LEC 1: I. Obligations of a Professional, II. Human Value Development & The System of Public Law, III. Theories and Principles of Health Ethics

1. Upholding Ethical Standards

2. Continuing Education

3. Providing Quality Services

4. Maintaining a Professional Relationship

5. Meeting Legal Requirements

6. Contributing to the Profession

6 Obligations of a Professional

Upholding Ethical Standards

Obligation of a Professional

• Expectations: Adhere to ethical standards set by their professional governing body

• Includes:

  • Confidentiality

  • Avoiding conflict of interest

  • Providing truthful and accurate information

• Confidentiality

• Avoiding conflict of interest

• Providing truthful and accurate information

Included in “Upholding Ethical Standards”

Continuing Education

Obligation of a Professional

• Keep up to date with the latest developments in their field and participate in ongoing training and education to maintain their knowledge and skills

Providing Quality Services

Obligation of a Professional

• Provide high-quality services to their client/customers

• Includes:

  • Providing timely information

  • Being responsive to client needs

  • Addressing concerns/complaints promptly

• Providing timely information

• Being responsive to client needs

• Addressing concerns/complaints promptly

Included in “Providing Quality Services”

Maintaining a Professional Relationship

Obligation of a Professional

• Involves being respectful, honest, and transparent in all interactions

Meeting Legal Requirements

Obligation of a Professional

• Most comply with all relevant laws and regulations in their field of work

•  Involves:

  • Obtaining licenses and certifications

  • Complying with tax and accounting requirements

  • Ensuring that their work is lawful and ethical

• Obtaining licenses and certifications

• Complying with tax and accounting requirements

• Ensuring that their work is lawful and ethical

Included in “Meeting Legal Requirements”

Contributing to the Profession

Obligation of a Professional

• Expected to contribute to the advancement of their profession through research, publishing, teaching, mentoring and other activities that promote knowledge and best practices in the field

1. Competence

2. Integrity

3. Confidentiality

4. Objectivity

5. Professionalism

6. Continuing Education

7. Accountability

7 General Obligations that Professionals are Expected to Uphold

Competence

General Obligations that Professionals are Expected to Uphold

• Knowledge, skills, and experience to perform their duties competently

Integrity

General Obligations that Professionals are Expected to Uphold

• Behave ethically, honestly, and transparently in all their professional activities.

Confidentiality

General Obligations that Professionals are Expected to Uphold

• Maintain ___ of client information and protect it from unauthorized disclosure.

Objectivity

General Obligations that Professionals are Expected to Uphold

• Remain ____ and unbiased in their work and avoid conflicts of interest.

Professionalism

General Obligations that Professionals are Expected to Uphold

• Maintain a professional demeanor and conduct themselves with dignity and respect at all times.

Continuing Education

General Obligations that Professionals are Expected to Uphold

• Stay up to date with the latest developments in the field and continually improve their skills and knowledge.

Accountability

General Obligations that Professionals are Expected to Uphold

• Take responsibility for their actions and be accountable for any errors and mistakes they make.

interconnected

Human values development and public law are deeply ______.

Values

Guide what we believe ought to be in our behaviour

Public Law

Establish legal framework governing relationships between individual and state

citizens

This explores how moral development shapes ___ who participate in and are regulated by public law.

World View (Value System)

An inner subjective set of feelings, attitudes, beliefs and opinions through which we screen events around us

Values

• Guides to understanding “what ought to be” in behavior

• Forms world view through experience

experience

Values forms world view through ____.

Needs

• Basic requirements of survival and well being

• Follows Maslow’s Hierarchy

Maslow’s Hierarchy

Needs follows _________.

1. Survival/Physiological

2. Safety

3. Belonging and Love

4. Prestige and esteem

5. Self actualization

Maslow’s Hierarchy of Needs

Hume’s Law

• Unbridgeable gap between fact and value between “is” and “ought”

Fact

• Tells us “What is” (Physical universe)

Value

• Tells us “What ought to be” (Behavioral guidance)

1. Preconventional

2. Conventional

3. Postconventional

3 Levels of Kohlberg’s Stage Theory of Moral Reasoning

3-7 y.o.

Preconventional: Age

• Punishment/Obedience

• Egotism (Satisfying desires)

Preconventional: Characteristics

7-12 y.o.

Conventional: Age

• Please others

• Respect rules

Conventional: Characteristics

12+ Years

Postconventional: Age

• Social contract

• Personal conscience

Postconventional: Characteristics

Public Law

• Governs the relationship between individuals and the state as well as the structure and operations of the government itself

  • Regulates the exercise of government policies

  • Ensures powers are not abused

  • Provides a framework for accountability and justice

  • Protects individual rights against public bodies

Private Law

• Governs the disputes between individuals

Key Ethical Boundaries

• Acts considered ethically wrong regardless of cultural orientation

  • Includes: R_pe, slavery, genocide, sexism

• Public law codifies through universal and moral boundaries

(1) reciprocal

(2) legal systems

(3) societal values

(4) moral foundations

(5) just society

Human value development and public law form a (1)____ relationship:

• Moral reasoning (from preconventional obedience to post-conventional conscience) shapes how we engage with (2) ____ ____

• Public law institutions (constitutional, administrative, criminal) protect rights and reinforce (3) ____ ___

Understanding both helps us be citizens who not only obey laws but understand their (4) ____ ____ and participate in shaping a (5) _____ ____

Ethical Theories

Important components for delivering quality healthcare for individuals, families, and the community

1. Deontology

2. Teleology

3. Utilitarianism

4. Virtue Ethics

4 Ethical Theories

Deontology

Ethical Theory

• The act being performed irrespective of the consequences

• Based on the ethical absoluteness, “a person is acting morally only when he suppresses his feelings and inclinations and does which he is obligated to do”

Ethical Absoluteness

Deontology is based on the ____ ____, in which “a person is acting morally only when he suppresses his feelings and inclinations and does which he is obligated to do”

obligated/duty

“dein” or “deon” means

Teleology

Ethical Theory

• A theory of morality that derives duty and moral obligation from what is good /

  desirable as an end to be achieved

• “the end justifies the means”

Utilitarianism

Ethical Theory

• Rightness and wrongness of acts depend entirely on the goodness and badness of their consequence

• Based on principles of beneficence / non maleficience. An act is good if it promotes happiness and wrong if it promotes unhappiness

beneficence/non-maleficence

Utilitarianism is based on principles of ______.

Virtue Ethics

Ethical Theory

• Cultivates good moral character and virtues in practitioners

• Develops and emphasizes compassion, integrity, and honesty in healthcare professionals rather than just rules and actions

1. Altruism

2. Autonomy

3. Integrity

4. Human Dignity

5. Social Justice

5 Core values of a professional nurse (Virtue Ethics)

Altruism

Core values of a professional nurse

• unselfish concern for well-being of patients and colleagues

Autonomy

Core values of a professional nurse

• respect the patients' rights to make their own healthcare decisions

Integrity

Core values of a professional nurse

• acting with the ethical framework of professionals' accepted standard of practice

Human Dignity

Core values of a professional nurse

• valuing and preserving the worth and uniqueness of individuals

Social Justice

Core values of a professional nurse

• upholding fairness, equity, non-discrimination in delivery in healthcare

1. Availability

2. Accessibility

3. Affordability

4. Acceptability

4A’s

1. Autonomy

2. Confidentiality

3. Veracity & Right to Information

4. Beneficence

5. Non-Maleficence

6. Fidelity

7. Justice

7 Ethical Principles

Autonomy

Ethical Principle

• freedom to make a decision for oneself

Patient’s rights

Autonomy

• right to refuse treatment

Patient’s bill of rights

Autonomy

• ensures px receives fair treatment, clear communication

Informed Consent

Autonomy

• a legal and ethical process to educate patients about risks, benefits, and alternatives of proposed treatment/procedures

Proxy Consent/Legally Acceptable Representative

Autonomy

• Legal guardian makes decisions and provides consent on behalf of the px who cannot legally/physically be unable; minor, incapacitated adults/cognitive disabilities

Confidentiality

Ethical Principle

• Anything stated to nurses or hc providers by px must remain confidential

• Patient may indicate harm to themselves or others

• Patient permits to share information

When may confidentiality be violated?

Veracity & Right to Information

Ethical Principle

• “Truthfulness” and building trusting relationships

Beneficence

Ethical Principle

• Doing “good” for others

• Assist clients in meeting all their needs

  (Bio/Psycho/Socio)

Non-Maleficence

Ethical Principle

• Do No Harm

• Protect individuals who are unable to

  protect themselves

Fidelity

Ethical Principle

• Loyalty, faithfulness, and promise to fulfill all commitments

• Basis of accountability

Justice

Ethical Principle

• Treated equally, requires nurses to be nonjudgmental

1. Formal Justice

2. Material Justice

3. Microallocation

4. Macroallocation

4 Types of Justice

Formal Justice

Type of Justice

• fair and consistent

• px are treated equally without

  bias, without regard to their personal characteristics/circumstances

• Provides no criteria for determining whether 2 or more individuals are in fact equals “substantive.”

Material Justice

Type of Justice

• Specify relevant characteristics for all equal treatment

• “Distributive justice”

  ○ Distribute resources according to need, contribution and according to effort

Microallocation

Type of Justice

• decisions regarding particular persons “px selection” determining which patient among those who need a particular scarce resource, such as a heart transplant, should receive treatment, or only a limited time is available for treatment

Macroallocation

Type of Justice

• Determines the amount of resources available for particular kinds of health care services (DOH, USMMC) and budgets their spending
  

1. Utilitarianism Theory

2. Distributive Theory

3. Social Justice

3 Theories of Justice

Utilitarianism

Theory of Justice

• Focuses on maximizing the greatest happiness for the greatest number of people

• Well-being of society

• Distributive theory states that the resources of society are supposed to be distributed among individuals in an equal manner

Distributive Theory

Theory of Justice

• Resources of society are supposed to be distributive among individuals in an equal manner

• Also concerned with the outcome which shall be fair

Social Justice

Theory of Justice

• Promotes equality, and also supports the idea of equal distribution of resources among individuals

1. Public Healthcare Models

2. Private Healthcare Models

3. Mixed/Hybrid Models

3 World Healthcare Models

Public Healthcare Model

World Healthcare Model

• Primarily funded by government - taxation

• Goal is to ensure universal access, regardless of an individual’s income level

Private Healthcare Model

World Healthcare Model

• Rely on individual payments, private insurance, or employer-provided coverage

Mixed or Hybrid Model

World Healthcare Model

• A combination of public/private healthcare models to balance equity with efficiency

• Aims to capture the strengths of better approaches to equity from the public sector and innovation from the private sector

1. Digital Health

2. Preventive Care

3. Global Collaboration

4. Sustainability

5. Standards of Care

5 Trends Shaping the Future of Healthcare Models

Digital Health

Trend Shaping the Future of Healthcare Models

• Telemedicine, e-records, etc

Preventive Care

Trend Shaping the Future of Healthcare Models

• Emphasis in shifting from treatment to prevention

Global Collaboration

Trend Shaping the Future of Healthcare Models

• International partnerships are influencing drug distribution, pandemic preparedness, and research sharing

Sustainability

Trend Shaping the Future of Healthcare Models

• Governments and private institutions alike are seeking ways to reduce costs while improving outcomes

Standards of care

Trend Shaping the Future of Healthcare Models

• level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers

locality rule

Some states use a ____ ____, where the standard of care is based on what other professionals in the same area would do in a similar situation

1. Principles of Double Effect

2. Principle of Legitimate Cooperation

3. Principle of Common Good & Subsidiary

4. Principle of Bioethics

   1. Principles of Stewardship and Role of Nurses as Stewards

   2. Principle of Totality and its Integrity

4 Other Relevant Ethical Principles

Principle of Double Effect

Other Relevant Ethical Principle

• If doing something morally good has a morally bad side effect, it is ethically okay to do it, provided the bad side effect wasn't intended

Principle of Legitimate Cooperation

Other Relevant Ethical Principle

• Used to evaluate when and how an individual can participate in an action that results in an immoral outcome

Formal Cooperation

Principle of Legitimate Cooperation

• Directly intends evil act

Material Cooperation

Principle of Legitimate Cooperation

• Indirectly intends evil act

1. Principles of Stewardship & Role of Nurses as Stewards

2. Principle of Totality & Its Integrity

Principles within the Principle of Bioethics

1. Personal

2. Social

3. Ecological

4. Biomedical

4 components under Principles of Stewardship & Role of Nurses as Stewards

Personal

Components under Principles of Stewardship & Role of Nurses as Stewards

• teacher to patients who do not fully understand their condition

Social

Components under Principles of Stewardship & Role of Nurses as Stewards

• nurses = leaders