HCE-NOTES-PPT1 (1).docx

For Jehovah's witness: \*\*If patient is a minor, and is not capable of making decision, parents can make decisions for him/her. \*\*If patient is a mature minor, and is capable of making decisions, he can personally make decision ( eg.Court case in Japan, Italy,etc.) \*\*If the patient is uncons...

For Jehovah's witness: \*\*If patient is a minor, and is not capable of making decision, parents can make decisions for him/her. \*\*If patient is a mature minor, and is capable of making decisions, he can personally make decision ( eg.Court case in Japan, Italy,etc.) \*\*If the patient is unconscious and not capable of making decisions, morally a physician is obligated to do everything to save the patient's life eventhough it is contrary to the patient's wishes. \*\*e.g. Japanese law---under 20 yrs old is considered a minor..Philippines= less than 18 years old(minor) **; if the parents of a minor Jehovah's Witness who is incompetent refuse permission for a life-saving blood transfusion, the physician may decide not to respect the parents' wishes;** - Since patient is a minor, a Jehovah's witness, there is a conflict between the patient's right to self determination and the religious beliefs as Jehovah's witnesses. - When a patient is a mature minor, his wishes should be respected. In the case of a minor patient lacking decision-making capacity, the wishes of the parents should be respected as much as possible. ETHICS- is a significant part in the life of a medical professional that guides his or her clinical practice in the care of patients. - WHY SHOULD ETHICS BE APPLIED IN HEALTH CARE SETTING AND FOR THE HEALTH CARE PROFESSIONALS? In this time of great change and challenge within the health care system, there is a need to apply ethics in all types of decision making.\ To make this application successful, one needs foundation in ethics, in addition to data and evidence based management tools including those offered by advanced technologies. An understanding of the ethics theory gives the ability to make and defend ethics based decisions that support both fiscal responsibilities and patient centered care. - **Ethics** is the study of the moral character and is consistent in the belief that the practice of medicine is based in that perfect character or behavior towards another person.It is the study of morality and defining what is right and wrong. - **MORAL DUTY**-it is the obligation based on morality or ethics. - **CHARACTER**-the mental and moral qualities which is distinctive to that individual; - **CUSTOM**-a traditional and widely accepted way of behaving or doing something that is specific to that particular society,place or time. - Ethics-is also related to Philosophy;.This attempts **to explain what is real and what is not real, or what is true and what is false.** **Philosophy=came from 2 Greek words= philos= love, lover Sophia= wisdom** - ETHICS as a branch of philosophy, that seeks to determine how human actions may be judged right or wrong. - With regards to ethics, its application in a clinical or health care setting, **provides a foundation in ethical decision making** which may be a tool to assist health care leaders in assessing the choices that they must make in certain problematic or challenging situations regarding patient care. - Medical ethics ***define the duty of the physician toward the patient.*** - MORALS are specific behaviors of accomplishing ethical practices - Morality provides ethics with a quality that determine and distinguishes Right Conduct from wrong conduct. - In health care, ethical concepts such as autonomy, beneficence, justice, and non-maleficence are derived from Normative ethics that often guide decision making. - Normative ethics is interested in determining the content of our moral behavior. - Normative ethical theories include- Natural laws theory, Egoistic theory, Authority based theories, Virtue ethics, Teleological theories, in which some of these will be discussed later. - METAETHICS -- Refers to the nature of ethical terms and concepts; This is also known as the Analytic ethics; It seeks to understand the nature of Ethical properties, ethical statements, attitudes and judgements. - E.g. Metaethics=Discussions whether ethics is relative and whether we always act from self interest - Bioethics studies the philosophical, social and legal issues arising in medicine and life sciences; It is a subpart of Health care ethics, that focuses on the moral issues in relation to life in Health care. - This focuses on the following topics: 1) organ donation and transplantation 2) Genetic research 3) Death and dying 4) environmental concerns - Bioethics entails a continuous process of decision making, in order to save lives or enhance quality of lives at all times as possible. - Heath care ethics- is the application of the Core principles of bioethics: Autonomy, Beneficence, Nonmaleficence, Justice to Medical and health care decisions. - Health Care ethics --a division of ethics that relates to human health. - Heath care ethics, WHAT IS IT FOR?- is for---striving to resolve ethical issues that confront health care professionals. - This oath dictates the obligations of the physicians and to students of medicine. In this oath, the physician pledges to prescribe only beneficial treatments, according to his ability and judgement, refrain from causing harm or hurt; and to live an exemplary personal and professional life. - The Hippocratic Oath is the foundation of Medical ethics, which defines the duty of the physician to his patient. - This oath is regarded as the first concept of ethics recorded in Medical and human history. Hippocrates set forth some important precepts. These remains as the principles that are applied to our medical profession today. - THE ART OF MEDICINE\--It is how we apply evidence based medicine to each and every patient we see. - DEONTOLOGY- Could be called the science of determining our duties. -. This is also known as nonconsequentialist because it doesn't consider the consequence of the action first. Rather, it examines the action first. - According to Kant,"The consequences themselves are not relevant in determining what is right. Thus doing the right thing might not always lead to an increase in the good." - According to Kant-"Morality is based on the actions of the person and not on the motive".. - Even when a person does not want to do his duty, he is **required** to do so. - The basic rightness or wrongness of an act depends on its intrinsic nature rather upon the situation or consequence - This Theory consider ethics of a decision to be dependent on the consequences of an action which is also called Consequentialism. The basic idea is to maximize the good of a situation. - Aristotle= founder of Teleology - TELEOLOGY- judge the morality of an action by the good or bad consequences of an act; Good is the general goodwill or love for humanity - Also called by its originators/proponents- Bentham and Stuart Mill- the Maximization of Good Utility, thus the name Utilitarianism. - Virtue ethics- the origin of these Virtue ethics can be traced back to Plato and Aristotle - Aristotle (384-322 BC) sought to explain the highest good for humans. "To develop one's character to make good ethical decisions when needed. The decisions made must not only be for some happiness of some people but the flourishing of society." - Good habits are used to regulate emotions. - Key idea of the Virtue ethics is to find the proper end for humans and then to seek that end. In this sense, people seek their perfection or Excellence. - -come into play as people seek virtuous lives, developing their potential for excellence to the best of their abilities. - Definition of terms: - Ascetic-the practice of severe self discipline, or abstention from all forms of indulgence - Bootlicking= excessively obedient or servile - Buffoonish=clownish, laughable, ridiculous - Boisterous=noisy, rowdy - Deferential=humble, respectful, considerate - Retribution= punishment for a crime; retributive= involving retribution - Conscientious=wishing to do what is right - Indignant=feeling or showing anger or annoyance at what is perceived to be an unfair treatment. - Boorish=rough and bad mannered; rude, uncouth - Depraved=morally corrupt, wicked, perverted, deviant, degenerate - According to the works of Aristotle, this term means " the highest human good", the condition of human flourishing or living well. - The satisfaction of knowing that you have accomplished a lot, and that you've pushed yourself to the limit to be the very best person that you could be. You worked hard for it and it wasn't just handed to you on a silver platter." - Florence Nightingale is the founder of Modern nursing, an English social Reformer; Trained the nurses during the Crimean War. She is known as " The Lady with the Lamp". - \- **\#2. Integrity** - To be a person of Integrity involves a personal choice to hold oneself to consistent high moral and ethical standards. It is living out practically the ethical principles you value and believe internally. - Another way to identify the degree of your integrity is the degree of congruence between how you behave in public vs. in private. - Integrity is also closely related to honesty. For example, a lack of disclosure and honesty with any type of error or mistake does not just impact you, it also affects the patient and can result in a possible adverse outcome. - Be honest with yourself and carefully reflect on how you handle mistakes in your life. Make it a priority to be a person of integrity who consistently does the right thing. - *What are you like when nobody is watching? Are you the same or different?* - *If you make a mistake, are you honest and own up to it? Or do you tend to minimize and hide your mistake from others so no one finds out?* - \- **\#4. Humility** - Humility is being humble, or in nursing is reflected as an attitude that finds joy and satisfaction in serving others. The best nurses have a strong desire to serve their patients and putting their needs ahead of their own. - A nurse with a humble, servant motivation has a love and empathy for others, is secure and does not feel that it is beneath them to serve others, but embraces and enjoys meeting the needs of the patient and their family. - *Do you enjoy and find fulfillment in serving others?* - *Do you readily recognize your limitations as a student learner? Are you comfortable asking questions to validate your knowledge base?* - \- **\#5. Thankfulness** - Though this was not on Nightingale's short list of virtues, I feel that it is timely as well as relevant and will make a difference when an attitude of gratitude is present and "in you." Student entitlement that sees education as a "right" and being owed a passing grade because they paid for it is the antithesis of gratitude and thankfulness. - -**\#6. Sympathy/compassion** - Caring and compassion remain the core virtue ethics of the nursing profession and their relevance remains obvious. The essence of caring as a nurse is that you recognize the value and worth of those you care for and that the patient and his or her experience MATTERS to you (Benner & Wrubel, 1989). - In order for the nurse to bring holistic care that includes the "art" of nursing into his/her practice, sympathy and compassion for others must be evident. - Nursing is a caring profession. -. If you care about someone, you are compassionate towards them, you make sure that you are capable in providing care, you communicate with someone you care about, you are courageous, and you are committed to them. That\'s why I said that caring is the most important one. It all start from there. - *sympathetic pity and concern for the sufferings or misfortunes of others.* - *Compassion literally means "to suffer together." Among emotion researchers, it is defined as the feeling that arises when you are confronted with another\'s suffering and feel motivated to relieve that suffering.* - *Compassion motivates people to go out of their way to help the physical, mental, or emotional pains of another and themselves* - As a nurse, you must not only be caring and compassionate, but you must also know what to do so that your acts of care are guided by wisdom and knowledge. For example, you may have a big caring heart for someone who just met an accident on the road but trying to carry the patient running to the hospital may create more injury to the patient. The nurse MUST be competent even with the care that he/she provides. - This is a combination of compassion and competence. Because you care and have the competence, regardless of the difficult situation, you put your hands to work to help. - It is a good thing to earn. But a nurse's commitment must go beyond seeing the salary. Because this is working for others, there is a big possibility of burn out in the process even with the present condition of nurses in the country. This must go both ways. The gov't should also be committed to strengthen the commitments of nurses. - \--should be clear and credible; - -helps clear patient's confusion, and fosters understanding on the process of nurse patient interaction. - A 2 way process -