Week 9: Ethical foundations Flashcards
Morals/morality
A sense of right and wrong
Related to your values, duty and character
Ethics
A systematic study of and reflection on morality
A system of moral beliefs that deal with the concepts of right and wrong
Personal morality
The values and principles individuals personally live by and believe to be morally right and sound
Group morality
The values that are adopted as part of a self-selected subgroup
Societal morality
What our society approves of being right and acceptable
What influences our personal ethics and morals?
Personal/spiritual/religious beliefs
Authority figures
Family
Culture
Social norms
Personal experiences
Teleological theory
Focus is on the effect, the consequences or the end result
Minimizing adverse consequences will bring about the greatest good
Teleological theory quote
“The end justifies the means”
Deontological theory
Focus is on the rules without particular concern for the consequences
Forms the basis for religious commandments and edicts, professional codes of conduct and societal laws
Deontological theory quote
“Don’t lie. Don’t steal. Don’t Cheat”
Biomedical ethics
A field of study and professional practice interested in ethical issues related to health
*field continues to grow with advances in medical technology
Why are health care ethics unique?
- Patients are injured and are in pain and are therefore more vulnerable to exploitation
- Delivery of health care to patients is often necessary on an emergency basis
- Consequences of bas decisions have the potential to be life altering or result in dire consequences
Ethical principles
- Autonomy
- Beneficence
- Non-maleficence
- Justice
- Fidelity
- Veracity
Autonomy
Self determination that is free from controlling interferences by others and personal limitations preventing meaningful choice
To have self governance or to function independently
Beneficence
Patient care is in the best interest of the patient
“do only good”
Non-maleficence
“doing no harm”
Providing care without doing harm by omission or commission
Justice
Fairness
Two types of justice
- Distributive
- Comparative
Distributive justice
- How equitably are health care services distributed at the societal level?
- Are resources equally available?
- Are certain diseases more likely to get attention?
- Is there an unequal distribution of resources at end or beginning of life?
Comparative justice
Distribution of health care services at the level of the individual
Issues with comparative justice
- Reimbursement and denial of care involving individual patients
- Disparate treatment of patients based on age, disability, gender, race, ethnicity or religion
Fidelity
Maintaining your commitments to your patients, your profession, your employer etc.
Veracity
Duty to be truthful and honest
CKO’s Principles of ethical conduct
REACH
R- respect
E- excellence
A- autonomy and well-being
C- communication, collaboration and advocacy
H- honesty and integrity
Respect
Members are respectful of the differing needs of each individual and honour the patient’s right to privacy, confidentiality, dignity and treatment without discrimination
Excellence
Members are committed to excellence in professional practice through continued development of knowledge, skills, judgement and attitudes
Autonomy and well-being
Members are at all times guided by a concern for the patient’s well-being; patients have the right to self-determination and are empowered to participate in decisions about their health-related quality of life and physical functioning
Communication, collaboration and advocacy
Members value contribution of all individuals involved in the care of the patient
Honesty and integrity
Each member’s commitment to act with honesty and integrity is fundamental to the delivery of high-quality, safe and professional services
RIPS model
The realm-individual process-situation model of ethical decision-making
Three components of RIPS
- Realm
- Individual process
- Situation
Three realms of RIPS
- Individual
- Organizational/institutional
- Societal
Individual realm of RIPS
Concerned with the good of the patient/client and focuses on rights, duties, relationships, and behaviours between individuals
**deals with the least complex problems
Organizational/institutional realm of RIPS
Concerned with the good of the organization and focuses on structures and systems that will facilitate organizational or institutional goals
Societal realm of RIPS
Concerned with the common
good
**most complex realm
Four components of moral behaviour (individual process)
- Moral sensitivity
- Moral judgement
- Moral motivation
- Moral courage
Moral sensitivity
Involves recognizing, interpreting, and framing ethical situations.
Moral judgement
Requires deciding on right versus wrong actions; involves generating options, selecting, and applying ethical principles.
Moral motivation
Places a priority on ethical values over other values, such as self-interest, status, or financial gain. Professionalism is a primary “motivator” for ethical behavior
Moral courage
Involves implementing the chosen ethical action, including the development of a plan and perseverance in the face of barriers and adversity.
Types of ethical situations
- Issue/problem
- Dilemma
- Distress
- Temptation
- Silence
Issue/problem
Important values are present or may be challenged
Dilemma
Two alternative courses of action may be taken, both of which fulfill an important duty, and it is not possible to fulfill both obligations “right versus right” decision
Distress
You know the right course of action but are not authorized or empowered to perform it; may present as a later “complication” of any of the ethical situation
Often identified during the implementation phase of decision-making
Tempation
Involves a choice between a “right” and a “wrong,” and in which you may stand to benefit from doing the wrong thing
“right versus wrong” situation.
Silence
Ethical values are challenged, but no one is speaking about this challenge to values. This may actually be the course taken by an individual who is experiencing moral distress.
Steps to implementing the RIPS model for ethical decision making
- Recognize and define ethical issues
- Reflect
- Decide the right thing to do
- implement, evaluate and re-assess
Step 1- recognize and define ethical issues
Define the issues by…
1. Analyzing the realm
2. Individual process (moral behaviour)
3. Classify the ethical situation
Step 2: Reflect
Who are interested parties?
What are relevant laws, regulations, professional standards and code of ethics?
What are the possible consequences?
Are any of the right vs wrong tests positive?
Five tests for right versus wrong situations
- Legal test
- Stench test
- Front-page test
- Mom test
- Professional Ethics Test
Legal test
Is something illegal?
Stench test
Does it feel wrong?
Front-page test
How would you like this on the front-page of your local news paper?
Mom test
If I were my mother, would I do this?
Professional ethics test
Does the code of ethics prohibit or discourage the action?
What does it mean if any of the five tests are positive?
The situation may be an issue of right versus wrong (moral temptation) and not an ethical dilemma
Therefore can skip step 3 and go right to step 4
Step 3: Decide the right thing to do
Decide which approach to ethical dilemmas you will be taking
Three basic approaches to solving ethical dilemmas
- Rule-based
- Ends-based
- Care-based
Rule based approach
Follow the rules, duties, obligations, or ethical principles already in place
Ends based approach
Determine the consequences or outcomes of alternative actions and the good or harm that will result for all of the stakeholders
Care based approach
Resolve dilemmas according to relationships and concern for others
Step 4: Implement, evaluate and re-assess
- Implement your plan
- Personal reflection and professional growth
Main word to describe autonomy
Self-governance
Main word to describe beneficence
Do only good
Main word to describe non-maleficence
Do no harm
Main word to describe justice
Fairness
Main word to describe fidelity
Faithfulness
Main word to describe veracity
Truthfulness
CKO’s steps to ethical decision making
- Recognizing that there is an ethical issue
- Identify the problem and who is involved
- Consider the relevant facts, laws, principles and values
- Establish and analyze potential options
- Choose a course of action and implement it
- Evaluate outcome and determine if further action is needed
Which ethical situation does moral courage apply to?
Ethical temptation (ex. gift of wine)
Which ethical situation does moral judgement apply to?
Ethical dilemma
How to think about the individual process- what does the ethical situation require most of me?
- to recognize the ethical situation? (moral sensitivity)
- to make a decision about right or wrong? (moral judgement)
- to put moral values above other values? (moral motivation)
- whether to implement my decision or take action at all? (moral courage)
What is step 3 of the RIPS model approach specifically for?
Ethical dilemmas and issues/problems to a lesser extent
*possible exception: situation where you are convinced that a law is unjust
Moral courage
Acting on ethical decisions despite potential risks or barriers
