Ethics Midterm

Confucius

• philosopher, poet, and politician who isolated himself to devote himself fully to study and reflection

• His teachings were influenced by the political conditions of East Asia and by personal tragedy.

Confucianism

• the system of ethics, education, and statesmanship

• stressing love for humanity, ancestor worship, reverence for parents, and harmony in thought and conduct.

Socrates

• regarded as the father of Democracy

• Teachings centered on critical thinking, moving from specific details to generalities (inductive reasoning).

Socratic Method

asking open-ended questions that caused reflection in a deeper and more meaningful way.

Plato

• foundational figure of western philosophy

• He argued that the physical world is just a shadow of a higher, unchanging reality of perfect ideas or forms (like Justice, Beauty, and Truth).

Meta Ethics

“the ethics of ethics”

• Seeks to understand the nature and source of ethics, the theory behind moral principles, and requires intensive examination and deep reflection.

• Considers right/wrong, good/bad, the origins of morals, and whether morality should vary for different people

Beyond

Greek word “meta” means…

Virtue-based, consequential, duty-based

3 approaches of normative ethics

virtue based

• Individual values determine ethical issues

• Puts emphasis on the practice of virtues

Applied Ethics

The investigation of morally controversial issues. The issue must be controversial in the sense that there is more than one viewpoint.

Consequential

• Seeks to balance good outcomes over bad

consequences.

• Utilitarianism

• Used in legal system

• resolving ethical and social problem for what is best for greater good

Duty-Based

• Individual rights central

• deontology or rights-based

• greater good does not override an individuals rights

Autonomy

• self ruling

• patients right to choose and have control over their body

Patients are competent, have capacity, free of coercion

Conditions that must be met for autonomy to exist

Beneficence

• action that is done for the benefit of others

• doing good- what is best for the patient

Non-maleficence

to do no harm or to inflict the least harm possible

Justice

fairness, equality, and equitable treatment in all medical decisions

Procedure Justice

due process;

standards and procedures are in place and followed to make decisions

Distributive Justice

Determining what is fair in the distribution of scarce resources

Compensatory Justice

individuals seek compensation for a wrong that has been done

Retributive Justice

response to wrong with punishment proportional to the offense

Ethical/moral dilemmas

situations in which there is a choice to be made between options, each of which raises a moral concern or question

Ethical decision making

a cognitive process in which individuals contemplate ethical rules, values, beliefs, principles, or guidelines to make decisions

Three-step model for ethical decision making

• Is it legal?

• Is it balanced?

• How does it make you feel?

• Seek your patients participation

• Help you patient explore and compare treatment options

• Asses your patients values and preferences

• Reach a decision with your patient

• Evaluate your patients decisions

S.H.A.R.E. decision making

• Dignity

• Empathy

• Autonomy

• Respect

Patient is D.E.A.R which means…

• Respect

• Empathy

• Dignity

Seeing R.E.D. means…

• competence;

• care, skill, or attention

• Standard of care requires…..

• giving the patient that degree of…..

Boundaries in healthcare

• no improper contact

• separate business and pleasure

• no inappropriate comments

• avoid making promises

Transference

occurs when a patient retains feelings or attitudes associated with childhood or some traumatic event, which may surface during treatment and be transferred onto the healthcare provider.

Counter-transference

occurs when the provider experiences feelings for the patient that are out of the norm, such as anger and resentment.

contract of care

An agreement that creates a relationship where the healthcare provider is to provide care to the patient.

• Non-payment of bills

  • Non-compliance

  • Change of insurance

  • Repeated missed appointment

  • Abusive/Violent behavior

Why can a provider “fire” a patient?

Express consent

occurs when a patient or patient representative affirmatively grants permission for a procedure or service.

Implied consent

occurs when a patient’s behavior suggests compliance

Emergency Consent

patient consent is not required, but it may need to be certified as a true emergency

Good Samaritan Law

protects the provider from being sued when performing medical care in good faith.

Informed consent

explains the treatment or procedure

– outlines the risks, benefits, and alternatives

– and the patient or patient representative agrees.

• should always be documented in writing

The Patient Care Partnership

a guide for patients to understand their rights and responsibilities when receiving care during a hospital stay

• Allows young adults to stay on a parent’s policy until age 26 if they meet certain requirements.

• Entitles patients to certain preventive screenings without paying extra fees or copays.

• Covers pre-existing medical conditions

Vulnerable populations

• Minors

• Older Populations

• HIV/AIDS

• Sexual Orientation/Gender

Expression

• Limited Means

• Differently-Abled

• Unhoused Individuals

• Cultural and Religious Differences

Mature minor doctrine

provides greater autonomy to minors older than 16 years of age who understand and consent to relatively simple medical procedures.

• Hear what the patient perceives to be the problem

• Encourage the patient and professional to discuss

• List treatment options and make recommendations

• Provide a chance to negotiate treatment

H.E.L.P. Model

Mandatory reporting laws

requires healthcare professionals to report suspected cases of abuse or imminent threats of harm.

Confidentiality

health care providers keep a patient's personal health information private unless consent to release the information is provided by the patient or otherwise required by law.

• Limits what gets out

Privacy

the patients’ health and other information are securely held so that only authorized persons have access to that information.

• Limits who gets in

HIPPAA

• The Health Insurance Portability and Accountability Act of 1996

• gives patients the right by law to have their medical information kept confidential.

Consolidated Omnibus Budget Reconciliation Act (COBRA), 1985

a forerunner to HIPAA, it mandates that businesses with 20 employees or more must provide health insurance for up to 18 months, usually paid by the employee.

Ransomware

malicious software used by computer hackers to block users from data in their own computer systems

The Health Information Technology for Economic and Clinical Health Act (2009)

seeks to accomplish the following with regard to technology:

1.Improve quality, safety, and efficiency

2. Increase coordination efforts for the benefit of the

patient

3. Improve health status

4. Promote patient autonomy

5. Assurance of privacy and security and protect against

ransomware attacks and identity theft

The Privacy Act of 1974

a United States federal law that controls how executive branch agencies collect, maintain, use, and share personal data

What HIPPA covers

medical records, billing and payment data, personal identifiers, formats

What HIPPA does not cover

Employers, Education and schools, life insurance and auto insurers, non-health entities.

Release of Information (ROI)

the secure, regulated process used to evaluate, process, and share a patient's protected health information (PHI) with authorized third parties

Healthcare Integrity and Protection Data Bank, 2000 (HIPDB)

Tracks final adverse actions against health care providers, suppliers, and practitioners to prevent fraud and abuse

The Patient Safety and Quality Improvement Act, 2005 (PSQIA)

designed to improve patient care and reduce medical errors by creating a voluntary, confidential reporting system.