Ethics Midterm

Ethics

A systematic reflection on, and analysis of, morality shared by a group of people

Normative ethics

Deals with the concepts of right and wrong in the context of human relationships and interactions; what is normal in a society

Law

A binding statement of duties for all individuals

Personal ethics

Based on a belief system, cultural and world view, family background, self-reflection

Health care ethics

Based on professionalism; professional realm, individual parties involved, applicable process, realm in which you are operating

Absolutism

Absolute truths are established; black and white

Relativism

No absolute truths; gray area

Deontological

Means-driven, focused on duties/actions

Duty-bound

Ethics for health care professionals say to focus on what you can do for the patient right now

Teleological

Ends-driven; focused on consequences

Prescriptive

A standard that should be followed/what we should do

Descriptive

Step-by-step format for what to do in a given situation

Self determination

Pursuit of happiness

Puritan and pioneer morality

The world is made up of good and bad people/foul and fair; you are either one of the good guys or one of the bad guys

Imprint period

Up to 7 years old: Observing people around you; absorbing and accepting form parents; confusion and blind belief lead to early trauma & problems; critical to learn sense of right and wrong

Modeling period

8-13 years: trying to find yourself; copy people, often parents; no longer blind acceptance, but trying values out for “feel”; influenced by religion or teachers

Socialization period

13-21 years; largely influenced by peers; look for ways to get away from earlier programming by turning to people more like you; influenced by media

Pre-moral

No real values; young children & psychopaths; basic nature says to be Machiavellian (do whatever it takes to achieve your goals, even if it means hurting others)

Conventional

Conventions of society (what is socially accepted within a community); bottom line is to follow the rules as long as you need to; occasional break of values if needs are threatened or can get away without others knowing about it

Principled

Firm in your beliefs; having integrity; right and wrong are absolutes beyond the person; stick to values through thick and thin, even sacrificing themselves rather than break their principles

Goal of health care ethics

To provide moral guidelines that any rational person would recognize as worthy ones to follow

Pluralism

A theory that there are more than one or two inks of ultimate reality; reality is composed of a plural of entities; a state of society in which members of diverse ethnic, racial, religious, or social groups maintain an autonomous participation in and development of their traditional culture or social interest within the confines of a common civilization; a concept, doctrine, or policy advocating this state

Egoism

Advocates self-interest

Rights-based theories

Defined by the society; rights that are recognized and protected as highest priority; based on the assumption that unman rights are a social contract and should be protected; each person has a duty as a moral agent towards other people’s rights based on moral principles

John Rawles

Explained rights-based theories

Negative rights

You cannot interfere with life or property; rights that have negative consequences

Positive rights

Actively doing good/providing; entitlements/society-given rights that cannot be taken away

Moral relativism

There is not one set of moral principles/values; everything is relative depending on environment, religion, culture, etc.

Virtue-based ethics

Focuses on moral character of the agent; a person’s act is a mark of their character

Aristotle

Person associated with virtue-based ethics

Care based ethics

Emphasizes relationships and personal interactions; follows the golden rule

Utilitarianism

Doing the greatest good for the greatest number of people; weighs the pros & cons and benefits & harms that may result form a particular action or process

Jeremy Bentham

Epitomized utilitarianism in healthcare; said that when you have power, you should advocate

Act utilitarianism

Based on the actions you take in a scenario

Rule utilitarianism

Based on rules/guidelines/code of ethics; guide the act

Nonutilitarianism

Does not subscribe to the basis of utilitarianism; does what is best for one individual patient instead of the greater good

Deontology

Focuses on how to best fill our obligations/duties as healthcare professionals; the ends do not justify the means

Immanuel Kant

Proposed duty-based ethics

Kant’s categorical imperative

Determined solely by a sense of duty, regardless of the outcome

WD Ross

Argued against utilitarianism; actual moral duty vs. prima facie

Prima facie duty

We must use these duties to think about what we need to do when carrying out our duty; obligatory; duties that must be carried out unless superseded

Natural law-based ethics

Natural laws based on the 10 Commandments; there is a hierarchical structure of aw that flows from the supernatural realm to the natural realm; free will & autonomy

Principle of totality

You cannot destroy your body or its ability to function unless it is absolutely necessary for your total well-being

Principle of double-effect

A situation in which there is an ethical dilemma; there are situations where it is ok to carry out Ana cation that causes a bad effect

Feminist approaches

An attempt to revise, reformulate, and rethink traditional ethics that were geared towards men and devalued women’s rights

Allison Jagger

Aid you must recognize power dynamics in ethics

Care based approaches

Ethics should emphasize human relationships between equally informed, equally powerful people; emphasizes equality and a level playing field

Power-based approaches

Power differences exist and must be considered when thinking of ethics; care must be taken

Autonomy

Individuals are regarded as moral agents; have capability to comprehend and make ethical decisions; self-determination

Beneficence

Promoting good; paternalism

Nonmaleficence

Preventing harm

Paternalism

Violating one’s autonomy for their own good

Justice

Obligation to be fair; treatments should be distributed fairly & equally, regardless of need

Veracity

Telling the truth

Confidentiality

Obligation to not disclose information about a patient

Fidelity

Being faithful to patients, clients, and colleagues

Rawles & Kant

Rights-based theorists

Individual

Relationship between two people; a one-on-one interaction only concerning those two people

Institutional/organizational

Handbooks, policies, institutional guidelines, codes of ethics; standardized approach; interpersonal relationships regarding system issues

Societal

Issues related to the common good; laws, statutes, legislation, culture

Veatch

Advocated balance between realms

Engineering

Skilled agent views themself as an expert and in complete control; does not consider patient opinions/culture; focuses on task at hand to complete it no matter what; physical & psychosocial aspects

Priestly

Adapting care to patient condition to ensure a good outcome; focuses on feelings of patient; considers other psychosomatic aspects that may be influencing the outcome of patient condition; paternalistic

Collegial

Balanced role of practitioner & patient; practitioner sees patient as a partner in health care

Contractual

Business-like relationship

Covenant

Patient is dependent on practitioner (beyond just a business relationship); most appropriate compromise for patient-practitioner relationship and can be used most often

Paternalistic

Violates one’s autonomy for their own good based on provider’s judgement to protect the patient’s well-being; conflicts with autonomy but is justified in emergencies

Informative

Health care professional provides all information; gives options & details and explains importance so the patient can make an informed choice

Interpretive

Information provided is based on patient’s cultural values; asks patient for preferences (autonomy) and what they think is best for them

Deliberative

The health care provider, while being paternalistic, tries to understand patient values and consider them to form an opinion about the patient; important to follow as a provider

HIPAA 1996

Confidentiality & privacy

Veracity & full disclosure

Factual truth-telling, disclosing risks and benefits

Informed consent

Consent must be given & understood; patient must understand interventions

Customary practice standard

Whatever is applicable where you are based on norms/customs/standards in that area

Reasonable patient standard

Following every step in a certain situation to the best of your ability based on need; doing what you can with what you have where you are; becoming what you need to alleviate pain & suffering

Health

State of complete physical, mental, and social well-being and not merely the absence of disease

Non-normative views

Health is best understood as functioning of the biological organism in conformity with its natural design

Normative views

Value claims are part of the meaning of health and disease; what is usual/normal; values & claims fit society & environment

Biomedical

Research to relieve pain; promote health & prevent disease

Behavioral

Research geared toward human attitudes, beliefs, behaviors, interpersonal relationships; psychological & sociological

Nuremberg Code

Legal judgement & statements handed down during trials of Nazi doctors & scientists who were charged with murder of inmates in Germany; emphasized not treating people differently based on appearance; consisted of 10 pt. summary

1947

Year of Nuremberg Code

Declaration of Helsinki

Reinterpretation of Nuremberg Code to make it more relevant; increased emphasis on therapeutic intent; World Medical Association developed code of ethics for all medical researchers

1964

Year of Declaration of Helsinki

National Research Act

Made official laws and reinforced ideas in the United States following the Tuskegee Syphilis Study to remedy and prevent future research injuries; protects humans participating in research & identify what is needed for informed consent

1974; 1977

National Research Act was created in _____; published in _____

Belmont Report

Document based on Kant’s writing; delineated 3 principles of human research

1979

Year of Belmont Report

Respect for persons, beneficence, justice

3 principles of human research according to Belmont Report

Respect for persons

People should be treated as autonomous human beings; autonomy must be defended and protected

Beneficence

Minimize harm; maximize benefit

Protectionism

Aims to protect vulnerable individuals/public from harm; protects patient by telling them they shouldn’t take part in a study because it might be to dangerous; paternalism

Accessionism

Access to the promise of investigational intervention; people that need a treatment want it because even the slightest bit of hope that it will work outweighs all risks

moral agent

Person carrying out moral action; gathers facts in a particular situation

Course of action

Bridge between agent & outcome; may be multiple courses that lead to different results (ethical dilemma)

James Rest

Said moral agent will manifest as ethical behavior

Moral sensitivity

Moral agent is able to recognize & interpret ethical situation; necessary for an appropriate response

Moral judgement

Moral agent’s ability to judge the action as right or wrong

Moral courage

Moral agent’s ability to decide whether or not to act

Ethical distress

When you are aware of the right course of action, but you don’t have the power or authority to carry out the action