What are Ethics?

• Ethics: are the study of standards that are right or wrong in human behavior

  • It is how people should behave, consider the rights and obligations, values of fairness, loyalty, and honesty

• Ethics refers to a code of conduct among a people group

• Morality and Morals

  • Morality: extends from a system of beliefs about what is right and what is wrong in how we behave in society

  • Morals can be said to define a person’s character

• Values: give weight to the decisions we make in our everyday lives

  • people typically have different types of value that take precedence depending on the context

• Sense of Duty: is given to all healthcare workers when a patient “lays claims to you” meaning you now must help them in a competent manner

Ethical Theories: The Basics

• Teleological Theory: an action as a right or wrong depending on the result it produced

  • Also known as the consequence-based theory

• Deontological Theory: moral and honest action is taken regardless of the outcome

  • Deontology is developed from the word duty

• Virtue Ethics

  • Looks at the ethical character of the person making the decision

• Divine Command: follows philosophies and rules set out by a higher power

Ethical Principals and the Health Care Profession

• Beneficence and Nonmaleficence

  • Beneficence: guides the process towards a morally right outcome

  • Nonmaleficence: to cause no harm

    • Beneficence is to do right and avoid harm when possible

• Respect: all patients have the right to be treated respectfully

  • Respect is a general right in the healthcare industry

• Autonomy: self-governance

  • To the ability to make informed decisions while given all the facts

  • Patients have the right to choose their course of treatment

• Truthfulness: the quality of being honest and not containing or telling any lies

• Fidelity

  • Required faithfulness and loyalty

  • Makes healthcare providers adhere to their professional code of ethics and the principles that define their roles and scopes of practice

• Justice

  • There are three types of justice

    • Distributive: deals with the proper and equitable distribution of healthcare resources

    • Compensatory: relates to the paying of compensation for wrongdoing

    • Procedural: acting in a first come first serve manner

  • The Canadian Health Act assures everyone has equal access to the same prepaid healthcare

Patient’s Rights in Health Care

• Rights in health care

  • Rights are entitlements or things that should be expected of healthcare providers

    • They may be tangible or intangible

  • Tangible rights are those that are measurable and physical

  • Intangible rights are vaguer like being treated with respect and dignity

1. Canadians have the Right to Healthcare

   1. grey areas in the way of IVF treatments

2. Canadians should have the right to timely healthcare

   1. having reasonable wait times for both urgent and non-urgent healthcare

• Duties and Rights

  • If a patient has a right within or to healthcare then a healthcare provider is obligated to give it to them

  • Patients also have the right to make decisions for themselves and not be judged for them

• Truthfulness: all patients have the right to the truth

  • Patient-focused care requires physicians to keep the patient fully and truthfully informed

Ethics at Work

• CODE OF ETHICS

• Special Boundaries and Relationships

  • With patients, personal relationships with patients are strictly prohibited.

    • Generally speaking, most doctors are not allowed to date patients for a whole year after they see them professionally

    • Though not as strict most medical professions have rules about seeing patients outside of work

  • With colleagues friendships between colleagues are natural.

    • As long as it does not get in the way of work it is not considered unethical

  • In the hospital setting everyone is expected to act professional

• Rationale for Boundaries

  • Patients trust when they go see a healthcare professional they trust them to do their job impartially and competently

• Balance of Power and Transference

  • Going to get help is a vulnerable thing and some patients mistake a doctor’s professional interaction and have a sense of “falling in love” in some instances the doctor has to remove themselves from the care of that patient

End-of-Life Issues

• Euthanasia

  • Voluntary euthanasia: when a person causes the death of another person with the dying person’s consent

  • Voluntary euthanasia: when a person causes the death of a dying person without consent

  • Active euthanasia: is taking deliberate steps in taking someone’s life

  • Passing euthanasia: allowing a person to die by taking away medical support

• Ethical Principles and Medical Assistance in Dying

  • Rights: A person’s right to self-determination is central when it comes to medical ethics

• Autonomy: The patient has to be mentally competent to make such a decision

• Values: When it is ethically right or wrong one’s self-dignity has to come into play

• Trust

• DNR

  • Must be signed by a doctor

  • Advanced directive can also be made such as a living Will or treatment directive____: it specifies the nature and level of treatment a person would want to receive when they are not capable of understanding the entirety of the situation

  • Levels of Care

    • Level 1 & 2 are congruent

      • The resident wishes to stay in their home (e.g. long-term care or nursing home), receiving comfort and supportive measures only. This includes pain control, but not usually intra- venous therapy for hydration.

      • The resident wants to stay in the facility and receive all treatments, medications, and interventions that are possible at the facility. This would include pain control and antibiotics if the patient developed an infection, pneumonia, or a urinary tract infection. Other medications may include those to treat cardiovascular problems. Intravenous hydration may or may not be considered.

    • Level 3

      • A resident choosing this level of care would be transferred to an acute care facility from their long-term care facility. They would receive recommended imaging and diagnostic tests, an intravenous if required, antibiotics, and other medications as needed. Level 3 does not include CPR protocol, or transfer to the intensive care unit.

    • Level 4

      • This level requires the person to be transferred to an acute care facility for all active measures required to sustain life.