to our actions; however, they are not ends in themselves. The relationship between means and ends and principles (virtues) and practice (values) is often difficult to grasp. A moral value is the relative worth placed on some virtuous behavior. A value is a code of conduct. Values are used to judge the goodness or badness of some action. Values are the motivating power of a person’s actions and necessary to survival, both psychologically and physically.

Donald: Just to be clear, religious ethics serve as a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source. These codes of conduct are enforced through fear of pain and suffering in the next life and/or reward in the next life for adhering to religious codes and beliefs?

Prof. Charles: Yes, the prospect of divine justice helps us to tolerate the injustices in this life where goodness is no guarantee of peace, or happiness, wellness, or prosperity.

Casey: I am still not quite clear how religious beliefs of a patient affect the actions of a caregiver in the hospital.

Prof. Charles: The caregiver can learn of a patient’s religion through information gathered upon admission. Caregivers often find it difficult to discuss spiritual issues for fear of offending a patient. Caregivers can share with the patient those religious and spiritual resources available in the hospital and community.

Slide 6

Check Your Understanding

Professional ethics are a --------------------- established by a the membership of a speicif profession

A. Code of conduct

B. Loose belief system

Correct Feedback:

A. Code of conduct. Most professions have a code of ethics to describe what is right or wrong.

Incorrect Feedback:

B. Loose belief system does not provide guidance of what is right or wrong for members faced with ethical dilemmas in their work.

Slide 7

Check Your Understanding

Healthcare ethics committees membership should be comprised of multidisciplinary groups such as --------------------------------

A. Bank tellers

B. Community leaders.

C. Nurses aides.

D. Real estate agents

Correct Feedback:

.Correct answer: Membership should be leaders in the community, an ethicist, educators, legal advisors, physicians, ministers, etc.

Incorrect Feedback:

A. Bank tellers

C. Incorrect. Please try again.

D. Incorrect. Please try again. Remember, to be successful the committee should select its members to include a wide range of leaders from the community.

Slide 8

Scene 4

Discussion of procreation and ethical dilemmas

Prof. Charles: Now let’s discuss procreation and ethical dilemmas.

We will discuss the various issues of procreation with primary focus on abortions. Discussed to a lesser extent are issues relating to sterilization, artificial insemination, and wrongful birth, wrongful life, and wrongful conception. While discussing these ethical issues you should apply the ethical theories, principles, and values discussed previously.

Can anyone explain the case, Roe versus Wade (1973)?

Casey: I think I can. In this Supreme Court case the court held that the Texas penal abortion law was unconstitutional stating: “State criminal abortion statutes….that except from criminality only a lifesaving procedure on behalf of the mother, without regard to the stage of her pregnancy and other interests involved is violating the Due Process Clause of the Fourteenth Amendment.”

Prof. Charles: Very good Casey! That is an excellent explanation. There will most likely be a continuing stream of court decisions, as well as political and legislative battles, well into this century. Given the emotional, religious, and ethical concerns, as well as those of women’s rights groups, it is certain that the controversies and ethical dilemmas surrounding abortion will continue for many years to come.

Donald: Prof. Charles….what about state abortion statutes?

Prof. Charles: Donald that is a great question…

The effect of the Roe v. Wade decision was to invalidate all or part of almost every state abortion statute in force then. Since then many state abortion laws have been enacted to restrict the performance of abortions as much as possible.

Casey: Do elective sterilizations on competent individuals cause problems similar to abortions?

Prof. Charles: No, Casey…. As long as proper consent has been obtained from the patient and the procedure is performed properly. If negligence is involved then a civil malpractice may occur.

Donald: I think that the discussion on procreation and ethics has really clarified some questions for me. Now, a little more clarification on the legal issues of wrongful birth, life, and conception would really help.

Prof. Charles: Well, that is a great lead-in to this next topic.

Slide 9

Scene 5

Discussion on the integrity and confidentiality of the patient record.

Prof. Charles: There is substantial legal debate regarding the impact of an improperly performed sterilization. Wrongful life suits usually are deemed frivolous since the courts are unwilling to permit financial recovery for the “injury” of being born into the world.

Prof. Charles: Wrongful birth cases result from improper sterilization cases where an unwanted child was born. Also, the parent can sue the physician who failed to determine the extent of harm of rubella infection during gestation resulting in birth defects.

Casey: I would say the birth defects of the child in such a case does result in injuries and added expense of child rearing and anguish by the parents. After all, it was the result of negligence by the physician.

Prof. Charles: Exactly…It is so important to remember that such negligence is the proximate cause of the injuries and expenses of child rearing.

Donald: Professor, in our discussion wrongful conception has not really been addressed.

Prof. Charles: To touch upon this subject again let’s discuss the case, Lovelace Medical Center versus Mendez. A physician employee at Lovelace Medical Center performed a negligent sterilization and failed to tell the wife of the unsuccessful operation resulting in a child nine months later. The parents sued the Medical Center for wrongful conception. The court awarded the couple reasonable expenses to raise the child to majority.

.

Casey: But unwanted pregnancy is not always the result of negligence on the part of the physician.

Prof. Charles: Exactly. The physician can always practice informed consent and notify the parents the sterilization attempt was unsuccessful.

Slide 10

Scene 6

Summary

Picture of Casey and Donald as they speak.

Prof Charles: We are just about out of time. Let’s go over what we learned in this lesson.

Abortion is defined as the premature termination of a pregnancy, either spontaneous or induced. Individuals have a right to refuse to participate in abortions for reasons of conscience or religious or moral conviction. Physicians feel the effects of the abortion controversy. There are cases in which physicians have filed successful litigation regarding physical and mental health injuries suffered as a result of the controversy.

Ethics is the branch of philosophy that seeks to understand the nature, purposes, justification, and founding principles of moral rules and the system they comprise. Morality is a code of conduct. It is a guide to behavior that all rational persons would put forward for governing the behavior of all moral agents. Ethics signify a general pattern or way of life, such as religious ethics; a set of rules of conduct or “moral code,” which involves professional ethics; or philosophical ethics, which involves inquiry about ways of life and rules of conduct.

Political corruption, antisocial behavior, declining civility, and rampant unethical conduct have heightened discussions over the nation’s moral decline and decaying value systems.

Before we adjourn, are there any questions?

Donald: I have no questions; I think that the information was clearly presented, Professor.

Casey: No questions for me…

Professor Charles: Well, if there are no further questions, I will say good evening and I will see you next time.