Health Care Ethics (NCM 108) PDF

Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga...

Republic of the Philippines Western Mindanao State University COLLEGE OF NURSING Zamboanga AY 2024-2025 HEALTH CARE ETHICS (NCM 108) TOPIC 1: THEORIES & PRINCIPLES OF HEALTH ETHICS INTRODUCTION Ethics is a set of moral standards and a code for behavior that govern an individual’s interactions with other individuals and within society. “‘Morality” is what people do in fact believe to be right and good, while ‘ethics’ is a critical reflection about morality and the rational analysis of it.” Although laws are more apt to be universal rules observed by all, different cultures have different moral codes. Therefore, there are no universal truths in ethics because it is difficult to say that customs are either correct or incorrect. Every standard for ethics is culture bound. Bioethics refers to the ethical implications of biomedical technology and its practices. Bio refers to life, and issues in bioethics are often life-and-death issues. Ethical and bioethical standards can be personal, organizational, institutional, or worldwide. CHARACTERISTICS OF A PROFESSIONAL HEALTH CARE EMPLOYEE Health professions be persons of high moral standards be clear, open, and knowledgeable about their personal choices and beliefs and be able to recognize vast diversity in a pluralistic society. Health care professionals must feel comfortable in a “servant” role while maintaining their own integrity and the respect of their clients. DEFINITION OF ETHICS -A system of philosophy of conduct and principles -Encompasses a process of determining right from wrong conduct -Provides structure for placing conduct into action ETHICS AND NURSING -Understanding one’s ethics and values is important for understanding those of others and therefore the delivery of appropriate nursing care  A. ETHICAL THEORIES -Different theories systemize, defend, and recommend concepts of appropriate and acceptable behaviors. I. Deontological theories The word deontology derives from the Greek words for duty (deon) and science (or study) of (logos). In contemporary moral philosophy, deontology is one of those kinds of normative theories regarding which choices are morally required, forbidden, or permitted. In other words, deontology falls within the domain of moral theories that guide and assess our choices of what we ought to do (deontic theories), in contrast to those that guide and assess what kind of person we are and should be (aretaic [virtue] theories). Deontological ethics, in philosophy, ethical theories that place special emphasis on the relationship between duty and the morality of human actions. The term deontology is derived from the Greek deon, “duty,” and logos, “science.” Deontology advocates the judgement of right or wrong according to the nature of the action itself. Deontology is very different from consequentialism, objecting that we should make moral judgement according to the consequences of the action. It focuses on whether or not we decide our action basing on deontological duties. A “duty” refers to the responsibility we have to bear in order to act according to moral principles. For example, as it is wrong to force others to act in a way that is against their will. For example, torture is, of itself, wrong and immoral, despite the possible consequences of bringing the criminals to justice. Immanuel Kant provided rich elaboration on many issues of deontology in ethics and he had a profound influence on later generations Key points of Kantian Deontology 1. Reason is the basis of morality. Kant thinks that we make moral judgments according to reason. Both humans and animals act under the influence of natural instincts. For example, we want food when we are hungry, defend ourselves against attacks, protect the people we love, and so on. However, the basic difference between humans and animals lies in the fact that human being is not solely under the domination of natural instincts but can also act by following our reason. We will step back and reflect on whether our actions are right or wrong. If we rationally judge an actions to be right, we have an obligation to do it. For example, we do not snatch the food from others when we are hungry, probably due to fear of punishment. Although our law-abiding action is correct, the motivation is to avoid the pain of punishment, which is the same as the natural instinct of animals. Only by making rational reflection and understanding that it is contrary to morality to snatch others’ belongings, will our action be genuinely moral. 2. Morality reflects human autonomy and freedom Some people think that morality has many restrictions on human conducts and limits people's freedom. Kant's view is exactly the opposite. He thinks that if we act only according to our instincts, doing whatever we like, we are actually under the control of the laws of nature. We are dictated by heteronomy (i.e. under the control of something other than oneself) thus losing our own freedom. True freedom is to use our rationality to set moral principles for ourselves and then act according to them. This is an autonomous act. For example, many people love sweet or deep-fried foods. If we eat whatever we like, we will put ourselves under the control of our instincts and cannot act freely. On the contrary, we may judge with our rationality that it is more beneficial to our health if we reject or eat less these food. If we can act accordingly, then human autonomy and freedom are reflected. -Derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed. -Deontological ethics look to the intention of the action; not the consequence -Greatest strength of this theory is its emphasis on the dignity of human beings -Virtue ethics: places less emphasis on learning rules and regulations and more emphasis on the development of good or appropriate character and habitually performing in this quality character mode a. E.g., because a person has mastered the concept of benevolence, he or she will continue to act in a benevolent manner toward other persons b. Virtues: wisdom, courage, temperance, justice, fortitude, generosity, self-respect, good-temper, and sincerity Duty ethics: based on the premise that there are some obvious obligations that one has as a human being, such as the duty to not commit murder and a duty to tell the truth a. Duties to self: avoiding wronging others, treating people as equals, and promoting the good of others b. Prima facie duties (W. D. Ross); fidelity, reparation, gratitude, justice, beneficence, self- improvement, nonmaleficence -Situation ethics: takes into account the unique characteristics of each individual, the caring relationship between the person and the caregiver, and determines the most humanistic course of action given the circumstances; e.g., when a nurse has cared for a particular patient over a long time; also called love ethics -Act deontology: based on the personal moral values of the person making the ethical decision -Rule deontology: based on the belief that certain standards for ethical decisions transcend the individual’s moral values; e.g., “all human life has value” and “one should always tell the truth” II. Teleological theories (Consequentialist Theories/teleology) Consequentialist theories are sometimes called teleological theories, from the Greek word telos, or end, since the end result of the action is the sole determining factor of its morality. It is common for us to determine our moral responsibility by weighing the consequences of our actions. According to consequentialism, correct moral conduct is determined solely by a cost-benefit analysis of an action's consequences: Consequentialism: An action is morally right if the consequences of that action are more favorable than unfavorable. Consequentialist normative principles require that we first tally both the good and bad consequences of an action. Second, we then determine whether the total good consequences outweigh the total bad consequences. If the good consequences are greater, then the action is morally proper. If the bad consequences are greater, then the action is morally improper. 1. Derive norms or rules for conduct from the consequences of actions; often referred to as utilitarianism a. Rule utilitarianism seeks the greatest happiness for all b. Act utilitarianism attempts to determine, in a given situation, which course of action will bring about the greatest happiness, or the least harm and suffering, to a single individual 2. Applied ethics: branch of ethics that concerns the analysis of specific, controversial moral issues such as abortion, euthanasia, genetic manipulation of fetuses, and the status of unused frozen embryos 3. Principalism: attempts to resolve conflicts by applying principles more so than ethical theories; used often in professional decision making a. Principles encompass basic premises from which rules are developed b. Moral norms that nurses both demand and strive to implement daily in clinical practice settings c. Ethical principles considered in most traditional view of principlism: respect for autonomy, nonmaleficence, beneficence, and justice 4. Relational ethics: views the relational commitments that individuals have to each other; ethics of care and caring a. Emerging ethical framework to help care deliverers apply ethical principles in clinical situations b. Redirects the issue of rights and responsibilities of the autonomous individual into the context of the environment in which these decisions are made and creating a more“practical action–oriented” ethics c. Components of relational ethics: engagement, mutual respect, embodiment, and environment d. Engages all parties to a potential dilemma, creating continued dialogue and consideration of all possible and realistic outcomes III. Utilitarianism It is an action is morally right if the consequences of that action are more favorable than unfavorable to everyone. Jeremy Bentham presented one of the earliest fully developed systems of utilitarianism. Two features of his theory are noteworty. First, Bentham proposed that we tally the consequences of each action we perform and thereby determine on a case by case basis whether an action is morally right or wrong. This aspect of Bentham's theory is known as act-utilitiarianism. Second, Bentham also proposed that we tally the pleasure and pain which results from our actions. For Bentham, pleasure and pain are the only consequences that matter in determining whether our conduct is moral. This aspect of Bentham's theory is known as hedonistic utilitarianism. Critics point out limitations in both of these aspects. -Act-utilitarianism would be morally wrong to waste time on leisure activities such as watching television, since our time could be spent in ways that produced a greater social benefit, such as charity work. But prohibiting leisure activities doesn't seem reasonable. More significantly, according to act- utilitarianism, specific acts of torture or slavery would be morally permissible if the social benefit of these actions outweighed the disbenefit. -A revised version of utilitarianism called rule-utilitarianism addresses these problems. According to rule-utilitarianism, a behavioral code or rule is morally right if the consequences of adopting that rule are more favorable than unfavorable to everyone. -Unlike act utilitarianism, which weighs the consequences of each particular action, rule-utilitarianism offers a litmus test only for the morality of moral rules, such as "stealing is wrong." Adopting a rule against theft clearly has more favorable consequences than unfavorable consequences for everyone. -The same is true for moral rules against lying or murdering. Rule-utilitarianism, then, offers a three- tiered method for judging conduct. -A particular action, such as stealing my neighbor's car, is judged wrong since it violates a moral rule against theft. In turn, the rule against theft is morally binding because adopting this rule produces favorable consequences for everyone. John Stuart Mill's version of utilitarianism is rule-oriented. -Second, according to hedonistic utilitarianism, pleasurable consequences are the only factors that matter, morally speaking. This, though, seems too restrictive since it ignores other morally significant consequences that are not necessarily pleasing or painful. For example, acts which foster loyalty and friendship are valued, yet they are not always pleasing.