Healthcare Ethics PDF

HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ○ Re-evaluation: action of assessing or...

HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ○ Re-evaluation: action of assessing or evaluating something What is Healthcare Ethics? ★ The aim is to deepen understanding. By doing philosophy we learn to think better, to act more ★ The field of applied ethics that is concerned with wisely, and thereby help to improve the quality of the vast array of moral decision-making all our lives. situations that arise in the practice of medicine, ○ Deep Understanding - to be able to put in addition to the procedures and the policies that the pieces together and to use such are designed to guide such practice. understanding to do things (ex: solve ★ HEALTH ETHICS problems, create new ideas etc) ○ Promotes consideration of values in the prioritization and justification of actions by health professionals, ETHICS researchers, and policy makers that ★ The word ETHICS is derived from the Greek word may impact the health and well-being ethos, as the word MORALS is derived from the of patients, families, and communities. Latin word mores. ★ ETHICS ★ Both are derived from the word for custom, ○ Refers to the well founded standards manners, or the disposition peculiar to a given of RIGHT AND WRONG that prescribe people (Loewy). In German a third word, sittlich, is what humans are ought to do similarly derivable. ○ Usually in terms of rights, obligations, ★ Ethics, also called moral philosophy, the discipline benefits to society, fairness, or specific concerned with what is morally good and bad and values. morally right and wrong. The term is also applied to any system or theory of moral values or RESPECT principles. ★ Ethics deals with such questions at all levels. Its ★ R - RECOGNIZE the inherent worth of all human subject consists of the fundamental issues of beings. practical decision making, and its major concerns ★ E - ELIMINATE derogatory words and phrases from include the nature of ultimate value and the your vocabulary. standards by which human actions can be ★ S - SPEAK with people - not at them...or about judged right or wrong. them. ★ P - PRACTICE empathy. Walk awhile in others' shoes. Definitions to Remember ★ E - EARN respect from others through ★ Scientific respect-worthy behaviors. ○ Based on or characterized by the ★ C - CONSIDER others' feelings before speaking methods and principles of science, and acting. systematic, methodical, organized, ★ T - TREAT everyone with dignity and courtesy. rigorous, exact, precise, accurate, mathematical PHILOSOPHY ○ Practicing or using through systematic methods ★ Philosophy is a way of thinking about certain ★ Naturalism subjects such as ethics, thought, existence, time, ○ The philosophical belief that meaning and value. everything arises from natural ★ That way of thinking involves 4 Rs: properties and causes and ○ Responsiveness: be able to react supernatural or spiritual explanations quickly are excluded or discounted ○ Reflection: an instance of reflecting ○ Existing in or not artificial ○ Reason: justification for an action or ★ Humanism event 1 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ○ Outlook attaching prime importance ○ Religion often inspires people to follow to human rather than divine or ethical rules because they want to supernatural matters, focusing on the please a higher power or live potential goodness of human beings, according to their faith. emphasizing common human needs, ★ Religion should not be identified with ethics and seeking rational ways of solving ○ Ethics and religion are not the same human problems. thing. A person can be ethical (do what ○ Attitude or way of life centered on is right) even if they don’t follow any human interest or values religion. ★ Morality ○ A non-religious person might still believe ○ Principles concerning the distinction stealing is wrong because it hurts between right and wrong or good and others. bad behavior. A particular system of ★ Ethics cannot be confined to religion nor is it the values and principles of conduct, same. especially one held by a specified ○ Ethics is bigger than religion. It applies person or society. to everyone, whether they are ○ System or set of ideas about right vs. religious or not, because it’s about wrong and good vs bad behavior fairness and respect in society. ○ Both religious and non-religious people can agree that treating others kindly is FEELINGS the right thing to do. ★ Feelings are sensation experienced and are subjective. The Law ★ Many equate ethics with feelings. But being ethical is clearly NOT a matter of following ★ Ethics ≠ Law feelings. Feelings frequently deviate from what ★ Being ethical is also not the same as following the is ethical. law. ★ The law often incorporates ethical standards to "Ethics has to do with what my feelings tell me is right or wrong." which most citizens subscribe. But laws, like feelings, can deviate from what is ethical. ★ Our own Pre-Civil War slavery laws are one ★ The statement above implies that ethics is based obvious example of laws that deviate from what is on personal feelings or emotions about right and ethical. wrong. ○ Slavery: practice of forcing people to ★ For example, if you feel guilt or discomfort about work and limit their liberty an action, you might decide it’s wrong based on ○ Apartheid: system of legalized racial that feeling. segregation and discrimination. ★ However, ETHICS IS NOT ALWAYS ABOUT PERSONAL EMOTIONS OR FEELINGS. Ethics What is Right? involves reasoning, principles, and sometimes rules that go beyond emotions. ★ In making decisions we should draw on the ethical notion that loyalty should never take precedence over other ethical values such as honesty, RELIGION trustworthiness, personal responsibility and so on. ”Ethics has to do with my religion” If loyalty trumped all else, then we can imagine the tight situations where we do what is ethically ★ Religions do advocate high ethical standards improper out of a sense of loyalty to another ○ Religions teach people to live good person or an organization. lives, like being kind, honest, and fair. ★ Religion provides intense motivations for ethical behavior 2 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. explores the question of what we ought to do, rather than simply discuss what people could do or actually do. In order to know what to do in a given situation, we need to explore the issue carefully in terms of the action involved, its consequences on others, and the context in which it takes place. Theory of Health Care Ethics ★ TELEOLOGY ○ "The study of ends or purposes." ○ Focuses on the purpose or goal of something. It judges actions based on their results or outcomes. HEALTH CARE ETHICS = APPLIED ETHICS ○ A teleologist attempts to understand the purpose of something by looking at ★ Applied Ethics refers to taking general ethical its results. principles and applying them to specific, real-life ○ Ex: A doctor recommends surgery to situations. save a life, focusing on the end goal of ★ Thus, Health Care Ethics is a type of Applied saving the patient. Ethics because it focuses on applying ethical ★ UTILITARIANISM principles to healthcare settings. ○ The doctrine that actions are right if ★ Both ask, “What is the right thing to do?” but they are useful or for the benefit of a Healthcare Ethics narrows this question to majority. medical situations. ○ It’s about creating the most happiness ★ In Healthcare Ethics: or good for the most people. ○ We make moral judgments about ○ Ex: A government enforces a lockdown actions (e.g., performing a to protect the majority of people from a risky surgery) virus. conditions (e.g., keeping a ★ DEONTOLOGY patient on life support). ○ An ethical theory that uses rules to ○ It provides a framework distinguish right from wrong. to guide decisions about ○ Judges actions by rules, not outcomes. complex medical issues Doing the right thing means following and medical the rules or duties. decision-making. ○ Ex: Always telling the truth, even if it ★ Ethics is a complex area. It is concerned with the causes trouble. kind of people we are. ★ FEMINIST ETHICS ○ Ethics of Being: The kind of people we ○ This focuses on women’s experiences are and challenges traditional ethics for explores personal values, overlooking women as undervalued character, and the type of and/or underappreciated. moral person someone ○ It values equality and care. strives to be. ○ Feminism ○ Ethics of Doing: The actions we take The advocacy of women's deals with the decisions we rights on the basis of the make. It focuses on what equality of the sexes we do and how we decide in ★ COMMUNITARIANISM specific situations. ○ A theory or system of social ★ Ethics is about right and wrong in human conduct. organization based on small Ethics is about choices, dilemmas and gray areas. It self-governing communities. 3 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ○ Values community and collective ★ It is easy to see how this theory can be applied to well-being over individual interests. other realms of moral life and why it has become ○ Ex: a ban on public cigarette smoking. particularly attractive in the realm of healthcare ethics, bioethics ★ First, many of the ethical problems we face in UTILITARIANISM medicine are directly about people's happiness: ★ Utilitarianism is a form of ethical theory that is ○ The very term "quality of life" concerned with the outcomes of actions. acknowledges that pleasure and pain ★ Utilitarians claim that it is the action itself that is are variables in life and need to be right or wrong, not the person performing the assessed as other life conditions action. change. ★ As such, it is a form of a more general theory ○ It is in the forefront of decisions about called Consequentialists. withdrawing or withholding treatment ○ Consequentialists refers to the as a means to end suffering. doctrine that the morality of an action ○ One reason to respect autonomy is the is to be judged solely by its idea that only the patient can make an consequences. accurate determination about what ○ A type of consequentialist theory that course of action will bring him or her has become powerful in bioethics is the greatest happiness, and we should utilitarianism. therefore accept that determination as ★ Jeremy Bentham (1748-1832) introduced both the reflective of the greatest good name "utilitarianism" and the most-recognized ★ Second, in medical ethics we are inevitably statement of its central thesis: concerned with the distribution of medical ○ The greatest happiness of the greatest resources. Although we do not generally have to number is the measure of right and make these decisions at the patient's bedside, we wrong, and it is common to hear people do need to be prepared to address these issues in today use the phrase "the greatest good a larger context and understand their implications for the greatest number.” for patient care. Distributing resources so that the ★ For Bentham, the good is defined very simply as greatest number of people can get the most happiness. benefit ○ He claimed that happiness was ○ Distributing resources so that the something that could be calculated by greatest number of people can get the measuring and adding up pleasure and most benefit from them is a direct subtracting pain. application of utilitarian theory ○ Thus any action that brings about ○ Ethical problems we face in greater happiness for more people is a nursing/medicine are directly about right action under Bentham's brand of people's happiness utilitarianism ★ Quality of life ★ John Stuart Mill (1806-1873) refined this idea of ○ Decisions about withdrawing Utilitarianism treatment as.a.. means to end suffering ○ He strengthened the notion that ★ Autonomy pleasure and freedom from pain are ○ Only the patient can accurately the only two things desirable as ends determine what action will bring him to in themselves greatest happiness ○ Thus, the term Utilitarianism was ★ Utilitarianism has been criticized as being simple refined John Stuart Mill & unable to cope with the complexities of real-life situations: ○ Utilitarianism requires us to do UTILITARIANISM IN HEALTHCARE ETHICS whatever act will bring about the ★ Originally, utilitarian theories were designed for greatest good, even if that means and applied to legislative matters. doing something we would otherwise consider immoral 4 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ○ True calculations of happiness are ○ The outcome or result of the action impossible doesn’t determine whether it is right ○ Utilitarianism does not consider issues or wrong. of distributive justice ★ Key Difference from Consequentialism ○ Utilitarianism requires us to do ○ Deontology: Actions are right or wrong whatever act will bring about the based on whether they satisfy moral greatest good, even if that means duties, regardless of the doing something we would otherwise consequences. consider immoral ○ Consequentialism: The morality of an ○ If we can bring about a good, then, action depends on whether it leads to according to utilitarian theory, we are the best outcomes or maximizes the required to do that action. good. ○ However, there are some goods that ★ Type of Deontological Theories: Divine Command can be achieved only through means Theory that most of us would consider wrong. ○ Moral duties and obligations come ○ Example, A patient asks that her from God’s commands. People family not be informed of her following religious rules may not diagnosis or prognosis realize they are practicing this form of ★ By utilitarian reasoning, it would require that you deontology; they are simply following disclose this information to the family. However, their faith’s teachings. respecting patient confidentiality is an important ○ Examples of Divine Command theory element of patient care in action, as well as its drawbacks, are ★ Most clinicians would agree that it is absolutely profuse in the health care setting: wrong to disclose patient information without the Orthodox Church has a very patient's consent following utilitarian reasoning strong pro-life stand. could put one in a situation in which breaking Orthodox Jewish patients ethical standards is required often take a more stringent ★ Utilitarians' have addressed this problem is to interpretation of God's adopt a rule-utilitarian stance command to respect and ★ A rule-utilitarian would reply: Disclosing preserve life. confidential patient information would bring about Jehovah's Witnesses, more harm than good and therefore one should although agreeing with the always follow the general rule of maintaining duty to respect and preserve confidentiality life, claim that there is a higher duty, given by divine command, not to ingest DEONTOLOGY blood, and therefore refuse ★ The major contender to consequentialist theory is blood transfusions deontological theory. Even people who do not ★ Deontology is derived from the Greek word deon identify with a particular meaning duty (Webster's College Dictionary, 1991, religious tradition may have p. 387). their own sense of what God ★ Deontology is an ethical theory that focuses on requires of them the morality of actions themselves rather than the ★ Rules and Duties in Deontology consequences of those actions. ○ Duties are often linked to absolute ★ According to this theory: moral rules that should always be ○ Actions are considered morally right if followed, no matter the consequences. they follow a set of moral duties or ○ For example, killing someone is obligations. considered wrong in deontology, even in self-defense, because the action itself (killing) violates a moral rule. 5 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. ★ Key Point Freedom from torture ○ Deontology is about doing what is Freedom of speech and morally right according to rules and religion duties, not about creating the best Rights to health, education, outcomes or maximizing happiness. It and a good standard of living emphasizes the rightness or wrongness of actions themselves ○ Man’s law is based on moral principles rather than their effects. and this makes the distinction clearer: natural law focuses on universal principles tied to human nature, while NATURAL LAW VS. MAN’S LAW man’s law comes from moral reasoning and societal agreements. ★ NATURAL LAW ○ A philosophical theory of ethics that CATEGORICAL IMPERATIVE IN HEALTHCARE states that human beings possess intrinsic values that governs our ★ Immanuel Kant’s categorical imperative asks us to reasoning and behavior. consider whether our actions would be ethical if ○ The way people use natural law they became universal rules that everyone depends on their intentions. It can be followed. It’s like asking: used either right or wrong. ○ “What if everyone did this in similar ○ Example: killing another human being is situations? Would it still be the right considered morally unjust, but doing so thing to do?” in self-defense would be morally ★ Example: justifiable by double effect. ○ The father of a 12-year-old patient asks ★ Misuse of Natural Law: you for the biopsy results because he ○ Natural law says that humans are wants to be prepared to support his naturally inclined to procreate, as child. Since the patient is a minor, the reproduction is a part of human nature. father is likely responsible for making However, if someone uses this to claim important decisions about the child’s that “a man can procreate with any care. woman, as long as they can have I. First Criterion: Universalizability children,” it becomes a misuse. This ○ Before acting, ask: What if everyone interpretation ignores other important did this? Would it still be ethical? aspects of natural law, like the ○ Example: A friend of a patient asks for importance of respect, consent, and test results. the social and emotional bonds ○ If we share the results, it could violate involved in relationships. patient privacy. Since this action can’t ★ Examples of why natural law is rightfully used be universalized, we shouldn’t release ○ Drunkenness is wrong because it injures the information. health and worse, destroys one's ability ○ However, if the patient were a minor to reason, which is fundamental to man and the friend was a parent needing as a rational being. the information to make decisions, ○ Theft is wrong because it destroys social sharing it could be ethical and relations, and man is by nature a social universalizable. animal. II. Second Criterion: Treat People as Ends, Not ★ MAN's LAW Means ○ The moral law based on the ○ Patients must be treated with respect conscience on moral consciousness; and dignity, not as tools for personal or our sense of right and wrong. professional gain. ○ It covers things like: ○ Example: A healthcare provider should The right to life prioritize the patient’s well-being, not The right to a fair trial just treat them to earn money. Even 6 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. though professionals earn a living ★ Ethics of Care through their work, the focus must ○ Feminist ethics emphasizes the “ethics always be on helping and respecting of care,” meaning that moral actions the patient. are deeply connected to emotions. ○ Instead of following strict rules, feminist ethics believes that morality APPLICATION OF KANT’S RULE comes from understanding the needs 1. Test the action: Should you share the medical and feelings of others in our information with the father? relationships. ○ If your action (sharing the results) can ○ Much of our daily life revolves around be universalized—meaning it’s ethical relationships, and these relationships for any healthcare professional to shape how we understand and act share medical results with the parents morally. So, to understand morality, we of a minor who need them to make need to focus on how we relate to informed decisions—then it aligns with others and the values we share with the categorical imperative. them. 2. Make the rule: In this case, you can create a rule: ★ Special Consideration in Relationships ○ “I should release medical information ○ Putting Others’ Needs First: In any to a minor patient’s parents so they relationship, it is expected that we give can make informed decisions.” special attention to the other person’s 3. Universalize the rule needs. ○ This rule makes sense because minors ○ Feminist ethics also points out that no typically depend on their parents to two people or groups are exactly alike. act in their best interests, especially in Each person has different strengths, medical situations. If everyone weaknesses, and needs, so moral followed this rule, it would ensure action must consider these minors receive proper care and differences, rather than treating support. everyone the same way. ★ Health Care Provider-Patient Relationship ★ However, the rule might have exceptions, like if ○ The healthcare provider-patient sharing the information could harm the child or relationship is an example of how violate their privacy unnecessarily. Kant’s moral action should focus on framework allows for fine-tuning in such cases, understanding and addressing the but the key idea is to act in a way that respects unique needs of the patient, using the patient’s needs and the parent’s responsibility. empathy, compassion, and care. FEMINIST ETHICS COMMUNITARIANISM ★ Feminist ethics is not just one way of thinking; it’s ★ Communitarianism in medical ethics emphasizes a collection of ideas that challenges traditional that we are not isolated individuals but part of a moral beliefs. network of communities that shape our identity ★ Feminists question the way the world works, and moral decisions. especially the power structures that often favor ★ Communities can be understood in many different men. They also focus on how these structures can ways: lead to the oppression of certain groups of people. ○ groups of people in a specific area ★ Traditional moral theories often focus on rights (geographical) and obligations, which come from legal ideas like ○ groups of people with a shared property and contracts. Feminists believe these nationality, institutions, or social units theories don’t fully address the importance of like schools and workplaces. relationships and care, which are central to ★ Our identity and moral actions are closely tied to morality. the community around us, and we must consider 7 HEALTHCARE ETHICS WEEK 1: Theories and Principles of Health Ethics 2nd Semester, Midterms | By: Aisha M. the impact of our actions on all the communities ★ The decision should consider how the baby’s care we belong to. affects the family. Can they continue to function ★ The Role of Communities as a unit, or will stress lead to dysfunction? ○ Communities and Identity: A person’s ★ Communitarianism emphasizes the importance of identity is deeply connected to the the community in moral decisions. Here, the community or communities they are family is the primary community, and their part of. For example, we don’t just exist collective well-being should be considered, not as isolated individuals; we are part of a just the individual child’s. family, a neighborhood, a school, a city, ★ Application: The decision to treat the baby a country, and more. involves more than the child’s needs—it must ○ Moral Decisions and Communities: consider the larger community’s well-being, When making moral decisions, we including the family and healthcare system. The must think about how those decisions moral action is to prioritize the good of the will affect all the communities community. involved. For example, in healthcare, it’s not just about the patient as an individual but about the patient’s family, healthcare providers, the institution they belong to, and the society they live in. ★ The “Institution of Medicine”: ○ In medical ethics, communitarians emphasize the importance of the institution of medicine—the network of health professionals, patients, and medical institutions that form the medical community. ○ Healthcare providers are expected to follow roles, norms, and expectations that come from this community. These standards help guide how medical professionals should behave and make ethical decisions in their practice. ★ Key Stakeholders in Medical Ethics ○ When considering medical decisions, it is essential to think about the following groups: The Patient The Family of the Patient Healthcare Providers The Healthcare Institution The Society Communitarianism in Medical Ethics: Example of Neonatal Care A baby born with severe anomalies may require multiple surgeries and lifelong care, making the parents’ decision to treat the baby complex. Parents must consider the impact on the family, including the time, resources, and emotional well-being of other children in the home. 8