EthicsEthics in in HealthCareHealthCareEthicsEthics in in HealthCareHealthCare

Treating Patients With DignityTreating Patients With Dignity

• Sometimes health professionals get so wrapped up in the scientific principles of healthcare that they forget they are dealing with human beings.

• Human beings that may be in pain, frightened or upset.

• Sometimes health professionals get so wrapped up in the scientific principles of healthcare that they forget they are dealing with human beings.

• Human beings that may be in pain, frightened or upset.

The Inequality of PowerThe Inequality of Power

• Healthcare professionals exercise a great Healthcare professionals exercise a great deal of power over patients. It is important deal of power over patients. It is important to make sure that this power is never to make sure that this power is never abused.abused.

• In an attempt to protect patients, many In an attempt to protect patients, many hospitals have implemented a patient’s bill hospitals have implemented a patient’s bill of rights.of rights.

• Healthcare professionals exercise a great Healthcare professionals exercise a great deal of power over patients. It is important deal of power over patients. It is important to make sure that this power is never to make sure that this power is never abused.abused.

• In an attempt to protect patients, many In an attempt to protect patients, many hospitals have implemented a patient’s bill hospitals have implemented a patient’s bill of rights.of rights.

Patients Bill of rights include:Patients Bill of rights include:

• The right to know the professional status of all people providing care

• To know the name of their attending doctor• To receive complete information on their diagnosis and

treatment• To be given the prognosis for their illness• To review all information in their medical record• To have every procedure, treatment or drug therapy

explained to them in language they understand

• The right to know the professional status of all people providing care

• To know the name of their attending doctor• To receive complete information on their diagnosis and

treatment• To be given the prognosis for their illness• To review all information in their medical record• To have every procedure, treatment or drug therapy

explained to them in language they understand

Bill of Rights Cont…Bill of Rights Cont…

• To know the possible risks, benefits, and costs of every procedure, treatment or drug therapy

• To accept or refuse treatment• To prepare in advance treatment directives and to expect that

these will be honored• To appoint a person to make decisions about their care, if

they become mentally disabled

• To know the possible risks, benefits, and costs of every procedure, treatment or drug therapy

• To accept or refuse treatment• To prepare in advance treatment directives and to expect that

these will be honored• To appoint a person to make decisions about their care, if

they become mentally disabled

Cont…Cont…

• To have personal privacy• To receive compassionate care and proper management of

pain• To seek a second opinion• To ask that the hospital ethics committee review their case

• To have personal privacy• To receive compassionate care and proper management of

pain• To seek a second opinion• To ask that the hospital ethics committee review their case

Ethics is:Ethics is:

• The study of ‘right’ and ‘wrong’

• A branch of human thought concerned with how human beings treat each other

• The study of ‘right’ and ‘wrong’

• A branch of human thought concerned with how human beings treat each other

Other DefinitionsOther Definitions

• Morals—personal standards of right and wrong

• Laws—rules that enforce behavior

*Just because something is legal does not necessarily mean it is moral.

• Morals—personal standards of right and wrong

• Laws—rules that enforce behavior

*Just because something is legal does not necessarily mean it is moral.

Relationship between Morals, Values and EthicsRelationship between Morals, Values and Ethics

Ethical Principlesof Analysis

Cultural & Religious Traditions

Social & EconomicSituations

Personal Value Judgments

MoralStandards

MoralDilemmas

Benefit to Some

Benefit to Some

Throughout history, philosophers have developed many models to guide people in ethical decision making.

Throughout history, philosophers have developed many models to guide people in ethical decision making.

HippocratesPlato Socrates

Some of these Models for Ethical Decision Making are Fairly ComplexSome of these Models for Ethical Decision Making are Fairly Complex

• Theoretical perspective

• Relativism• Utilitarian• Subjectivism• Egoism• Golden Rule

• Theoretical perspective

• Relativism• Utilitarian• Subjectivism• Egoism• Golden Rule

• Universal Rule• Economic efficiency• Government

requirement• Personal values• Distributive Justice• Stakeholder

• Universal Rule• Economic efficiency• Government

requirement• Personal values• Distributive Justice• Stakeholder

Two schools of ethical thoughtTwo schools of ethical thought

• Deontological School

• Teleological School

• Deontological School

• Teleological School

Deontological SchoolDeontological School

• The Greek word ‘Deon’ means ‘duty.’• This school studies moral obligations.• Followers believe in the existence of

good and evil and believe that people have an obligation to do good for other people.

• The Greek word ‘Deon’ means ‘duty.’• This school studies moral obligations.• Followers believe in the existence of

good and evil and believe that people have an obligation to do good for other people.

Teleological SchoolTeleological School

• The Greek word ‘Telos’ means ‘end.’• The branch of ethics dealing with right action and

the nature of duty, without regard to the goodness or value of motives or the desirability of the ends of any act.

• In other words: This school believes that the end is all that matters, that “the end justifies the means.”

• The Greek word ‘Telos’ means ‘end.’• The branch of ethics dealing with right action and

the nature of duty, without regard to the goodness or value of motives or the desirability of the ends of any act.

• In other words: This school believes that the end is all that matters, that “the end justifies the means.”

Bioethics . . .Bioethics . . .

• Came into existence as a discipline in about 1970.

– During this period science shifted from focusing solely on science and treatment to focusing on the patient as a human being.

• Came into existence as a discipline in about 1970.

– During this period science shifted from focusing solely on science and treatment to focusing on the patient as a human being.

What caused bioethics to become so important?What caused bioethics to become so important?• New technologies that necessitated a

new definition of the term “death”• Revelations of abuses in the use of

human subjects in medical research

• New technologies that necessitated a new definition of the term “death”

• Revelations of abuses in the use of human subjects in medical research

• Euthanasia

• Abortion

• In vitro fertilization

• Organ transplants

• Genetic engineering

• Euthanasia

• Abortion

• In vitro fertilization

• Organ transplants

• Genetic engineering

What caused bioethics to become so important?

• Increasing healthcare costs necessitating a rethinking of the allocation of healthcare resources

• Increasing healthcare costs necessitating a rethinking of the allocation of healthcare resources

What caused bioethics to become so important?

How does all of this apply to me?How does all of this apply to me?

• Many students upon graduating are surprised to find that there is a great deal of ambiguity in the real world.

• SometimesSometimes there are no clear cut answers.

• Many students upon graduating are surprised to find that there is a great deal of ambiguity in the real world.

• SometimesSometimes there are no clear cut answers.

How does all of this apply to me?How does all of this apply to me?

• Healthcare personnel often find their decisions clouded by dilemmas, paradoxes (A seemingly contradictory statement that may nonetheless be true), inconsistencies, and with differing expectations.

• Healthcare personnel often find their decisions clouded by dilemmas, paradoxes (A seemingly contradictory statement that may nonetheless be true), inconsistencies, and with differing expectations.

Applying the Model to Case StudiesApplying the Model to Case Studies

Case StudiesCase Studies

• One way to teach health ethics is through case studies.

• Case studies allow the discussion of real-world situations absent the stress and politics that unjustifiably influence ethical decisions.

• One way to teach health ethics is through case studies.

• Case studies allow the discussion of real-world situations absent the stress and politics that unjustifiably influence ethical decisions.

FrameworkFramework

• Since many ethical problems involve ambiguity (uncertainty as regarding to interpretation), it is good to have a framework to provide structure in analyzing these situations.

• Since many ethical problems involve ambiguity (uncertainty as regarding to interpretation), it is good to have a framework to provide structure in analyzing these situations.

The model in Healthcare is based on the following principles:The model in Healthcare is based on the following principles:

• Free agency• Equality• Kindness• Obligation to do good for others• Obligation to do no harm• Honesty• Legality

• Free agency• Equality• Kindness• Obligation to do good for others• Obligation to do no harm• Honesty• Legality

Free AgencyFree Agency

• A patient has the right to make decisions about his or her own body without outside control.

• A patient has the right to make decisions about his or her own body without outside control.

EqualityEquality

• The healthcare system has an obligation to treat all patients fairly.

• The healthcare system has an obligation to treat all patients fairly.

KindnessKindness

• A patient has a right to expect that a healthcare worker will be merciful, kind and charitable.

• A patient has a right to expect that a healthcare worker will be merciful, kind and charitable.

Obligation to do Good for OthersObligation to do Good for Others

• Healthcare workers are obligated to take the action that will result in the best outcome for the patient.

• Healthcare workers are obligated to take the action that will result in the best outcome for the patient.

Obligation to do no HarmObligation to do no Harm

• The first obligation of the healthcare practitioner is to avoid injury to his or her patient.

• The first obligation of the healthcare practitioner is to avoid injury to his or her patient.

HonestyHonesty

• A healthcare worker should be honest.• A healthcare worker should be honest.

In-class AssignmentIn-class Assignment

• Break into groups of four to five students.

• Read the Nightingale Pledge and the Hippocratic Oath

• Analyze their meaning

• Break into groups of four to five students.

• Read the Nightingale Pledge and the Hippocratic Oath

• Analyze their meaning

The End!The End!The End!The End!