Ethical Principles and Problems - HAN 335.02 Lecture Notes PDF

Ethical Principles and Problems HAN 335.02 Week 2  In healthcare humanity plays a big role Its important that the patient respects you because these relationships are short, the Ethics...

Ethical Principles and Problems HAN 335.02 Week 2  In healthcare humanity plays a big role Its important that the patient respects you because these relationships are short, the Ethics Caring response: It is important when you are delivering news that is not the best so you need to think about how you are telling them, your future interactions can be impacted by that so you need to be careful Systematic reflection on, and analysis of morality Originally: system of analysis developed as parts of philosophy and theology. ○ Today other disciplines are involved as well Ethics Principles: Inherent dignity of human life Deep respect for all life and the environment What do dignity and respect demand in terms of response to others? What does it mean to provide a caring response in this situation?  You are analyzing issues Ethicists Its hard to have one response for all situations So in a situation so you need to help clarify values and duty etc. In ethics we provide guidance Primary career activity revolves around ethics. ○ Analyze issues ○ Help to clarify values, duties and other aspects of morality in specific situations (medical ethicists in health care) ○ Resolve situations Ethics committees: ○ Conducts a holistic examination of a patient’s or their family’s situation that might involve a complicated ethical dilemma ○ Nurses, chaplains, physicians, social workers, lawyers ○ Variety inspires debates to obtain new information an consider alternative ideas When you ANALYZE and REFLECT on the moral thing to do and still agree with it, that is the ethical thing to do Caring Response Health - soundness of body or mind; freedom from disease or ailment Care - to protect, serious attention, to be concerned about, to look out for. A caring response is the ethical goal of every professional-patient relationship, and honoring patient dignity. Primary loyalty is to the patient. Keep it in mind that as people come in they have a lot of different emotions so your focus needs to be on the patient Patient-Centered Care “Patient-centered care” is a term used to emphasize the idea that professionals keep their focus on the values and well being of their patients. “Working with patients and families in defining, designing, participating in and assessing the care practices and systems that serve them to assure they are respectful of and responsive to individual patient preferences, needs, and values. This collaborative engagement allows patient values to guide all clinical decisions and drives genuine transformation in attitudes, behavior, and practice” - The US Center for Medicare and Medicaid Services definition person and family engagement  Patient-Centered Care Attention to detail Communication tools think about when you do the doctor, amy talks to you and has a conversation with you to ask how other things are too Burdens and Benefits The burden of care: Not limited to personal relationships Having negative feelings at times about your profession/caregiving does not make you unfit for the role Benefits of care: One of the most important ways adults gain a recognized place in society is through contribution to said society’s well being Caregiving benefits the clinician by putting them in a position to participate in activities that are respected by society Primum non nocere Not harming vs acting to benefit another are treated as two separate duties Important that you provide that care https://www.youtube.com/watch?v=GoTxlWu- F2E&ab_channel=KaiserPermanenteThrive We think about the caregiver/patient relationship The health professional has all the “power” “I will keep them from harm AND injustice” – Hip. Oath. People do NOT want to become patients Personal Integrity “Personal values systems are our most fundamental resource for maintaining a sense of personal integrity”  foundation terms Principle When applicable Nonmaleficence (refraining from potentially I am in a position to harm someone else. harming myself or another Beneficence (bringing about good) I am in a position to benefit someone else. being loyal: Following up with a patient regular Fidelity being respectful, following their wishes I have made a promise, explicit or implicit, to Doing your job someone else. Advanced directives: things like wanting to not get any more medical treatment a patient can always change their mind Autonomy I have an opportunity to exercise my self- does the patient have the capacity to make their own decisions determination, say-so. Telling the truth always to the patients Veracity One of the times you don’t have to is if telling the I am in a position to tell the truth or to deceive patient will cause harm to them someone. Justice I am in a position to distribute benefits and burdens among individuals or groups in society who have legitimate claims on the benefits Paternalism making a decision for someone else I am in a position to decide for someone else  The Case of Esther Korn The ethics committee has been asked to give advice on whether Esther Korn should be sent back home or to a nursing home. Esther Korn, a 72-year-old woman, has been admitted to the hospital with a diagnosis of dehydration and serious bruises from a fall sustained in her home. She was found by a neighbor, Anna Knight, who says she stops by Esther’s home daily because Ms. Korn has lived alone with her eight cats since being discharged from a state hospital with a diagnosis of paranoid schizophrenia, which is believed to be under control with medications. From the degree of dehydration, the health professionals believe that Ms. Korn was very dehydrated before she fell and that she had been lying on the floor for at least a day. The emergency medical technicians who brought her to the hospital described her home as “filthy, full of dirty dishes and clothes strung all over, with cat droppings everywhere.” Now, 5 days later, Ms. Korn seems confused about where she is, but she does know her own name. She says over and over, “Let me out of here! I want to go home!” Her sister, whom she has not seen “for several years” (according to Anna Knight), does not return the nurses’ calls or voice messages. The nurses are not in complete agreement, but most of the staff believe that Esther would be better off placed in a supervised setting for her own safety. Anna Knight and the local priest, who visits her regularly, also have strong opinions about where Esther should live.  The Case of Esther Korn This is an opportunity for the class to create a narrative of a patient, Esther Korn. This group exercise is about a healthcare situation that came to the attention of the hospital ethics committee. Break up into 5 groups - one member from each group will be the recorder and transcribe your groups story (legibly), one member will be the groups reader Group 1: write about Esther from her neighbor anna’s perspective and what Anna thinks should be done Group 2: Write about Esther from the episcopal priest’s perspective and what they may recommend Group 3: write about esther from the perspective of her long-lost sister and what they may recommend Group 4: Write a report from the POV of the head nurse and what they think Group 5: speaking as Esther, give some background as to what kind of person she believes herself to be, what is important to her etc. Questions Did anything that was said in these stories change your mind about your initial thoughts regarding what should be done? What must healthcare professionals in this situation do to show caring in their relationship with Esther Korn? Compare what we have discussed with what you originally wrote down When working in teams It is important when working on a team and attempting to reach a consensus about a course of action that you: ○ Identify the basic ethics of your teammates ○ Can their minds be changed morality consent