Exam Flashcards
What are morals(2)?
- Right vs Wrong: Standards of behaviour or beliefs concerning what is ‘right’ and ‘wrong’ in human behaviour
- A code of standards in a particular society, or what an individual believes should be universal
- WIDESPREAD
Define morals?
Standards of behaviour or beliefs concerning what is ‘right’ and ‘wrong’
Define ethics?
A set of standards of behavior or moral principles especially those relating to a specific group
* Codes of conduct in professions
* Sets of moral principles and their analysis traditionally studied by philosophers
What are values?
One person’s standards of behavior or moral principles; one’s judgement of what is important
What is deontology?
- Morality of action is based on whether action itself it right or wrong
Study of duties and obligations, or if there is even such a thing - ‘deon’ = duty ‘logos’=science
What branch of deontology did William David Ross come up with?
Deontological pluralism
What are Ross’s prima facie duties? (7)
- Fidelity (loyal)
- Beneficence
- Non-malefecance
- Justice
- Reperation (making amends)
- Gratitude (loyalty esp to parents)
- Self-improvement
Describe Ross’s deontological pluralism?
- Rules of proper action and conduct may at times contradict each other resulting in ethical dilemmas
- Moral decisions or actions are fraught with conflict
- We can resolve such dilemmas through an intuitive faculty and reasoning process
What is Teleology/ Consequentialism?
Study of ends or goal, the purpose of actions
Results based, morality of action is based on greatest good
What is utilitarianism?
Utilitarianism (type of teleology): greatest good for the greatest # of people
‘telos’ = ends ‘logos’ = science
John Stuart Mill (1806-1873)
What are Beauchamp and Childress’s 4 biomedical ethical principles?
Autonomy
Beneficence
Non-maleficence
Justice
(once doesn’t have any heirachy over the other.)
What is the principles approach to an ethical dilemma(3)?
- Decision is not clear or simple; there is no specific solution
- There are moral questions, judgments and values to be considered
-At the time of considering an ethical dilemma, examine moral differences between yourself and others. Cultural norms at the time, as well as expectations, will also impact upon the process.
-Dominant approach in western health care/ clinical ethics
What is Autonomy?
Free and informed consent
(actions that are intentional, without coercian, and informed)
What is beneficence?
Do good to others (cannot be met by doing nothing; duty to help)
What is non-maleficence?
Do no harm (can be met by doing nothing)
What is justice?
Treat others fairly
What is B & C’s principles approach in a nutshell (4)?
A physician has the ethical responsibility to:
* (Autonomy) Respect patient choice and confidentiality
* (Beneficence) Do good, remove conditions that create harm
* (Non-maleficence) Do no harm
* (Justice) Provide and distribute treatment fairly
What is bioethics?
- Concerned with ethical evaluations of questions in medicine & health related sciences
- Fundamental aspects of medicine and health are included such as beginning and end of life, value of life
- Traditionally a focus on ethical issues that emerge as medicine and biology advances, e.g. ethics of medical technology and treatments
What are some ethical issues in reproductive care?
- Ethics of advertising/marketing/relationship with industry
- Prenatal testing, screening, sex selection
- Termination, e.g. ‘selective reduction of multiple pregnancy’
- Fetal medicine
- Human cloning
- Embryo research
- “Management of the severely malformed fetus”
- Resuscitation / threshold of viability
Are midwifery ethics different than other healthcare ethics? Why or why not?
Birth/Perinatal period and the decisions around this time are a whole person experience, connected to community and culture.
What are the steps in the ethical decision making framework (10)?
1) First reaction
2) Issues of concern
3) Gatherrelevant information
4) Indentify principles and conflict among principles
5) Assess healthcare professionals obligations
6) Which values have the top priority (you, others)
7) Identify all the options
8) Explore alternatives
9) Select the best alternatives all things considered
10) Explain your rationale for recommending this alternative
How does ICM ethics differ from BCCNM ethics?
A focus on rights, autonomy = global context where those things aren’t available in the same way
Signs of an ethical dilemma? (5)
- Uncertainty about what to do/ “right” thing to do
- Conflict between different providers about right thing to do
- Distress or feeling that something isn’t right
- Organizational or personal barriers to doing what’s right
- Wondering if someone “good” would do this differently
What isn’t an ethical dilemma?
-When a clinician perceives clinical risk differently than their client
-When a client has different values and beliefs than you do
-Differing clinical recommendations
Some things BCCNM code of ethics: relationship and accountability?
Informed consent, supporting clients acceptance of responsibility of outcomes for decision
-Respect autonomy and rights of each client to make decisions of care that the client determines is in their best interest.
-Recognizes inherent power inbalance of relationship
What is liberty?
“liber” (Latin) = free
* State of being free within society from oppressive restrictions
* The power to act as one pleases
* In philosophy: A person’s freedom from control by fate or necessity
What is autonomy?
“autos” + “nomos” = self + law
Capacity to make an informed, un-coerced decision
In Kantian moral philosophy:
“the capacity of an agent to act in accordance with objective morality rather than under the influence of desires.”
Difference bw liberty and autonomy?
Liberty: the freedom to act without others interfering: the decision is made by the person whose right is it to make the decision.
Autonomy:requires liberty AND capacity to think and make a rational, informed decision.
Being free from restrictions isn’t quite the same thing as autonomy.
Capacity to make an informed decision (un-coerced, un-influinced, with all the info)
What is Fidelity?
Be faithful, loyal. Honor trust relationships that we have with our profession and with patients.
What is Veracity?
Be truthful. Provide full honest disclosure.
What is Accountability?
Take responsibility for one’s actions, decisions and their consequences
What is proportionality?
Is the public health benefit weighed and balanced against any negative effects e.g. on individual freedom.*
Explain relational autonomy?
- There is no such thing as an independent subject.
- Autonomy is developed in relation with one’s environment.
- Environments shape autonomous capacities.
- Capacities can be developed or oppressed by social norms and institutions.
- Concept of rationality in autonomy should be expanded to include emotional factors.
- Move from autonomy towards empowerment.
What are Beuchamp and Childress’s criteria for distributive Justice? (6)
To each person
equal share according to:
- need
-effort
-contribution
-merit
- freemarket exchanges
How did medical ethics traditionally think about justice?
Focusing on equality/fairness rather than equity/human rights
What is an updated view of distributive justice?
Focus on equity rather than equality would better address and prevent the disparities
What does disruptive justice need to be effective for equity? (3)
Focusing on:
-outreach
-anti-racism
-listening to the community
What are additional components that should be added to distributive justice? (3)
- treats all patients equitably
- accounts for historical harm
- focuses on transparency in allocation and public health decision-making
What is the purpose of the cultural safety practice standard?
In response to
-colomnialism in healthcare and the In Plain Sight report, The purpose of this standard is to set clear expectations for how BCCNM registrants are to provide culturally safe and anti-racist care for Indigenous clients
What are the 6 Core Principles of the cultural safety practice standard?
- Self reflective
- Education
- Anti Racist
- Safe healthcare
- Person led
- Stengths based and traum informed
Principles of self-reflective practices? (3)
1.1 Reflect on, identify, and do not act on any stereotypes or assumptions they may hold about Indigenous Peoples.
1.2 Reflect on how their privileges, biases, values, belief structures, behaviours, and positions of power may impact the therapeutic relationship with Indigenous clients.
1.3 Evaluate and seek feedback on their own behaviour towards Indigenous Peoples.
Principles of Building knowledge through education? (4)
2.1 Undertake ongoing education on Indigenous health care, determinants of health, cultural safety, cultural humility, and anti-racism.
2.2 Learn about the negative impact of Indigenous-specific racism on Indigenous clients accessing the health care system, and its disproportionate impact on Indigenous women and girls and two-spirit, queer, and trans Indigenous Peoples.
3 2.3 Learn about the historical and current impacts of colonialism on Indigenous Peoples and how this may impact their health care experiences.
2.4 Learn about the Indigenous communities located in the areas where they work, recognizing that languages, histories, heritage, cultural practices, and systems of knowledge may differ between Indigenous communities.
Principles of Anti-Racist Practice? (3)
Take appropriate action when they observe others acting in a racist or discriminatory manner towards Indigenous Peoples by:
* 3.1.1 Helping colleagues to identify and eliminate racist attitudes, language, or behaviour.
* 3.1.2 Supporting clients, colleagues and others who experience and/or report acts of racism.
* 3.1.3 Reporting acts of racism to leadership and/or the relevant health regulatory college.
Principles of Creating safe healthcare experiences? (4)
- Treat clients with respect and empathy by:
4.1.1 Acknowledging the client’s cultural identity.
4.1.2 Listening to and seeking to understand the client’s lived experiences.
4.1.3 Treating clients and their families with compassion.
4.1.4 Being open to learning from the client and others. - 4.2 Care for a client holistically, considering their physical, mental/emotional, spiritual, and cultural needs.
- 4.3 Acknowledge and incorporate into the plan of care Indigenous cultural rights, values, and practices, including ceremonies and protocols related to illness, birth, and death, where able.
- 4.4 Facilitate the involvement of the client’s family and others (e.g., community and Elders, Indigenous cultural navigators, and interpreters) as needed and requested.
Principles of Person-led care? (3)
- 5.1 Respectfully learn about the client and the reasons the client has sought health care services. 5.2 Engage with clients and their identified supports to identify, understand, and address the client’s health and wellness goals. 5.3 Actively support the client’s right to decide on their course of care..4 Communicate effectively with clients by: 5.4.1 Providing the client with the necessary time and space to share their needs and goals.
- 5.4.2 Providing clear information about the health care options available, including information about what the client may experience during the health care encounter.
- 5.4.3 Ensuring information is communicated in a way that the client can understand.
Principles of Strength Based/Trauma informed care? (4)
- 6.1 Work with the client to incorporate their personal strengths that will support the achievement of their health and wellness goals.
- 6.2 Recognize the potential for trauma (personal or intergenerational) in a client’s life and adapt their approach to be thoughtful and respectful of this, including seeking permission before engaging in assessments or treatments.
- 6.3 Recognize that colonialism and trauma may affect how clients view, access, and interact with the health care system.
- 6.4 Recognize that Indigenous women, girls, two-spirit, queer, and trans Indigenous Peoples are disproportionately impacted by Indigenous-specific racism in the health care system and consider the impact gender-specific trauma may have on the client.
What is the maternal fetal conflict?
Midwives care for both pregnant people and the newborn. As part of pregnancy, midwives are also expected to provide recommendations for the benefit of the fetus.
In bioethics, any situation where maternal well-being or wishes contradict fetal benefit are discussed/analysed as a “maternal-fetal conflict”.
What is the legal standard re: fetus in Canada?
Long-standing legal principle that the fetus has no legal status until it is born alive and viable, which means its purported rights cannot take precedence over those of its pregnant person.
How does midwife’s legal responsibility change with the birth of the newborn?
Legal responsibility to the parent and the newborn
How does consent work for infants?
“Generally, parents are considered to be the best surrogate decision makers for their own babies”*. Parents have parental authority and thus also must give their consent before care is provided to a baby.
In an emergency, can treatment can be carried out without parental consent?
As in adult cases, in an emergency, treatment can be carried out without consent.
When does a midwife have a duty to report for children? (12)
- Physical harm from parent
- Sexual abuse from parent
- Physical or sexual abuse from someone else that parent is unable to stop
- Likely or has been harmed from neglect
- harmful environment
- Not given necesary healthcare
- development is likely to be seriously impaired by a treatable condition and the child’s parent refuses to provide or consent to treatment;
- parent unable to care for child
- parent gone
- parent dead
- child abandoned
- legal agreement for change of care
What is your ethical and legal responsibility, if parents refuse recommended treatment?
depends on whether refusing the treatment will put the child at risk.
When were birth alerts discontinued in BC?
2019
What ethical principles did birth alerts violate?
Violated birther’s autonomy. Fetus not considered a person in Canada law
“The court issue with the birth alert process is there is no jurisdiction for a child protection authority to act before there is a child.”
Thus even if there is perceived beneficence for the fetus, as we know the legal status of the fetus in Canada does not allow us to violate the rights and autonomy of the pregnant person
