Week 3 & 4 Bioethics PDF

 Originated in ancient Greece Has been associated with Greeks, Plato and Aristotle. In eastern philosophy specifically in Buddhism, virtue ethics is valued. In virtue ethics, moral conduct is not determined by universal code of conduct or an outcome of specific action but by specific...

 Originated in ancient Greece Has been associated with Greeks, Plato and Aristotle. In eastern philosophy specifically in Buddhism, virtue ethics is valued. In virtue ethics, moral conduct is not determined by universal code of conduct or an outcome of specific action but by specific personal traits that guarantee the right choice in front of moral dilemmas. Ethical value - is determined by character which refers to virtues, inclinations and intentions that dispose of a person to be ready to act ethically. Character - builds a substantive moral foundation for one’s actions. VIRTUE - Refers to excellence in character - Are thought of as purposive dispositions - Are the character of the health care provider, which are morally praiseworthy traits. PROFESSIONAL VIRTUES - Purity and holiness have religious overtones but these are embodied in The Hippocratic Oath. - In nursing, to maintain purity and manifest a holy disposition is also important. SECULAR VIRTUES - According to Plato, the four classical Greek virtues which are found to be praiseworthy are: Justice, Temperance, Courage and Wisdom. RELIGIOUS VIRTUES - Roman Catholics tend to affirm both Greeks and Christian virtues , thus having full list of seven virtues: Prudence, Justice Temperance , Fortitude Faith, Hope, Love While Protestants, being more prone to see tension between the Greeks and Christian, often limit their list to the three Pauline virtues such as faith, hope, and love ( agape or charity).  VIRTUE BASED NURSING MODEL - The Moral Ground Model has its own foundation in Aristotle’s approach to “ virtue ethics with a proposed path to moral ground adapted from the Eightfold Path of Buddhism. - The following activities and attitudes will develop the nurses “ intellectual and moral virtues which could facilitate growth in her character as a person and as a nurse in the profession: A. Insight (Sophia) Sophia is translated as wisdom. - This is the ability to think well about the nature of the world, and it involves careful deliberation of universal truths. B. Practical Wisdom (phronesis) Phronesis is sometimes translated as prudence. - It is the capability to consider the mode of action in order to deliver change, especially to enhance the quality of life. C. Choice (prohairesis) Morality is achieved through choice (prohairesis), facilitated by insight, practical wisdom, and evenness of emotional states.  D. Goal or telos. It embodies personal and professional excellence in nursing which is characterized as active happiness and well- being that is consistent with an enlightening awareness of the causes of moral suffering as well as the awareness of the sacredness of the day to day moral nature of nurse’s work. VIRTUES OF the HEALTH CARE PROVIDER/NURSING FIDELITY - Refers to the obligation of a person to be a faithful to agreements, responsibilities, and commitments that he has made to others. - It is the main principle that supports the concept of accountability of nurses and other professionals. Example: Nurses who promote patient autonomy demonstrate excellent example of fidelity.  HONESTY - Being fair and just in character and behavior , not cheating or stealing, free of deceit. - Synonymous with sincerity, integrity, truthfulness, uprightness - Honesty to self and in the performance of duty is expected to the nurse. HUMILITY - This is defined as being modest in dealings, unpretentious, with simplicity and submissive. -Nurses are known for this virtue as they perform their role as member of the health care team. RESPECT - This is showing a deferential esteem felt or shown toward a person. COMPASSION - This is a virtue that is important for the nurse because this enables her to serve others selflessly. PRUDENCE - This is described as acting with cautiousness, with foresight, and with discretion. - A nurse is expected to be prudent in all that she does, especially in the performance of her duty. COURAGE - This is the ability to disregard fear in acting out one’s convictions and beliefs. - Nurses have to muster up strength and persevere to be able to perform their duties and responsibilities. TYPES OF VIRTUE ETHICAL THEORIES: INDIVIDUAL CHARACTER ETHICS - It holds that the identification and development of noble human traits help in determining both the instrumental and intrinsic value of ethical interactions. WORK CHARACTER ETHICS - The identification and development of reflective practitioner noble traits at work such as creativity, honesty, loyalty, honor, trustworthiness, civility, dependability, shared work pride, empathy, etc. which determine the intrinsic & instrumental ethical quality of life. PROFESSIONAL CHARACTER ETHICS - Holds that self-regulation, loyalty, impartial judgements, altruism, truthfulness, public service determine the intrinsic and instrumental ethical quality of an individual associated with communities.  ETHICAL PRINCIPLES AUTONOMY - From Greek word “autos” meaning self - “ nomos” meaning rule, governance, or law. - Refers to freedom from external control. - In health care concept, applies to provider respect for the autonomy of patients. PATIENT AUTONOMY - Is the right of patients to make decisions about their medical care without their health care provider trying to influence the decision. - Patient autonomy does allow for healthcare providers to educate the patient but does not allow the healthcare provider to decide for the patient. Patient’s rights - Patient right are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. - A patient is anyone who has requested to be evaluated by or who is being evaluated by any healthcare professional. PATIENT’S RIGHT The right to be treated with respect The right to obtain medical records The right to privacy of medical records The right to make a treatment choice The right to informed consent The right to refuse treatment The right to make decisions about end-of-life care. PATIENT’S BILL OF RIGHTS A Patient’s Bill of Rights is a document that provides patients with information on how they can reasonably expect to be treated during the course of their treatment. These documents are, in almost all cases, not legally- binding. They simply provides goals and expectations for treatment. The Patient’s Bill of Rights was recently renamed Patient Care Partnership.  The patient has the right to considerate and respectful care. The patient has the right to obtain from his doctor complete current information about his diagnosis, treatment and prognosis in terms the patient can be reasonably expected to understand. The patient has the right to receive from his doctor information necessary to give informed consent prior to the start of any procedure or treatment.  The patient has the right to refuse treatment to the extent permitted by the law and to be informed of the medical consequences of his action. The patient has the right to every consideration of his privacy concerning his own medical care program. The patient has the right to expect that all communications and records pertaining his care should be treated as confidential.  The patient has the right to expect that within his capacity a hospital must take a reasonable response to the request of a patient for services. The patient has the right to obtain information as to any relationship of his hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment.  The patient has the right to expect reasonable continuity of care. The patient has the right to examine and receive an explanation of his bills, regardless of source of payment. The patient has the right to know what hospital rules and regulations apply to his conduct as patient.  A patient’s signed consent form is necessary for admission to a health care agency, invasive procedures, such as intravenous central line insertation, surgery, some treatment programs such as chemotherapy, and participation in research studies.  The “ Principle of Informed Consent” advocates that it is the right and responsibility of every competent individual to advance his/her welfare. 1. decision making capacity 2. documentation of consent 3. disclosure of information 4. comprehension of information 1. that the individual’s decision is voluntary 2. that the decision is made with an appropriate understanding of the circumstances; and 3. that the patient’s choice is deliberate insofar as the patient has carefully considered all the benefits, burdens, risks, and reasonable alternatives.  In case of emergency, if it is impossible to obtain consent from the patient or an authorized person, a health care provider may perform a procedure required to benefit the patient or save a life without liability for failure to obtain consent. Patients with mental illness must also give consent. They retain the right to refuse treatment until a court has determined legally that they are incompetent to decide for themselves.  Fundamentally, the primary function of informed consent, is the protection of the patient’s right of self determination to accept proposed treatment. - allows one person to make decisions for another -assists person to make decisions when they do not have sufficient expertise.  A. Strong (also called extended) paternalism - which attempts to overrule or override the wishes of a competent person. B. Weak (limited or restricted), in which consent is missing or the health care provider overrule or overrides the wishes of incompetent patient.  - Legally Acceptable Representative - is the process by which people with the legal right to consent to medical treatment for themselves of for a minor or a ward, delegate that right to another person. 2 types of proxy consent power-of-attorney living will - as state when it is intended or expected from someone to keep information is secret. -extracted from word ‘confidence’ means “trust”. Confidentiality implies that: - Information about a patient be kept private -Information in the patient’s record is accessible only to those providing care to the patient.  Discussing patients outside the clinical setting, friends or family violates patient confidentiality. Maintaning confidentiality may be observed by: Not discussing patient issues with other patients or uninvolved staff in a patient care Not publishing, information embarassing facts about the patient  is the state when an individual is free from public interruption and intrusion. derived from word “private” means the role of public is limited.  Examples of violations and invasion of patient’s privacy: Taking photographs of patient. Use of the patient’s name or picture for the sole advantage of the health care agency Leaving the curtains or room door open while a treatment or procedure is being performed. Allowing individuals to observe a treatment or procedure without the patient’s consent.