Ethics Week 1 Dr Aruoma Lecture

Okezie I ARUOMA MSc PhD DSc CSci CChem FRSC MBA

School of Pharmacy and Biomedical SciencesAmerican University of Health Sciences

1600 East Hill StreetSignal Hill

California, USA

E-mail: [email protected]

mailto:[email protected]

ETHICS(Phil 304)

One should not feel guilty for the choices that are made on a daily basis, instead be aware of how

filled with ethical issues in life

Let us first understand how the way the courseis going to be assessed

Week Lecture Topics Reading and Assignments Week 1 March 30th 2012 8.00 -12.00

Introductions. What is Ethics? Why do ethics? What is an ethical argument? Healthcare ethical and legal issues Dr Aruoma

MacKinnon, Chapter 1 and Chapter 2 Pozgar Chapter 1 and 10 Student group and paper assignment

Week 2 April 6

No Class Good Friday

Self-directed study

Week 3 April 13th 8.00-12.00

Virtue ethics, economic, Heathcare professionals’ ethical and legal issues Dr Chong

MacKinnon, Chapter 8 Pozgar Chapter 9 Quiz 1

Week 4 April 20th 8.00-12.00

Egoism and Utilitarianism, Employee rights and responsibilities Dr Aruoma

MacKinnon, Chapter 3 and Chapter 4 Pozgar Chapter 11 Quiz 2

Week 5 April 27th 8.00-12.00

Moral theory, End of life dilemmas Dr Aruoma

MacKinnon, Chapter 5 and Chapter 10 Pozgar Chapter 3 Mid-term Exam

Week 6 May 4th 8.00-12.00

Natural Law and natural rights, Governments, ethics and the law Dr Aruoma

MacKinnon, Chapter 7, 14 and 15 Pozgar Chapter 7,

Week 7 May 11th 8.00-12.00

Equality and discrimination, global issues and globalization Dr Aruoma

Mackinnon, Chapter 13, Chapter 20 Quiz 3

Week 8 May 18th 8.00-12.00

Stem cell research, cloning and genetic engineering, Healthcare ethics committees Dr Aruoma

Mackinnon, Chapter 18 Pozgar Chapter 4 Quiz 4

Week 9 May 25th 8.00-12.00

Patients consent, abuse, rights and responsibilities Dr Chong

Pozgar Chapter, 12, 13 and 14, Pozgar Chapter 9 pp 310, 317, 324, 333, 347

Week 10 June 1st 8.00-12.00

Group Presentations on thematic ethical issues through the course Dr Aruoma

Final paper submission and presentations

Week 11 June 8th 10.00-12.00

Final exam Final Exam

1. Essay/Quizzes receiving 10% of the course grade

2. Mid-term Examination 20% of the course grade

3. Final Examination receiving 25% of the course grade

4. Group Presentation receiving 15% of the course grade

5. Group Paper receiving 20% of the course grade

6. Class participation receiving 10% of the course grade

STUDENT GROUP 1Hesselink, B.A.M., Onwuteaka-Philipsen, B.D., Janssen, A.J.G.M., Buiting, H.M., Kollau, M., Rietjens, J.A.C., Pasman, H.R.M., 2012. Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis. Journal of Medical Ethic: 38: 35-42.

STUDENT GROUP 2De Grazia, D., 2012. Genetic enhancement, post-persons and moral status: a reply to Buchanan. Journal of Medical Ethics 38: 135-139.

STUDENT GROUPS

GROUP 1:ALAS Ann MichelleBAGAYGAY Roland JamesCABANILLA AveelynHOANG Michelle PhanLIN Chien-HuiHSIAO Tiffany

GROUP 2:ALGADO Marc ABATCHILLY FatouGANDHI Chintan AKIM Samantha PhanangONG Elora Liane YCANAPI Kimberly LLUU Phillip

STUDENT GROUP 3Labonte, R., Schrecker, T., 2007. Globalization and social determinants of health, Globalization and Health 3: 1-10

STUDENT GROUP 4VandeWoude, S., Rollin B.E., 2010. Practical considerations in regenerative medicine research: IACUCs, Ethics and the use of animals in stem cell research studies. Institute for Laboratory Animal Research Journal 51: 82-84

STUDENT GROUPS

GROUP 3ALVAREZ PaulinaCASTELLANOS YeseniaGELUA Karen CateLAM Xuyen TMOHD YusofSREEKUMAR NAIR Swathy

GROUP 4BANGAL Audrey Rose RGARDNER CaitlinLU KelleyNguyen NHu (Jaemee)TANG EngHOANG Nhan

STUDENT GROUP 5Saunders, B., 2012. Opt-out organ donation without presumptions. Journal of Medical Ethics, 38: 69-72.

STUDENT GROUP 6Birchley, G., 2012. A clear case for conscience in healthcare practice, Journal of medical Ethics, 38: 13-17

STUDENT GROUPS

GROUP 5BUI Michael MinhHUA Xuan MLUU DianaPATEL Trishila RTUDOR Stacey CROSS Judy

GROUP 6BAUTISTA Sheree TMENDEZ MariaNGUYEN Minh YenOLIVEROS MarcoPHU Ann HBROOKS Serrono

STUDENT GROUP 7Magelsen, M., 2012. When should conscientious objection be accepted? Journal of Medical Ethics, 38: 18-21.

STUDENT GROUP 8Johnson, J., Rogers, W., 2012. Innovative surgery: the ethical challenges. Journal of Medical Ethics, 38: 9-12.

STUDENT GROUPS

GROUP 7PATEL NitalPETROVIC NicoleRIVAS MildredSITANGGAN Pongkarn TopTRUONG DannyLAPUZ Ephraim

GROUP 8TANTIONGCO RhealynTRUONG KimTYRELL MoniqueYANG JacquelineZhao NaTHAI JasonKHANH Mai

GROUP PRESENTATIONS OF THE PROJECTS (15 Marks)Each group will have 30 minutes to make a presentation and this will be followed by 5 minutes of questions from the rest of the class. Everyone enrolled for this course must attend. An absent will lose the entire 15 Marks

STUDENT GROUPS PRESENTATIONS

Course Paper (GROUP PROJECTS) (20 Marks)The projects are as assigned below. The report must adopt the in-house style exactly as in the sample paper provided (Journal of Medical Ethics in-house style). The report should be a maximum of 10 page including Figures, Tables and Schemes. The text should be done with a 12pt font size with single spacing. Not following the guideline (from the title page through to the listing of references) will result in an automatic deduction of 10 Marks. You are required to submit 1 hard copy of the group report and an electronic file (word document) to Dr Aruoma on or before class on Friday June 1, 2012. Late submission will incur a 10 Marks deduction. No exceptions.

STUDENT GROUP PROJECTS

Exam (Mid term and final combined): 45%

Student Class effort: 55%

So absolutely no excuse for not passing the class and more importantly for not getting an A grade

How does it add up

WEEK 1

INTRODUCTION

What is ethics? Why do ethic? What is an ethical argument

Healthcare ethical and legal issues

MacKinnon Chapter 1 and Chapter 2Pozgar Chapter 1 and Chapter 10

Learning Objectives

• Explain what ethics is, its importance, & application to ethical dilemmas

• Describe the concepts of morality, codes of conduct, & moral judgments

• Understand relevant ethical theories & principles• Describe virtue ethics & values & how they describe moral

character• Explain why courage is often considered to be the “ladder

upon which all other virtues mount”• Describe why there is a declining trust in the politics of

healthcare

© 2009 Jones & Bartlett Publishers, LLC


Learning Objectives, con’t

• Understand how religious ethics can affect one’s moral character

• Explain the concept of “situational ethics” & how changes in circumstances can affect one’s behavior

• Describe the concepts of “ethical relativism” & one’s “moral compass”

Do what is right, legally and morally. Be willing to do what is right even when no one is looking. It is our "moral compass" an inner voice

Morality (from the Latin moralitas "manner, character, proper behavior") is the differentiation of intentions, decisions, and actions between those that are good (or right) and those that are bad (or wrong). A moral code is a system of morality (for example, according to a particular philosophy, religion, culture, etc.) and a moral is any one practice or teaching within a moral code. The adjective moral is synonymous with "good" or "right." Immorality is the active opposition to morality (i.e. good or right), while amorality is variously defined as an unawareness of, indifference toward, or disbelief in any set of moral standards or principles (wikipedia definition)

http://en.wikipedia.org/wiki/Latin

http://en.wikipedia.org/wiki/Social_actions

http://en.wikipedia.org/wiki/Philosophy

http://en.wikipedia.org/wiki/Religion

http://en.wikipedia.org/wiki/Culture

http://en.wikipedia.org/wiki/Adjective

Learning Objectives

• Describe the principles of medical ethics.• Explain the hospital’s duty to ensure the competency of

physicians.• Understand how ethics & the law impact physicians/nurses.• Identify the variety of patient care issues that physicians and

nurses face daily.• Describe how practicing one’s professional code of ethics can

assist in resolving the day-to-day issues that arise during the care of patients.

• Explain the importance of understanding the physician-patient relationship. Also nurse –patient relationship


Ethics and Ethical Reasoning Why Study Ethics?

There are differing views of moral rights and wrongs Matters are not always easy to judge

What is Ethics?

The set of values or principles held by individuals or groups

A study of the various sets of values that people do have

Ethics is a branch of philosophy; moral philosophy

Normative Ethics Metaethics Philosophical questions can be asked about many

subjectsEthics and Religion

Ethics and ReasoningEthics and Religion

Ethics and religious grounding Religion as a motivation for morality

Ethical and Other Types of EvaluationDescriptive judgments Normative judgmentsDifferences between the two

Ethical TermsRight/Wrong Good/BadOught/Ought not

Ethics and Ethical ReasoningEthics and Reasons

Rational or EmotionalInituitionism or emotive

Ethical Reasoning and Arguments ReasonsConclusions Premises

Evaluating and Making Good Arguments Soundness Value assumptions Conceptual mattersFactual assertions

So we study ethics to aid us in making:• Sound judgments• Good decisions• Right choices (and if not right better ones)

See page 3 - 6 of Pozgar and note examples given

Health care industry: Recognizing health care dilemmasand making good judgments and decisions based on universal values that work in hand with the laws and the Constitution

-when the law remain silent, rely on the ability of the caregiver to make the right judgment as guided by one’s wisdom

Ethical Reasoning

By Dr. Richard Paul and Dr. Linda Elder

Based on Critical Thinking Concepts & Principles

The Miniature Guide

to

Understanding the Foundations of

The Foundation for Critical Thinking

© 2005 Foundation for Critical Thinking www.criticalthinking.org

The world does not present itself to us in morally transparent terms. We live in a world in which propaganda and self-deception are rife. Public discussion and media communication are not neutral centers of open debate. A tremendous amount of money is spent on persuading people to see the events of the world in one way rather than another. Furthermore, depending on the society and culture in which we are raised, we ourselves are strongly pre-disposed to see some persons and nations on the side of good and other persons and nations on the side of evil.

Humans typi-cally take themselves to be on the side of good and their enemies on the side of evil.

“We must rid the world of evil.”

“Now is the time to draw a line in the sand against the evil ones.” “Across the world and across the years, we will fight the evil ones, and we will win.”

“You are either for us or against us.” President George Bush, 2002

In the everyday world, the ethical thing to do is sometimes viewed as obvious and self-evident when it should be a matter of debate, or, conversely, viewed as a matter of debate when it should be obvious and self-evident. One and the same act is often ethically praised by particular social, religious or political groups and ethically con-demned by others.

Through example and encouragement, we can cultivate important intellectual traits. We can learn to respect the rights of others and not simply focus on fulfilling our desires. The main problem is not so much distinguishing between helping and harm-ing, but our natural propensity to be focused almost exclusively on ourselves and those closely connected with us.

This is clear in the behavior of national, religious, and ethnic groups. Few groups, in fact, value the lives and welfare of others (other nations, other religions, other ethnic groups) as they value those of their own. Few think about the consequences to other groups of their own group’s pursuit of money, power, prestige, and property. The result is that few people (in virtually any society) act consistently on ethical principles when dealing with “outsiders.” A double standard in applying ethical principles to human life is virtually universal and often flagrant.

In short, ethical persons, however strongly motivated to do what is ethically right, can do so only if they know what is ethically right. And this they cannot do if they systematically confuse their sense of what is ethically right with self-interest, personal desires, or social taboos. Ethically motivated persons must learn the art of self- and social-critique, of ethical self-examination. They must recognize the pervasive everyday pitfalls of ethical judgment: moral intolerance, self-deception, and uncritical conformity.

Few have thought much about the difficulty of getting ethically relevant facts about the world. Few are skilled in tracing the implications of the facts they do have. And few can identify their own moral contradictions, or clearly distinguish their self-interest and egocentric desires from what is genuinely ethical. Few have thought deeply about their own ethical feelings and judgments, have tied these judgments together into a coherent ethical perspective, or have mastered the complexities of moral reasoning. As a result, everyday ethical judgments are often a subtle mixture of pseudo and genuine morality, ethical insight and moral prejudice, ethical truth and moral hypocrisy.

4 Miniature Guide to Ethical Reasoning


Egocentrism as a Fundamental Barrier to Ethical Reasoning The human tendency to judge the world from a narrow, self-serving perspective is powerful. Humans are typically masterful at self-deception and rationalization. We often maintain beliefs that fly in the face of the evidence. We often engage in acts that blatantly violate ethical principles. What is more, we feel perfectly confident in our righteousness.

In other words, humans naturally develop into narrow-minded, self-centered thinkers. In a way, this makes perfect sense. We feel our own pain; we don’t feel the pain of others. We think our own thoughts; we do not think the thoughts of others. And as we age, we unfortunately do not naturally develop the ability to empathize with others, to consider points of view that conflict with our own. Consequently, we are often unable to reason from a genuinely ethical perspective.

Nevertheless, it is possible to learn to think critically through ethical issues. With practice and sound instruction, we can acquire the disposition and skills required to analyze and evaluate situations from opposing ethical perspectives.

At the root of virtually every unethical act lies some form and degree of self-delu-sion. And at the root of every self-delusion lies some flaw in thinking. For instance, Hitler confidently believed he was doing the right thing in carrying out egregious acts against the Jews. His actions were a product of the erroneous beliefs that Jews were inferior to the Aryan race, and that they were the cause of Germany’s prob-lems. In ridding Germany of the Jews, he believed himself to be doing what was in the best interest of his Germany. He therefore considered his actions to be ethically justified. His deeply flawed reasoning resulted in untold human harm and suffering.

We cannot develop as ethical persons if we are unwilling to face the fact that every one of us is prone to egotism, prejudice, self-justification, and self-deception and that these flaws in human thinking are the cause of much human suffering. Only the systematic cultivation of fair-mindedness, honesty, integrity, self-knowledge, and deep concern for the welfare of others can provide foundations for sound ethical reasoning.

Ethical reasoning entails doing what is right even in the face of powerful selfish desires. To live an ethical life, then, is to develop command over our native egocen-tric tendencies. It is not enough to advocate living an ethical life. It is not enough to be able to do the right thing when we ourselves have nothing to lose. We must be willing to fulfill our ethical obligations at the expense of our selfish desires and vested interests.

Strives to gain its selfish interests

EGOCENTRIC THINKING

Strives to validate its current way of thinking

Considers the rights and needs of others

RATIONAL THINKING

Strives to see things as they are

6

Miniature Guide to Ethical Reasoning


Three Modes of Character Integration (Expressed in exclusive categories for purpose of theoretical clarity.

In fact, these are matters of degree).

The Uncritical Person

The Self-Serving Critical Person

The Fair-Minded Critical Person

unconcerned with the

development of intellectual abilities

develops intellectual abilities to serve one's selfish interests without

regard to the rights and needs of others

develops intellectual abilities to serve one's

interests while respecting the rights and needs of others

manipulated by self-serving critical persons and easily

indoctrinated

resulting in the person being victimized or

blindly led into victimizing others

manipulates less sophisticated people

resulting in those people being harmed (directly or indirectly)

acts as forthrightly as possible

resulting in people being treated

reasonably and fairly

unethical self-righteous,

and self-deceived

ethical, empathic and just

good-hearted but self-deceived

Miniature Guide to Ethical Reasoning 13


We Must Learn to Distinguish Among Questions of Ethics, Social Conventions, Religion and the Law

If we are ever to reach a point in human development where skilled ethical reasoning is the norm, each of us must cultivate in ourselves the ability to determine whether any belief system, practice, rule, or law is ethical. To be skilled at ethical reasoning means to develop a con-science not subservient to fluctuating social conventions, theological systems, or unethical laws. Consistently sound reasoning in any domain of thought presupposes practice in reasoning through cases and issues in that domain. As we face problems in our lives, we must dis-tinguish the ethical from the non-ethical and the pseudo-ethical, and apply appropriate ethical principles to those problems that are genuine-ly ethical problems. The more often we do so, the better we become at ethical reasoning.

deal with the nature of spirituality (and are therefore subject to unlimited theological debate)

deal with the customs,

traditions, and taboos of groups

(which vary enormously

from group to group)

deal with what has

been codified into

law in particular societies

(and which may or may not have an ethical basis)

deal with helpful or harmful behavior

toward people or other creatures (ethical

principles converge

across cultures and groups)

Religious

Social

Legal

Ethical Questions

Questions

Questions

Questions (divergent)

(divergent)

(divergent)

(convergent)

Four Ethical Groupings (this is

important to remember)

• Universal Ethics – helpful or harmful behavior towards living creatures

• Social Ethics – customs & taboos• Religious Ethics – theological debate• Legal Ethics – codified laws developed from social

customs

Do the right thing by applying the universal morals and values

OneWorldInsight.com

Pseudo-Ethic Groups

Universal Ethics

Social Rules

Religious Beliefs

The Law

Ethics• The connection of Ethical Theory, Ethical Principles,

and Ethical Judgments• Can Ethics Be Taught?

A matter of knowledge A matter of motivation

Aims of Ethics Education in

• Teach pertinent laws and rules• Sensitive students to ethical issues• Give students tools necessary to think through

ethical issues: vocabulary and techniques• Enable students to take part in ethical

discussions about policy

Ethical reasoning is important both now as a student and as a future professional in your career

Ethics• Plato’s Euthyphro

• The First Definition of Piety

• The Second Definition of PietyLet us go through the handout and discuss

• Is the pious holy because it is loved by the gods or is it loved by the gods because it is holy?

Ethics• Stevenson - The Emotive Meaning of Ethical Terms

• How can ethical questions be made clear? - The question of relevance - The question of goodness• The Traditional Interest theories - Ethical terms are instruments - Emotive meaning and the dynamic use of words


Ethics

Good can triumph over evil.

Author Unknown

Words are “Tools of Thought”

Good vs. Evil: Example

In Disney’s The Lion King, Simba represents good while Scar exemplifies evil. Most cartoons will depict a good vs. evil archetype.

The Fall: Example

In the Christian faith, Adam and

Eve were the first two human

creations of God. By choosing to

eat the forbidden fruit, the two

lost their innocence and fell out of favor

with God.

Examples of Choices From the Fairy Tale Snow White

• The Queen is evil and powerful but her power is temporary.

• Snow White is good and sweet.• Snow White usurps the Queen’s power.• Snow White becomes the hero of the story.• Children identify with the hero.

Good and Evil in Cinderella

• The Wicked Step-Mother and Step-Sisters are powerful in the beginning of the story.

• Cinderella’s goodness of character is demonstrated throughout the story.

• Cinderella becomes the powerful hero in the end.• Children identify with the hero of the story.

Fairy Tales present the polarities of character, such as good and evil, and this allows the child to comprehend easily the differences between the two.

Examples From Fairy Tales

• Snow White, Cinderella, and Mufaro’s Beautiful Daughters show how characters overcome isolation and loneliness.

• Each character succeeds and becomes an example to the reader that goodness can triumph over evil.

The next slide puts his into context

Aligning Fairy Tales with State Standards

• Fairy Tales help students understand plot, setting, and character.

• Fairy Tales help students understand beginning, middle and ending in stories.

• Fairy Tales can be used to develop critical thinking skills.

Words are “Tools of Thought”

• As with the principles of learning a new language or the study any new subject:• New vocabulary & an understanding of abstract theories &

principles of ethics will be necessary.• Such knowledge will arm the decision-maker with the

information necessary to help make difficult care decisions.

So we can recall What is Ethics?

• A moral philosophy that helps us to distinguish right from wrong, good from bad.

• It involves the study of morality, virtues, & values & how they affect one’s character.

• It involves how individuals decide to live within accepted boundaries & how we live in harmony with one another & nature.



Scope of Ethics

• Micro-ethics: individual’s view of right & wrong.

• Macro-ethics: global view of right & wrong.


Ethics from Various Perspectives

• Ethics used in different but related ways

• philosophical ethics, which involves inquiry about ways of life & rules of conduct

• a way of life (e.g., religious ethics)• moral codes


Why Study Ethics?

• To recognize health care dilemmas.• To provide tools for constructive deliberation & conflict

resolution.• To make sound judgments.• To better understand the goodness & badness of motives &

ends.


Morality

Aim above Morality. Be not simply good; be good for something.

−Henry David Thoreau


What is Morality? (see page 5 of Pozgar)

• A code of conduct.• Implies quality of being in accord with standards of right

& good conduct.• Describes class of rules held by society to govern the

conduct of its individual members.


Morals

• Ideas about what is right & wrong.• Guides to behavior that rational persons put forward for

governing their behavior. –describing a class of rules held by society to govern the conduct of its individual members

• Note: what rule that are considered right varies from nation to nation, culture to culture, religion to religion and from one person to another

• Also note that morals should not be confused with cultural habits or customs such as wearing a certain type of clothing

Fundamental Questions About Moral Relativism

If, as it appears, most of us belong to a number of competing “cultures,” then the claim that cultures are so isolated that we cannot understand and make judgments about another culture is false.

In fact, it is common for us to make judgments among several cultural influences, and to decide which moral principles we prefer.

Questions About Moral Relativism: Why Should Moral Values Hold such Special Place (A Sacred Cow)

When cultures hold differing scientific views, e.g., the world is flat/the world is round, we do not hesitate to say one culture is wrong.

If some culture holds, contrary to the values of almost all cultures, that enslaving a particular ethnic group or killing all Jews is morally good, isn’t it just as logical to say that culture holds false moral principles?

Ethical Relativism to expand on previous two slides

• What is Ethical Relativism? - No objective right or wrong - Compared to objectivism• Two Forms of Ethical Relativism

• Individual Ethical Relativism• Cultural Ethical Relativism

Ethical Relativism • Are These Reasons Convincing?

• The Diversity of Moral Views • How widespread and deep is the disagreement? • What does such disagreement prove?

• Moral Uncertainty – the complexity and difficulty - The view of skepticism - The form of subjectivism

Ethical Relativism • Moral Realism

• Realism – the view of the relation between science and nature

• Are moral properties supervenient?

• Moral Pluralism • Is there one good moral principle or a variety of equally

moral principles?

Ethical Relativism• Reading: Trying Out One’s New Sword

• Moral isolationism in practice• The symbolism of the Samurai sword• The liability of the isolating barriers between cultures• The effect of moral isolationism on moral reasoning

Ethical Relativism • Reading: Master and Slave Moralities

• Master moralities

- Description of “good” and “bad”

- The noble type of person feels himself as a determining value

• Slave moralities

- Description of “good” and “evil”

- The longing for freedom


Codes of Ethics Provide for

• Standards – as guides to human conduct.

• Principles – describe responsibilities.

• Rules of expected conduct – no allowance for individual judgment.


Moral Judgments• Judgments concerned with what an individual or group

believes to be right or proper behavior in a given situation.

• Involves assessment of another person’s moral character based on how he or she conforms to moral convictions established by the individual &/or group.


Moral Judgments, con’t• Lack of conformity typically results in:

• moral censure• condemnation• possibly derision of the violator’s character

• What is considered right varies from nation to nation, culture to culture, religion to religion, person to person . . . .


Moral Judgments, con’t

• No “universal morality.”

• Whatever guide to behavior an individual regards as overriding & wants to be universally adopted is considered that individual's morality.


Moral Dilemmas

• Moral dilemmas arise when values, rights, duties, & loyalties conflict.

• A caregiver must not only examine what he or she considers the right thing to do, but what are the alternatives, & what are the patient’s known wishes.


Morality Legislated

• Law is distinguished from morality in that

• the law has explicit rules, penalties, & officials who interpret the laws & apply the penalties.

• Laws are created to set boundaries for societal behaviour.

• laws are enforced to ensure that expected behavior happens.


EthicsEthics, too, are nothing but reverence for life. This is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil.

-Albert Schweitzer


Theories of Ethics

• Ethical theories attempt to introduce order into the way people think about life & action.

Normative Ethics • Attempt to determine what moral standards should be

followed so that human behavior & conduct may be morally right.

• General normative ethics is

• the study of major moral precepts of what things are right …


Consequential Ethics

• The morally right action involves• maximum balance of good over evil

• The rightness or wrongness of an action is based on the consequences or effects of the action.



Utilitarianism

• A form of consequentialism

• philosophy that advocates the greatest good for the greatest number

• everyone is obligated to do whatever will achieve the greatest good for the greatest number.


Deontological Ethics• Focuses on

• duty to others• rights of others

• Forms• Religious Ethics

• based on religious beliefs• Secular Ethics

• based on codes developed by societies that have relied on customs


Non-Consequential Ethics

• Rightness or wrongness of an action is based on properties intrinsic to the action.• not on its consequences

Virtue Ethics & Values

• Virtue ethics focuses on the inherent character of a person rather than on the specific actions he or she performs.

• A virtue describes moral excellence & that which has beneficial quality.• Virtues are habits. Once acquired, they become

characteristic of a person


Moral Value• Is the relative worth placed on some virtuous behavior.

• What has value to one person may not have value to another.


Values

• Values represent a standard of conduct.

• they are used for judging the goodness or badness of an action.



Intrinsic & Instrumental Values

• Intrinsic Value• something that has value in & of itself

• Instrumental Value• something that helps to give value to something else

• money is valuable for what it can buy)

Virtues & Values (see page 26 of Pozgar Pillars of Moral strength)

• Courage

• Wisdom

• Temperance

• Commitment


Virtues & Values, continued

• Compassion

• Conscientiousness

• Cooperativeness

• Discernment


Virtues & Values, continued

• Fairness

• Fidelity

• Freedom

• Honesty/Trustworthiness/Truth-Telling



Virtues & Values, continued (Class Discussion)

• Integrity –”Nearly all men can stand adversity, but if you want to test a

man’s chararcter, give him power” Abraham Lincoln

• Kindness-”When you carry out acts of kindness, you get a wonderful feeling inside. It is as though something inside your body responds and

says, yes, this is how I ought to feel” Harold Kushner

• Respect –”respect for oneslves guides our morals, respect for others guides our manners” Laurence Sterne

• Hopefulness –”Hope is the last thing that dies in a man; and thought it be exceedingly deceitful, yet it is of this good use to us, that while we are traveling through life, it conducts us in an easier and more pleasant way to

our journeys end” F de la Rochefoucauld


Courage

Courage is the greatest of all virtues, because if you haven’t courage, you may not have an opportunity to use any of the others.

SAMUEL JOHNSON


What is Courage?

• Courage is the mental or moral strength to persevere & withstand danger. “Courage is the ladder on which all the other virtues mount.”

• Courage involves balancing fear, self-confidence, & values. Without courage, we are unable to take the risks necessary to achieve the things most valued.


The Courageous Person

A courageous person has good judgment, a clear sense of his or her strengths, correctly evaluates danger, & perseveres until a decision is made & the right goal that is being sought has been achieved.

Values May Change

If one’s basic needs for food, water, clothing & housing have not been met, one’s values may change in such a way that a friendship, for example, might be sacrificed if one’s basic needs can be better met as a result of the sacrifice.


Values Can Change

• People make value judgments & choices among alternatives.• Values one so dearly proclaims may change as needs

change.• Motivating power of a person's actions are a necessity for

survival.• Values give purpose to each life. They describe one’s moral

character.

Differing Values

If mom’s estate is being squandered at the end of life – a family member financially well-off may want to hold on to mom despite the financial drain on her estate. Another family member financially struggling to survive may more readily see the futility of expensive medical care & find it easier to let go.


Religious Ethics

• Religion provides a moral code for appropriate behavior.• The prospect of divine justice helps us tolerate the injustices

in life.• There is a need to better understand cultural diversity & the

importance of religion in the healing process.


Spirituality

• Spirituality in the religious sense implies that there is purpose & meaning to life; spirituality generally refers to faith in a higher being.


Varying Religious Beliefs

• Judaism• Hinduism• Taoism• Zen• Christianity• Islam


Secular Ethics

• Secular ethics is based on codes developed by societies that have relied on customs to formulate their codes.

• Code of Hammurabi


Atheism

• Rejection of belief in God• Claims the existence of God cannot be scientifically proven.• Belief that ethics is the product of culture & politics


Principles of Health Care Ethics

• Autonomy• right to make one’s own decisions

• Beneficence• to do good

• Nonmaleficence• avoid causing harm


Principles of Health Care Ethics, con’t

• Justice• obligation to be fair in the distribution of benefits & risks

• distributive Justice

• requires that all individuals be treated equally

• justice & government spending

• change is coming


Injustice for the Insured

• Even if you’re insured, getting ill could bankrupt you.• Hospitals are garnishing wages, putting liens on homes &

having patients who can’t pay arrested.• It’s enough to make you sick.

• Sara Austin, SELF, October 2004, 247


Age & Justice

• Should an 89 year old patient get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a ten year old girl?


Age & Justice, con’t

• Should a pregnant 39 year old single parent get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a ten year old boy?


Which Disaster Patients Get Treated First?• Room #1: Severely injured patients not expected to live.

• Room #2: Severely injured patients most likely to live if treated.

• Room #3: Injured patients will live but will suffer varying degrees of disability if not treated promptly.


Emergency Care

Two patients in critical condition, who gets treated first:

• 1st patient who walks through door• Younger patient• Patient most likely to survive• Patient who can pay for services• Patient with most serious condition


Scarce Resources

• What happens when resources are scarce & only one of two patients can be treated?

• What should be the determining factors• age• position in life• patient wishes . . .

Situational Ethics

• Situational ethics refers to a particular view of ethics, in which absolute standards are considered less important than the requirements of a particular situation.

• The importance of a particular value may vary as one’s situation changes.


Situational Ethics, con’t• Moral character can be compromised when faced with difficult

choices.

• Good people behave differently in different situations.



Situational Ethics, con’t• Good people sometimes do bad things.

• One’s moral character can sometimes change as circumstances change.

• thus the term situational ethics.


The Creation of IgnoranceSituational Ethics

How Common is the Creation of Ignorance?

It’s pretty common. I mean in terms of sowing doubt, certainly global warming denialists who for years have managed to say, “well the case is not proven. We need more research.” And what’s interesting is that a lot of the people working on that were also the people working on Big Tobacco.

Interview with Robert Proctor, Professor Standford University Discover 2008


The Creation of IgnoranceDiscussion1. Why do people who do bad things in one job repeat their

pattern of doing bad in another? What is their motive?

2. Why do people watch bad things happen & then deny they are happening? Explain.

3. What is often referred to as being the “root of all evil?” How does it apply in this case.

Sustaining Life: Situational Ethics

A decision not to use extraordinary means to sustain life of an unknown 84 year old “may” result in a different decision if the 84 year old is one’s mother.


Ethical Decision-Making

Ethical decision-making is the process of deciding, what the right thing to do is in the event of a moral dilemma.


Case: High in the Andes

Those who survived the plane crash high in the Andes Mountains were faced with some difficult survival decisions. Their need to survive illustrates to what lengths one may go in certain situations in order to survive .


72 - Days of ordeal, Nando Parrado and other survivors of a plane crash in the Andes had to endure before being rescued. Flying over the mountains on a Friday the 13th, the young men and their families who boarded the charter plane joked about the unlucky day when the plane's wing hit the slope of the mountain and crashed. On impact, 13 passengers were instantly dead while 32 others were badly wounded. Hoping to be rescued, the survivors waited in the freezing -37C temperature, melting snow for drinks and sleeping side by side to keep themselves warm. Food was so scarce, everyone had to pool whatever food they can find for a rationed pool. 9 days after the crash, due to dire desperation and hunger, the survivors called for an important meeting. One member proposed that they eat the dead. The 2 hours meeting ended with a conclusion. If any of them died in the Andes, the rest had the permission to use the corpse as food. After 2 weeks, their hope of being found dashed when they found out via their radio transistor that the rescue effort was called off.

http://2.bp.blogspot.com/-x_1HZyZFvgA/TZW7WECNLqI/AAAAAAAAVzg/XDbim6PUEmM/s1600/a96763_a483_nando.jpg

High in the Andes, con’t

• How might you change as circumstances change?• Describe how your consultative advice might change based

on the patient’s needs, beliefs, & family influences.



Ethical & Legal Issues

• Ethical issues• Autonomy• Paternalism

• Legal issues• Informed consent


Ethical Relativism

• Theory that holds that morality is relative to the norms of one's culture.

• An action can be considered right or wrong depending on the accepted norms of the society in which it is practiced.• For example, slavery may be considered an acceptable

practice in one society & unacceptable in another.


Lack of a Moral Compass

• Hartford Police Chief questions the city’s “moral compass” a week after bystanders & drivers maneuvered around the motionless body of 78-year-old victim of a hit-&-run crash.

Review the hand out


Lack of a Moral CompassDiscussion1. What moral principles might the sheriff have been referring

to when he questioned the city’s lack of a moral compass? Explain.

2. Discuss your thoughts as to why society in general is losing its moral compass.

Alert!… STRESS Attack!

DEFINITIONS and reviewing what we have been discussing

Morals

Ethics

MORALS

• Refers to… Rightness or Wrongness Of Something

• Based on... What people BELIEVE To be Good or Right In Conduct or Character Values vs Preference

• Implies... Conformity with the Generally Accepted Standard

Of Goodness or Rightness In BEHAVIOR

ETHICS

• Discipline of dealing with what is good & bad...

Your Moral Duty & Obligation

• Set of... Moral Principles & Values

• Conforming to...

Professional Standards of Conduct• Principles of Conduct...

Governing an Individual or Group

SYNONYMS Two or More Words with Basically the Same Meaning

That Which Is . . .

• MORAL... Is Conformity to a Standard of what is Good & Right.

• ETHICAL... Asks the difficult question... What is Right & Fair?

YOUNG PEOPLE AND ETHICS

Have you ever stolenany from a store before

Have you cheated on aexam

If there are pressures inthe Job/school, I will

cheat to survive

Age 15-18

Age 19-24

Age 25+

Where Do Our Values Come From?

• Parents, Family Members, Teachers, Mentors, Laws, World View, Personal Values

• Spiritual Teaching & Upbringing

• Basic National Values,

• AF Traditional & Core Values Integrity - Service - Excellence

• Orders, AF Instructions, Tech Orders

• Unit Operating Values

• Other Areas

HISTORICAL EXAMPLES OF

ETHICAL VALUES

THE TEN COMMANDMENTS1-4 Deal with Ones Relationship with God

5 Honor... YOUR FATHER AND MOTHER

6 Do Not... MURDER

7 Do Not... COMMIT ADULTRY

8 Do Not... STEAL

9 Do Not... LIE OR GIVE FALSE TESTIMONY

10 Do Not... Covet Envy your neighbor’s wife/husband or belongings

HISTORICAL EXAMPLES OF

ETHICAL VALUES Continued

THE GOLDEN RULE

“DO UNTO OTHERS

AS YOU WOULD HAVE THEM

DO UNTO YOU!”

Found in . . . HINDUISM - JUDAISM

BUDDHISM - ISLAM - CHRISTIANITY

ACTIVE (Religious) BELIEFS = How One Lives & Treats Others

RECENT EXAMPLE OF

ETHICAL VALUES

COVEY’S UNIVERSAL VALUESStephen R. Covey

FAIRNESS PATIENCE

DIGNITY KINDNESS

INTEGRITY CHARITY

QUALITY HONESTY

SERVICE

Your Ethical Responsibility to Your Unit & People...

Being... A Role Model

Promoting... Character Development

with Your Subordinates & Peers

Creating... A Climate at Work

that Promotes Trust and

Professional Commitment

Be... A Role Model

• Exhibit Ethical Behavior... The way you live!

Who likes?... “Do what I say! Not what I do!”

• Use Wisdom… When your Ethical standards

are not the same as others.

• Let Credibility Soar… Flee Double Standards!

• Excel as a Role Model… Give your Unit

an example of great leadership to follow.

Promote...Character Development With Subordinates & Peers

• Personal Contact...

One on One! Know Your People!

• Share with Your Subordinates…

Let them know what you are Thinking!

• Teach Them... The Process

To Make the Right Decisions

Create... A Work Climate Promoting Trust and Professional Commitment

HOW?

Be Honest... LACK OF Ethical Clarity, Incompetence, Conflicting Policies & Decisions SENDS the wrong messageReward... CORRECT Ethical BEHAVIOR

Establish... A SENSE OF PURPOSE in the organizationStick Up... FOR YOUR PEOPLE

Set Expectations... MAKE them CLEAR

Speak through Actions... AS WELL AS Words

Create... A Work Climate Promoting TrustAnd Professional Commitment Continued

WHY Does the Ethical Climate Fall Apart?

Peer Pressure…

Lack of Understanding... Of what is EXPECTED of them

Ignorance of Rules… WITHIN Organization, Wing, AF

Ignorance of Your Responsibility... AS a LEADER

Unhealthy Competition & Fear... OF the UNKNOWN

The Ethical Decision Making Process

1st - Recognize... You have a Problem

2nd - Analyze... The Moral Values, Principles or Rules

that Relate to the Problem

3rd - Seek... Counsel or Spiritual Guidance

4th - Choose... A Course of Action that Results

in the Highest Moral Good

YOUR MORALS, VALUES & WORLD VIEW

SPIRITUAL TEACHINGUPBRINGING

TRADITIONAL & AF CORE

VALUES ORDERS REGULATIONS TECH ORDERS

UNIT OPERATING

VALUES

PEER PRESSURE

DECISION RESPONSE

BASIC NATIONAL VALUES

ETHICAL PROBLEMS

ETHICAL REASONING

Failure to Respond to Emergency Call

We use the next set of slides to look at healthcare ethical and legal issues: Expanded in Chapter 10 of Pozgar

Dr Chong will expand on the various scenarios during lecture Week 3 13th April lecture.

• Physicians on emergency call are expected to respond to requests for assistance.

• Failure to respond is grounds for negligence should a patient suffer injury.



Emergency Department Care

Mr. Doe arrived in the ED at 12:00 AM complaining to the desk clerk of right face & arm numbness that had persisted since the day before. The clerk asked Mr. Doe to have a seat in the waiting area & that a triage nurse would be with him shortly. At 12:31 AM, Mr. Doe was taken to a triage room. Mr. Doe’s vital signs were taken. His blood pressure was 190 over 119. After being triaged Mr. Doe’s was asked to have a seat in the waiting area until he was called for treatment.


Emergency Department Care, con’t

At 1:09 AM, Mr. Doe was taken to a treatment room. At 1:40 AM, the ED physician ordered blood work & a CT scan. At 2:30 AM, Mr. Doe had his CT scan. At 3:10 AM, the nurse conducted a reassessment & noted that the patient’s “speech was slightly slurred” with his mouth slightly off center. At 3:15 AM, Mr. Doe’s CT results indicated suspicion for small infarcts.



The treating physician was interviewed as to the patient’s presenting symptoms (e.g., right sided numbness in face & arms), recorded vital signs (e.g., 190/119), & timeliness of care. The physician claimed that he was not concerned about the any delay in the patient’s treatment due to the patient’s symptoms or vital signs.



The nurse stated that there was no stroke protocol for use of TPA. The physician stated there were very few strokes in his community & that the jury was still out on the value of TPA in treating ischemic strokes.


How the Courts ViewPoorly Conducted H&Ps

J.D. felt a severe headache. Paramedics took J.D.'s history, which included hypertension. His blood pressure was high, ranging from 200/120 to 170/130. At the hospital, J.D.’s vital signs were reassessed. His blood pressure was recorded at 170/130. Dr. M examined J.D. Dr. M sent J.D. for x-rays. J.D. was diagnosed with a pinched nerve. He told J.D. he was being discharged with a muscle relaxant & an anti-inflammatory painkiller. Dr. M did not know J.D.'s blood pressure when he treated him & did not review the ambulance records or the E.R. form.


How the Courts ViewPoorly Conducted H&Ps, con’t

The next morning, J.D. was found unconscious on the floor. An ambulance crew responded & took J.D.'s blood pressure four times between 7:16 & 7:50 a.m. The readings were extremely high (e.g. 220/120). At the hospital, a neurosurgeon diagnosed a hemorrhagic stroke. Excess fluid in JD’s brain caused JD to lapse into a coma. The neurosurgeon believed that had he been called, he would have stopped bleeding by the time he arrived at the emergency room the first day.


How the Courts ViewPoorly Conducted H&Ps, con’t

Mr. M was determined to have been "grossly negligent" because he " assessed, treated & discharged J.D. without knowing his blood pressure" & because he "did not actively seek out information about the blood pressure & medical history which might have led him to the correct diagnosis." Dr. M failure to ascertain & assess information about a patient in order to adequately prepare a patient history fell below the standard of care for an ED physician & constituted gross negligence. Moheet v. State Board of Registration for the Healing Arts, No. WD63543 (Mo. Ct. App. 2004).

Failure to Read Nursing Notes

A surgeon breached his duty of care owed to the patient by failing to read the nurse’s notes. Testimony convinced the court that the surgeon chose not to review the nurses’ observations. The surgeon’s failure to review nursing notes exacerbated an already critical condition & deprived the patient of a chance of survival.


QuizzesQuestions are designed to test students knowledge and comprehension

In knowledge base, the student is required to recognize both legal and ethics terminology and their application

For comprehension, the student is required not only to demonstrate knowledge about the law and ethics but also to demonstrate a degree of understanding of the material involved in the question. This is accomplished by questions that have more than one right answer, thus requiring the student to select the best answer.

Throughout the course we will practice the types of questions that embrace knowledge and comprehension.

Question 1The branch of philosophy that deals with values relating to human conduct A. moralityB. ethicsC. valuesD. virtuesE. paternalism

Question 1The branch of philosophy that deals with values relating to human conduct A. moralityB. ethicsC. valuesD. virtuesE. paternalism

Question 2An individual’s view of what is right and wrong A. Macro-ethicsB. Ethical theoryC. Micro-ethicsD. Consequential ethicsE. Moral values

Question 2An individual’s view of what is right and wrong A. Macro-ethicsB. Ethical theoryC. Micro-ethicsD. Consequential ethicsE. Moral values

Question 3Ethics primarily concerned with establishing standards or norms for conduct A. Normative ethicsB. DistributiveC. FidelityD. BeneficenceE. Nonmaleficence

Question 3Ethics primarily concerned with establishing standards or norms for conduct A. Normative ethicsB. DistributiveC. FidelityD. BeneficenceE. Nonmaleficence

Question 4The critical study of major moral precepts, such as, what things are right and what things are good is referred to as A. MoralityB. General normative ethicsC. Distributive justiceD. MoralityE. Virtues

Question 4The critical study of major moral precepts, such as, what things are right and what things are good is referred to as A. MoralityB. General normative ethicsC. Distributive justiceD. MoralityE. Virtues

Question 5The application of normative theories to practical moral problems is referred to as? A. Normative ethicsB. Distributive justiceC. Secular ethicsD. Applied ethicsE. Nonmaleficience

Question 5The application of normative theories to practical moral problems is referred to as? A. Normative ethicsB. Distributive justiceC. Secular ethicsD. Applied ethicsE. Nonmaleficience

Question 6The ______ theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. A. Non-consequentialB. ReligiousC. SecularD. ConsequentialE. Normative

Question 6The ______ theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. A. Non-consequentialB. ReligiousC. SecularD. ConsequentialE. Normative

Question 7The ethical theory that denies that the consequences of an action or rule are the only criteria for determining the morality of an action or rule. A. non-consequentialB. consequentialC. normativeD. distributiveE. paternalism

Question 7The ethical theory that denies that the consequences of an action or rule are the only criteria for determining the morality of an action or rule. A. non-consequentialB. consequentialC. normativeD. distributiveE. paternalism

Question 8The theory of ethics that focuses on one’s duties to others A. DiscernmentB. NormativeC. TeleologicalD. ConsequentialE. Deontological

Question 8The theory of ethics that focuses on one’s duties to others A. DiscernmentB. NormativeC. TeleologicalD. ConsequentialE. Deontological

Question 9One’s need to survive can change his or her ______character in order to survive. A. PaternalisticB. MoralC. NormativeD. VirtuousE. Deontological

Question 9One’s need to survive can change his or her ______character in order to survive. A. PaternalisticB. MoralC. NormativeD. VirtuousE. Deontological

Question 10The ___ ___were a turning point where essential commands such as "thou shalt not kill" or "commit adultery" were accepted as law.

A. Normative ethicsB. Ten CommandmentsC. Virtuous moralsD. Code of Hammurabi)E. None of the above

Question 10The ___ ___were a turning point where essential commands such as "thou shalt not kill" or "commit adultery" were accepted as law.

A. Normative ethicsB. Ten CommandmentsC. Virtuous moralsD. Code of Hammurabi)E. None of the above

Question 11Ethics that are based on codes (e.g., Code of Hammurabi) developed by societies which have relied on customs to formulate their codes. A. compassionB. religiousC. secularD. deontologicalE. morality

Question 11Ethics that are based on codes (e.g., Code of Hammurabi) developed by societies which have relied on customs to formulate their codes. A. compassionB. religiousC. secularD. deontologicalE. morality

Question 12One who has control over his/her own actions is A.Virtuous B.EthicalC.CompassionateD.AutonomousE.Hopeful

Question 12One who has control over his/her own actions is A.Virtuous B.EthicalC.CompassionateD.AutonomousE.Hopeful

Question 13 _____________ said, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body..." A. William the PhilosopherB. Justice Brenner C. MosesD. HammurabiE. Justice Carodozo

Question 13 _____________ said, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body..." A. William the PhilosopherB. Justice Brenner C. MosesD. HammurabiE. Justice Carodozo

Question 14_____________ describes the principle of doing good, demonstrating kindness, and showing compassion, and helping others. A. BeneficenceB. NonmaleficenceC. JusticeD. CompassionE. Virtue

Question 14_____________ describes the principle of doing good, demonstrating kindness, and showing compassion, and helping others. A. BeneficenceB. NonmaleficenceC. JusticeD. CompassionE. Virtue

Question 15A form of beneficence that may involve, for example, withholding information from a person because of the belief that it is in the best interest of that person. A. PaternalismB. JusticeC. AutonomyD. DeontologyE. Normative

Question 15A form of beneficence that may involve, for example, withholding information from a person because of the belief that it is in the best interest of that person. A. PaternalismB. JusticeC. AutonomyD. DeontologyE. Normative

Question 16.An ethical principle that requires caregivers to avoid causing patients harm. A. BeneficenceB. JusticeC. NonmaleficenceD. Medical paternalismE. Consequential

Question 16.An ethical principle that requires caregivers to avoid causing patients harm. A. BeneficenceB. JusticeC. NonmaleficenceD. Medical paternalismE. Consequential

Question 17The obligation to be fair in the distribution of benefits A. BeneficenceB. AutonomyC. JusticeD. NonmaleficenceE. Responsibility

Question 17The obligation to be fair in the distribution of benefits A. BeneficenceB. AutonomyC. JusticeD. NonmaleficenceE. Responsibility

Question 18Justice that implies that all are treated fairly. A. MoralB. DisproportionalC. ConditionalD. DistributiveE. Common

Question 18Justice that implies that all are treated fairly. A. MoralB. DisproportionalC. ConditionalD. DistributiveE. Common

Question 19One’s moral character can sometimes change as circumstances change, thus the term __________ ethics. A. DiscerningB. IntegrityC. CompassionateD. NormativeE. Situational

Question 19One’s moral character can sometimes change as circumstances change, thus the term __________ ethics. A. DiscerningB. IntegrityC. CompassionateD. NormativeE. Situational

Question 20If the ethical responsibilities of caregivers involves respecting a patient’s right to make his or her own decision, the ethical principle of _______ is being practiced is?

A. IntegrityB. Normative ethicsC. JusticeD. BeneficenceE. Autonomy

Question 20If the ethical responsibilities of caregivers involves respecting a patient’s right to make his or her own decision, the ethical principle of _______ is being practiced is?

A. IntegrityB. Normative ethicsC. JusticeD. BeneficenceE. Autonomy

Question 21Gen. Nguyen Ngoc Loan, chief of South Viet Nam’s national police, walked up and shot a prisoner in the head. His reason: The prisoner, a Viet Cong lieutenant, had just murdered a South Vietnamese colonel, his wife and their six children. Assuming this is out of one’s moral character, what ethical theory might apply. A. BeneficenceB. Normative ethicsC. Religious ethicsD. Situational ethicsE. Autonomy

Question 21Gen. Nguyen Ngoc Loan, chief of South Viet Nam’s national police, walked up and shot a prisoner in the head. His reason: The prisoner, a Viet Cong lieutenant, had just murdered a South Vietnamese colonel, his wife and their six children. Assuming this is out of one’s moral character, what ethical theory might apply. A. BeneficenceB. Normative ethicsC. Religious ethicsD. Situational ethicsE. Autonomy

Question 22What Christian religious group believes it is a sin to accept a blood transfusion. A. TaoistB. JewC. Jehovah’s WitnessD. MethodistE. Islam

Question 22What Christian religious group believes it is a sin to accept a blood transfusion. A. TaoistB. JewC. Jehovah’s WitnessD. MethodistE. Islam

Question 23A person is one who has moral integrity and has a strict regard for doing what is considered the right thing to do. A. VirtuousB. ConscientiousC. CommittedD. CompassionateE. Ethical

Question 23A person is one who has moral integrity and has a strict regard for doing what is considered the right thing to do. A. VirtuousB. ConscientiousC. CommittedD. CompassionateE. Ethical

Question 24A physician who falsifies entries on a patient’s medical record

A.Does it intentionallyB.Does it to avoid liability

for one’s medical negligence

C.Risks losing credibility with a jury should a case go to trial

D.Does it to protect a patient from harm

E. A and C above

Question 24A physician who falsifies entries on a patient’s medical record

A. Does it intentionallyB. Does it to avoid liability for

one’s medical negligenceC. Risks losing credibility with a

jury should a case go to trialD. Does it to protect a patient

from harmE. A and C above Please note

that the answer can also be “all of the above” since B and D may also be applicable under certain circumstances

Question 25Misdiagnosis may involve diagnosis & treatment of

A. A disease different from that which patient actually suffers

B. A disease that the patient does not have

C. Symptoms of a disease but not the underlying disease

D. A & c aboveE. All of the above

Question 25Misdiagnosis may involve diagnosis & treatment of

A. A disease different from that which patient actually suffers

B. A disease that the patient does not have

C. Symptoms of a disease but not the underlying disease

D. A & c aboveE. All of the above See page 372

of Pozgar

Question 26The surgeon in a Long Beach case failed to read nursing notes in a patient’s record

A. The surgeon breached his duty of care owed to the patient by failing to read nursing notes

B. Testimony convinced a Long Beach Court of Appeal that the surgeon chose not to take advantage of nurses’ observations

C. The surgeon’s medical malpractice exacerbated an already critical condition

D. The surgeon’s failure to read the nursing notes deprived the patient’s chance of survival

E. all of the above

Question 26The surgeon in a Long Beach case failed to read nursing notes in a patient’s record

A. The surgeon breached his duty of care owed to the patient by failing to read nursing notes

B. Testimony convinced a Long Beach Court of Appeal that the surgeon chose not to take advantage of nurses’ observations

C. The surgeon’s medical malpractice exacerbated an already critical condition

D. The surgeon’s failure to read the nursing notes deprived the patient’s chance of survival

E. all of the above (See page 367-369 of Pozgar)

Question 27Evidence of a disruptive physician or duty nurse

A. Can have negative impact on staff

B. Can affect quality of care

C. Is disruptive to ensuring patient welfare

D. Can support denial of privileges

E. All of the above

Question 27Evidence of a disruptive physician or duty nurse

A. Can have negative impact on staff

B. Can affect quality of care

C. Is disruptive to ensuring patient welfare

D. Can support denial of privileges

E. All of the above

Question 28The Hippocratic Oath provides that a physician

A. Follow regimen I consider for the benefit of my patient

B. Give no deadly medicine to any one if asked

C. Not give to a woman a pessary to produce abortion

D. Will abstain from seduction of females or males

E. All of the above

Question 28The Hippocratic Oath provides that a physician

A. Follow regimen I consider for the benefit of my patient

B. Give no deadly medicine to any one if asked

C. Not give to a woman a pessary to produce abortion

D. Will abstain from seduction of females or males

E. All of the above see page 532 of Pozgar

Question 29In Tarasoff v. Regents of the University of California

A. A former patient allegedly did not kill a third party after revealing his homicidal plans to his therapist

B. The therapist made effort to inform the victim of the patient’s intentions.

C. A former patient allegedly killed a third party after revealing his homicidal plans to his therapist

D. There is no duty to exercise reasonable care to protect the foreseeable victims & to warn them of any impending danger

E. All of the above

Question 29In Tarasoff v. Regents of the University of California

A. A former patient allegedly did not kill a third party after revealing his homicidal plans to his therapist

B. The therapist made effort to inform the victim of the patient’s intentions.

C. A former patient allegedly killed a third party after revealing his homicidal plans to his therapist

D. There is no duty to exercise reasonable care to protect the foreseeable victims & to warn them of any impending danger

E. All of the above

The Law and Counseling

• Confidentiality• is the ethical duty to fulfill a contract or promise to

clients that the information revealed during therapy will be protected from unauthorized disclosure.

• Privacy• is a legal concept that recognizes individuals’

rights to choose the time, circumstances, and extent to which they wish to share or withhold personal information.

• Privileged communication• regulates privacy protection and confidentiality by

protecting clients from having their confidential communications disclosed in court without permission.

Exceptions to Confidentiality

• When a client is a danger to self or others• In cases of child abuse or neglect• When vulnerable adults are being abused• When a client is considering committing a

crime• When a client has been a victim of a crime• During court-ordered psychological

evaluations• For the purposes of involuntary

hospitalization• When a client raises the issue of mental

condition in legal proceedings• In client-counselor disputes

Tarasoff v. Board of Regents of the University of California (1976)

Prosenjit Poddar Tatiana Tarasoff

Tarasoff v. Board of Regents of the University of California (1976)

• Prosenjit Poddar told the student health center that he wanted to kill Tatiana Tarasoff. The psychologist told the supervising psychiatrist, who told campus cops, who detained Poddar but then let him go. Poddar killed Tatiana two months later. Her parents sued for “failure to warn.” The Trial Court said that no such duty existed. The CA Supreme Court cited Simenson v. Swensen and ordered a trial. The case was heard twice:• Tarasoff I: “Privilege ends where public peril

begins”• Tarasoff II: A therapist has an obligation to use

reasonable care to protect potential victims

Question 30At the beginning of a physician–patient relationship, the physician must understand

A. Patient’s complaints B. Underlying feelings C. Goals D. Expectations E. All of the above

Question 30At the beginning of a physician–patient relationship, the physician must understand

A. Patient’s complaints B. Underlying feelings C. Goals D. Expectations E. All of the above

Ethical or Unethical• 1.) You are a successful counselor. One of your clients tells

you that you have been very, very helpful to him, and in order to show his appreciation to you, he gives you a $10,000 diamond ring as a gift. You accept the ring.

• 2.) A client cannot afford to pay for one of her counseling sessions with you. In lieu of payment, you ask her to babysit your 2-year-old son at your home a few times.

• 3.) One of your clients feels sexually attracted to you, and tells you this. Immediately following the termination of counseling, you and the client mutually agree to start a dating relationship.

Ethical or Unethical

• 4.) You and your friends have a dinner at your home. One of your friends tells you that he is emotionally disturbed by some conflict in his marriage. You take your friend into the next room and provide him with a brief counseling session there.

• 5.) You go to lunch with another counselor. In the restaurant, you each talk about some of your cases to learn from each other. Neither of you mentions the names of any of your clients.

Definitions

• Ethics• “Making decisions of a moral nature about people

and their interactions with society”• “A philosophical discipline that is concerned with

human conduct and moral decision making”• Professional behavior

• Morality• “Judgment or evaluation of action”• Right and wrong behavior

• Law• “The precise codification of governing standards

that are established to ensure legal and moral justice”

• Government behavior

ETHICS(Phil 304)

ENJOYNothing but an A or A+ will do

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Ethics Week 1 Dr Aruoma Lecture

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