Transcript Chapter 5: Ethical Standards

Chapter 5:
Ethical Standards
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
1
Chapter 5: Introduction
• Literacy in the field of ethics will impact
– Decision making in everyday life
– Navigation of complex dilemmas
• Ethics is comprised of various
– Models
– Concepts
– Theories
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
2
Ethical Models
• Definition of ethics:
– The formal study of moral choices that conform to
standards of conduct
– Listening to one’s conscience
– Making judgments between right and wrong
• Sometimes confused with other areas of study:
–
–
–
–
Morals
Values
Etiquette
Law
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
3
Ethical Models:
Comparisons
• Ethics is the formal study of moral choices.
– Basis is in philosophy
• Morals
– The principles of right conduct that individuals
internalize
– Based in religious belief and personal choice
– Related to ethics
– Ethics put moral principles into practice
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
4
Ethical Models:
Comparisons
• Etiquette
– The social code of custom and ritual
– Based in society
• Values
– Concepts that give meaning to a person’s life
– Based in society, family, and religion
– Conflict may arise when values of different
countries or groups differ
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
5
Ethical Models:
Comparisons
• Law
– Body of rules with legal force
– Choice is external: based in a controlling
authority (legislature)
– Law: minimum level of expectations for right
and wrong
– Ethical choice is internal: based in one’s conscience
– Look to ethics when:
•
•
•
•
No obvious right or wrong
Enforcement of law does not bring justice
Right behavior brings wrong effect
Personal sacrifice is consequence for following ideals
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
6
Ethical Concepts
• Ethical concepts: abstract ideas are
part of the values that form the basis
for decisions
• Multiple approaches to ethical reasoning
– Autonomy
– Beneficence / nonmaleficence
– Best interest standard
– Fidelity
– Justice
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
7
Ethical Concepts:
Autonomy
• Independence, self-determination, freedom
• Three main elements:
– Ability to decide
– Power to actualize or implement a decision
– Respect for the autonomy of others
• Concept of informed consent: power rests with
patient to make decisions about health
• Dilemma: balance between rights of individual
and rights of others
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
8
Ethical Concepts: Beneficense
and Nonmaleficence
• Two interlocking concepts
• Beneficence: qualities of kindness, mercy
and charity, duty to always do good
• Nonmaleficence: prohibition against doing
harm, duty to prevent evil
• Hippocratic oath:
I swear . . that . . . I will apply measures that
benefit the sick . . . keep them from harm and
injustice
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
9
Related Principle:
Double Effect Principle
• Recognizes that ethical choices may result
in untoward outcomes
• Harm versus benefits analysis
– Is the untoward outcome secondary
or unintended?
– Is that outcome outweighed by an intended
positive outcome?
– Example: If adverse drug reaction occurs as
an unexpected outcome of administering
a treatment
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
10
Ethical Concepts:
Best Interest Standard
• Determining what is in the best interest of a
person when that person cannot decide
for themselves
• Patient cannot give consent
– Incompetent due to age (a child), mental limitations
(Alzheimer's or retardation), coma
– Another decides whether there will be benefit or harm
– May base decision on past evidence of person’s
wishes (advanced directive, previous statements)
• Legal application: famous cases
– Quinlan, Cruzan, and Schiavo
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
11
Ethical Concepts: Fidelity
• Faithfulness, loyalty, and devotion to
one’s obligations
• Related to accountability
• Working in health care requires providers
to exercise fidelity to the role of caring for
the patient
– It is the physician’s duty to the patient to be
the first one to inform her of the diagnosis
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
12
Ethical Concepts: Justice
• An obligation to be fair to all
– Fairness, honesty, and impartiality
• Requires that no one be favored
over another
• Does not require that each one be treated
the same
• What one considers fair may conflict with
another’s opinion
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
13
Ethical Concepts: Justice
• Comparative justice
– Group with greater need or interest may
receive more resources than those with
lesser need
• Distributive justice
– Fair distribution of burdens and benefits
– Requires one in position of authority to
provide service due to others
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
14
Ethical Concepts: Access
and Distributive Justice
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
15
Ethical Concepts: Rights
• A just claim or entitlement that others are
obliged to respect
• Rights may vary with the moral values of
a culture
• Right to confidentiality
– Obligation of health care provider to protect health
information from improper disclosure
• Right to privacy:
– Right to be left alone or to control
personal information
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
16
Ethical Concepts: Veracity
• Habitual truthfulness and honesty
• One may argue that there are situations in which
not telling the truth may be justified:
– Person not strong enough to handle or understand
truth, too much anxiety or grief
• Patients must truthfully inform health care
provider of all relevant information
• Health care provider must disclose facts to
patient to enable patient to decide care
• Medical research issues: use of placebos
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
17
Ethical Theories
• Systematic statements or plans used to
deal with ethical dilemmas
• Theories enable consistent and coherent
process when making ethical decisions
• Utilitarianism
• Deontology
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
18
Ethical Theories:
Utilitarianism
• Consequentialism
• Everyone should make choices that
promote the greatest balance of good over
harm for everyone
• An act is right when it is useful in bringing
about a good end
• Consideration of the effects of action on
everyone involved is encouraged
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
19
Ethical Theories:
Utilitarianism
• Application
–
–
–
–
Used when preparing cost/benefit analysis
All possible options are considered
Value of each option determined
Option with highest total utility chosen
• Group benefit is valued
• Weakness:
– End justifies the means
– Difficulty identifying and measuring all of the possible
benefits; requires some prediction into the future
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
20
Ethical Theories:
Deontology
• Formalism or duty orientation
• Decision making is based on moral rules
and unchanging principles
• Derived from reason and
applied universally
• Look at the intrinsic nature of act
– Determine its basic rightness or wrongness
– Consequences of the act are irrelevant
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
21
Ethical Theories:
Deontology
• Categorical imperative
– A command derived from a principle that does
not allow exceptions
– Application of unconditional commands in a
similar manner in all situations
• Examples:
– Life is sacred. Killing is never justified.
– Medical research: value on freedom of
choice. No subject should ever be tricked into
participating.
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
22
Ethical Theories:
Deontology
• Weaknesses
– Does not consider the variety in real-life
situations
– Overly rigid
– Disregard for consequences of action may
lead to absurd results
– Disagreement as to whether motivation is
derived from universal values
• One may be motivated by changing values instead
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated,
or posted to a publicly accessible website, in whole or in part.
23