Health policy,politics and professional ethics.pptx

HEALTH POLICY, POLITICS, AND PROFESSIONAL ETHICS PRESENTED BY: ROULA AL-BUSTANJI SUPERVISED BY: PROF. WADDAH D’EMEH  Outline Introduction Definition Ethics in health care The Ethics of Influencing Policy Professional Ethics and Moral Agency...

HEALTH POLICY, POLITICS, AND PROFESSIONAL ETHICS PRESENTED BY: ROULA AL-BUSTANJI SUPERVISED BY: PROF. WADDAH D’EMEH  Outline Introduction Definition Ethics in health care The Ethics of Influencing Policy Professional Ethics and Moral Agency Ethical Dilemmas Allocating Scarce Resources Health Care Disparities  OBJECTIVES At the end of this lecture, colleagues will be able to: Define Bioethics and Ethics correctly Discuss the Ethics in health care completely Recognize Professional Ethics and Moral Agency Identify Ethical Dilemmas Describe Allocating scarce resources Discuss Healthcare disparities INTRODUCTION  “TO SEE WHAT IS RIGHT AND NOT DO IT IS WANT OF COURAGE.” In a political context, this quote suggests that recognizing what is morally or ethically right in a given situation but failing to act on it reflects a lack of courage. It implies that in political decision-making, it takes bravery to stand up for what is just, fair, or morally right, even if it may be unpopular or politically risky. This could apply to situations where politicians or leaders know what actions would benefit society or uphold democratic values but choose not to take them due to fear of backlash, loss of power, or other consequences. Thus, the quote underscores the importance of moral courage in politics and the necessity of taking principled action, even in challenging circumstances.  INTRODUCTION The authors of the chapter believe that too few nurses take seriously their responsibilities as citizens, Despite being frequently reminded that their sheer numbers as the largest group of health professionals (3.1 million) and as the public’s most trusted professionals (Gallup, 2022) All of that Makes us a Formidable Force. highlights the importance of nurses actively participating in political processes, advocating for policies that benefit both their profession and the broader community, and leveraging their collective influence to address healthcare challenges and promote societal well-being. (possibly due to various factors such as lack of awareness, motivation, or empowerment)  FORMIDABLE FORCE IN JORDAN According to the World Health Organization's Global Health Observatory Data Repository, as of 2020, there were approximately 29,000 nurses and midwives in Jordan, which is equivalent to approximately 2.9 nurses and midwives per 1,000 population.  DEFINITIONS The word “Ethics" is derived from the Greek word ethos (character), and the Latin word mores (customs). In the legal context, Ethics defines how individuals choose to interact with one another. In philosophy, Ethics defines what is good for the individual and society and establishes the nature of duties that people owe themselves and one another (Allen, 2021).  DEFINITIONS Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research.  Bioethics includes :  Medical ethics, which focuses on issues in health care.  Research ethics, which focuses on issues in the conduct of research.  Environmental ethics, which focuses on issues pertaining to the relationship between human activities and the environment.  Public health ethics, which addresses ethical issues in public health. (Allen, 2021) WHAT ARE THE DIFFERENCES??  ETHICS IN HEALTH CARE Dan Callahan, One of the Founders of U.S. Bioethics, states Three paramount human Questions lie at the Heart of Bioethics: 1. What kind of person ought I be to live a moral life and make good ethical decisions? 2. What are my duties and obligations to other individuals whose lives and well-being may be affected by my actions? 3. What do I owe the common good or the public interest in my life as a member of society?  ETHICS IN HEALTH CARE Designing a system for delivering health care that adequately meets the needs of a diverse public is a complex challenge. Health care planners have always worried about access, quality, and cost. Who should get what quality of care and at what cost? What you think about health care in the United States as well as in Jordan depends on your past experiences.  ETHICS IN HEALTH CARE Many now believe that.. “A Moral Society Owes Health Care to Its Citizens.”  ETHICS IN HEALTH CARE  People’s health, well-being, and dying, as well as our daily nursing practice, are directly affected by decisions made by governments, insurers, and healthcare institutions.  Nursing needs a seat at these decision-making tables, and nurses must be prepared and willing to take these seats and should be committed to ethical decision-making.  Drivers( ‫ ) ا لدوافع‬for much of Human Enterprise are power, position, prestige, profit, and politics.  ETHICS, HEALTH POLICY-MAKING, AND THE ECONOMIC CRISIS: A QUALITATIVE INTERVIEW STUDY WITH EUROPEAN POLICY- MAKERS INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH (2019) Research aimed to assess the relevance of ethics in decision-making by policy-makers during the economic crisis. Methods included qualitative interviews with eight European policy-makers from six countries. Results showed that policy-makers faced difficult decisions on prioritizing healthcare investments, such as medications, staffing, equipment, and infrastructure. Values like trust and responsibility were considered important in the decision-making process. Policy-makers expressed the need for ethical tools and assistance to make morally sustainable decisions in health policy. Conclusions emphasized the frequent involvement of ethical concepts and values in health policy-making. Policy-makers lack ethical guidance for making decisions, highlighting the need for support in this area. The study's relevance lies in providing ethical foundations for future decisions on austerity-related health issues and identifying areas of moral concern.  ETHICAL DIMENSIONS OF PUBLIC HEALTH ACTIONS AND POLICIES WITH SPECIAL FOCUS ON COVID-19 2021 Ethicists, public health professionals, and human rights advocates highlight the need for integrated global policies during pandemics. Rationalizing healthcare resources and prioritizing cases is a longstanding challenge, but the focus is on doing so without further disadvantaging vulnerable populations. Healthcare professionals utilize various scoring systems to allocate resources and triage patients, but the efficacy of these systems for managing COVID-19 cases is uncertain. Managing non-COVID patients with chronic conditions during the pandemic is complex, requiring balance to prevent worsening conditions while addressing COVID-19 demands. The article addresses the challenge of maintaining ethical standards amid COVID-19's impact on preexisting standards. Monitoring the application of ethical standards in medical trials of new medications, vaccines, or unproven interventions is crucial.  ETHICS IN HEALTH CARE  Nursing’s challenge, as profits( ‫)ا الرباح‬and politics increasingly dictate health priorities, is to keep health care strongly focused on the needs of patients, their families, and the public.  Health care can never be only a business rather, it is a service a moral society provides for its vulnerable members.  Our relationships with patients are fiduciary (‫( )ائتمانيه‬trust, confidence, and ethical responsibility), not merely contractual(‫)ت ع اقديه‬.  Nurses play a critical role in keeping health care centered on the people it purports to serve.  THE ETHICS OF INFLUENCING POLICY  An ethical critique of human behaviour involves paying attention to :  The intention of the moral agent,  The nature of the act performed,  The consequences of the action,  The circumstances surrounding the act.  Ethics has to do with right and wrong in this world, and policy and politics have everything to do with what happens to people in this world.  THE ETHICS OF INFLUENCING POLICY  Policy and Politics involves :  Justice in the distribution of social goods(‫)ا لمنفع ة ا الجتماعيه‬.  Fairness and equity in relationships among and between people of different races, genders, and creeds.  Access to education and assistance when one is in need.  THE ETHICS OF INFLUENCING POLICY  Although the goodness of an action lies in the intent and integrity of the human being who performs it, the rightness or wrongness of an action is judged by the difference it makes in the world.  In the real world, legislators and lobbyists intend many things other than the good of the public and some use unethical means to achieve dubious ends.  THE ETHICS OF INFLUENCING POLICY Therefore, we may ask :  Which strategies to influence policy can nurses use without sacrificing(‫ )ا لتضحيه‬personal and professional integrity?  What means can be legitimately used to achieve an end that someone believes to be good?  Should we assure the passage of health care insurance reform by strong-arm tactics?  Using "strong-arm tactics" to ensure the passage of health care insurance reform typically implies employing forceful or aggressive methods to push through legislation, potentially disregarding normal legislative procedures or opposition voices. From a political perspective, this approach can be controversial and divisive. Advocates might argue that achieving comprehensive health care reform is crucial for improving access, quality, and affordability of health care for citizens, and assert that using strong-arm tactics may be necessary to overcome political obstacles and vested interests that oppose reform. However, opponents might argue that such tactics undermine democratic principles and the integrity of the legislative process. They may suggest that genuine reform should be achieved through consensus-building, negotiation, and respect for democratic norms, rather than through coercion or manipulation. Ultimately, whether employing strong-arm tactics to pass health care insurance reform is deemed acceptable or not depends on one's political beliefs, values, and priorities regarding the role of government and the legislative process.  The Ethics of Influencing Policy…Telling Lies  What is a true difference of judgment about what would benefit society versus knowingly lying to deceive the public to achieve a political end?  Why do we now have numerous resources to uncover media bias and to fact check?  When people ask whether it is wrong to lie about something to get funding for research and/or treatment of patients with a particular disease, in a word the answer is yes. It is wrong…(WHY???)  The Ethics of Influencing Policy…Telling Lies  lying to further a political agenda is wrong not only because it undermines trust, but also because it fosters further dishonesty.  Judging by the amount of political dishonesty reported in the media, one is led to the conclusion that there is a lot of lying going on!  Adding to it, telling more lies to further our agenda will only make matters worse.  "TELLING LIES" From a political perspective, "Telling Lies" in the context of influencing policy suggests the use of misinformation, deception, or falsehoods to manipulate public opinion or decision-makers in order to achieve a particular political agenda or policy outcome. This could involve spreading false or misleading information about opponents, distorting facts, or making exaggerated claims to sway public opinion or gain support for a certain policy position. In politics, the deliberate spreading of falsehoods can have significant implications. It can erode trust in political institutions, undermine the credibility of policymakers, and damage public discourse. Additionally, it can lead to decisions being made based on false premises, potentially resulting in harmful consequences for society. Therefore, from a political perspective, "Telling Lies" in the context of influencing policy is often viewed as unethical and detrimental to the democratic process, as it distorts public debate and undermines the principles of transparency, honesty, and accountability in governance.  REFLECTIVE PRACTICE:” DEATH PANEL” The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil. Sarah Palin  PROFESSIONAL ETHICS AND MORAL AGENCY  A professional ethic is built around three essential components:  Its purpose.  The conduct expected of the professional.  The skills and outcomes expected in professional practice.  Society demands that professionals be held to a separate moral standard of conduct because the choices professionals make affect other people’s lives more than their own. PROFESSIONAL ETHICS AND MORAL AGENCY Nursing’s foundational documents make each nurse’s advocacy and health policy responsibilities clear. Although some may think that advocacy and health policy are an ethical ideal, they are rather a non-negotiable moral obligation embedded in the nursing role.  PROFESSIONAL ETHICS AND MORAL AGENCY  The American Nurses Association (ANA) Code of Ethics for Nurses in 2015 states:  “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient”.  “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.  PROFESSIONAL ETHICS AND MORAL AGENCY Moral agency is quite simply the ability to be what is professed: a human, a parent, a professional nurse. Moral agency in any specific situation requires more than knowing what is the right thing to do; it also entails moral character, valuing, sensibility, accountability, ethical reasoning, and transformative moral leadership REFLECTIVE PRACTICE: CONSCIENTIOUS OBJECTION As nurses, we have :  long been aware of our right to opt out of processes or procedures that violate our conscience or religious values.  These acts may include assisting in a surgical abortion, withdrawing life-sustaining treatments, or administering blood products.  The basis for this right of refusal is the protection of our moral integrity as health professionals and the preservation of our autonomy as individuals. (Lewis-Newby et al., 2015). Reflective Practice: Conscientious Objection  Magelssen (2012) ask for “ Patient Harm “ and points out four types of burdens to patients: (1) delay in care. (2) restricted access to treatment. (3) lack of information. (4) patient’s sense of moral disapproval for his or her choices.  Ethical Dilemmas It is a situation in which an individual is compelled to choose between two actions that will affect the welfare of a human being.  An ethical dilemma occurs when an individual must choose between two unfavorable alternatives.  Ethical dilemmas usually have no perfect solution, and those making decisions may find themselves in the position of having to defend their decisions. NURSES EXPERIENCES OF ETHICAL DILEMMAS: A REVIEW 2020 Introduction: Nursing care faces evolving challenges due to technological advancements and increased focus on standardization, impacting nurses' ability to uphold ethical principles. Aim: To explore and discuss the ethical dilemmas experienced by nurses in contemporary clinical practice. Method: Conducted a literature review using the matrix method, analyzing 15 relevant articles published between 2011 and 2016 to synthesize findings across methodologies. Results: Identified three overarching themes: (1) Balancing harm and care, (2) Work overload affecting quality, and (3) Navigating disagreement, highlighting the complexity and diversity of ethical dilemmas across nursing practice settings. Conclusion: Nursing practice faces challenges from organizational structures and healthcare system developments, compromising nurses' ability to adhere to fundamental nursing values and make professional decisions.  CHALLENGING TIMES: ETHICS, NURSING AND THE COVID-19 PANDEMIC 2020 Nurses' Heroic Efforts: Nurses and midwives globally are working tirelessly during the COVID-19 pandemic. They are detecting cases, providing care, educating the public, and dealing with the emotional toll of the crisis. Challenges Faced by Nurses: Nurses face numerous challenges, including shortages of resources, overwhelming patient numbers, staff shortages, and emotional stress. Many are infected or dying from the virus. Ethical Dilemmas: Nurses encounter complex ethical dilemmas, including moral distress, conflicting professional values, and difficult decisions regarding patient care and allocation of resources. Global Response to COVID-19: The pandemic has exposed poor planning and leadership in some governments and health systems. There's a lack of adequate medical supplies and misinformation proliferating, leading to further distress.  Impact on Nursing Profession: The pandemic has shifted the focus of nursing from celebration to crisis response. Nurses are hailed as heroes but face immense challenges and risks. Psychological Impact on Healthcare Workers: Healthcare workers, including nurses, are experiencing psychological trauma from the pandemic, with parallels drawn to past outbreaks like SARS. Lessons Learned and Future Outlook: There are opportunities to learn from the pandemic, improve practices, and develop policies to guide future responses. Nurses need strong moral courage, resilience, and support to continue their vital work. Overall, the text highlights the extraordinary efforts of nurses during the pandemic, the ethical challenges they face, and the need for support, education, and policy changes to ensure their well-being and effectiveness in future public health emergencies.  ALLOCATING SCARCE RESOURCES Principles of distributive justice  To each the same thing.  To each according to his need.  To each according to his ability to compete in the open marketplace.  ALLOCATING SCARCE RESOURCES Principles of distributive justice  To each according to his/her merits (desserts) : Contribution: People should be rewarded for their work activity according to the value of their contribution to the social product. Effort: People should be rewarded according to the effort they expend in their work activity. Compensation: People should be rewarded according to the costs they incur in their work activity.  REFLECTIVE PRACTICE: BARRIERS TO THE TREATMENT OF MENTAL ILLNESS Austin Deeds, the son of Virginia State Senator Creigh Deeds, was discharged home from a Virginia hospital emergency room because there were no open psychiatric beds. He then stabbed his father and killed himself. Reflective Practice: Barriers to the treatment of mental illness Reflective Practice: Barriers to the treatment of mental illness 47  HEALTH CARE DISPARITIES  Reverend Martin Luther King is often quoted as saying that of all the forms of inequality, injustice in health care is the most shocking and inhumane (1966).  Health Care Disparities  Health Equity: This means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives. No one should be denied this chance because of who they are or their socio-economic opportunities.  Health Care Disparities  Health Inequities: Differences in health that are avoidable, unfair, and unjust. Health inequities are affected by social, economic, and environmental conditions.  Health Disparities: Differences in health outcomes among groups of people. Inequalities in Access to Health Services and Health 51 Care JPFHS, 2017  Health Care Disparities  Nurses can be on the frontlines of reducing inequities, but many of us are affronted at the thought that we aren’t treating everyone with the same degree of respect, compassion, and responsiveness.  SUMMARY Ethics in health care. The ethics of influencing policy. Professional ethics and moral agency. Ethical dilemmas. Allocating scarce resources. Health care disparities.