Ethics Flashcards
What’s ethics
The science of morals or moral philosophy
Ethics of profession are
Principles that are accepted by any profession as basis for proper behaviour
Morality is
Moral is
Ethics are
Right moral conduct or a moral system
Moral: aspect reflecting the rightness or wrongness of an action
Interchange with the word ethical
Refer to qualities that are good and bad and conform with behavioural standards
Ethics are used in dealing with moral qs from a theoretical point of view. It’s science of morals in human conduct
Ethical norms are
Moral intuitions are
Rules or behaviour to be complied with or used to evaluate or direct human conduct
Moral intuitions are considerations mainly from upbringing, cultural background, reflecting personal experiences and feelings or religious teachings and faith
Ethical dilemma is
It is where a problem needs to be overcome or a difficult choice made using a process known as as ethical decision-making
Difference between facts and values
A fact is indisputable(objective) whereas a value is more open to question(subjective)
3 main ethical theories
Deontological
Consequentialist
Virtue ethics
Deontological ethics
Duty and obligations-
Respond to law like categorical imperatives - unconditional moral obligations
Do not consider consequences
Duty is more important than outcome
Consequencalist ethics
opposite of deontological
Main consideration is favouring action that will achieve the best possible consequence -result
Not nature of action but its outcome that is most relevant
Virtue ethics
Being aretetic - goodness, excellence or virtue
Focus is the moral uprightness or goodness of induvidual
Summary of the 3 theories
Duties and obligations
Outcomes and max benefit
Moral character
4 key moral concepts in healthcare
The Georgetown mantra
Beneficence Non maleficence Respect for autonomy Justice The Georgetown mantra
What’s beneficence and non maleficence
Act in ways that benefit a patient- patient care or interest
Do no harm
Ethics of care is
Similar to virtue ethics
But more emphasis on employing altruistic (unselfish) emotions
Humans have and in that capacity for sympathy and compassion
A good decision will involve
Systemic structure - create stages and inc analysis of what you did and why to inform future thinking
Rational reasoning -reasonable in the circumstances
Value based reasoning
Recorded decision -interventions in PMR
The 4 stage approach of decision making
Gather relevant facts (cirminal, nhs, civil law)
Prioritise , ascribe values
Generate options - cause least harm
Choose an option - justify why
Virtue based morality
The values that should be internalised are
Honour Integrity Humanity Confidentiality Empathy Compassion
Rational reasoning must have a reference to
Ethical principles
A process of rational reasoning
A combination of premises (facts)
A reference to general ethical principles
A conclusion (factual and moral claims)
Kohlberg’s stages of moral reasoning
Level 1: Preconventional: based on self interest, conform to get rewards
2: Conventional: based on conformity to social norms and expectations , good boy
3: Postconventional: centred on justice and based on universal ethical principles, conform democratic law and individual right
Fallacies
Logical mistakes in reasoning
Contains factual mistake or
Draws an erroneous conclusion from correct facts , direct attention to others from main consideration
When is principle ethics being used?
When at first sight obligations form the basis of a particular approach
Technical imperatives
Achieve a particular end
Assertoric imperative
Relate to more generally shared human aspirations
Respect for autonomy
This is a capacity for self government in the individual
You got the right to make your own decision in consideration of an ability to be open to reason and consider consequences
Justice in healthcare context
Distributive allocations (resources)
E.g. Access and denial of trt
Equitable distribution of benefit and burden
What is clinical pragmatism
The essential difference with clinical pragmatism is that once all parties have identified and agreed what the clinical and directly related facts are about ,attention shift to the factors that reflect as the ethical disparities (differences)
Take account of the perspectives of patient’s family and members of healthcare team
It recognises both limits of knowledge and the differences in lived experiences which can lead to different understandings
This can enhance decision-makingwhen principle is not treated as absolute
What is moral reasoning
This is defined as individual or collective practical reasoning about what we should do, take into account the moral values that are important in our lives
2 invalid reasoning methods
Ad hominem
Tu quoque
What’s hominem argument
An argument against the man
It is normally an attack on particular person and is intended to discredit what he says or does
What’s Tu quoque argument
You too
This method is used to reduce the force of an argument that a person is making
The universal system of making a decision
What about in ethical dilemma
- Weighing the fact
- Setting this fact against possible outcomes
- Deciding on the preferred course of action
In Ethical dilemma there is an extra step of taking account of conflicting ethical issues
What is rational enquiry
This is how we can establish beliefs and judgement in an object at manner
A process of reasoning is considered as either…
Deductive - logically sound with conclusion follows and entailed from its supporting premises)
Inductive - inferred (supportive conclusion but not entailed by its premises)9
Rational reasoning must have a reference to ethical principles
A combo of premises, (the facts of the matter)
A reference to general ethical principles
A conclusion
E.g. Human embryos are a part of human life
Taking human life is wrong
Kill human embryos is Wring
Which type of morality does health promotion campaign relate to?
Goal based morality
What’s personal accountability
Duty to ourselves
Terms used in professional accountability
Responsibility accountability liability- pay if failure lead to harm
Ethics in practice - 3 areas that relabemt to pharmacy
1 conscience clause - right for HCP to follow their conscience
2 resource allocation - max benefit to max amount of ppl
3 essential medicines - third world country ppl don’t have essential meds
What is judgement
The evaluation of evidence to make a decision and the ability to make considered decisions. Or come to sensible conclusion
What’s the msg from Berwick report
- place patient safety and quality of care above all
- hear patients at all times
- foster staff to improve the process they work
- transparency
What are the three types of decisions
Legal
Clinical- use judgement
Ethical - use J
Type of clinical decision making
Selective - easy decision with options, cognitive process
Creative- think freely, generate solutions, use emotions and bias, risky
Half of the hospital ADverse event involved errors of
Reasoning or decision quality
The 6 stage of approach
Gather info
Identify and clarify the ethical problem
Analyse the prob by considering ethical theories/ approaches
Exposure options
Make decision
Apply then reflect on decision
You need to be able to justify your decisions
Patient/ public interest
Legal issues
Professional standard
Policies and procedure
Calgary Cambridge guide on shared decision making
Share own thinking
Involved patient making suggestion not directions
Encourage patient to contribute their thoughts
Negotiate to an acceptable plan
Offer choices
Check with patient if an is ok
Factors influence decision making
Evidence
Patient belief/ scenario
Environment
Yourself
What’s intuitive
Automatic response - used in non- analytic reasoning
With increasing age and experience what would happen when making a decision?
Less knowledge less adherence to guideline sometimes worse patient outcomes
Increase pattern recognition
Can consider less common conditions
Too much reliance on data gathered early and less willing to re added new information
So how should we carry out clinical reasoning?
Trust feelings of similarity -non analytical but avoid giving conclusion straight away by using a diagnostic algorithm (analytic)
How to minise bias in decision making
Deliberately consider possible alternative options
Ask question that would disprove your hypothesis
Is a piece of info important cuz you seen it before or just because it really is important?
Be aware of biases
Using checklist before making a decision
- generic
- disease specific (force you to go through different options)
