Midterm Review

Doherty’s ethical decision-making process

1. gather as much relevant information to get your facts straight

2. determine the precise nature of the ethical problem

3. decide on the ethics approach that will best get to the heart if the problem

4. decide what should be done and how best it can be done

5. act

6. reflect and evaluate the action

Ethics - definitions

systematic reflection on and analysis of morality to decide what to do in a specific case

• its not about right vs wrong

Morals - definitions

shared norms about right/wrong

• ex: when someone cuts the line at dunkin, people object because line cutting is seen as wrong

• external and collective expectations a community holds its member’s to

Duty - definitions

Binding obligations from roles, promises or rules

• you agreed to be the DD, so you don’t drink when someone offers you a drink

• creates a accountable “must” independent from convenience or preference

Value - definitions

priorities about what matters most

• internal and personal rankings of good and goals

• ex: a graduate picks a lower-paying role at a mission-driven nonprofit because they prioritize impact over salary

core ethical principles : AUTONOMY

patients have the right to decide for themselves

• two conditions

  • individuals must have liberty(freedom form controlling influences )

  • must have agency(capacity for intentional actions)

paternalism

core ethical principles : BENEFICENCE

1. Beneficence

   1. bringing about good

   2. minimize harm/ maximize benefits

   3. remove harm when its being inflicted

      1. align care with person’s goals, offer support(pain control) that add value to them

core ethical principles : Non maleficence

to avoid foreseeable, preventable harm

• somewhat passive

  • chose the least-harmful effective option and avoid treatment plans that result in all preventable harm

core ethical principles : Fidelity

• practitioners has the responsibility to be faithful to patients, self, colleagues, etc

  • faithfulness is see when a provider engages in follow-ups and callbacks, stays within scope and capacity, appropriate boundaries

    • made a promise

core ethical principles : Veracity

• a practitioner telling the patient the truth about

1. diagnosis

2. prognosis: avoid false reassurances

3. treatment options: be clear about uncertainty

therapeutic privilege: uncommon situation when truth would harm the patient more

core ethical principles : Justice

• is this fair

• fair distribution of burden/benefits across people/groups

• check for bias

• ensure access

• apply criteria consistently

core ethical principles : Confidentiality

Ethical problems

1. Ethical Dilemma: multiple possible solutions, they all feel right but have to choose the best possible solution but none feel completely right

2. Moral Distress: you know what the right answer is but are not able to do it ( policy is blocking or insurance)

3. locus of authority; who has the right/role to decide

   
   
   

   
   
   

Philosophical and ethical theories

1. Deontological theory(Kant)

• duty driven

  • honoring a refusal for a test bc it our duty to honor the patients autonomy even though its beneficial to the patient

  • means justify the ends

    • ethical principles: autonomy, veracity, fidelity, non-maleficence

2. teleological/utilitarian (mill,bentham)

• which option would lead to the best overall outcome

• ends justify the means

  • ethical principles: beneficence, justice

Paternalism

1. hard paternalism:a medical provider makes a decision against the wishes of patients 

2. Soft paternalism(temporary) : when a patient's autonomy is questioned( they are not able to make a decision in certain moments) so the doctors makes the decision without the patient 

   
   
   

   
   
   

Informed consent (4 types)

Patient authorizes a procedure based on an understanding of the risks, benefits, and alternatives
- even after signing, patients retain the right to withdraw consent. emergencies may override formal consent requirements

expressed consent

• patient acknowledges they want you to provide care

• most often applies to simple, common procedures

implied consent

• patients whose behaviors implies compliance to simple procedure

  • they are incapable of making informed decisions because they are either unconscious, no surrogate/wishes unknown, danger to life or impairment of health, immediate treatment to avert danger

involuntary consent

court making decision or decision being legally imposed upon patient

• applies to patient who are mentally illm behavioral crisis, intellectual or developmental disabilities

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HIPAA

• the health insurance portability and accountability act enacted in 1996

• HIPAA required the dept. of health and human services to issue privacy regulations governing individually identifiable health information

  privacy rules apply for

  • health plan

  • health care clearinghouse

  • healthcare provider who transmits any health information in electronic form in connection with transaction

  • any information, whether oral or recorded

  • identifiable health information

Protected Health Information

is any individually identifiable health information held or transmitted by covered entity or its business associate in ant form or media, whether electronic, paper or oral

advance directive

• legal document that lets you state health care wished in case you become unable to make decisions for yourself

  • living will: written statements of your wishes

  • health care proxy: appoints a specific person to make healthcare decisions on your behalf

capacity v competence

competence : decided by a judge that they can make decision or not, legal term

Capacity : is an ethical observation. Someone can have capable today but not tomorrow 

• medical concept; ability to weigh medical information to make health decisions

Moral repudence

physician protection to refuse a procedure they don’t deem moral or is against religious reasons( ex: abortion) 

confidentiality vs privacy

• confidentiality is an obligation; an ethical issue

• privacy is a right; a legal issue invoked or relinquished by the patient that requires the professional to not disclose information

violation of privacy vs confidentiality

• A violation of privacy occurs when an individual's personal boundaries, space, or data are collected, accessed, or shared without their consent, whereas

  • A company tracking your location without consent, a landlord entering a private home unannounced, or installing unauthorized surveillance cameras

• a violation of confidentiality occurs when a professional or organization breaks an ethical or legal duty to protect information that a person explicitly entrusted to them within a special relationship

  • A therapist telling a friend about a patient's sessions, a doctor leaking medical records, or leaving client files open on a public computer screen.p

patient right and legal concepts

patient bill of rights

Understand and use these rights. If for any reason you do not
understand or you need help, the hospital MUST provide assistance,
including an interpreter.
2. Receive treatment without discrimination as to race, color, religion,
sex, gender identity, national origin, disability, sexual orientation,
age or source of payment
3. Receive considerate and respectful care in a clean and safe
environment free of unnecessary restraints
4. Receive emergency care if you need it.
5. Be informed of the name and position of the doctor who will be in
charge of your care in the hospital.
6. Know the names, positions and functions of any hospital staff
involved in your care and refuse their treatment, examination or
observation
7. Identify a caregiver who will be included in your discharge planning
and sharing of post-discharge care information or instruction.

professional conduct and responsibility ( code of ethics, whistleblowing)

Code of ethics: not a rulebook but a guide 

Whistleblowing: ethical duty; if you witness misconduct or fraud you have a duty to report but you are protected

nancy cruzman

•  — Nancy Beth Cruzan was thrown from her car in a single-vehicle crash; she suffered anoxic brain injury and was subsequently diagnosed as being in a persistent vegetative state (PVS).

• . She was sustained by a feeding tube (ANH). In 1987, her parents petitioned to have the feeding tube removed, believing this aligned with Nancy’s prior statements about not wanting to live “like a vegetable.” The State of Missouri opposed removal unless there was “clear and convincing evidence” of Nancy’s own wishes.

• The case moved through Missouri’s courts and ultimately to the U.S. Supreme Court, which held that a competent person has a constitutionally protected liberty interest in refusing medical treatment, but a state may require clear and convincing evidence of an incompetent patient’s wishes before allowing withdrawal of life-sustaining measures.

• After the Supreme Court ruling, additional witnesses testified to Nancy’s prior statements; a Missouri trial judge then authorized removal of ANH. Nancy died on December 26, 1990, twelve days after the feeding tube was withdrawn.

Elisabeth Kubler-Ross

swizz american, introduced the stages of grief, patients can handle and need to know  all information about their condition so they can make come to terms with their mortality and be an active participant in their care 

Professional conduct and responsibility (code of ethics, whistleblowing)

Code of ethics: not a rulebook but a guide ( professional duties/responsibilites to honor rights and deliver safe care)

Whistleblowing: ethical duty; if you witness misconduct or fraud you have a duty to report but you are protected 

• following unethical orders does not excuse personal responsibility