Ethics Exam

what is a law

a systematic set of rules created by an authorized body such as the government to direct the action or behavior of its constituents (members)

what are ethics

principles that guide a person/group into deciding what is right or wrong given a situation

-established moral codes that may or may not be codified by law or statute

what 2 things can happen if moral codes are violated

1. license revoked even if no laws are borken

2. fired/sued even if no laws are broken

ethics vs law relationship

not all laws are ethical and not all ethical standards are legal standards

unethical definition

course of action that violates most ethical norms

what are the 4 reasons why ethics instruction is important for healthcare professionals

· Pts are a vulnerable population

· Health professionals make life or death decisions and decisions that can cause or alleviate suffering

· Health professionals have not always acted in the best interests of their patients

· Advances in science have many moral issues that need to be contemplated

macro ethical situation

an ethical situation we confront as a society or as members of a society

micro ethical situation

an ethical situation we confront as pharmasicts, physicians, nurses, etc

what 5 things to do regarding ethical principles

o Don't get addicted to stuff

o Be humble and less judgmental

o Treat others the way you want to be treated

o Leave a legacy

o Promote peace, justice and respect in your professional actions

what 4 things are wrong even if no one is watching you

o Killing is wrong

o Lying is wrong

o Cheating is wrong

o Being envious of others is wrong

what are ethical codes

guides for ethical behavior that are justified by ethical principles and moral rules

sanctioned by their profession and its members in some way

what are ethical codes used for?

· can be used in legal proceedings, by state boards governing the profession, and by patients deciding whether a health professional is living up to their obligations

· can help professionals push back on employers or colleagues who want unethical actions

what are modern ethical codes based on?

based on greek philosopher & physician Hippocrates in the 5th century BCE

points of the APhA/ASHP Code of Ethics

·      pharmacist respect the covenantal relationship (fidelity) between the patient and pharmacist

·      a pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner

·      a pharmacist respects the autonomy and dignity of each patient

·      a pharmacist acts with honesty and integrity in professional relationships

·      a pharmacist maintains professional competence

·      a pharmacist respects colleagues and other health professionals

·      a pharmacist serves individual, community, and societal needs

·      a pharmacist seeks justice is the distribution of health resources

autonomy

a patients' right to independent thought, choice, and action without coercion

veracity

honesty in professional relationships (don't lie, cheat, or steal)

fidelity

loyalty or promise keeping in professional relationships

justice

respect people's rights and dignity as patients and colleagues as well as human beings

competency in pharmacy

maintain contemporary skills to provide the best treatments or recommendations to patients and colleagues

what are the 5 features an ethical pharmacist exhibits

1. autonomy

2. veracity

3. fidelity

4. justice

5. competency

why has pharmacists' ranking in the most trusted positions gone form 1st to 4th?

o due to expansion of chains vs. independents and PBM reimbursement cuts increased hourly prescription fill rates, longer waiting times, less time for patient interaction

what's another word for unprofessionalism

incivility

beneficence

the act of promoting good and removing or preventing the bad (active process)

nonmaleficence

the act of avoiding causing harm or worsening a situation (passive process)

beneficience in action

establishing a personal culture of civility is the biggest thing you can do to improve ethical practice every day

where do highly effective people spend most of their time

in their circle of control (only place you can directly make a change in yourself and the world)

how to be "response-able"

· put time between the stimulus and your response

o Assure your response is aligned with your principles

o Use that response until it becomes your new habit

what quadrant is urgent and important?

I: cirsis

-priorities

-emergency needs

-pressing issues

-deadlines

what quadrant is not urgent and important?

II: quality

-personal leadership

-preparation

-prevention

-planning

-relationship building

in QII, define your ethical principles and think about your practices in action (if they're at odds, conceive or changes)

what quadrant is urgent and not important?

III: noise

-interruptions (phone notification/call/text)

-some meetings

-some email & reports

-many popular activities

what quadrant is not urgent and not important?

IV: waste

-trivia & busywork

-some phone calls

-time wasters

-social media

-most video and TV

-"escape" activities

where should you invest QIV/waste time?

into QII/quality

where to invest QIII/noise time?

into QII/ quality

improve processes to minimize QIII

prejudice

an irrational attitude of hostility/disrespect direct against an individual or group based on their supposed characteristics

implicit bias

unconscious differential perceptions of people of a particular ethnicity, gender, or social group

· This is not prejudice where there is conscious intent to treat people differently based on a defining aspect of their being

· Unconscious determinants of decisions that bias for or against certain individuals

who has implicit bias?

everyone

cultural competency

understanding some general trends about people different than you

is cultural competency or cultural humility better

cultural humility

cultural humility

understanding that an individual may or may not coform to the average person from any population subset

ethical dilemma

a situation in which the ethical course of action is in question

the right/justice lens

which options, if any, respect the rights of all people who have a stake and give them all what they are due

utilitarian lens

which options will produce the most good and do the least harm for as many stakeholders as possible

hierarchial utilitarian lens

which options produce the most good for the primary stakeholders while minimizing harm for the other stakeholders?

the common good lens

which options best serve the community as a whole?

scattered power

the ability of a product, technology, or data to be used or adapted by people outside the core group, causing downstream issues

cognation

information or a situation spreads out of our ability to control

process of discreet decisions getting out of control affecting others beyond the immediate context

how to deal with scattered power and cognation when dealing with stakeholders?

o Ask yourself, are there potential stakeholders outside of this immediate situation who could be impacted by this decision?

o Does the inclusion of the broader group of stakeholders change the calculus of the best decision?

misinformation

spreading information that is not true but the person espousing it is unaware of its truthfulness

disinformation

intentionally disseminating false information to manipulate others

what does 24 hour news cycles prioritize?

drama

what does the trend of self-centeredness look like?

· People are more self-centered today than in the past

. People who are more focused on self, have higher levels of anxiety, more demands for items to bring them happiness

utilitarianism/consequentialism

the action that produces the greatest good for the greatest number of people is right and just

depends on the result

non-consequentialism

judges the rightness of an action in concrete terms regardless of the consequences

right is right, no matter the consequences

what is the opposite of autonomy

paternalism

what is medical paternalism

the healthcare professioal acts in a "parent-like" way toward the patient

weak paternalism

Overriding a patient’s autonomy because they are unable to make an independent decision

i.e. patient in a coma, a young child, a patient with Alzheimer's, or a patient with an uncontrolled mental illness

generally considered ethically justifiable

strong paternalism

Overriding a competent patient’ autonomy because you believe they are making the wrong decision

i.e. Decision to withdraw from treatment or refuse treatment

generally considered to be ethically unjustifiable

the harm principle (John Stuart Mill)

may be invoked in situations where an individual’s autonomous choices or actions may cause either emotional or physical harm to others

generally considered to be an ethically justifiable reason to limit autonomy

confidentiality

the act, by a healthcare professional, of keeping information private from others, unless given permission to do so by the patient

what does HIPAA stand for?

Health Insurance Portability and Accountability Act of 1996

HIPAA rules

o if an insurer or healthcare provider wants to share your health information with someone NOT DIRECTLY INVOLVED in your care, you must give formal consent

§ this includes consent for family and friends

o you can ask for copies of your health information, and make appropriate changes to it

o you have the right to complain to HHS about violation of HIPAA rules

o when you health information get shared, only minimum necessary amount of information should be disclosed

what are the 2 ethically-justifiable exceptions to confidentiality and autonomy in healthcare

a practitioner may violate a patient’s confidentiality if, by keeping the information private, harm may come to others (“harm principle”), or if the patient lacks autonomy (weak paternalism)

what are the 4 points of a win-win recipe (in a conflict)

·      Principle centered

·      Value differences in opinion

·      Seek third-alternative solutions (win-win) to meet challenges

·      Less concerned about who is right and be more focused on what is right

what is radical candor

challenging directly because you care about the mission, the team, and the individual

-honest two-way communication

-production now and growth in production capacity over time

-high loyalty, empowered culture

what does PLAN stand for and what is this approach used for?

Paraphrase, listen, acknowledge, negotiate

it is used when hearing difficult feedback

Paraphrase in PLAN approach

o In this stage, you are not agreeing or disagreeing, just restating the feedback in your own words to be sure you heard it properly

o Make sure you understand what they say before anything else

Listen in PLAN approach

o Ask for more detail so you really understand the nature of the issue

acknowledge in PLAN approach

o Acknowledging is not agreeing with the person

o Acknowledging is showing you understand the situation and its gravity

Negotiate in PLAN approach

o By going through the PLA before N, you know exactly what you are being accused of and the person knows that they have been heard

what does CANDID stand for and what is this approach used for?

Compartmentalize, ask questions, normalize, discuss, incentivize, disengage

it is an approach used when giving difficult feedback

Compartmentalize in CANDID approach

o Compartmentalize the message into parts that are safe to talk about and those that are emotionally charged to begin with a neutral opening

Ask questions in CANDID approach

o Seek first to understand and then be understood

Normalize in CANDID approach

o Normalizing takes some of the sting out of the conversation since it isn't something unique to this person that you or someone else does not like

Discuss in CANDID approach

o The discuss stage is when you actually discuss the problem in frank detail

o Same as negotiate in PLAN process

Incenivize in CANDID approach

o Incentivize is a benefit, tangible or esoteric, for changing

Disengage in CANDID approach

o Disengaging is turning from the discussion and getting back to the normal workday

conscientious objection

·      Invoked by health professionals who oppose, on moral ethical grounds, the use of medications or procedures to: impede fertility, induce abortion, or encourage gender transformation

is an ethical dilemma: patient autonomy vs pharmacist autonomy

euthanasia

the practice of intentionally ending a life to relieve pain and suffering

passive euthanasia

withholding or withdrawing treatment needed to sustain life when it is believed there is no medical or moral point

voluntary passive euthanasia

·      patient unable to make the decision but has advanced directives

o   “Living will”: stating your wishes regarding treatment prior to the onset of an illness

o   DNR/DNI, withdraw intubation if it continues for more than __ days, withdraw if I am unlikely to live independent without it, DNI/DNR if I am unlikely to recover

rigidity could be an issue

healthcare proxy (durable power of attorney)

o designating another individual to make decisions for you if you are unable to make them for yourself

active euthanasia

aiding or causing the patient's death through an active process

suicidal euthansia

patient kill themselves to alleviate pain or suffering

active involuntary euthanasia

euthanasia conducted against the will of the patient to alleviate pain/suffering

illegal throughout the developed world

active voluntary euthanasia (assisted suicide)

euthanasia at the request of the competent patient or their healthcare proxy

terminal sedation

high, but not lethal doses of medicatiin are administered to induce deep sleep

legal throughout the US