Topic 1: Ethical Theories, Principles, and Standards - Ch 1 Intro to Ethics Flashcards
What are the four basic principles of healthcare ethics?
Beneficence
Nonmaleficence
Autonomy
Justice
What is “ethics”?
the branch of philosophy that seeks to understand the nature, purposes, justification, and founding principles of moral rules and the systems they comprise
deals with values relating to human conduct
focuses on the rightness and wrongness of actions, as well as the goodness and badness of motives and ends
encompasses the decision-making process of determining ultimate actions—that is, answering the questions What should I do? and Is it the right thing to do?
is concerned with human conduct as it ought to be, as opposed to what it actually is
Microethics
involves an individual’s view of what is right and wrong based on one’s personal life teachings, traditions, and experiences.
Macroethics
involves a more global view of right and wrong.
What are the 3 distinct ways ethics are used?
- philosophical ethics - involves inquiry about ways of life and rules of conduct
- general pattern or way of life - such as religious ethics
- set of rules - conduct or “moral code” (e.g., professional codes for ethical behavior)
Bioethics
addresses a diversity of issues that include the nature of life and death, what sort of life is worth living, how we distinguish between assisted suicide and murder, how we should treat people who are especially vulnerable, and the responsibilities that we have toward other human beings
Morality
a class of rules held by society to govern the conduct of its individual members
is a code of conduct
requires us to reach a decision as to the rightness or wrongness of an action
Morals
ideas about what is right and what is wrong
are deeply ingrained in culture and religion and are often part of its identity
should not be confused with religious or cultural habits or customs
That which is considered morally right can vary from nation to nation, culture to culture, and religion to religion.
There is no universal morality that is recognized by all people in all cultures at all times
code of conduct
prescribes standards of conduct, states principles expressing responsibilities, and defines the rules expressing duties of professionals to whom they apply
Wikipedia describes a code of conduct as a “set of rules outlining the social norms, religious rules and responsibilities of, and or proper practices for, an individual, party or organization. Related concepts include ethical, honor, moral codes and religious laws.”
Standards
e.g., honesty, respect for others, conscientiousness - are used to guide human conduct by stating desirable traits to be exhibited and undesirable ones (dishonesty, deceitfulness, self-interest) to be avoided
Principles
responsibilities that do not specify what the required conduct should be.
Professionals need to make a judgment about what is desirable in a particular situation based on accepted principles.
Rules
specify specific conduct; they do not allow for individual professional judgment.
Moral judgments
those judgments concerned with what an individual or group believes to be the right or proper behavior in a given situation.
Making a moral judgment is being able to select an option from among choices.
A lack of conformity can result in moral disapproval and possibly ridicule or censure of one’s character.
Laws
created to set boundaries for societal behavior.
They are enforced to ensure that the expected behavior happens.
Can morality be legislated?
Yes.
You can’t not legislate morality.
Moral dilemmas
often arise when values, rights, duties, and loyalties conflict
theories and principles of ethics
introduce order into the way people think about life
They are the foundations of ethical analysis that provide guidance in the decision-making process.
Ethical theories
help caregivers determine the outcome of alternative choices, when following their duties to others, in order to reach the best ethical decision under the circumstances.
Meta-Ethics
the study of the origin and meaning of ethical concepts
seeks to understand ethical terms and theories and their application
attempts to discover the origin or cause of right and wrong
Normative Ethics
prescriptive in that it attempts to determine what moral standards should be followed so that human behavior and conduct may be morally right.
primarily concerned with establishing standards or norms for conduct and is commonly associated with investigating how one ought to act.
One of the central questions of modern normative ethics is whether human actions are to be judged right or wrong solely according to their consequences.
Descriptive Ethics
also known as comparative ethics
is the study of what people believe to be right and wrong and why they believe it.
describes how people act
Difference between normative and descriptive ethics?
Normative prescribes how people ought to act, vs descriptive describes how they DO act.
Applied Ethics
the philosophical search (within western philosophy) for right and wrong within controversial scenarios
the application of normative theories to practical moral problems, such as abortion, euthanasia, and assisted suicide
Consequential Ethics
emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil.
theories that judge actions by their consequences
Revolve around the premise that the rightness or wrongness of an action depends on the consequences or effects of an action.
based on the view that the value of an action derives solely from the value of its consequences
goal of a consequentialist is to achieve the greatest good for the greatest number
ends justify the means
Utilitarian Ethics
involves the concept that the moral worth of an action is determined solely by its contribution to overall usefulness
commonly holds that the proper course of an action is one that maximizes utility, commonly defined as maximizing happiness and reducing suffering
describes doing the greatest good for the greatest number of people
form of consequential ethics - moral worth of an action is determined by its outcome, and, thus, the ends justify the means
Deontological Ethics
“doing your duty.”
commonly attributed to the German philosopher Immanuel Kant. He believed that although doing the right thing is good, it might not always lead to or increase the good and right thing sought after
focuses on one’s duties to others and others’ rights
includes telling the truth and keeping your promises
often referred to as duty-based ethics
involves ethical analysis according to a moral code or rules, religious or secular
Deon is derived from the Greek word meaning “duty.”
heavy on obligation, in the sense that a person who follows this ethical paradigm believes that the highest virtue comes from doing what you are supposed to do
Nonconsequential Ethics
denies that the consequences of an action are the only criteria for determining the morality of an action
the rightness or wrongness of an action is based on properties intrinsic to the action, not on its consequences
believes right or wrong depends on the intention, not the outcome
good intentions
They accept the fact that sometimes good intentions can lead to bad outcomes.
Focus more on character as to whether someone is a good person or not
Ethical Relativism
morality is relative to the norms of the culture where one lives
right or wrong depends on the moral norms of the society in which it is practiced
A particular action by an individual may be morally right in one society or culture and wrong in another
Ethical principles
universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued
assist caregivers in making choices based on moral principles that have been identified as standards considered meaningful when addressing health care
Autonomy
involves recognizing the right of a person to make one’s own decisions
is not an absolute principle
actions of one person must not infringe upon the rights of another
Are their laws related to autonomy?
Yes, Respect for autonomy has been recognized in the Fourteenth Amendment to the Constitution of the United States.
The law upholds an individual’s right to make healthcare decisions
Patients can refuse treatment, refuse to take medications, and refuse invasive procedures regardless of the benefits that may be derived from them.
They have a right to have their decisions adhered to by family members who may disagree simply because they are unable to let go.
What can affect a persons ability to make autonomous decisions?
one’s disabilities, mental status, maturity, or incapacity to make decisions
What can help in cases where a person is unable to make an autonomous decision?
one’s autonomous wishes may be carried out through an advance directive and/or an appointed healthcare agent
Beneficence
the principle of doing good, demonstrating kindness, showing compassion, and helping others
In the healthcare setting, caregivers demonstrate beneficence by providing benefits and balancing benefits against risks
requires one to do good
Paternalism
a form of beneficence
People sometimes believe that they know what is best for another and make decisions that they believe are in that person’s best interests
may involve withholding information
can occur because of one’s age, cognitive ability, and level of dependency
Can paternalism violate a patient’s rights to self-determination?
Yes, A patient’s rights to self-determination are compromised when a third party imposes their wishes upon those of another person.
Centers for Medicare and Medicaid Services Memorandum - CPR Policies
Memorandum Summary:
1. Must provide CPR to patients who have cardiac arrest in accordance to their advance directives or in the absence of advance directives or a Do Not Resuscitate (DNR) order. CPR-certified staff must be available at all times.
- Facilities must not establish and implement facility-wide no-CPR policies.
- Surveyor Implications - Surveyors should ascertain that facility policies related to emergency response require staff to initiate CPR as appropriate and that records do not reflect instances where CPR was not initiated by staff even though the resident requested CPR or had not formulated advance directives
Medical paternalism
involves physicians unwittingly making decisions for patients who are capable of making their own choices
can influence a patient’s healthcare decision simply by selectively telling the patient what he or she prefers based on personal beliefs
This directly violates patient autonomy
Employment-related paternalism
at it’s best - a shared and cooperative style of management in which the employer recognizes and considers employee rights when making decisions in the workplace
at it’s worst - occurs when the employer’s style of management becomes more authoritarian, sometimes arbitrary, and unpredictable
Are there laws that protect employees decisions related to employment paternalism?
Yes!
Under Title VII of the Civil Rights Act of 1964, the courts and the Equal Employment Opportunity Commission (EEOC) reject such paternalism, demanding that the applicant alone decide whether to pursue (and accept) a job that poses risks related to his or her sex, race, color, religion, or national origin.
Nonmaleficence
an ethical principle that requires caregivers to avoid causing patients harm
“first, do no harm.”
Physicians today still swear by the code of Hippocrates, pledging to do no harm.
Can telling the truth cause harm?
yes.
What is the Tuskegee Syphilis Experiment?
designed to analyze the natural progression of untreated syphilis in African American men
participants were not warned during the study that penicillin was available as the cure for syphilis
They believed that they were receiving adequate care and unknowingly suffered unnecessarily
Was the Tuskegee Syphilis Experiment morally or ethically right or wrong? Why?
Yes, to both. Nonmaleficence requires a person to do no harm. This study purposefully withheld information causing harm to the subjects.
Is letting a patient die the same as killing them?
No. Killing a patient is never justified, whereas letting a patient die by removing respirators (for example) can be right.
Justice
the obligation to be fair in the distribution of benefits and risks
demands that persons in similar circumstances be treated similarly
Justice involves how people are treated when their interests compete with one another
When is a person considered to be treated justly?
A person is treated justly when he or she receives what is due, is deserved, or can legitimately be claimed.
Distributive justice
a principle requiring that all persons be treated equally and fairly
What is a common issue with providing justice related to healthcare?
There are not enough funds to go around. This causes less funding for diseases that are less common.
Virtue ethics
focuses on the inherent character of a person rather than on the specific actions he or she performs
A virtue
is a positive trait of moral excellence.
are those characteristics that differentiate good people from bad people.
such as courage, honesty, and justice
What is a morally virtuous person?
one who does the good and right thing by habit, not merely based on a set of rules of conduct
Values
standards of conduct
used for judging the goodness or badness of some action
are rooted in customs and habits of a culture
the standards by which we measure the goodness in our lives.
moral value
the relative worth placed on some virtuous behavior
Intrinsic value
something that has value in and of itself (e.g., happiness)
Instrumental value
something that helps to give value to something else (e.g., money is valuable for what it can buy)
Can values change?
Yes. As needs change a persons values may change.
What are abstract virtues?
a persons principals.
Are virtues and values used interchangeably in healthcare?
yes.
Pillars of Moral Strength
describes a virtuous person
Courage
Wisdom
Temperance
Commitment
Compassion
Conscientiousness
Discernment
Fairness
Fidelity
Freedom
Honesty
Integrity
Kindness
Respect
Hopefulness
Tolerance
