Healthcare Values and Ethics Chapter 1

religious ethics: Buddhism

1. Buddhism is a religion and philosophy encompassing a variety of traditions, beliefs, and practices, based largely on teachings attributed to Prince Siddhartha Gautama, son of Kind Suddhodana and Queen Mayadive, who lived in present day border of India and Nepal 2. He had gone on a spiritual quest and eventually became enlightened, and took on the name Buddha 3. religion to some, philosophy to others to "do good, avoid evil" and purify the mind 4. when caring for the dying, Buddhists like to be informed about their health status in order to prepare themselves spiritually -a side room with privacy is preferred

religious ethics: Judaism

1. Jewish law refers to the unchangeable 613 mitzvot (commandments) that God gave to the Jews 2. Halaknah (Jewish Law) comes from three sources: -the Toran (the first five books of the Bible) - laws instituted by the rabbis -longstanding customs 3. the Jewish people is another name for the children of Israel, referring to the Jews as a nation in the classical sense, meaning a group of people with a shared history and a sense of a group identity rather than a specific place or political persuasion 4. Judaism is a monotheistic religion based on principles and ethics embodied in the Hebrew Bible (Old Testament) 5. ex. 10 Commandments -no other gods -no idols -not take the Lord's name in vain -remember the Sabbath - honor father and mother -don't kill -don't commit adultery -not steal -do not bear false witness -don't covet

normative ethics and assisted suicide

1. Oregon's Death with Dignity Act of 1997: allows terminally ill state residents to end their lives through voluntary self-administration of a lethal dose of medications prescribed by a physician 2. the Oregon Act is controversial at best and has placed morality and the law in conflict

religious ethics: zen

1. Zen evolved from Buddhism in Tibet 2. emphasizes dharma practice (from the master to the disciple) and experiential wisdom based on learning through the reflection on doing, going beyond scriptual readings 3. in Zen Buddhism, learning comes through a form of seated meditation known as zazen, where practioners perform meditation to calm the body and the mind and experience insight into the nature of existence and thereby gain enlightenment

Anointing of the Sick

1. a catholic priest should be offered when last Rites need to be administered to those of the Catholic faith

virtue: conscientiousness

1. a conscientious person is one who has moral integrity and a strict regard for doing what is considered the right thing to do 2. a person acts conscientiously if he or she is motivated to do what is right, believing it is the right thing to do 3. conscience is a form of self-reflection on and judgment about whether one's actions are right or wrong, good or bad 4. internal sanction that comes into play through critical reflection -can have bad feelings when the actions were wrong

religious ethics: Hinduism

1. a polytheistic religion with many gods and goddesses 2. believe God is everything and is infinite; around 1200 BC 3. believe in reincarnation and one's present condition is a reflection of one's virtuous behavior or lack 4. when caring for the dying, relatives may wish to perform rituals at this time 5. sacred items should not be removed as washing the body is part of the funeral rites and should be carried out by relatives

distributive justice

1. a principle requiring that all persons be treated equally and fair 2. everyone is treated the same, all the time 3. there are many ethical issues involved in the rationing of healthcare -this is often a result of limited or scarce resources, limited access as a result of geographic remoteness, or a patient's inability to pay for services combined with some physicians unwilling to accept patients who are perceived as "no pays" with high risks for legal suits

bioethics

1. 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 when addressing diverse complex care issues with a wide variety of circumstances

ethical theories: descriptive ethics

1. also known as comparative ethics, is the study of what people believe to be right and wrong and why they believe it 2. descriptive ethics describes how people act, "and/or what sorts of moral standards they claim to follow" -whereas normative ethics prescribes how people ought to act 3. both normative and descriptive ethical theories have application in the Oregon Act

ethical theories: applied ethics

1. applied ethics is "the philosophical search (within western philosophy) for right and wrong within controversial scenarios" 2. applied ethics is the application of normative theories to practical moral problems, such as abortion, euthanasia, and assisted suicide

consequentialism

1. assets that determining the greatest good for the greatest number of people (the utilitarian goal) is a matter of measuring outcome, and so decisions about what is moral should depend on the potential or realized costs and benefits of a moral belief or action

employment-related paternalism

1. employment-related paternalism at its best is a shared and cooperative style of management in which the employer recognizes and considers employee rights when making decisions in the workplace 2. paternalism at its worst occurs when the employer's style of management becomes more authoritarian, some times arbitrary, and unpredictable 3. presently, the federal employment discrimination laws fail to provide uniform and consistent legal protection when an employer engages in applicant specific paternalism-the practice of excluding an applicant merely to protect that person from job-related safety and or health risks 4. attributable to his or her federally protected characteristics under Title VII of the Civil Rights Act of 1964, the Courts and the 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

age and justice

1. ethical dilemma of who should have the health preference

principles of ethics: autonomy

1. autonomy involves recognizing the right of a person to make one's own decisions 2. "auto" comes from a Greek word meaning "self" or the "individual" -in this context, it means recognizing an individual's right to make his or her own decisions about what is best for him- or herself 3. autonomy is not an absolute principle -the autonomous actions of one person must not infringe upon the rights of another 4. each person has a right to make his or her own decisions about health care -ex. a patient has the right to refuse to receive health even if it would be beneficial to saving his or her life 5. respect for autonomy has been recognized in the 14th Amendment to the constitution of the US -the law upholds an individuals right to make healthcare decisions -patients can refuse treatment, refuse to take medications, and refuse invasive procedures regardless of their benefits that may be derived from them 6. although patients have a right to make their own choices, they also have a concomitant right to know the risks, benefits, and alternatives to recommended procedures 7. autonomous decision making can be affected by one's disability mental status, maturity, or incapacity to make decisions -a person's autonomous decision may be carried out through an advanced directive and/or an appointed healthcare agent in the event of one's inability to make decisions

secular ethics

1. based on codes developed by societies that have relied on customs to formulate their codes

religious ethics: Christianity

1. based on the Bible's New Testament teachings 2. Christians accept both the Old and New Testament as being the Word of God 3. Jesus Christ as the way of salvation 4. the primary and final authority for christian ethics is found in the life, teachings, ministry, death, and resurrection of Jesus Christ

ethical theories: consequential ethics

1. based on the consequences -does the ends justify the means 2. the theory of consequential ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil 3. from a contemporary standpoint, theories that judge actions by their consequences have been referred to as consequential ethics 4. consequential ethics theories revolve around the premise that the rightness or wrongness of an action depends on the consequences of the effects of an action 5. the theory of consequential ethics is based on the view that the value of an action derives solely from the value of its consequences -the consequentialist considers the morally right act or failure to act is one that will produce a good outcome 6. the goal of a consequentialist is to achieve the greatest good for the greatest number 7 "what will be the effects of each course of action?" "who will benefit?" "what action will cause the least harm?" "what action will lead to the greatest good?"

virtue: commitment

1. commitment is the act of binding oneself intellectually and/or emotionally to a course of action or a person 2. it is an agreement or pledge to do something 3. it can be ongoing or a pledge

virtue: compassion and empathy

1. compassion is the profound awareness of and sympathy for another's suffering -the ability to show compassion is a true mark of moral character 2. compassion is a moral value expected of all caregivers -a person with compassion recognizes that someone is in pain (emotional, physical, or both) and tries their best to alleviate it 3. those who lack compassion have a weakness in their moral character 4. empathy is a visceral feeling where a person sees another in pain and can place themselves in their shoes and feel that pain -according to Webster's dictionary "empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner 5. five specific ways for physicians to foster empathy during conflict -recognizing one's own emotions -attending to negative emotions over time -attuning to patient's verbal and nonverbal emotional messages, and becoming receptive to negative feedback

situational ethics

1. concerned with the outcome or consequences of an action in which the ends can justify the means 2. a person's beliefs and values can change as circumstances change

virtue: cooperation and teamwork

1. cooperation is the process of working with others 2. in the healthcare setting, caregivers must work together to improve patient outcomes 3. technological change is occurring at a pace faster than the human mind can absorb, thus requiring team work between individuals with a wide variety of skill sets 4. change comes when the players learn to cooperate for the common good

virtue: courage

1. courage is the mental or moral strength to persevere and withstand danger 2. courage can be characterized as the ladder upon which all the other virtues mount 3. it involves balancing fear, self-confidence, and values 4. a courageous person has good judgment and a clear sense of his or her strengths, correctly evaluates danger, and perseveres until a decision is made and the right goal that is being sought has been achieved 5. courage, in differing degrees, helps to define one's character ( the essence of one's being) and offers the strength to stand. up for what is good and right 6. courage must not be exercised to an extreme

creating a culture of ethics

1. creating a culture of ethics begins with the governing body 2. the CEO must take a leadership role in creating and maintaining a culture of ethics 3. important to define, both in word and deed, ethical conduct and to determine the degree to which ethics are a part of the organization's culture

principles

1. describe 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

Morality

1. describes a class of rules held by society to govern the conduct of its individual members 2. it implies the quality of being in accord with standards of right and good conduct 3. morality is a code of conduct -it is a guide to behavior that all rational persons should put forward for governing their behavior 4. morality requires us to reach a decision as to the rightness or wrongness of an action

circular reasoning

1. describes a person who has already made up his/her mind on a particular issue and sees no need for deliberation (close minded)

Pillars of Moral Strength

1. describes a virtuous person 2. in the final analysis, it is one's virtues and values that build moral character

principles of ethics

1. ethical principles are universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued 2. ethical principles assist caregivers in making choices based on moral principles that have been identified as standards considered meaningful when addressing healthcare-related ethical dilemmas

topic 1

1. ethical theories, principles and standards 2. overview of the four basic principles of healthcare ethics 3. the cultural, social, economic factors that affect patient care: and the role of a healthcare manager in addressing corporate ethics

ethical theories

1. ethics seeks to understand and to determine how human actions can be judged as right or wrong 2. ethical judgments can be made based on our own experiences or based upon the nature of or principles of reason 3. the theories and principles of ethics introduce order into the way people think about life 4. they are the foundations of ethical analysis that provide guidance in the decision-making process 5. the various theories present differing viewpoints that assist caregivers in making difficult decisions that impact the lives of others 6. 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

virtue: fairness

1. fairness requires each person to be objective, unbiased, dispassionate, impartial, and consistent with the principles of ethics 2. fairness is the ability to make judgments free from discrimination, dishonesty, or one's own bias -it is the ability to be objective without prejudice or bias 3. Question: so where are we as It relates to fairness in the delivery of healthcare?

virtue: fidelity

1. fidelity is the virtue of faithfulness, being true to our commitments and obligations to others 2. a component of fidelity, veracity, implies that we will be truthful and honest in all our endeavors -it involves being faithful and loyal to obligations, duties, or observances 3. the opposite of fidelity is infidelity,, meaning unfaithfulness 4. caregivers must be faithful to their duties and obligations to provide quality patient care

medical integrity and patient autonomy

1. for many medical providers, the relationship between medical ethics and professionalism may be what they consider to be integrity 2. with professionalism comes an expectation of expertise, in a responsible and reliable manner 3. the integrity of the medical profession is not threatened by allowing competent patients to decide for themselves 4. patient autonomy sets the foundation of ones right to bodily integrity, including the right to accept or refuse treatment -those rights are superior to the institutional considerations of hospitals and their medical staffs

virtue: forgiveness

1. forgiveness is a virtue and a value 2. it is the willingness to pardon someone who has wronged you in some way 3. it is also a form of mercy

virtue: freedom

1. freedom is the quality of being free to make choices for oneself within the boundaries of law -ex. US Citizens can enjoy freedom of speech, freedom of religion, freedom from want, and freedom from physical aggression -in healthcare, the freedom to consent to a medical procedure or refuse treatment is an unequivocal right of a competent patient who is capable to choose or assign a surrogate to choose for him 2. freedom of choice is not always recognized as a given

code of conduct

1. generally prescribes standards of conduct, states principles expressing responsibilities, and defines the rules expressing duties of professionals to whom they apply 2. wikipedia: code of conduct "set of rules outlining the social norms, religious rules and responsibilities of, and or proper practices for, an individual, party or organization 3. related concepts include ethical, honor, moral codes, and religious laws 4. most members of a profession subscribe to certain "values" and moral standards written into a formal document which describes the organization's code of conduct 5. codes of conduct often require interpretation by caregivers as they apply to the specific circumstances surrounding each dilemma

ethical theories: utilitarian ethics

1. greatest utility think more hot dogs than steaks 2. the utilitarian theory of ethics involves the concept that the moral worth of an action is determined solely by its contribution to overall usefulness 3. it describes doing the greatest good for the greatest number of people 4. it is thus, a form of consequential ethics, meaning that the moral worth of an action is determined by its outcome, and, thus, the ends justify the means 5. the utilitarian commonly holds that the proper course of an action is one that maximizes utility, commonly defined as maximizing happiness and reducing suffering

injustice for the insured

1. high rate of bankruptcy for patients who do have insurance 2. when an insured person gets ill and exhausts his or her insurance benefits ground the hospital: -withhold the money? -place a lien -arrest -block the patient from applying for government funds

virtue: honesty/trustworthiness/truth telling

1. honesty and trust involve confidence that a person will act with the right motives -it is the assured reliance on the character, ability, strength, or truth of someone or something -to tell the truth, to have integrity, and to be honest are most honorable virtues 2. veracity: is devotion to and conformity with what is truthful -it involves an obligation to be truthful 3. truth telling: involves providing enough information so that a patient can make an informed decision about his or her healthcare -ex. physicians often find it difficult to disclose medical errors to their patients -moral courage is therefore needed if doctors are to do the right thing when medical errors occur -can be facilitated by institutions having policies and guidelines on disclosure of errors in place 4. declining trust in the healthcare system -evidenced in the system caught up in the quagmire of managed care companies 5. politics and distrust -truthfulness is just one measure of one's moral character and politicians do not always set good examples for the people they serve

virtue: hopefulness

1. hopefulness in the patient care setting involves looking forward to something with the confidence of success 2. caregivers have a responsibility to balance truthfulness while promoting hope; the caregiver must be sensitive to each patient's needs and provide hope

scope of ethics

1. the scope of healthcare ethics encompasses numerous issues, including the right to choose or refuse treatment and the right to limit the suffering 2. the scope of healthcare ethics is not limited to philosophical issues but embraces economic, medical, political, social, and legal dilemmas

morals

1. ideas about what is right and what is wrong 2. morals are deeply ingrained in culture and religion and are often part of its identity 3. should not be confused with religious or cultural habits or customs 4. that which is morally right can vary from nation to nation, culture to culture, and religion to religion 5. there is no universal morality that is recognized by all people in all cultures at all times

memorandum summary

1. initiation of CPR: prior to the annual of emergency medical services (EMS), nursing homes must provide basic life support, including initiation of CPR, to resident who experiences cardiac arrest in accordance with that resident's advance directives or in the absence of advance directives or a DNR order 2. facility CPR Policy: some nursing homes have implemented facility-wide no-CPR policies -not encouraged 3. Surveyor implications: surveyors should as certain 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

virtue: integrity

1. integrity involves a steadfast adherence to a strict moral or ethical code and a commitment not to compromise this code 2. integrity is a concept that includes consistency in actions, expectations, measures, methods, outcomes, principles, and values 3. integrity means over actions are honest and trustworthy -ex. patients and professionals alike often make health care decisions based on their integrity and their strict moral beliefs 4. a person without personal integrity lacks sincerity and moral conviction and may fail to act on professed moral beliefs 5. integrity of hospital staff not only involves the care for patients in the hospitals but extends to those outside accrediting agencies and their employees responsible for identifying problems associated with the delivery of quality patient care in the hospital -starts at the top of the organization

macroethics

1. involves a more global view of right and wrong 2. solving ethical dilemmas involves consideration of ethical issues from both a micro and macro perspective

partial reasoning

1. involves bias for or against a person based on one's relationship with that person

principles of ethics: justice

1. justice is the obligation to be fair in the distribution of benefits and risks 2. justice demands that persons in similar circumstances be treated similarly 3. a person is treated justly when he or she receives what is due, is deserved, or can legitimately be claimed 4. justice involves how people are treated when their interests compete with one another

virtue: kindness

1. kindness involves the quality of being considerate and sympathetic to another's needs 2. some people are takers, and others are givers 3. if you go through life giving without the anticipation of receiving, you will be a kinder and happier person

detachment

1. lack of concern for the patient's needs 2. often translates into mistakes that result in patient in juries 3. there needs to be a comfortable balance between compassion and detachment

justice and government spending

1. limited financial resources are challenging to the principles of justice 2. justice involves equality 3. how should healthcare dollars be allocated between healthcare education preventative care, healthcare insurance programs for curative care, rehabilitation programs, long-term care, and research 4. considering the scarcity of resources for healthcare expenditures, who and what should the parameters be as to how to allocate scarce financial resources? -if the parameter sets merely short-term objectives to maximize the health benefits for the population served, some will receive a higher quality of care while others will receive, at best, satisfactory -with an aging population, long-term care will be competing for funding against other healthcare areas (like education and prevention which are fundamental to a healthy lifestyle) 5. with an aging population, long term care will be competing for funding against other healthcare areas 6. the funding allocation challenge remains as to how this generation will prioritize the need for a healthier lifestyle and allowing for improved funding for research activities that extends the quality of life 7. justice in the distribution of limited dollars often results in fewer dollars for so-called orphan diseases (ex. lupus), which are underfunded because they affect fewer people 8. there are many variable to take into consideration when determining how to distribute limited funds that will equally benefit all when there are other variables that must be considered that affect the quality of a healthy society 9. in summary, the allocation of limited resources requires the appropriate distribution of funds that address the promotion of healthy lifestyles, improvement in education and training programs building state of the art safe healthcare facilities equipped with the latest medical equipment, research, and translational medicine

Physicians and Paternalism

1. medical paternalism often involves physicians unwittingly make decisions for patients who are capable of making their own choices 2. physicians often find themselves in situations where they can influence a patient's health care decision simply by selectively telling the patient what he or she prefers based on personal belief 3. this directly violates patient autonomy 4. the problem of paternalism involves a conflict between the principles of autonomy and beneficence 5. the traditional concept of the doctor-patient relationship places the patient in a passive, compliant role 6. ultimately, as determined by court decisions, it is the patient's right to know and choose what course of treatment

moral dilemmas

1. moral dilemmas in the healthcare setting often arise when values, rights, duties, and loyalties conflict 2. the best answer when attempting to resolve an ethical dilemma includes the known wishes of the patient and other pertinent information, such as a living will, that might be available when the patient is considered incompetent to make his or her own choices 3. ex. the right answer is often elusive when the patient is in a coma, there are no known documents expressing a patient is wishes, and there are no living relatives

moral judgments

1. moral judgments are those judgment concerned with what an individual or group believes to be the right or proper behavior in a given situation 2. making a moral judgment is being able to select an option from among choices 3. it involves assessing another person's moral character based on how he or she conforms to the moral convictions established by the individual and/or group 4. a lack of conformity can result in moral disapproval and possibly ridicul or censure of one's character

principles of ethics: nonmaleficence

1. non-maleficence is an ethical principle that requires caregivers to avoid causing patients harm 2. it derives from the ancient maxim primum non nocere, translated from the latin, "first, do no harm" ex. telling the truth 3. to avoid causing harm, alternatives may need to be considered in solving the ethical dilemma

ethical theories: normative ethics

1. normative ethics is prescriptive in that it attempts to determine what moral standards should be followed so that human behavior and conduct may be morally right 2. normative ethics is primarily concerned with establishing standards or norms for conduct and is commonly associated with investigating how one ought to act 3. it involves the critical study of major moral precepts, such as what things are right, what things are good, and what things are genuine 4. one of the central questions of modern normative ethics is whether human actions are to be judged as right or wrong solely according to their consequences 5. determination of a universal moral principle is hard; however, there is a need to have a commonly held consensus about what is right and wrong in order to avoid chaos -thus there are generally accepted moral standards around which laws are drafted

ethical dilemmas

1. often arise when ethical theories, principles, and values conflict 2. healthcare dilemmas occur when there are alternative choices, limited resources, and differing values among patients, family members, and caregivers 3. consensus building during the decision-making process will occur when the parties involved can sit and reason together -the process of identifying the various alternatives to an ethical dilemma, determining the pros and cons of each choice, and making informed decisions decisions requires a clear, unbiased willingness to listen, learn, and in the end, make an informed decision

Beneficience--paternalism

1. paternalism is a form of beneficence 2. people sometimes believe that they know what is best for another and make decisions that they believe are in that person's best interests 3. paternalism can occur because of one's age, cognitive ability, and level of dependency 4. a patient's rights to self-determination are comprised when a third party imposes their wishes upon those of another person

the term ethics is used in three distinct but related ways

1. philosophical ethics: involves inquiry about ways of life and rules of conduct 2. a general pattern or way of life, such as religious ethics 3. a set of rules or conduct or "moral code"

absence of a moral compass

1. political corruption, antisocial behavior, declining civility and rampant unethical conduct have heightened discussions over the nation's moral decline and decaying value systems in the delivery of healthcare

principles of ethics: beneficience

1. principle of doing good 2. beneficence describes the principle of doing good, demonstrating kindness, showing compassion, and helping others 3. in the healthcare setting, caregivers demonstrate beneficence by providing benefits and balancing benefits against risks 4. beneficence requires one to do good 5. doing good requires knowledge of the beliefs, culture, values, and preferences of the patient--what one person may believe to be good for a patient may in reality be harmful

ethical theories: deontological ethics

1. rational behind the decision 2. duty and rights of others 3. religious values may come into play 4. deontological ethics is commonly attributed to the German philosopher Immanuel Kant (1724-1804) 5. Kant believed that although doing the right thing is good, it might now always lead to or increase the good and right thing sought after 6. it focuses on one's duties to others and others' rights -it includes telling the truth and keeping your promises 7. deontology ethics is often referred to as duty-based ethics -it involves ethical analysis according to a moral code or rules, religious, or secular 8. "deon" is derived from the Greek word meaning "duty" 9. Kant's theory differs from consequentialism in that consequences are not the determinant of what is right; therefore, doing the right thing may not always lead ot an increase in what is good 10. Duty-based approaches are 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-either because you have to (ex. following the law) or because you agreed to (ex. following an employer's policies) 11. doesn't matter the consequences as long as you are doing your duty

reasoning and the decision-making process

1. reasoning is the process of forming conclusions, judgments, or inferences based on one's interpretation of facts or premises that help support a conclusion 2. reasoning includes the capacity for logical inference and the ability to conduct inquiry, solve problems, evaluate, criticize, and deliberate about how we should act and to reach an understanding of other people, the world, and ourselves

religious beliefs and duty conflict

1. religious beliefs and codes of conduct sometimes conflict with the ethical duty of caregivers to save lives

atheism

1. the rejection of belief in any god, generally because atheists believe there is no scientific evidence that can prove God exists 2. they argue that there is no objective moral standard for right and wrong and that ethics and morality are the products of culture and politics, subject to individual convictions 3. those of various religious faiths, however, believe there is overwhelming evidence that there is reason to believe that God does exist and that the evidence through historical documents, archaeological finds, and the vastness of space and time clearly support and confirms the existence of God

religious ethics

1. religious ethics serve a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source 2. these codes of conduct are enforced through fear of pain and suffering in the next life and/or reward in the next life for adhering to religious codes and beliefs 3. the prospect of divine justice helps us to tolerate the injustices in this life, where goodness is no guarantee of peace, happiness, wellness, or prosperity 4. religion should be a component of the education, policy development, and consultative functions of ethics committees -ex. need to know how to respond to Jehovah's witnesses who refuse blood transfusions 5. religion is often used as a reason to justify what other wise could be consider a unjustifiable behavior 6. spirituality implies that there is purpose and meaning to life; spirituality generally refers to faith in a higher being -it is a well proven fact that patients who are able to draw on their spirituality and religious beliefs tend to have a more comfortable and often improved healing experience 7. difficult questions regarding a patient's spiritual needs and how to meet those needs are best addressed on admission by first collecting information about the patient's religious or spiritual preferences 8. staff education is often helpful

virtue: respect

1. respect is an attitude of admiration or esteem 2. Kant believed that persons are ends in themselves with an absolute dignity, which must always be respected 3. in contemporary thinking, respect has become a core ideal extending moral respect to things other than persons, including all things nature 4. Caregivers who demonstrate respect for one another and their patients will be more effective in helping them cope with the anxiety of their illness -respect helps to develop trust between the patient and caregiver and improve the healing processes

CPR and Paternalism in Nursing Homes

1. some nursing homes have implemented no-CPR policies 2. nursing home patients have the right to make their own care decisions 3. having a policy of no resuscitation measures in the nursing home setting is a paternalistic approach to patient care that eliminates patient's option to make that decision for themselves-a clear violation of patients' rights and autonomous decision making 4. such policies are unconditionally morally and legally wrong

rules

1. specify specific conduct; they do not allow for individual professional judgment

utilitarianism

1. starting point is that we all attempt to seek happiness and avoid pain, and therefore our moral focus ought to center on maximizing happiness and minimizing pain for the greatest number of people

religious ethics: Taoism

1. taoists believe that ultimate reality is unknowable and unperceivable 2. the founder of taoism is believed to be Lao Tzu (6 BC) 3. Taoists doctrine includes the beliefs that the proper way of living involves being in tune with nature -everything is ultimately interblended and interacts 4. taoists ethics include compassion, frugality, and humility -they emphasize the importance of meditation in daily life, which can be a challenge in the hospital setting

virtue: temperance

1. temperance involves self-control and restraint 2. it embraces moderation in thoughts and actions 3. evidenced by orderliness and moderation in everything one says and does 4. control one's actions as not to go to extremes

virtue: discernment

1. the ability to make a good decision without personal biases, fears, and undue influences from others 2. a person who has discernment has the wisdom to decide the best course of action when there are many possible actions to choose from

ethics

1. the branch of philosophy that seeks to understand the nature, purposes, justification, and founding principles of moral rules and the systems that they comprise 2. ethics and moral are derived from the Greek: ethos and mos -convey a meaning describing customs or habits 3. ethics deals with values relating to human conduct -it focuses on the rightness and wrongness of actions and the goodness and badness of motives and ends 4. encompasses the decision-making process of determining ultimate actions 5. ethics is an expression of how individuals decide to live with one another within accepted boundaries and how they live in harmony with the environment as well as with one another 6. ethics is concerned with human conduct as it ought to be, as opposed to what it actually is

in search of economic justice

1. the high cost of US hospital care is motivating patients to travel to places like India and Thailand for major procedures

law and ethics intersect

1. the intersection of "law" and "ethics" is clear 2. deviation from either can lead to unsatisfactory outcomes for both physicians and patients

religious ethics: Islam

1. the islamic religion believes there is a god named Allah 2. Muhammad is considered to be a prophet/messenger of God -revelations received from their god and recorded in the Qur'an -the Qur'an is believed to supersede the Torah and Bible 3. muslims believe that there is no need for God's grace and that their own actions can merit God's mercy and goodness 4. the five pillars of the practice of Islam are believing the creed, performing five prayers daily, giving alms, fasting during Ramadan, and making a pilgrimage to Mecca at least once in a lifetime 5. when caring for the dying, patients may want to be with relatives and die facing Mecca (in the US, the southeast)

ethical theories: nonconsequential ethics

1. the nonconsequential ethical theory denies that the consequences of an action are the only criteria for determining the morality of an action 2. in this theory, the rightness or wrongness of an action is based on properties intrinsic to the action, not on its consequences 3. believes right or wrong depends on the intention, not the outcome

Nonmaleficence and ending life

1. the principle of nonmaleficence is defeated when a physician is placed in the position of ending life by removing respirators, giving lethal injections, or writing prescriptions for lethal doses of medication 2. helping patients die violates the physician's duty to save lives 3. in the final analysis, there needs to be a distinction between killing patients and letting them die. It is clear that killing a patient is never justified

ethical theories: meta-ethics

1. the study of the origin and meaning of ethical concepts 2. seeks to understand ethical terms and theories and their applications 3. explores the connection between values, reasons for actions and human motivation, asking how it is that moral standards might provide us with reasons to do or refrain from doing 4. attempts to discover the origin cause of right and wrong 5. ex. comfort care

ethical theories: ethical relativism

1. the theory of ethical relativism holds that morality is relative to the norms of the culture where one lives -in other words, right or wrong depends on the moral norms of the society in which it is practiced 2. caregivers must be aware of cultural, religious, and legal issues that can affect the boundaries of what is acceptable and what is unacceptable practice, especially when delivering health care to persons with beliefs different from their own

values are standards of conduct

1. they are used for judging the goodness or badness of some action 2. a moral value is the relative worth placed on some virtuous behavior -values are rooted in customs and habits of a culture because the words moral and ethics themselves were essentially created to describe these topics 3. values are the standards by which we measure the goodness in our lives 4. intrinsic value -something that has value in and of itself 5. instrumental value: -is something that helps to give value to something else 6. values may change as needs change 7. values give purpose to each life -they make up one's moral character 8. all people make value judgments and make choices among alternatives. Values are the motivating power of a person's actions and necessary to survival, both psychologically and physically 9. the relationship between abstract virtues (principles) and values (practice) is often difficult to grasp

total unfailing quality patient care

1. to better understand the complexity of distribution requires understanding that the factors necessary to deliver high-quality care are ever-expanding a + b + c = d -a: unlimited resources for equipment -b: unlimited number of caregivers -c: sufficient facilities -d: unfailing quality patient care 2. for example, it is not enough to merely have equipment; it must be high quality equipment that improves patient outcomes -it is not enough to have merely the "right" number of persons on staff; the individual staff members must also be competent enough to perform the assigned tasks -it is not enough to have health facilities; they must be high-quality facility -improving the health and will being of the people is a moral concern -the careless allocation of scarce resources that are not cost-effective produces fewer benefits than would have been possible through the thoughtful and wise distribution of scare resources 3. because resources are limited, the allocation of funding must be equitable and just 4. justice requires the fair distribution of limited funds, which is associated with the moral theories of utilitarianism and consequentialism

virtue: tolerance

1. tolerance can be viewed in two ways: positive or negative 2. positive tolerance: implies that a person accepts differences in others and that one does not expect others to believe, think, speak, or act as he or she does -tolerant people are generally free of prejudice and discrimination 3. negative tolerance: implies that one will reluctantly put up with another's beliefs -merely tolerates the views of others -although tolerance can be viewed as a virtue, not all tolerance is virtuous nor is all intolerance necessarily wrong (an exaggerated tolerance may amount to a vice, whereas intolerance is virtuous)

religious ethics: Falun Gong

1. traditional Chinese spiritual discipline belonging to the Buddhist school of thought -truthfulness, compassion, and forbearance/tolerance towards others 2. it consists of moral teachings, a meditation, and four exercises that resemble tai chi and are known in Chinese culture as qigong 3. does not consist of physical places of worship, formal hierarchies, rituals, or membership and is taught without change

standards

1. used to guide human conduct by stating desirable traits to be exhibited and undesirable ones to be avoided

virtue ethics and values

1. virtue ethics focuses on the inherent character of a person rather than on the specific actions he or she performs 2. a virtue is a positive trait of moral excellence -virtues are those characteristics that differentiate good people from bad people -virtues such as courage, honesty, and justice are abstract moral principles -a morally virtuous person is one who does the good and right thing by habit, not merely based on a set of rules of conduct -the character of a virtuous person is naturall good

why study ethics

1. we study ethics to help caregivers make sound judgments, good decisions, and right choices 2. in the healthcare industry, it is about anticipating and recognizing healthcare dilemmas, and making good judgments and decisions based on universal values that work in unison with the laws

morality legislated

1. when it is important that disagreements be settled, morality is often legislated 2. law is distinguished from morality by having explicit rules and penalties, as well as officials who interpret the laws and apply penalties when laws are broken 3. there is often considerable overlap in the conduct governed by morality and that governed by the law 4. laws are created to set boundaries for societal behavior -they are enforced to ensure that the expected behavior happens

justice and emergency care

1. when two patients arrive in the emergency department in critical condition, consider who should receive treatment first 2. should the caregiver base his or her decision on the: -1st to arrive, age, likelihood of survival, ability to pay, or the condition 3. patients are to be treated justly, fairly, and equally -the principles of distributive justice raises numerous issued, including how limited resources should be allocated

virtue: wisdom

1. wisdom is the judicious application of knowledge 2. wisdom begins first by learning from the failures and successes of those who have preceded us 3. "the function of wisdom is to discriminate between good and evil" 4. in the healthcare setting, when the patient's wishes and end-of-life preferences are unknown, wisdom with good judgment without bias or prejudice springs forth more easily

microethics

2. deals with an individual's view of what is right and wrong based on one's personal life teachings, traditions, and experiences

Tuskegee Syphilis Study

Research study conducted by a branch of the U.S. government, lasting for roughly 50 years (ending in the 1970s), in which a sample of African American men diagnosed with syphilis were deliberately left untreated, without their knowledge, to learn about the lifetime course of the disease.

chapter 1

introduction to ethics