PT 435 Midterm 1

moral distress

focuses on the agent when a situation blocks him or her from doing what is right

special case of ethical dilemma

justice issues when there is not enough supply of a needed resource or service

social helping

- no defined or professional skills used- altruistic act to benefit someone else- unhealthy when used to satisfy your own needs

accountability

active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist including self-regulation and other behaviors that positively influence patient/client outcomes, the profession and the health needs of society

altruism

primary regard for or devotion to the interest of patients and clients, thus assuming the responsibility of placing the needs of the patients and clients ahead of the PTs or PTAs self interest

duty

Duty is the commitment to meeting one's obligations to provide effective physical therapist services topatients and clients, to serve the profession, and to positively influence the health of society.

personal morality

collage of values, duties, actions, and character traits each person adopts as relevant for his or her life- requires self reflection and inculcation- results in sense of integrity- provides guidance for sense of purpose

four components of moral behavior

- moral sensitivity- moral judgement- moral motivation- moral character

gold standard question in study of ethics

what do human dignity and respect demand of us- a process that sees what is and asks what ought to be

practice acts

- state statutes that guide limits of professional obligation and responsibility- determine what is within and what is outside scope of practice

personal needs vs values

- guide behavior but are more automatic and basic to lower level needs/functions

- involve beliefs accepted by one which determines behavior- require reflection- less impulsive and more mature

caring response

- balances friendly and professional conduct- demands professional responsibility to uphold pt dignity- retains competence

patient-centered care

the imperative that professionals keep a focus on the well being of the whole person

rights

stringent claims on someone else or society for a caring response to a person or groups needs- claims may come from both health professionals and patients, shaping responsibility and providing a caring response

categories of ethical problems

- moral agent (A)- course of action (C)- outcome (O)

emotion in ethics

- alert system that warns you may be veering off a caring response- kicks in at point of decision making to complete the human picture of whats happening- alerts, focuses attention, motivates, and increases ones knowledge on complex situations

course of action

includes agent's analysis, judgement process of discerning the best resolution, and decision to act in accordance with that judgement

locus of authority

ethical question of who should have the authority to make an important ethical decision

four ways of thinking of authority in healthcare decisions

- professional expertise- traditional arrangements- institutional arrangements- authority of experience

intimate helping

- involves person you care deeply for- willing to risk injury/danger to self

personal helping

- involves personal act but not at intimate level- looks at tools used rather than level of involvement with other person- social and therapeutic helping

basic elements to build a caring relationship

- concern- responsibility- respect- knowledge

sympathy vs empathy

- sympathy: to feels similar feelings along with another about something outside of the self- empathy: feeling in a frame of reference of another person's experience, sharing understanding, putting yourself in their shoes type shit

normative ethics

deal with methods for ascertaining right and wrong actions and morally praiseworthy or blameworthy attitudes and behaviors

narrative approach

based on the observation that humans pass on information, impute, and explore meaning in theirs and others' lives, commemorate and celebrate, denounce, clarify, get affirmation, and, overall become a part of a community through the hearing and telling of stories- attention to details of story and all voices be considered before situation is assessed for moral significance

ethics of care approach major question

"what is required of a health professional to be best able to express, 'I care'?"- care involves attentiveness, competence, and responsiveness- make contact with the patient as a person- foster trust

principle of self determination in each persons role

- professional autonomy of HCP- social autonomy of individual- patient autonomy within healthcare

fidelity

faithful to one's commitments- meeting patient's reasonable expectations- respect, competence, adhere to code of ethics

paternalism

healthcare professional acts as a parent with all negative and positive connotations- limits pt autonomy- makes decision for client instead of w/ client

justice

ensure a proper distribution of burdens and benefits when there are competing claims

teleology

uses principle of beneficence or nonmaleficence as a guide- focus on the ends brought about and the consequences of actions

prima facie duties

rights allow you to make choices among conflicting principles

utilitarianism

an act is a right if it helps bring about the best balance of benefits over burdens

step 2: identify type of ethical problem

looks at moral distress, ethical dilemma, locus of authority- prototypes of ethical problems

step 5: complete the action

goal of analysis is to act

step 6: evaluate process and outcome

reflection on action prepares you for how you can continue to learn from experience

values

deeply held beliefs and attitudes about actions, ideas, etc- inner force which provides standards on which choices are made

moral character

habitually act in a manner that will be praised by others because it upholds high standards

nonmaleficence

do no harm- basis of hippocratic oath

collaboration

working together with patients and clients, families, communities, and professionals in health and other fields to achieve goals. Collaboration within the physical therapist‐physical therapist assistant team is working together, within each partner's respective role, to achieve optimal physical therapist services and outcomes for patients and clients.

compassion and caring

Compassion is the desire to identify with or sense something of another's experience; a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others.

excellence

Excellence in the provision of physical therapist services occurs when the physical therapist and physical therapist assistant consistently use current knowledge and skills while understanding personal limits, integrate the patient or client perspective, embrace advancement, and challenge mediocrity.

inclusion

occurs when the physical therapist and physical therapist assistant create a welcoming and equitable environment for all. Physical therapists and physical therapist assistants are inclusive when they commit to providing a safe space, elevating diverse and minority voices, acknowledging personal biases that may impact patient care, and taking a position of anti-discrimination.

integrity

steadfast adherence to high ethical principles or standards, being truthful, ensuring fairness, following through on commitments, and verbalizing to others the rationale for actions. Core Values for the Physical Therapist and Physical Therapist Assistant

social responsiblity

is the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness

societal morality

- from cultural beliefs about mankind and relationship with each other- laws, customs, and policies stem from societal group values- not uncommon for differences between personal and societal morality

professional morality

embraces moral values, duty, and character traits that do not apply equally or at all to others in society, although it goes beyond a strictly personal morality to a public statement

ethics

- systematic reflection on morality and use of special methods to examine a moral situation

laws vs ethics

laws:- defined by government- based on justice + equality- minimum standard of behavior- uniform- mustethics:- defined by individual or community- based on how you define a meaningful life- some uniformity- ideal or aspirational- should

moral repugnance

allows an individual who believes it is morally wrong to participate in a procedure to be exempt from having to do so. It does not allow the refusal of care of patients whose lifestyles are morally unacceptable to you.

4 stages of moral development (Piaget)

- amoral (0-2)- egocentric (2-7): lacks morality- heteronomous (7-12): total acceptance of morality imposed by others- autonomous (12+): internalized morality of cooperation

pre-conventional moral development (kohlberg)

- age 3-7- satisfying ones own needs- must obey authority figure or else- responsive to cultural rules and labels of good/bad as it relates to physical consequences of actions

conventional moral development (kohlberg)

- social convention with respect for authority and laws- I probably should because everyone expects me to- maintaining expectations of family, group, or nation is valuable regardless of consequence

post-conventional moral development (kohlberg)

- conformity to ever changing values and demands of society and a conscience- I may because of my role in society but question societies values- clear effort to define moral values and principles that have validity and application apart from authority of groups or other people

moral vs ethical

- moral: refers to using tradition, laws, customs of an individual, society, or group as guidance for a course of action to be taken- ethical: a moral course of action chosen has been reflected on and remains the right thing to do

types of legal protection for ethical decisions

- constitutional law- statutory law- administrative law

traditional characteristics of professional identity

- advanced expertise- independent judgement- societal recognition- commitment to public good

the ethical goal of every health professional and patient relationship

a caring response

claim

a request made verbally or nonverbally by virtue of the expectations people have of your professional role

technical competence

the ability to apply specialized knowledge or expertise- a caring response includes the exercise of compassion understood as the conscientious expression of a professionals technical competence

professional responsibility

accountability + responsiveness- what is reasonably expected of you in your role as a provider of a professional service

human rights

- universally understood needs such as food, shelter, health care and protection of life- rights applying to all people

mastery and caring

- prepared to recognize, give attention, and fully address a challenge with resolution- mastery is affirmed only when the patient experiences your response as a caring response

caring response and professional conduct

caring response must always focus on interactions on health related matters that you are competent to address- intent of conversation should be guided with health related matters in mind

ethical question

Places the focus on one's role as a moral agent and those aspects of the situation that involve moral values, duties, and quality-of-life concerns in an effort to arrive at a caring response- "should" vs must or can

moral agent

a person who acts for him or herself or in place of another by the authority of that person, and does so by conforming to a standard of right behavior

3 prototypes of ethical problems

- moral distress- ethical dilemmas- locus of authority

moral distress type A

cannot do what is right: due to internal or external barriers

moral residue

an accumulation of compromises that takes a heavy toll on one's integrity

moral distress type B

Not sure what to do but you know something is wrong

ethical dilemma

involves two or more morally correct courses of action that cannot both be followed

therapeutic helping

- personal but not intimate act w/ specific, well defined professional skills- performance of professionally competent act benefits patient, not oneself- can lead to state of dependence

detrimental dependence

- over-dependence and based on insecurity- unable to control level of involvement b/w therapist + patient- hinders pt from achieving goals

constructive dependence

- based on mutual respect- acceptance of responsibility so dependent on oneself, not another person- facilitates pt reaching goals

ethical reasoning

moral basis for professional behaviors and actions- focus on what should be done for the pt vs what can and must be done

metaethics

tries to discover the nature and meaning of ethical reasons we propose as valid for making judgments about morality- deals with the source of the reasons we give our positions

story/case approach

- assumption that morally relevant information is embedded into the story

virtue theory

focuses on character and the ways in which people practice and facilitate the practice of virtues in community, thereby facilitating happiness- link b/w motivation to find caring response and ethical acts/behaviors that follow from character traits we cultivate- shift to the kind of person one should aspire to be

character trait

disposition or readiness to act in certain ways- courage, honesty, compassion

principle based approach

an approach to bioethics that offers specific action guides- guide action and serve as standard for moral behavior- elements that provide a way to view a situation more concretely

beneficence

not harming and acting to benefit another

autonomy

capacity to think act, and decide freely and independently- aka self-determination- can be professional, social, or patient

veracity

honestly, truthfulness

principles

provide general moral guidelines in search for a course of action that will result in an outcome consistent w/ a caring response

deontology

appeals to principles that help delineate what a particular duty entails- veracity, fidelity, autonomy, etc- you act correctly when you act according to duties/rights

absolute duties

binding under all circumstances

conditional duty

commitment that comes into being only after certin conditions are met

rule utilitarians

hybrid of deontologic and utilitarian approaches- bring about good consequences by following certain rules or duties

procedural justice

used to be fair/impartial to several- first come first served

rights based justice

obligation to respect pts rights

legal justice

honor morally acceptable laws- observe all legal practical guidelines unless morally in question

confidentiality

moral obligation to keep private confidential information concerning patients even if not specifically requested

relationship approaches

- focus on what builds interconnections- patient centered focus always drives ethical decisions

step 1: get the story straight/gather relevant info

- gather as much info as possible- ask questions and seek out facts to understand why people act as they do- clinical vs legal vs ethical- based on: clinical indications, pt preference, quality of life, contextual factors

step 3: use ethics theories or approaches to analyze problems

tools of ethical analysis further help move you towards resolution and action- use of normative ethical theories- ex: utilitarianism, deontology, teleology

step 4: explore practical alternatives

determine what to do in a situation- imagination enhance ethical decision making by allowing you to think creatively/expansively about alternatives

six steps of ethical decision making

1. gather the facts2. determine type of ethical problem3. use ethical theories/approaches4. explore practical alternatives5. complete the action6. evaluate the outcome

ends-based moral principles

- beneficence- non-maleficence

duty based moral principles

- autonomy- confidentiality- fidelity- veracity- justice

ends based ethical situation

issues of public policy, common good, or balancing multiple interests