Ethical Concepts Flashcards
what is morality?
principles, guidelines and standards of right/wrong or good/bad conduct
personal morality
societal morality
morality of health professions- PT as a moral agent
there may be conflicts between/among
what shapes our ideas about morality?
religious teaching culture philosophy parents family friends school media
what are the 3 types of ethical problems?
1- ethical distress
2- ethical dilemmas
3- locus of authority challenges
what is an ethical dilemma?
values in conflict
“right vs. right”
honorable, moral, just individuals can come to different “solutions” for the same problem
serious losses are at risk or gains are at stake no matter what is done
what are ethical theories?
ethical theory guides us in choosing a course of action that is (hopefully) right or more right than others
what are 2 ethical theories?
1- Teleological - Utilitarianism
2- Deontological- Duty
what is absolutism?
what is right is based on knowledge that can be known to be a truth
ex: religious truths believed to be absolute
what is relativism?
all is relative
ethical statements are not known to be ultimately true or false, but “truth” is dependent on circumstances
what is teleological theory?
Tele= end or outcome
focus on the consequences of the actions
goal-based, consequentialist
only when the potential consequences of an action are taken into consideration can one determine the right course of action
moral task in life= produce as much good as you can
what are the 3 components of the teleological theory?
1-utilitarianism
2- hedonism
3- pluralism
what is utilitarianism?
an act is useful if it brings about the best consequences overall
good=happiness
bad= unhappiness
what is hedonism?
pleasure= good pain= bad
palliative care- relief from pain and suffering is a desirable goal
what is pluralism?
the ultimate good may be a variety of other values
ex: knowledge, beauty, freedom, etc
what are criticisms to the theological theory?
must be able to predict consequences (good intentions are not enough!)
defining happiness is problematic
happiness is different for each person
difficult to measure or compare happiness to decide on the greatest net happiness
what is the deontological theory?
Deonto= duty
based on obligation to duties or principles
most famous theorist= Immanual Kant
“can’t judge the rightness or wrongness of an act on the basis of its consequences alone. Some actions are intrinsically immoral no matter how positive and beneficial one might judge the consequences to be”
what are criticisms to the deontological approach?
moral rules may conflict with one another
absolute duties (Kant)
Prima facie (other things being equal) -moral duty may be overridden by another moral duty
ethical conflict= determine which duty is weightier
what is a duty?
AKA ethical principles/elements
moral bonds or obligations
what are the 4 generally accepted duties in health care?
1- autonomy
2- non maleficence
3- beneficence
4- justice
what is autonomy?
self-determination
respect for patient’s decision making
what is non maleficence?
do no harm
what is beneficence?
promote good
sometimes considered on a continuum with non-maleficence
what is justice?
fairness in the distribution of benefits and burdens
what are 2 extra duties?
5- fidelity
6- veracity
what is fidelity?
faithfulness to implicit and explicit promises (to patients, profession, colleagues, etc)
what is veracity?
honesty, telling the truth
what are specific ethical principles for PTs?
APTA CODE OF ETHICS:
a- general ethical guidelines that guide behavior
b- guide for professional conduct- more specific interpretation of the code
c- different codes for PTs and PTAs
d- not laws, no enforcement power of law
e- individual state regulations govern practice in each state
f- code is applicable in all states, but only to APTA members
g- ethical violations may or may not violate the law
h- violations reported to the APTA Judicial committee for review
i-Violation of Code can result in loss of APTA membership, with decision published
j- if violate State licensure laws, individual state boards take action; penalty, possible suspension or loss of license
what are top ethical concerns in PT?
inequality of health services
utilization and supervision
business relationships
over-utilization
entry level qualifications
other professionals
education program accountability
informed consent
confidentiality
justifiability of fees
ethical limits of intervention
truth in advertising
billing fraud
sexual abuse
pts with HIV
clinical competency
documentation
legal vs. ethical
lack of evidence base
lack of cultural diversity
ethics in research
endorsement of products
ethics= personal gain
ethical decision making models facilitate what?
facilitate resolution of ethical dilemmas
what are advantages of ethical decision making models?
more systematic, don’t leave things out
organizes thinking
agree on language and terms
balanced debate of all sides
decreases emotionalism
what are 2 ethical decision making models?
1- Purtillo
2- Realm-individual process-situation (RIPS) (PT specific)
what are the 6 steps to the Purtillo model?
1- get the story straighter
-gather relevant facts
2- identify the type of ethical problem
- ethical distress
- ethical dilemma
- locus of authority
3- use ethical theories to analyze the problem
- Teleological
- Deontological
4-explore the practical alternatives/options
5- complete the action
6- evaluate the process and outcome (reflect)
what is an ethical distress?
right vs. wrong
barrier to doing what is right or don’t know what is the right thing to do.
maintain integrity
what is an ethical dilemma?
right vs. right
values are in conflict
2 divergent courses of action
what is locus of authority?
who is the primary decision maker? who should it be?
what are the 4 main steps to the RIPS model?
1- recognize and define ethical issues
- Realm
- Individual Process
- Situation
2- reflect
3- decide (chose a theory)
- duty based (deontological)
- ends based (teleological)
- care based (golden rule)
4-implement, evaluate, re-assess
what are the 3 sub-steps to step #1 of the RIPS model?
1- Realms (look at each realm –> pick a process and situation for each)
- individual
- organizational/institutional
- societal
2- individual process (pick 1)
- moral sensitivity
- moral judgement
- moral motivation
- moral courage
3-situation (pick 1)
- issue/problem
- dilemma
- distress
- temptation
- silence
what is the individual realm concerned with?
concerned with the good of the patient/client and focuses on rights, duties, relationships and behaviors between individuals
what is the institutional/organizational realm concerned with ?
concerned with the good of the organization and focuses on structures and systems that will facilitate their goals
what is the societal realm concerned with?
concerned with the common good
what are the 4 components of individual process?
1- moral sensitivity
2- moral judgement
3- moral motivation
4- moral courage
what is moral sensitivity?
recognizing, interpreting and framing ethical situations
being sensitive to the fact this is immoral
what is moral judgement?
deciding between right and right actions
considering ethical principles (autonomy, etc), then selecting and applying them
what is moral motivation?
prioritizing ethical values over financial gain or self-interest
what is moral courage?
implementing the chosen ethical action, even though doing so may cause adversity
what are the 5 types of ethical situations?
1- problem/issue 2- temptation 3- silence 4- distress 5-dilemma
what is a problem/issue situation?
a situation in which important moral values are being challenged
what is a temptation situation?
a situation in which a choice must be made between a right action and a wrong one, where the wrong action may benefit the decision maker in some way
what is a silence situation?
key parties realize ethical values are being challenged, but do nothing
what is a distress situation?
“ethical distress” right vs wrong
there is a structural barrier to doing the right thing
type A: there is a barrier keeping you from doing what you know is right
type B: there is a barrier bc something is wrong but you are not sure what that is
what is a dilemma situation?
“ethical dilemma” right vs right
there are 2 or more correct courses of action that cannot both be followed
you are doing something right, and also something wrong
most often involve ethical conduct
may involve conflicting traits of character (honesty vs. compassion)
what is step #2 of the RIPS model?
REFLECT
what are the relevant facts and contextual info?
who are the major stakeholders?
what are the potential consequences, intended or unintended?
what are the relevant laws, duties and ethical principles?
what professional guidance do we have?
what do the “right vs. wrong” tests suggest you do?
what are right vs. wrong tests?
Legal test: did anyone do anything illegal?
Stench test: does the situation smell wrong?
Publicity test: would any of the parties involved be embarrassed by the truth coming out?
Universality (mom test): what would your mom do? is this the right thing to do regardless of who is involved?
Ethics test: do the code of ethics, guide to professional conduct or professionalism in PT: core values say anything about this situation??
what is step #3 of the RIPS model? what are the 3 components of this step?
Decide what to do (use one of the following)
1- rule- based
2- ends-based
3- care-based
what is a rule-based decision?
“deontological”
follow only the principle you want everyone else to follow
what is a ends-based decision?
“teleological”
do whatever produces the greatest good for the greatest number
what is a care-based decision?
“the golden rule”
do onto others as you would have them do onto you
what is step #4 of the RIPS model?
Implement, evaluate, and re-assess
Implement: moral courage (role-play, prepare, imagine)
Evaluate and re-assess:
- did things turn out the way you expected?
- what did you do well? not so well?
- what were the most challenging aspects of this situation?
- how did this situation compare with others you have encountered or read about?
- how will this experience make you a better professional?
