TOPIC OUTLINE
(1) Ethics
(2) Morality
(3) Bioethics
(4) Ethical Issue
(5) Health Care Ethics
(6) Deontology
(7) Immanuel Kant
Ethics
... [Show More] Philosophical and practical science that deals with the study of the morality of human acts or human conduct.
“Is the enterprise of discipline reflection on the moral intuitions and moral choices that people make”
The concept of interpreting morality
How should we behave?
What choices should we make about how we live our lives?
What do we consider acceptable in our society?
Ethics as Science
Comprises data on the morality of human acts that are put together and arranged in order.
Morality
Addresses the question of what is RIGHT and what is WRONG.
We are all born with a certain mind of direction and this is our gift.
What factors affect how we find answers?
1 Family
2 Religion
3 Traditions
4 Customs
5 Beliefs
6 Practices
7 Nurturance
8 Quality of living-rearing experiences
9 Society
10 Environment we live in
An act is right if it conforms to an overriding moral duty
Example: do not tell lies, do not kill
(Christian ethics- 10 commandments)
*but Christian ethics are not important for some people in the world so moral duties vary between cultures and societies.
We usually think of the ‘big’ issues
Like: definition of life, what is a person, quality of life, prolonging life, ending life, human rights.
But day-to-day ethical issues can involve:
-respecting people
-treating people fairly
-supporting patient’s choices
Bioethics
Is the investigation of ethical issues that arise in life sciences by applying moral philosophy principles.
Includes:
Medicine
Healthcare
Genetics
Biology
Research
Pharmacology
The study of bioethics affects how healthcare evolves and is delivered.
Healthcare, medicine, and research are regulated by the law.
Often the outcome of medical advancement can be unknown.
It is essential to recognize that law and bioethics are NOT ALWAYS a reflection of each other.
*simply because something is illegal does not always mean it is morally wrong.
(Consider the arguments for euthanasia)
*likewise, because something is legal does not mean that it is morally right.
(Consider the opposition arguments to abortion and cosmetic surgery)
Ethical Issue
• When you have to judge what is right or wrong
• Choosing between options
• Deciding whether to do something or do nothing
• Should I or shouldn’t I?
• Weighing up the potential impact of your decisions or actions
• A dilemma - making a difficult choice
Ethical Issues in Healthcare
1 Improving access to care
2 Protecting patient privacy ad confidentiality
3 Building and maintaining a strong healthcare workforce
4 Care quality vs. efficiency
Health Care Ethics
Set of moral principles, beliefs and values that guide us in making choices about medical care.
Branch of ethics that deals with ethical issues in heath, health care, medicine and science.
It involves discussions about treatment choices and care options that individuals, families, and health care providers must face.
It reacquires a critical reflection upon the relationship between health care professionals and those they serve, as we as the programmers, systems and structures developed to improve the health of a population.
Health Care Ethics (CON)
Involves deliberating about the allocation of resources, and reflecting on the complex moral choices arising from ongoing health care restructuring and advancing technology.
Entails a critical, political, and ethical analysis of the definition and the determinants of health.
Why are the ethic part of professional practice?
Professional codes of conduct exist as a result of the ethical and legal duties and responsibilities expected of practitioners.
Through ethically reasoned argument we establish what is considered right and a positive obligation, or what is considered wrong and prohibited.
Provides a moral standard that patient and staff can expect from us.
Deontology
Greek:
Deon – “duty”
Logos – “science”
Duty or principle based theory – the right course of action is that which is consistent with one’s moral duties.
According to Immanuel Kant, the theory’s most well-known proponent, one of these duties is to never use another person as a means to one’s own ends.
Before making a decision, one should think about whether it would be reasonable for everyone to act in the proposed way.
According to deontology then,
An action itself has features that are distinct from the action’s consequences, and that make the action right.
Our care for patients should be based on sound judgment
-some of this judgment is about having a strong sense of what is right or wrong
-having a strong sense of what we should be doing and shouldn’t be doing
-as nurses having a strong sense of what our priorities ought to be
Deontology (CON)
Holds that certain things are right or wrong regardless of the consequences.
Example:
Telling the truth may cause happiness or upset but is considered the right thing to do
In deontological ethics, an action is considered morally good because of some characteristics of the action itself, not because the product of the action is good.
Immanuel Kant
First great philosopher to define deontological principle.
The founder of critical philosophy whose ethics were much influenced by Christianity.
OUTLI
Teleology
Greek:
Telos- “end”
Logos- “science”
Teleology
Is the study of the ends or purposes that things serve?
Aristotle believed that the best way to understand why things are the way they are is to understand what purpose they were designed to serve
Key questions which teleological ethical systems ask include:
- What will be the consequences of this action?
- What will be the consequences of inaction?
- How do I weigh the harm against the benefits of this action?
Also known as
Consequentialism
A Normative Moral Theory
Theory in morality that derives duty or moral obligation from what is good or desirable as an end to be achieved.
It is opposed to deontological ethics which holds that the basic standards for an action’s being morally right are in dependent of the good or evil generated.
Actions are right or wrong according to the balance of their good and bad consequences
What is Happiness?
Pleasure! This called the HEDONISTIC THEORY OF VALUE OF THE GOOD- What makes people happy is to experience Pleasure.
To a UTILITARIAN THIS DOES NOT always aim to promote the Idea.
The Moral task is to promote as much pleasure as possible as such taking every person into account sometimes we need to sacrifice our own pleasure! PETER SINGER (Famous Utilitarian). Do the most good you can for the most people.
If the action creates the most good possible, it is morally right according to the consequentialism. The consequentialist determines the Right action in terms of what causes good to people, one must provide the definition of “Good”
Great Consequentialist of the UTILITARIAN MOVEMENT- JEREMY BENTHAM And JOHN STUART MILL
Teleological moral systems are characterized primarily by a focus on the consequences which any action might have for that reason, they are often referred to as consequentialist moral systems. In order to make correct moral choices, we have to have some understanding of what will result from our choices.
When we make choices which result in the correct consequences, then we are acting morally.
When we make choices which result in the incorrect consequences, then we are acting immorally.
CONSEQUENTIALISM
Does not supply us with very good guidance, It is very difficult, if not impossible to predict the consequences of actions.
If we constantly measure our actions, it undermines important practices and norms.
First and foremost a standard for what makes actions right not a procedure to apply to every action.
Calculating the positive and negative consequences
UTILITARIANISM
Utilitarian type theories hold that the end consists in an experience or feeling produced by the
Action.
The Happiness Paradox
The source of UNHAPPINESS is the constant Striving for HAPPINESS.
JOHN STUART MILL- “Ask yourself whether you are Happy and you cease to be so. The process of optimizing happiness is like finding your way.
Travel from A to B, it is not always good idea to constantly focus on B, keep your eyes on the road and direct to relevant sign post. In the same way to do the most good you can do, do not focus constantly on the abstract goal, consider the rules norms and values established precisely to help us produce the most happiness possible
JOHN STUART MILL - Not only the quantitative amount of pleasure is a measure for the right action, there are different qualities of pleasure.
BENTHAM- Higher Pleasures in mind such as intellectual pleasure as something for us to make a priority, not because they have a better quality than so called simple pleasures but because in the long
run, intellectual pleasures tend to produce even more happiness
Eating Ice Cream- a short term pleasure- can also lead to displeasure (fat) if too much
Reading books - long term pleasure, crucial to your ability to become wiser and creates happiness throughout the rest of your life.
SUMMARY
Teleological ethics, says that one’s ethical decisions should be based on final goals and ends
Deontology says that ethics should be based on commitments to moral principles, without regard for ends.
A teleologist would say that one should kill an innocent person if that would save two other innocent lives
A deontologist would say that if killing is wrong, it remains wrong, even if it could save lives
Star Trek film Mr. Spock before he died mentioned “the needs of the many outweigh the needs of the few or one,” justifying a variety of heroic sacrifices and risks.
Consequences of action - Good/Bad — this idea embodies teleological ethics, or consequentialism.
Utilitarianism- The end results of an action—the salvation of many lives—justifies the sacrifice of one life
HEALTH CARE ETHICS
ETHICAL PRINCIPLES
AUTONOMY
Greek word:
Autos (self) Nomos
( governance)
AUTONOMY
Refers to one’s moral power or right to self-governance and determination to make decisions in directing one’s own life.
It presupposes the exercise of freedom upon which autonomy is incumbent to determine the course of action to choose and take in pursuing that which upholds human dignity and life.
The term self determination is often used synonymously with autonomy.
In health care milieu, the patient’s autonomy should be exercised to facilitate his implicit or explicit participation in the treatment of his illness, alleviation of his suffering, and restoration of his health for a quality for a quality life.
IMPLICATIONS OF PATIENT’S AUTONOMY
1. The patient is responsible for his choices and decisions
2. His human dignity is upheld and recognized
3. His personal value and worth are affirmed
4. His patient’s rights are protected and are not unduly interfered with
5. He cannot be constrained or forced to make decisions and perform actions against his will
PATIENT’S RIGHTS
This refer to the moral power incumbent upon the dignity of the patient as a human person which is enjoined by both natural law and positive law requiring that what is due must be rendered to the patient as justice demands.
PATIENT’S BILL OF RIGHTS
1. Right to Appropriate Medical Care and Humane Treatment
2. The Right to Informed consent. Except in the following cases:
a. emergency cases
b. when the health of the population is dependent on the adoption of a mass health program to control epidemic
c. when the laws makes it compulsory for everyone to submit to a procedure
d. when the patient is either a minor or legally incompetent, where third party consent is required e. when disclosure of material information to patient will jeopardize the success of treatment f. when the patient waives his right in writing.
3. Right to Privacy and Confidentiality
4. Right to information
5. Right to Choose Health Care Provider and Facility
6. Right to Self Determination
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right Refuse Participation in Medical Research
11. Right to Correspondence and to Receive visitors
12. Right to Express Grievances
13. Right to be Informed of His Rights and Obligations as a Patient
INFORMED CONSENT
Informed consent in health care refers to the patient’s deliberate and voluntary acceptance of a health care procedure which presupposes sufficient disclosure of the nature and goals of the procedure, its possible side effects, risks and benefits and the available medical options.
The procedure can be diagnostic, preventive, curative and/ or research for experimentation that may have some effects on the patient’s bodily integrity and human dignity. That is why, informed consent is sought in agreement with the principle of autonomy.
FORMS OF CONSENT
a. Proxy Consent/ Legally Acceptable Representative
This is done when the patient is not capable of giving informed consent and is legitimately represented by a competent surrogate who acts on his behalf.
The patient may either be unconscious , insane or a minor/ child who is out of reason or not at the age of reason.
The competence of the representative primarily resides in his manifested motivation to serve the best interest of the patient.
b. Consent by presumption
This is reasonably presumed to be present in the subsequent employment and series of procedures as they are aligned with the primary procedure to which explicit consent is expressed.
Attributed to the patient who in his current biological condition, cannot utterly articulate consent. The judgment of prudence and reason takes a sufficient ground for the consent of the most appropriate medical procedure to serve the best interest of the patient.
PRIVACY
Confidentiality
An important aspect of the trust that patients place in health care professionals. If the patient felt that information in regard to his body or condition was the subject of public conversation used to brighten the coffee break in the cafeteria or was subject to release to publications, a great barrier between practitioner and patient would exist. This fear of disclosure has, in the past led minors with sexually transmitted disease to suffer without care rather than seek to aid , knowing that the system required the health care system to notify their parents.
VERACITY
Binds both the health practitioner and the patient in an association of truth. This patient must tell the truth in order that appropriate care can be provided. The practitioner needs to disclose factual information so that the patient can exercise personal autonomy.
FIDELITY
By fidelity, we mean the obligation to act in good faith and to keep vows and promises, fulfill agreements, maintain relationships and fiduciary responsibilities.
Fiduciary responsibility refers to the contract of relationship we enter into with the patient.
Fiduciary responsibility bank on trust and confidence.
This means that once the physician or nurse enters into a relationship with the patient, these professionals become the trustees of the patient health and welfare. Hence both the physician and the nurse are obligated to maintain the contract of care.
The model for fidelity is keeping one’s word of honor, loyalty to commitments and oaths , and reliability.
The model of fidelity leans on the values of loyalty and trust as well as standing true to one’s word .
In popular Spanish parlance, known as palabra de honor. With fidelity goes the traits of maturity and commitment of the person.
JUSTICE/ FAIRNESS
The principle of justice states that there should be an element of fairness in all medical decisions: fairness in decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments, and for medical practitioners to uphold applicable laws and legislation when making choices.
Aristotle: equals must be treated equally and un-equals must be treated unequally.
In health care we are confronted by distribution problems that seem to provide better care to he rich than to the poor, the urban dweller over the rural, the middle aged over the child or elderly.
Compensatory justice- in which individuals seek compensation for a wrong that has been done. Recent cases where cigarette smokers have received compensation from tobacco companies for their lung cancer or emphysema suggest how large an issue this may become. Fines or compensation for injury, are requested.
Retributive justice- an eye for an eye and a tooth for a tooth. Requires equal suffering.
BENEFICENCE
The term beneficence suggest acts of mercy and charity, although it certainly may be expanded to include any action that benefits another.
Most health care professions have statements that echo the Hippocratic oath, which states that “the physician will apply means for the benefit of the sick”.
In the pledge of American nurses association this is clearly stated the nurse’s primary commitment is to health, welfare and safety of the client.
One ought to prevent evil or harm, one ought to remove evil or harm , one ought to do or promote good.
BENEFICENCE
This principle states that health care providers must do all they can to benefit the patient in each situation.
All procedures and treatments recommended must be with the intention to do the most good for the patient.
To ensure beneficence, medical practitioners must develop and maintain a high level of skill and knowledge, make sure that they are trained in the most current and best medical practices, and must consider their patients’ individual circumstances; what is good for one patient will not necessary benefit another.
NON- MALEFICENCE
Most health care professional pledges or codes of care echo the principle paraphrased from the Hippocratic oath statement- I will never use treatment to injure or wrong the sick.
One ought not to inflict evil or harm.
All the statements of the beneficence involved positive action toward preventing or removing harm, and promoting the good.in the non-maleficence statement, the admonition is stated in the negative, to refrain from inflicting harm.
It means, “to do no harm.”
This principle is intended to be the end goal for all of a practitioner’s decisions, and means that medical providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient.
SUMMARY
VIRTUE ETHICS
RARE THESE PEOPLE DO EXIST, and they
are what we should aspire to be: VIRTUOUS.
VIRTUE THEORY
Ethical theory that emphasises an individual’s character rather than following a set of rules.
It is all about character.
Rather than saying “ follow these rules so that you can be a good person. If we can just
focus being good people, the right actions will follow, effortlessly.
EUDAIMONIA
It means a life well lived. It is sometimes translated as “Human flourishing”
A life of Eudaimonia is a life of striving. It is alive of pushing yourself to your limits, and finding success.
A eudaimonistic life will be full of the happiness that comes from achieving something really difficult rather than just having it handed to you.
Choosing to live a eudaemonistic life means that you’re never done improving, you’re never to point where you can just coast. You are constantly setting new goals and working to develop . Choosing to live life in this way also means you will face disappointments and failures
Proper functioning- everything has a function , and It is sometimes translated as “thing is good to the extent that is fulfils its function, and bad to the extent that it doesn’t Objects created by human: Knife is to cut, so dull knife is a bad knife. A flower is to grow and reproduce, so a flower that doesn’t do that is just bad of being a flower.
❖ The same goes for Humans: we’re animals- so all the stuff that would indicate proper functioning for an animal holds true for us as well- we need
to grow and be healthy and fertile. We’re also the Rational Animal and a social animal, so our function also involves using reason and getting along with our pack.
❖ Aristotle said that having virtue just means doing the right thing, at the same time, in the right way, in the right amount, toward the right people.
❖ There’s no need to be specific, because if you’re virtuous, you know what to do. All the time. You know how to handle yourself and how to get along with others, you have good judgment, you can read a room, and you know what is right and when.
❖ Virtue as the midpoint between 2 extremes, which Aristotle called vices.
❖ Virtue is just the right amount, the sweet spot ( Golden Mean) between the extreme of excess and the extreme of deficiency.
❖Acorns are built with the drive to become oak tree
COURAGE
Sizing up the situation
A virtuous person in Aristotelian sense - would first take stock of the situation. If you size up the mugger and have a good reason to believe that you can safely intervene, then that probably the courageous choice. But if you assess the situation and recognise that intervention is likely to mean that both you and the victim will be in danger, the courageous choice is not to intervene, but to call for help instead.
❖ According to Aristotle, Courage is the midpoint between the extremes of cowardice and recklessness.
❖ Cowardice is a deficiency of courage and recklessness is an excess of courage and both are bad.
❖ You definitely can have too much of a good thing.
Courage is finding the right way to act
Courageous person will assess the situation, they‘ll know their own abilities, and they will take action that is right in the particular situation.
Part of having courage is bing able to recognize.
When rather than stepping in, you need to find an authority who can handle a situation that I that is too big for you to tackle alone.
HONESTY
Midpoint between Brutal honesty and failing to say things that need to be said
❖ The virtue of Honesty means knowing what needs to be put out there, and what you should keep quiet about.
❖ Honesty also means knowing how to deliver hard truths gracefully.
❖ How to break bad news gently, or to offer criticism in away that is constructive , rather than soul -crushing.
GENEROSITY
❖ It Avoids the obvious vice of stinginess but also doesn’t give too much.
❖ It is not generous to give drugs to an addict or to buy a round of drinks for everyone when you need that money to pay the rent or tuition fee
❖ If you have to figure out what virtue is in every situation, how can you possibly learn to be virtuous?
❖ Aristotle said- Virtue is a skill, a way of living, and that is something that can really only be learned through experience.
❖ Virtue is a kind of knowledge that he called Practical Wisdom.
Aristotle said your character is developed through habituation. If you do a virtuos thing over and over again, eventually it will become part of your character.
So you learn virtue by watching it and then doing it
PRINCIPLE OF DOUBLE EFFECT
Keep in Mind!
•T h e r e i s a d i ff e r e n c e between performing a GOOD act, which has both good and evil effects and performing an EVIL act in order that good may result.
Guiding elements
a. The Nature of the act
the course chosen must be good or at least morally neutral
b. Not means to an end
the good must not follow as a consequence of the secondary harmful effects
c. The right intention
the harm must never be intended but merely tolerated as casually
d. Proportionality
the good must outweigh the harm
GOOD ACT/EVIL ACT
PRINCIPLE OF COMMON GOOD
COMMON GOOD
“The sum total of social conditions which allows people, either as groups or as individuals, to reach their fulfillment more fully and more easily.”
God created the world for all and the goods of the world should in principle, be at the disposal of all and for the good of all, without preferential treatment.
PRINCIPLE F SUBSIDIARITY
What can be done by an individual or lower group should not be done by a higher group
Every task of society should be assigned to the smallest possible group that can perform it. Only if the smaller group is unable to resolve the problem itself should a group at a higher level assume responsibility. [Show Less]