Lecture 2

Question 0

Healthcare Ethics

Answer 0

ethical issues directed at nurses and other healthcare providers (care ethics)

Question 1

What is “Medical Ethics”?

Answer 1

physician-centered ethical issues; high level of intervention

Question 2

Bioethics

Answer 2

general issues from biomedical technology and social policy
(eg. reproduction, organ transplants, human subject research, physician-assisted suicide, end of life issues, technology beyond human capacity)

Question 3

Describe “Principalism”

Answer 3

Described in 1979 Beauchamp and Childress’ Principles of Biomedical Ethics
Helped create the 1847 AMA Code of Ethics, which defined the duties and decorum expected of physicians
A structured approach to identifying, analyzing and resolving ethical dilemmas by applying guiding principles

Question 4

What are the 6 main principles of principalism?

Answer 4

1. Respect for Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
5. Fidelity and Veracity
6. Respect for Dignity

Question 5

Describe the principle of Autonomy

Original 4.

Answer 5

OUGHT to honor that each rational, competent person has the right to make (medical) decisions for themselves
(deontology - duty)

Question 6

What does autonomy require?

Answer 6

• informed consent
• confidentiality
• shared decision making between patient and doctor
• implies capacity (consciousness, intellectual capacity, maturity)
  “First among equals”

Question 7

What are the issues/problems with autonomy?

Answer 7

• must a doctor always follow a patient’s wishes, even when they are wrong?
• this is very euro-american approach: individuality; what about other cultures who emphasize family and community, beneficence and virture (islam), “loving” physician (Confucianism)
• Public health risks: confidentiality vs. public disclosure

Question 8

What is PARQ?

Answer 8

The pieces that make up "informed consent"
P - procedures
A - alternatives
R - risks (of treatment/not treating)
Q - answer all questions

Question 9

Describe Beneficence.

Original 4.

Answer 9

“do good” for patients
(teleology - outcome)
physician shall provide the best quality of care, act in the best interest of the patient
Try to remove suffering, pain, disease, etc
The treatment should have good evidence/odds of working (efficacy)

Question 10

What are some issues/problems with Beneficence?

Answer 10

What is of benefit to the patient is not always obvious
Patient’s self-assessment vs medical evidence
Does a doctor really know what will help?
The use of placebo
In trying to help, the physician may unintentionally harm the patient

Question 11

Describe Non-maleficence.

Original 4.

Answer 11

avoid causing harm (teleology - outcome)
The risks to the patient should not be disproportionate to the benefit of the patient
Primum non nocere - first, do no harm
Clinician must weigh risks vs. benefits

Question 12

What are some issues/probems with non-maleficence?

Answer 12

public concerns over safety and standards
financial exploitation of patients
Use of unconventional or untested techniques (experimental research, “off-label” use of meds or procedures)
The use of placebo - intentional deception

Question 13

How are Beneficence and Non-Maleficence often combined?

Answer 13

• weighing risks vs benefits
• providing info to patient
• intended effects vs side effects
  example: surgery

Question 14

Describe the principle of Justice.

Original 4 principle.

Answer 14

patients ought to be treated equally, fairly and justly (deontology - duty)
Fair distribution of resources and healthcare services (distributive justice); equal access to healthcare (hospitals, government; includes: ability to pay, contribution to society, first come/first serve, level of need/urgency, prioritization)
Respect for people’s rights; non discrimination; treat sim cases in sim fashion;
Respect for morally acceptable laws (legal justice)

Question 15

What are some issues/problems with Justice?

Answer 15

Universal Healthcare: right or privilege? Mandated HC?
Accessibility (financial constraints, physician’s prerogative, fee for service, geographic location, #’s, insurance coverage)
Third-party billing (what is covered? limits what you can and cannot do; to treat or not?

Question 16

Define Fidelity and Veracity.

Answer 16

Fidelity: being faithful to patients, meeting their reasonable expectations (duty), truth telling (virtue)
Veracity: truth telling, not misleading patients, being accurate; keep promises and follow the rules of your practice

Question 17

Describe the qualities of a doctor under Fidelity and Veracity.

Answer 17

Basic respect, modesty
Doctor is/remains competent
will adhere to professional code of ethics
will follow procedures and laws in their jurisdiction
will honor all agreements
will not mislead patient

Question 18

Problems with Fidelity and Veracity as principles

Answer 18

different physicians unaware/critical of other options
Doctors obligation towards a patient: firing a patient, mandatory reporting (child abuse, elder abuse, illegal practice by licensed individual, self-reporting, continuing edu)
Telling the truth may cause harm (end of life care or critical care)

Question 19

Describe dignity.

Answer 19

Patients, families, surrogates, providers have a right to dignity
Each person is worthy of honor and respect
Honoring patient’s time, attending to their comfort
Respect for confidentiality and privacy, emotions goals and bodily integrity, social cultural and religious background
Necessitates good communication and cultural sensitivity!!!
Responsibility of doctor to utilize judgment and expertise (own dignity)

Question 20

Issues/problems with dignity.

Answer 20

Patient’s desire or medical need for procedure versus a provider’s moral stance
(examples: contraception, abortion, PAS, medical marijuana)

Question 21

What is the doctrine of Double Effect?

Answer 21

An action with two possible effects: 1 good, 1 bad; is morally permitted if the action:

1. Is not itself immoral
2. is undertaken with the intention of achieving the good effect (even if the bad effect can be foreseen)
3. is undertaken for a proportionately grave reason.

Question 22

Overall criticism if Principalism

Answer 22

It is a western concept and is automatically assumed to be an accepted stance

Question 23

Deontology in framework of medical ethics

Answer 23

duties to adhere to oaths, to obey practice laws, etc

Help, not harm, don’t lie, keep promises

Question 24

Casuistry

Answer 24

referring to similar cases to help inform the current one; draws on the ethical understanding from moral experience and judgment based on rules and maxims
Similar to case precedent in law

Question 25

Virtue Theory

Answer 25

Striving for “high moral character” since patient care involves vulnerabilities, power imbalance, risk, etc.

Question 26

Utilitarianism

Answer 26

Rationing - at hospital level