M6 Professional and Institutional Self-Regulation

Course Approach Distinction

Differs from typical ethics courses (e.g. fall course focused more on ethical frameworks like ontological, care, applied, consequentialist, utilitarian, virtue ethics)

Focus: Holistic approaches beyond mere ethical frameworks, considering cultural, social, and political implications

Goal: Foster empathy guided by ethics, not limited by it, especially for future leadership roles dealing with diverse groups

Key Aims:

1. Understanding ethics of self through reflective and non-judgmental communication, drawing from lived experiences

2. Resisting Western Universalist Eurocentric framework domination, which can undermine marginalized/colonized experiences

3. Creating new alternative relationships (e.g. care relationship vs patient-client) to treat individuals as humans, not just clients/numbers

4. Developing a critical and ethical self that can respond intellectually, politically, and personally to dilemmas, combining various “moral compasses”

5. Ensuring practical application of theoretical knowledge through case study analysis

Power

Making someone do certain things

Hegemony

Creating consent or dominant values without force

Power and Hegemony in Health Spaces

We must address power imbalances (e.g. leadership demographics, exclusion of racial communities) to create a more equitable health sector

DKEM Model

Origin: Alternative framework to Biomedical Principlism

Biomedical principles: Autonomy, beneficence, non-maleficence, justice

DKEM additions:

• Justice → Social Justice

• Vulnerability: Two-way understanding for both practitioners and clients/patients

• Context: Importance of situation and background

• Relationship: Connected to both contemporary and historical inequality

Ethical Frameworks and Concepts

Reviewed: Biomedical ethics, DKEM, micro-affirmations table, organizational ethics, quantified self, ethical boundary

Application: Diversify answers by applying multiple frameworks and concepts to different questions to demonstrate breadth of reading

Key Concepts Highlighted:

• Intersectionality (most important)

• Hegemony

• Capitalism/colonialism

• Equality vs equity

• Masculinity, femininity, gender theories

• Race, racism, gender sexism, ableism

• Social determinants of health

Theories

1. Feminist theory

2. Critical race theory

3. Space theory (Lefebvre’s triad)

4. Post-colonial theory

5. Decolonization

Ethics in Space (Lefebvre’s Triad Space Theory)

Types of Space: Concept space, passive space, lived space

Goals:

• Mindfulness of inclusion/exclusion

• Ensuring access based on user needs

• Creating justice

• Acknowledging socio-historical legacies

Process of Imagining Ethical Spaces

Process of Imagining Ethical Spaces

1. Needs Assessment: lit. review (scholarly works, observation (walking, mapping, noting gaps in structures, entrances/exits), identify existing met/unmet needs, missing elements, challenges, ask for participant input

2. Theorizing and Analyzing: Break down space components using theories, assess and plan conversion into an ethical space

3. Imagine and Implement: Focus on effectiveness, ethical awareness, justifiable outcomes, consider identity, physical logic, situation, transformation, and values

4. Interventions: Previous reports, past practices, data, policy/structural cahgnes

5. Evaluation: Apply Benefit-Cost Analysis (economic, environmental, social costs vs. benefits) to choose optimal solutions

Case Study Hospital Wait Times (Application of Space Ethics)

Need Assessment (Major Problem):

Lack of medical professionals, visibility, resources, government support, infrastructure.

How do we know it's a problem (Evidence): Patient complaints, doctor/nurse burnout, surveys, complaint boxes, lived experiences, increased risk of severe diseases/death, studies.

Qualitative Methods: Community consultation, oral history/testimony, vulnerability needs assessment (patients), stakeholder needs assessment (patients, practitioners, policymakers), participant observation.


Whose Needs are Met/Not Met: Marginalized groups (Indigenous, racialized communities), those with lower income, medical staff (nurses, doctors) due to high workload.
• Example: Indigenous person dying in ER due to neglect

Theorizing and Analyzing

Socio-Historical Considerations:
• Immigration policy hindering foreign-trained health professionals

Hegemonic masculine norms in healthcare (e.g., brushing off pain of women/racialized women).


Historical stereotypes affecting Black and Indigenous populations' treatment.


Space Considerations for Resolution:

Online medical care.


More hospitals/facilities in remote areas.

Home visits by doctors/nurses, mobile health clinics

boat clinics (innovative solutions from developing countries).


Increased investment in family medicine to reduce ER workload.

Expanding medical schools (requires addressing faculty quality, rural incentives for doctors, high cost of medical degrees due to pharmaceutical/health industry complex).

Educating health professionals on issues faced by underserved populations.

Prioritizing family medicine within medical careers.

Whistleblowing

An individual exposing unethical activities within an organization, often for moral reasons or the greater good

Whistleblowing (Ray Article)

Ray proposes that whistleblowing occurs when internal systems fail to address wrongdoing (e.g. complaints to superiors are ignored, higher authorities are ineffective)

Types:

• Internal Whistleblowing: Reporting within the organization (can be questionable if internal accountability is weak)

• External Whistleblowing: Reporting outside the organization (more effective, especially with social media pressure)

Example (Ray’s Experience)

Ray was an advanced practice nurse reporting colleague who claimed to cure schizophrenia by laying hands, touching patients w/o consent. This lead to patient distress. Internal complaints failed; action taken only after reporting to professional regulatory body

Conflicts: Moral/ethical responsibility often conflicts with organizational loyalty especially in critical sectors like health

Root Cause: External whistleblowing often reflects organizational ethical failure (policies exist but are not upheld)

Obstacles: Pressure to conform (‘go along and get along”), red tape, bureaucratic structures

Solution: Ethical Infrastructure

• Clear organizational goals for ethics

• Ethics committees and task forces

• Designated ethic officers

• Ethics training and case discussions

• Procedures for investigating complaints

• Mechanisms for anonymous reporting/raising concerns without retaliation

• Creation of a moral community to promote ethical practice, encourage open discussion, support staff moral distress, and prioritize patient welfare over organizational self-protection

Relational Ethics: Views ethical practice as rooted in relationships, dialogue, mutual respect, trust, and shared responsibility, echoing DKEM and care ethics

Apology

An admission of error, discourtesy, wrongdoing accompanied by an expression of regret (Merriam Webster)

Functions (Both percieved and real): To make amends, resolve conflict, reconcile, address personal guilt (or sometimes just because one “got caught”)

Outcomes: Can lead to removal of guilt, reconciliation, relief, de-escalation; results vary (apology may not be accepted)
Importance: Shows true intentions, rectifies wrongdoing, restores justice. Demands more than jsut words for oppression/marginalization — requires accountability through actions

Good Apology Attributes:

• Acknowledges one’s role and actions in wrongdoing

• Validates the other’s experience and feelings

• Demonstrates willingness to learn and commit to repair/improvement

• Involves showing remorse, taking full ownership, and identifying specific actions to rectify wrongdoing

• For institutions/governments, includes systemic change to policy and systems

• Requires courage, vulnerability, open communication, and proper planning (choosing actionable/policy-oriented words)

• Offender must be ready to bear consequences and provide substantial support if needed, allowing to offended party to define “good enough”

Non-Apologies

• “I’m sorry you feel that way.” (shifts blame onto victim)

• “I’m sorry if I offended you” (justifies action, minimizes impact)

• “I’m sorry, but in my defense…” (justification invalidates apology)

• “I didn’t mean it that way” often occurs within power differentials, a common example

• “I feel so bad” (shifts focus onto perpetrator)

Apology Challenges

Public apologies (hard to do), irreparable damage, ego, belief of no wrongdoing (complicity), fear of judgment

Post-Colonial Critique (Darkmaul)

• Apologies can be a distraction or substitution for reparation when wrongdoing is ongoing

• May assuage guilt for the apologizer without true change

• Can sustain state foundations built on takeover and assimilation

• May pressure Indigenous peoples to “forget” for “national healing,” disrespecting their autonomy

Conclusion: Only time and actions determine if an apology is a positive step towards healing or another form of colonization and neglect

Positive perceptions from affected communities (e.g. Indigenous people) are crucial and must be considered

Overall: Apologies are an avenue of vulnerability, especially for historical injustice, aiming for responsibility and good intention rather than perfection