Han 335 Midterm Review

Beliefs and practices about what people ought or ought not do.

Morality

Systematic reflection on and analysis of morality.

Ethics

Morality concerns right and wrong; ethics critically examines those beliefs.

Ethics vs. morality

Things a person, group, or society holds important.

Values

Responsibility to take actions that prevent harm and support others.

Moral duty

Values are what matters; duties are obligations to act.

Values vs. duties

Duty-based theory: actions or means matter, not just outcomes.

Deontological ethics

Outcome-focused theory: the ends or consequences matter.

Teleological ethics

Teleological reasoning focused on producing the greatest overall good.

Utilitarianism

Deontological = means and duty; teleological = ends and results.

Means vs. ends

Respecting a patient’s right to make their own informed choices.

Autonomy

When a person can exercise self-determination or have a say.

When does autonomy apply?

Actively doing good: prevent harm, remove harm, and promote benefit.

Beneficence

When you are in a position to benefit someone.

When does beneficence apply?

Do no harm; refrain from causing avoidable harm.

Nonmaleficence

When you are in a position to harm someone.

When does nonmaleficence apply?

Fair distribution of benefits and burdens among people.

Justice

When deciding who receives benefits or bears burdens.

When does justice apply?

Beneficence means actively doing good; nonmaleficence means avoiding harm.

Beneficence vs. nonmaleficence

Telling the truth about diagnosis, prognosis, and treatment options.

Veracity

When you could tell the truth or deceive someone.

When does veracity apply?

Being faithful to responsibilities and promises to patients and others.

Fidelity

When you have made an explicit or implied promise.

When does fidelity apply?

Making decisions for another person, rather than letting them decide.

Paternalism

Overriding decisions of a competent person for their supposed benefit.

Strong paternalism

Intervening when a person’s decision-making ability is impaired or uncertain.

Weak paternalism

Autonomy honors patient choice; paternalism substitutes another’s decision.

Autonomy vs. paternalism

A profound moral objection to participating in an act.

Moral repugnance

A professional may seek exemption, subject to applicable duties and law.

Conscience-based objection

Two or more courses of action exist; none feels completely right.

Ethical dilemma

Ethical uncertainty about who should be the primary decision-maker.

Locus of authority problem

You know or believe what is right but are blocked from acting on it.

Moral distress

Life preservation is not always the best choice if burdens outweigh benefits.

Life-saving measures and ethics

Not starting treatment versus stopping treatment already underway.

Withholding vs. withdrawing treatment

Treatments supporting basic life functions such as breathing or nutrition.

Life-sustaining interventions

Gather relevant information and get the facts straight.

Six-step ethical decision process: step 1

Determine the exact type of ethical problem.

Six-step ethical decision process: step 2

Choose ethical theories, principles, or approaches to analyze it.

Six-step ethical decision process: step 3

Explore alternatives and decide what should be done.

Six-step ethical decision process: step 4

Act on the ethical decision.

Six-step ethical decision process: step 5

Reflect on and evaluate the action and outcome.

Six-step ethical decision process: step 6

Start with accurate facts; finish by reflecting on the result.

Why are steps 1 and 6 important?

The right to participate in decisions and refuse treatment.

Patient right expressing autonomy

Receive understandable information about treatment, risks, and benefits.

Patient right to informed consent

Privacy in the hospital and confidentiality of care information.

Patient rights: privacy

Legal and professional protections, including certain conscience objections.

Healthcare professionals’ rights

Provide accurate history, medications, prior illnesses, and hospitalizations.

Patient responsibilities

Providers need accurate context to plan safe, appropriate care.

Why share a complete health history?

A profession’s public guidance for duties, values, conduct, and integrity.

Professional code of ethics

Different professions have different roles and obligations.

Why do professions have different codes?

No. Professionals still need ethical analysis and judgment.

Can a code solve every ethical case?

Reporting suspected wrongdoing or unsafe or unethical practices.

Whistleblowing

Certain laws protect qualifying reports; protections depend on circumstances.

Whistleblower retaliation

Scarce organs should be distributed using fair, appropriate criteria.

Organ allocation and justice

Justice: fairness in allocating benefits and burdens.

Organ donation ethical principle

Whether life-sustaining artificial nutrition could be withdrawn.

Nancy Cruzan case: central issue

Nancy Cruzan, her parents Joe and Joyce, and the state of Missouri.

Nancy Cruzan case: people involved

Autonomy, surrogate decision-making, and life-preserving treatment.

Nancy Cruzan case: ethical principles

States may require safeguards proving an incapacitated patient’s wishes.

Cruzan Supreme Court principle

Shows the importance of documented treatment wishes and advance directives.

Cruzan case: why it matters

Instructions made ahead of time for healthcare decisions during incapacity.

Advance directive

Advance directive stating wishes about future treatment.

Living will

A chosen adult who makes healthcare decisions if you lose capacity.

Health care proxy

The patient’s known wishes; otherwise the patient’s best interests.

What guides a health care proxy?

Elisabeth Kübler-Ross, author of On Death and Dying.

Who pioneered the five stages of grief?

Denial, anger, bargaining, depression, acceptance.

Five stages of grief

No. People may experience stages in different orders or not at all.

Are stages of grief linear?

Voluntary authorization after understanding the care, risks, benefits, and alternatives.

Informed consent

Clear explanation, risks and benefits, alternatives, questions, and no coercion.

Key elements of informed consent

The patient directly states or indicates agreement to care.

Expressed consent

Urgent treatment when the patient cannot consent, no surrogate is available, and wishes are unknown.

Implied consent in emergencies

Treatment authority legally imposed, such as by court order.

Involuntary consent (lecture term)

Yes. Patients may change their minds or refuse treatment.

Can informed consent be withdrawn?

Capacity is a clinical ability; competence is a legal determination.

Capacity vs. competence

Communicate, understand, appreciate consequences, and reason about options.

Decision-making capacity: four abilities

Health Insurance Portability and Accountability Act.

HIPAA stands for

1996.

HIPAA enactment year

U.S. HHS Office for Civil Rights (OCR).

Who enforces the HIPAA Privacy Rule?

Protected Health Information.

PHI stands for

Individually identifiable health information held or transmitted by a covered entity.

What is PHI?

Privacy is a right; confidentiality is a professional ethical duty.

Privacy vs. confidentiality

Education records covered by FERPA are generally excluded from HIPAA PHI.

FERPA vs. HIPAA student records

Treatment, payment, and healthcare operations.

TPO: three routine HIPAA uses

Generally yes under HIPAA without separate patient authorization.

May PHI be shared for TPO?

Threats, abuse, reportable disease, or when disclosure is permitted or required by law.

When may confidentiality have exceptions?

Relevant reporting may be permitted or required for public health protection.

Communicable diseases and disclosure

Share private information only when relevant to the person’s authorized role.

Need-to-know standard

Associated with nonmaleficence.

Hippocratic Oath: do no harm

Paternalism overrides choice; a proxy represents the patient’s wishes.

Paternalism vs. health care proxy

No. A patient can appoint an eligible adult, not necessarily family.

Must a health care proxy be a relative?

At least 18 years old; two witnesses to the signatures.

Health care proxy in class slides: age and witnesses

Court-appointed representative helping the court assess a person’s interests.

Guardian ad litem (GAL)

The patient.

A healthcare professional’s primary loyalty

Use appropriate supervisor or official reporting channels.

Reporting suspected misconduct

No. Mandatory reporting depends on specific laws and circumstances.

Are all ethics concerns mandatory reports?