Ethical Issues and Problems Flashcards
a situation in which one or more moral norms or principles are present but do not create a problem.
Ethical Issue
a situation in which two or more moral norms or principles create a challenge about what to do
Ethical Problem
there are 4 basic types of ethical problems:
ethical distress
ethical dilemma
ethical dillemma of justice
locus of authority issue
3 types of ethical problem that is focused on what to do
ethical distress
ethical dilemma
ethical dilemma of justice
type of ethical problems that focus on who should do it
locus of authority issue
3 basic concepts of ethical problem
moral agent
course of action
desired outcome
anyone who is in a situation in which he must (and can) assure responsibility for the outcome of his actions
moral agent
capable of thinking, deciding and acting in accordance with moral standards and rules
moral agent
may not always fulfill the requirements of a moral standard or rule i.e. he need not be morally perfect but must have the capacity to judge himself
moral agent
the agent’s judgments process and final decision about what will happen if one or more paths are chosen
course of action
also called the process of applying ethics
course of action
the projected positive result/s of having taken the course of action
desired outcome
a kind of ethical problem a health professional faces when ho knows exactly what course of action is right but there is a barrier keeping the person from doing it
ethical distress
arises when one knows the right thing to do but institutional constraints make it nearly impossible to pursue the right course of action
ethical distress
the most common type of ethical problem
ethical dilemma
involves 2 (or more) morally correct courses of action but you cannot do both (or all)
ethical dilemma
sometimes considered as a problem in which there is no right or wrong solution
ethical dilemma
there is more than one right thing to do but to act on one necessarily prohibits you from acting on the others
ethical dilemma
as a result, you (the agent) necessarily are doing something right and also wrong (by not doing the other right thing)
ethical dilemma
may be presented in special case of paternalism or parentalism
ethical dilemma
the patient’s autonomy conflicts with the health professional’s judgment of what is best for the patient
paternalism
when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient
paternalism
the health professional is acting as a parent to the patient
paternalism
a dilemma that arises in regard to distributing societal benefits and burdens
dilemmas of justice
the scarce supply of these resources requires difficult decisions by the agent
dilemmas of justice
because to choose to provide the good to one group may necessarily mean there are no resources available for others
dilemmas of justice
these situations arise as problems when roles or other institutional policy or societal arrangements create a confusion about who is in charge
locus of authority issue
in the diagram, the 2 agents, each of whom assumes himself to be the legitimate authority for making a particular decision, they may come to different conclusions about how to achieve the best outcome for a patient
locus of authority issues
they may disagree on the course of action and benefit, or they agree on the course of action and desired outcome, disagreeing solely on who is the proper authority to effect that outcome
locus of authority issues
there are several aspects that may consider in deciding who is in charge
difference in professional expertise
traditional arrangements
institutional arrangements and mechanisms
the weight of experience
five steps of process of ethical decision making
Gather relevant information
identify type of ethical problem
determine ethics approach to be used
explore practical alternatives
complete the action
relevant facts include (4)
clinical indications
patient preferences
quality of life
external factors
Is the illness or condition reversible?
Is the life saving treatment medically useless?
What is the usual treatment for this type of condition in the community?
What is needed to relieve suffering and provide comfort?
Is the patient brain dead or in persistent vegetative state?
what kind of relevant facts
clinical indications
Is the patient informed?
Is the patient competent?
If the patient is not competent, how can I discern what this patient would want? (substituted or surrogate judgment)
If the patient is not competent, how can I discern what this type person would want? (best interest)
what kind of relevant facts
patient preferences
What is the patient’s judgment?
What is the health professional’s judgment?
Is there any hope for improvement from present quality of life?
what kind of relevant facts
quality of life
Costs? Reimbursement issues?
What policies are there? Hospital, judicial opinions, professional societies, etc.
What are the legal implications? (court cases, statutes)
Is allocation of beds, other resources an issue?
what kind of relevant facts
external factors
simultaneous with the initial fact-finding and sorting of information, the health professional can begin to determine the type of ethical problem he is facing
as he observes, asks questions, and reflects, he can begin to decipher where his initial observations were correct and where they were not until he arrives at a point where he has as clear a picture of the situation as he is able to put together
what step
identify the type of ethical problem
if the moral agent is a ____his thinking will be guided by the duties and/or rights that are in conflict
deontologist
he will spend a lot of time weighing the two duties in dilemma and will probably decide that the weightier or more compelling duty is to the patient
what type of moral agent
deontologist
if the moral agent is a ___, he will spend less time thinking about the duties and will be guided by his desire to bring about the over-all best consequences in the situation
utilitarian
the over-all best consequences might well be to leave well enough alone, not to make waves with the patient
what kind of moral agent
utilitarian
the health professional has to explore the actual strategies and options open to him
these alternatives should be duty-bound and would produce the desired outcome
what step
explore practical alternatives
the final and necessary step in moral judgment and action
without the necessary attention to a strategy for carrying out the plan, the entire process, steps 1 to 4, is just an intellectual exercise
the health professional must assume that he is prepared to accept the consequences of his actions, and that he has the motivation to go beyond mere identification of the problem
in order to see the benefits of his own struggle he must now proceed to action
to do this, he needs the character traits of compassion, a sense of responsibility, and the courage to go ahead
what step
complete the action
read doctor patient relationship
beginning and ending the relationship
a voluntary relationship entered freely by both sides
a patient cannot be compelled to accept a particular doctor as his/her physician; a physician cannot be compelled to accept a patient without his/her agreement
there is no legal obligation on the part of the physician to accept a patient; this is true no matter what need the patient has and whatever expertise the doctor may possess
this is different from a hospital’s mandate to provide emergency treatment to anyone who comes to the emergency department; hospital cannot turn anyone away at the door of the emergency room
once a patient and a physician have entered into a care relationship, there is far greater complexity in ending the relationship
the doctor cannot suddenly end the relationship; he/she must maintain the care of the patient until the patient can find an appropriate alternate source of care and the doctor must give reasonable notice
read doctor patient relationship
gifts from patients (or from pharmaceutical industry)
small gifts from patients of nominal or modest value are acceptable
provided that there is no expectation of a different form of therapy or a higher level of care based on the value of the gift
rules on gifts from patients are less rigorous, precise or clear than the rules on gifts from pharmaceutical industry
there is an automatic presumption that gifts from pharmaceutical industry always carry an influence toward a product, service or prescribing practice
gifts from industry are viewed differently because there can only be no other intention behind them except to buy influences
read
doctor/patient sexual contract
sexual contact between a physician and a patient is always inappropriate
at the very least, the physician and the patient must mutually agree to end the formal professional relationship of a doctor and a patient
not clear how much time must elapse between the ending of the formal relationship and the start of the personal relationship
the American Psychiatric Association guidelines specifically state that there can never be a sexual or personally intimate private relationship between doctor and patient even after the professional relationship
these guidelines apply no matter who initiates the relationship; it is not more acceptable for a doctor and patient to have sexual relations if the patient initiates the relationship
no account is given on gender or sexual orientation
it is always unacceptable for a physician of any kind to have sexual relationship with a current patient
If the patient is not competent, how can I discern what this patient would want?
(substituted or surrogate judgment)
If the patient is not competent, how can I discern what this type person would want?
best interest
