Lecture 11-Ethics - Copy PDF

ETHICS Prof. Glushchenko Objectives After attending lecture and completing all required readings and activities, the learner will be able to: 1. Identify and describe the ethical principles guiding ethical behavior and decision making. 2. Describe the concept of common good. 3. Define an...

ETHICS Prof. Glushchenko Objectives After attending lecture and completing all required readings and activities, the learner will be able to: 1. Identify and describe the ethical principles guiding ethical behavior and decision making. 2. Describe the concept of common good. 3. Define an ethical dilemma. 4. Describe the steps outlined in the ethical dilemma resolution framework. 5. Describe the steps outlined in the ethical dilemma resolution framework model to ethical dilemmas encountered in community settings. WHAT IS ETHICS? Guiding principle for individuals or groups based on what is right and what is wrong Bioethics Role of ethics in health care Differentiates morally acceptable and unacceptable research practices Hippocratic Oath Hippocrates – Father of modern medicine Defines ethical standards for the physician Developed in 400 BC  Act as guide to conduct Each principle can be applied to the professional interactions of the dental hygienist with patients, dental colleagues, health care providers, and community members. Ethical – Autonomy Terminology/Principl – Beneficence es – Justice – Nonmaleficence – Paternalism – Veracity Autonomy Ability to govern one's profession Respect for others – The belief that patients have a right to make decisions that may impact their health Beneficence Remove existing harm Provide quality health care that is a benefit to the patient  JUSTICE Providing patient with what is owed to them Nonmaleficence To do no harm Provider should not inflict harm, should prevent harm, remove harm, do/promote good PATERNALISM Doing what the provider thinks is right for the patient basd on their own professional judgment VERACITY Being honest  Nuremberg War Crimes Done in concentration camps during World War II Unethical Experimen Tuskegee Study ts Done in U.S. on African American men who had syphilis Rules and regulations were later developed to prevent these experiments and protect human subjects  Ethics enforces “doing the right thing” In research: Ensures that the mission and goals are upheld Doing what is right, legal and fair Ethics and What’s the problem with this? Code of Ethics the Law Large institutions/universities all have these Institutional Review Board (IRB) Institutions that conduct medical research have this Two responsibilities Ensure the rights and safety of research subjects are respected and protected Protects the institution and researchers from lawsuits and helps ensure that the research results will not be flawed because the study was ethically unsound  Common Ethical Misconduct Animal Consideratio Plagiarism, copyright/patent Research Should ensure that animals do not suffer needlessly, ns infringement, falsifying/fabricating data, are not euthanized for no reason, frivolous research misrepresenting data, and is prohibited, and that they conflict of interest are cared for properly Must be intentional to be during the research considered misconduct Common Ethical Considerations Cont’d Informed Consent – Educating the human subject about the study’s purpose, duration, experimental procedures, alternatives, risks, and benefits – Allows subjects to voluntarily decide whether or not to participate – Subjects should be able to withdraw at any time – Should be written in “layman’s terms” and in appropriate language – Not required if the study is using a survey method  Confidentiality Obligates the provider to keep all information about a patient private and to not share the information with Common third parties without consent Subjects should never be identified Ethical Health Information Portability and Consideratio Accountability Act (HIPAA) Repeat volunteers ns Cont’d Students, low-income/unskilled workers often participate as a way to make money May eventually cause harm (if receiving different treatments) Can skew results  Promotes research while protecting the public Sets standards for conducting research and ethics Governmen Controls what treatments ,medicines and medical devices can be sold and what t’s Role claims can be made Provides funding for research Conducts research through organizations like the NIH  The oral health care provider is frequently challenged by situations in which there is difficulty determining the ethically correct action, one in which there is not a simple Ethical solution. Dilemmas An ethical dilemma occurs when one duty or obligation is in conflict with another.  As part of the discussion with a dental provider a 28-year-old patient indicates that she wants all her teeth extracted due to limited financial resources, and also her family history of everyone “losing their teeth”. She also makes it clear her lack of interest to return to the clinic for multiple appointments. Example The dental provider understands that of a respecting the patient’s right to determine his or her care is a necessary component of the patient – provider relationship. Dilemma What two ethical principles are in conflict? Ethical Dilemma Resolution Framework Can give the provider a mechanism to address the issue, individually or as part of a team Dilemmas cannot always be resolved by a code of ethics Useful to have a framework to make decisions Helps to encourage broad thinking/solutions Ethical Dilemma Resolution Framework Cont’d 1. Define the problem – Occurs when the ethical principles are in conflict with each other 2. Identify the stakeholders – Licensed and non-licensed personnel, patients, community, health care colleagues, professional associations, licensing agencies 3. Identify possible alternatives to the problem – Consider all alternatives Ethical Dilemma Resolution Framework Cont’d 4. Gather information to assist you in evaluating the alternatives – Investigate information that is important to better understand the dynamics of the current dilemma 5. Evaluate the identified alternatives – As each alternative is reviewed, consider consistency with policies, procedures and guidelines 6. Rank the alternatives – List the results each alternative will achieve – List the consequences of each chosen alternative Ethical Dilemma Resolution Framework Cont’d 7. Make a decision 8. Act on the decision 9. Evaluate the decision  Patients at the City Health Example Department have dental care paid through Medicaid or other assistance programs. The clinic clearly informs Using the the patients it provides “cleanings, fillings, and extractions.” No prosthodontic care is provided, Ethical although dentures are occasionally repaired, because the staff dentist is willing to help out. There are two Dilemma part time dentists and one full time dental hygienist , completing her second year of employment at the Framework clinic. The R.D.H is concerned about the quality of care provided by one of the dentists.  At recall visit appointments, the R.D.H, Example repeatedly observes caries in teeth that have been restored by the dentist. Using the The patients are “unaware” there maybe a problem, and are happy that they have their “fillings” Ethical The R.D.H has discussed her concerns with the clinic manager, who is Dilemma somewhat sympathetic, but emphasizes how difficult it is to get dentists to work in the clinic. She told Framework the hygienists that the clinic has gone for months and months without a dentist on staff; and she is just happy Cont’d that there are two dentists willing to treat patients.  Example As part of the annual clinic evaluation Using the the health department conducts volunteer staff interviews to obtain feedback about the health department, Ethical the clinics and personnel. All interviews and discussions are confidential. Dilemma The R.D.H. is interested in discussing her observations and concerns, but unsure Framework about what to do. Cont’d How do you apply the ethical dilemma resolution framework?  There are several conflicts presented in this scenario: The dental hygienist is aware that 1. Define harm is occurring. the Problem The patients are not receiving optimal care. The ethical principle of beneficence, do no harm, is compromised.  2. Identify The stakeholders are primarily those patients in the community who rely on the the dental clinic to provide dental services – Additional Stakeholders: The Stakeholde dental public health clinic (as the employer); the dental rs hygienist who works with the dentist and the community  Possible alternatives include: 3. Identify The R.D.H. can speak to the DMD and use radiographs to assist in possible identifying the caries removal problem. alternative The R.D.H. could speak to the other DMD and share radiographs and suggest the dentist discuss the issue s to the with the dental colleague. R.D.H. could notify the quality assurance board of the Health problem: Department and recommend peer review be conducted by a D.M.D. The R.D.H. could contact the state and request a state peer review evaluation. The R.D.H. could ignore the situation. 4. Gather In Preparation for prioritizing the alternatives, the dental hygienist could take several steps. information to assist Determine the length of employment and years of practice for the dentist. you in Contact the state board of dentistry to determine if issues of lack of competence evaluating for that particular dentist are documented and on record. the Is it a consistent and long-term problem? Is adequate time allotted for patient care? alternatives Determine if peer review or staff : evaluation occurs as part of the policy of the clinic. 5. Evaluate The R.D.H. should evaluate each alternative using different resources. the The ADA code of ethics encourages dental identified hygienists to act as patient advocates. In this case, the dental patient, is unaware of alternatives the quality of care that is provided. : The ethical principles of beneficence doing good and Nonmaleficence – do no harm, are important to the facts. The DMD is providing care that is substandard. The patient is at risk for future problems. The dental hygienist is aware of this and to be fair, must let someone know the truth. 6. Rank the alternatives: The dental hygienist must consider the anticipated In all instances the dental hygienist is most likely outcome of each chosen alternative. The ranking guided by the principles of doing the right thing, must be based on sound ethical and legal even if it means the decision will jeopardize the principles. relationship with the dentist. Final Steps… 7. Make a decision This decision is based on a thorough analysis of the situation, the options available, and the potential outcomes for each alternative. It is important that a decision be made that allows resolution of the issue. 8. Act on the decision. 9. Evaluate the decision. Summary All members of the dental team are obligated to practice using ethical principles, code of ethics for guidance and demonstrate the professional behavior. In situations in which the dental hygienist encounters an ethical dilemma, the use of an ethical decision – making framework provides a structured assessment and resolution of the problem. The framework can be used for patient provider, colleague – to – colleague, and provider – to – community dilemmas. Healthcare providers recognize the importance of ethics and ethical decision – making as a core aspect of the profession. Reference: https://www.youtube.com/ watch?v=hpvYVc8pPuA