HCE reviewer

Theories and principles of health ethics


R - RECOGNIZE THE INHERENT WORTH OF ALL HUMAN BEINGS

E - ELIMINATE derogatory words and phrases from your vocabulary

S - SPEAK with people-not at them or about them

P - PRACTICE empathy. Walk awhile in other’s shoes

E - EARN respect from others through respect-worthy behaviors

C - CONSIDER others; feelings before speaking and acting

T - TREAT everyone with dignity and courtesy


What is philosophy?

  • Way of thinking

  • Deep understanding

  • Learn to think better, act more wisely, improve quality of life

  • 4 R’s: Responsiveness, Reflection, Reason and Re-evaluation


What is ethics?

  • Ethics (Greek Ethos), Morals (Latin Mores)

  • Also called moral philosophy,


Ethics

  • Concept of good

  • Concept of right

  • Intrinsic good

  • Instrumental good

  • Summum bonum (ultimate good)


What is healthcare ethics

  • Is the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice


Feelings

  • Many equate ethics with feelings

  • Being ethical is clearly not a matter of following feelings

  • Feelings frequently deviate from what is ethical


Religion

  • Religions do advocate high ethical standards

  • Provides intense motivation for ethical behavior

  • Should not be identified with ethics

  • Cannot be confined to religion nor is it the same


The law

  • Ethics is not equal to law

  • Incorporates ethical standards to which citizens subscribe

  • Law can deviate from what is ethical

- slavery

- Apartheid


Socially acceptable behavior

  • Ethics is not equal to “:whatever society accepts”

  • Standards of behavior can deviate from what is ethical

- slavery

- Nazi Germany


What is right

  • Honesty - talking straight, genuine and ethical

  • Trust - keeping promises

  • Courage - taking accountability, being up from mistakes and taking considered risks

  • Caring - listening carefully to others, working together to achieve shared goals

  • Fairness - treating people justly and equitably

  • Respect - treating individuals with dignity


Healthcare ethics = applied ethics

Moral judgements about:

  • Actions

  • Conditions


Framework for discussing:

  • Medical issues

  • Medical decision making


Theories and principles of health ethics

  1. Teleology

  • The study of ends or purpose

  • Attempts to understand the purpose of something by looking at its result

  1. Utilitarianism

  • Effort tp provide an answer to the practical question “what ought a person do?” the answer is that a person ought to act so as to maximize happiness or pleasure and to minimize unhappiness or pain

  • Form of ethical theory that is concerned with the outcomes of actions

  1. Deontology

  • An ethical theory that uses rules to distinguish right from wrong

  1. Feminist Ethics

  • An approach to ethics that builds on the belief that traditionally ethical theorizing has undervalued and/or underappreciated women’s moral experience

  1. Communitarianism

  • Communal responsibility

  • This perspective emphasizes the importance of community values, social ties, and shared responsibilities among individuals within a society


Virtue Ethics in nursing core

Virtue Ethics

  • Defines “expectations” of behavior

  • Responding to ethical dilemmas depends upon the nurse’s own virtuous characteristics

  • Becoming an ethical nurse requires commitment, personal investment, and the intention to become a “good” nurse Code of Ethics in Nursing Practice


Major points

  • Introduces the character of the individual

  • Individual moral actions are based on innate morale virtue

  • Based on cardinal virtues


Approaches to moral dilemmas in nursing

  • Ethical principles applied during moral decision-making insist on the use of reason only 

  • According to the patient rights charter (Department of Health, 1999). Patients and their significant and their significant others have a right to be involved in Decision-Making

  • It is necessary for them to understand the language, theories and methods of analysis used in ethical discourse


Ethical Principles applied during moral decision-making insist on the use of reasons only.

  • Reasons itself is a virtue

  • Require from nurses as moral agents during moral decision making to “bracket” their emotional experiences

  • Virtues are beneficial to human interactions and communication, and to the functioning of human society (Scott, 1995:280)


Patients Rights charter (DOH, 1999), Patients and their significant others have a right to be involved in decision-making

  • Williams (1998;264) indicates that on the level of society, patients as consumers of health care demonstrate an increased demand for accessibility and interest in hospital, such as decision making 

  • Patients  also become increasingly aware of their right to participate in health care decision impacting on their health 

  • Patient and family members are increasingly demanding to be involved in decisions about treatment, including the termination or withdrawal thereof

  • Demand to be empowered in as far as decisions that affect their daily life is concerned

  • Demands certain virtues in order to tolerate differences in opinion that might arise during an ethical situation


Autonomy

  • Greek Autos (self) and Nomos (governance/law)

  • Form of personal liberty

  • Individual is free to choose & implement his/her own decision

  • Ethical principle that obliges one to allow individuals to SELF-DETERMINE their plans and actions

  • Respecting individual choices based on their personal values and beliefs

  • 3 major basic elements involved in the process:

  1. Ability to decide

  2. Power to act on your own decision

  3. Respect for the individual autonomy of others


  • A patients has decision-making capacity “when the patient has:

- ability to comprehend relevant to the decision at hand

- the ability to deliberate in accordance with his or her own values and goals

- ability to communicate with caregivers


  • Any determination of capacity  must address the:

- individual abilities of the patient

- requirement of the task at hand

- consequences likely to flow from the decision


  • Only the courts have the authority to declare a person “incompetent”

  • Nurses often played a strong patient advocacy role, championing the patient’s right to be self-determining


Patient self-determination act (PSDA)

  • Passed by U.S. congress in 1991

  • Principle of autonomy enacted into law

  • Individuals’ choices regarding health care matters would be honored


Patients decision and interventions

  • Assist in making informed treatment choices

  • Useful tool to support shared decision-making

  • Present evidence-based estimates of the benefits and risks of the available treatment options

  • Include printed materials, videos, and interactive web-based tutorials, provide patients with information about specific health issues, diagnoses, treatment risk and benefits, and questionnaires to determine whether they need more information


Ethical Principals

  1. Non maleficence

  • Do no harm

  • No inflicting harm to others

  • Avoid harm

  • Wag maging gago

  • Wag magtatanga tanga

Derivative principles

  • Principle of due diligence

- refers to the care that a reasonable person exercises in a given situation to ensure that he or she does not harm another person

- Breaches of due diligence is negligence

  • Principle of double effect

- is derived from catholic moral theory regarding the permissibility of acts that will have both a harmful and a beneficial outcome

- to be justified, an act that has both a harmful and a beneficial outcome must meet the following guidelines:

  1. The act itself must be either good or morally neutral

  2. The good effects must be intended and the harmful ones unintended, though they may be foreseen

  3. The harmful effects may not be a means to the beneficial or good effects


  1. Beneficence

Derivative principles of beneficence

  1. Principle of Compassion

  2. Principle of Veracity

  3. Principle of Fidelity

  4. Principle of Paternalism

  5. Principle of Proportionality


  1. Autonomy

  • That obliges one to follow individuals to self-determine their plans and actions

  • Respecting the personal liberty of individuals and the choices they make, based on their personal values and beliefs


Derivative principles of autonomy

  • Principle of Privacy 

- the right to be free from interference and to control how personal information is collected and used

  • Principle of Confidentiality

- obligation to keep personal information private and secure, and to share it responsibly

  • Principle of Advocacy (Something to believe or support)

- idea that individuals or groups with power, influence or expertise should take action to support the interest of others

  • Principle of Informed Consent

- ensures that patients understand the risks, benefits, alternatives, and potential consequences of medical interventions, allowing them to weigh


Rights as a patient

  1. Right to appropriate health care and humane treatment

  2. Right to informed consent

  3. Right to privacy and confidentiality

  4. Right to information

  5. Right to choose a health care provider

  6. Right to self-determination

  7. Right to religious belief

  8. Right to medical records

  9. Right to leave

  10. Right to refuse participation in medical research

  11. Right to correspondence and to receive visitors

  12. Right to express grievances

  13. Right to be informed of one’s rights and obligations as a patient


Responsibilities as a patient

  1. Provide complete and accurate information as required by the hospital and its personnel as part of his/her treatment plan

  2. Ensure that s/he has fully understood all the benefits. Risks, and consequences of a procedure before deciding to go through with such a treatment

  3. Follow the prescribed and agreed upon treatment plan and comply with all the instructions of one’s doctor and other health care providers

  4. Respect the right and privacy of other patients by following all hospital rules and regulations

  5. Informs one’s attending physician should one desire to seek a second opinion or refuse a treatment plan

  6. Ensure one’s financial obligations to the hospital are fulfilled or properly settled

  7. Fully understand the coverage of one’s PhilHealth/HMO benefits

  8. Respect the integrity of the institution by submitting any grievances to the proper channels, and not to resort to unwarranted publicity


Derivative principle of justice

  • Principle of respect

- primary derivative principle of justice

- the efforts to help patients to maintain or preserve dignity or protect them from anything that threatens to infringe on their rights

- treating people in such a way as to recognize and value their status as fellow human beings