HTH 423 (Ethics) - EXAM 1
Ethical theories and principles are helpful in addressing ethical issues in two key ways:
(1) they explain why the issue at hand is an ethical issue (2) they justify why one course of action ought to be preferred over another
why is health ethics important for the work of WHO?
- One of WHO's six core functions is to develop "ethical and evidence-based policy options - While principles of human rights must guide the analysis of these issues, those principles often do not point to a single, objectively correct answer
Nozick vs Rawls
- Rawls: liberal tradition that the government should step in to help people disadvantaged in life's lottery - Nozick: conservative tradition that if you want something you should obtain it yourself
ideal rights
- a statement of a right that is meant to be motivational, a goal to seek - serve to guide organizations, communities, and nations to provide higher standards
4 key points of double effect
- act must be good, or at least morally neutral, independent of its consequences - the agent intends only the good effects, not the bad - the bad effect must not happen because of the good effect - the good effect must outweigh the bad effect
process rights
- also legal rights - many laws relate to ensuring that due process is followed
substance rights
- can be legal rights or not - the right to do a particular thing (healthcare, housing, minimum wage, welfare, food stamps, safe streets, a clean environment, etc)
importance of ethics theories to health care professionals
- clinicians and healthcare administrators can use practical wisdom to advance interests of specific patients, the aggregate, the community, and healthcare organizations - helps in decision making - policy makers can enhance their evaluation of the behaviors or motivations of various stakeholders by determining the stakeholders' ethical system
categorical imperative
A concept developed by the philosopher Immanuel Kant as an ethical guideline for behavior. - In deciding whether an action is right or wrong, a person should evaluate the action in terms of what would happen if everybody else in the same situation acted the same way. - criterion for determining what ethics principles meet the test of reason
Utilitarianism
A set of theories centred on the principle of utility which is often taken to require that any action should maximize benefits for the greatest number of people
solidarity
A social relation in which a group, community, or nation stands together
procedural justice
Discussion of the values and processes necessary to bring about a just outcome
8 KQs
Fairness Outcome Responsibility Character Liberty Empathy Authority Rights
accountability for reasonableness
Framework that requires that the rationale or reasons underlying health-care-limiting decisions be made publicly available
negative rights
- you have the right to be left alone and to do anything not strictly forbidden by the law - Bill of Rights is all negative rights - they are clear and enshrine liberty
elitism theory
a good person who exemplifies virtue or integrity has likelihood of being better than other people, which causes them to set a standard that many people may fall below; creates a hierarchy
distributive justice
a set of principles that provide "moral guidance for political processes and structures that affect the distribution of economic benefits and burdens within societies
specific competence
ability to do some things but not others
preexisting conditions
ailments or diseases that the patient has before health insurance coverage begins
the goal of consequentialism theory is
the greatest good for the greatest number; intent doesn't matter only outcomes
what is health ethics?
the interdisciplinary field of study and practice that seeks to understand the values undergird-ing decisions and actions in health care, health research and health policy, and to provide guidance for action when these values conflict
nonmaleficence
to do no harm
substituted judgment
trying to figure out the person's wishes when they were competent and making the best call from that
consequentialism theory is also known as
utilitarianism
______ are central to ethical judgments
values
Character - question
what actions will help me become my ideal self? am I allowing my own personal beliefs to get in the way of how I interact with people/making the right decision?
Outcomes - question
what are the short and long term outcomes of possible actions?
Authority - question
what do legitimate authorities (experts, law, my god(s)) expect of me?
Responsibilities - question
what duties and obligations apply?
ethical relativism
what is ethical in one situation may not be ethical in another and that is accepted by most philosophers
Liberty - question
what principles of liberty and personal autonomy apply?
Rights - question
what rights (innate, social, legal) apply?
what is harm as negligence?
when a person has not exercised the due diligence expected of someone in his or her role and level of responsibility
Autonomy means what?
you rule yourself
natural rights
- we should respect attributes that humans have by nature (life, liberty, and pursuit of happiness) - moral right to healthcare
Rawls version of deontology
- defined characteristics of a just society; "justice as fairness" - principle #1: liberty; people should have equal rights to basic liberties (bill of rights) - principle #2: justification of inequalities (difference principle); social and economic inequalities are appropriate if they are arranged such that the inequalities help out the least fortunate persons in society
deontology theory
- duty based ethics - ability to choose good makes us human - free will makes ethics possible/necessary - actions judged by intention and not outcome - categorical imperative and golden rule (due unto others as you would have them do unto you) - difficult in modern society
Nozick's version of deontology
- emphasized autonomy and right of individual - we should influence people to take steps to improve their own situations - no principle of distributive justice; everyone has equal opportunity
key ethical issues in health research
- ethical issues regarding groups (economically disadvantaged, topic selection, new drug/device patents, whether research surveillance is necessary) - ethical issues regarding individuals - managing ethical dilemmas
research ethics committees
- evaluate research protocols with the aim of safeguarding participants' rights and well-being - reduce risks of the research - make sure risks are reasonable in relation to anticipated benefits - make sure the researchers have made adequate plans for obtaining participants' informed consent
Consolidated Omnibus Budget Reconciliation Act (COBRA)
- forerunner to HIPAA - mandates that businesses with more than 20 employees must provide employees who leave that business extended health insurance for up to 18 months
examples of need based on misfortune
- genetic defects - reduced abilities in physical or mental capacity - motivation - special talents - children/elderly
harm as a violation of autonomy
- giving a patient treatment even though they don't want it - not fully educating a patient/dissuading a patient due to cost or a lack of insurance - making best decision if person is incompetent
key ethical issues in public health
- harm prevention, public good, and individual liberty - treatment and prevention - health promotion and equity - public health surveillance
clinical ethics committees
- multidisciplinary - may include ethicists, health care professionals, patient advocates, and religious representatives - provide guidance to clinicians, patients, and families in clinical dilemmas - may also contribute to the development of institutional policies and procedures
3 types of ethics committees
- national ethics committees (NECs) - research ethics committees (RECs) - clinical ethics committees
national ethics committees
- official bodies to advise their executive and legislative branches, and often the general public, about ethics of health and health care. - meet to facilitate international dialogue and foster consensus on ethical issues of global concern
relationship between health ethics and law
- often complementary; define how people are supposed to act - some laws could be considered unethical - ethics is concerned with a broader set of relationships and behaviors than most forms of legal regulation - concrete punishment for breaking a law but social/individual grief for being unethical
examples of material reasons to discriminate
- one's level of contribution or results and effort - circumstances characterized as misfortune - mental/physical disabilities; unequal natural endowments - special talents or abilities - opportunities a person might have or lose - past discrimination against a group that is perceived as having negative effects in the present - structural social problems perceived as restricting opportunity or motivation
egoism theory
- people either should seek to advance solely their self-interests or this is actually what people do - the benefit, pleasure, or greatest good is from the self alone - not very important in health care ethics which is all about the patient not the provider
major criticisms of consequentialism
- portion of the minority is always left out - some say that this theory says that the ends justify the means (no matter how you get there it's fine as long as the end result is good)
key ethical issues in clinical care
- proper communication of info with patient - clinician's opinion/treatment recommendation vs patient's needs - when should patient be able to make own decisions?
key ethical issues in health organizations and systems
- resource allocation across health services and programs - corporate partnerships and philanthropic fundraising - workplace ethics - equitable access - individual vs population health - public accountability
key ethical issues in global health
- specification of actions that wealthier countries should take to help poor countries - cultural relativity - should everyone be treated the same regardless of their culture? - standards of care - should they be equal for everyone regardless of location or if in a control group in a trial
authority-based ethics theory
- usually based on religion, elders, traditions, culture, or ideology - many authority based theories conflict so there is no way to sort them out other than by an appeal to reason - arguments may also arise relating to the religion itself and the truth behind it - can help in patient understanding, treatment, and creation of healthcare policy
two important conditions must be met for autonomy:
1. are patients competent to make decisions for themselves? 2. are patients free of coercion in making decisions?
3 reasons for engaging stakeholders
1. to improve the quality of decisions by examining ethical issues from diverse perspectives and bringing relevant experience and expertise, both lay and professional, to the table 2. to provide input on values, to inform policy decisions and guide the application of available evidence 3. to provide a mechanism for improving public accountability for these decisions
beneficence
Principle requiring that governments, health care providers, and researchers do good for, provide benefit to, or make a positive contribution to the welfare of populations, patients and study participants
virtue ethics theory
The Greek philosopher Aristotle's theory that we must cultivate character traits that will best bring us the best life and eudaimonia
proportionality
The balancing of the positive features and benefits of a particular intervention, policy, or research study against its negative features and effects, when deciding whether or not to implement it
bioethics
The field of enquiry that examines ethical issues arising from the "creation and maintenance of the health of living things"
natural law theory
all things subject to Divine providence are rules and measured by the eternal law - can be seen as a version of deontology which is simply any view that defines the right thing to do as dependent on something other than consequences
beneficence requires a decision to engage in beneficent acts or to be ________
altruistic
autonomy
an individual's right to make their own decisions and to be their own person
egalitarianism
belief in equality
eudaimonia
human flourishing brought about by a perfection of character nurtured by engaging in virtuous acts over a life of experience
health ethics and _______ go hand in hand
human rights
classical utilitarianism vs rule utilitarianism
classical: each act considered on its own; can make it very hard to make a quick decision rule: based on rules/policies and acts more as a guideline for decision making
autonomy and liberty are very important to the _______ theory
consequentialism
making ethical decisions requires ________ ________ and rational ______ _________
considered judgments; moral reasoning
reflective equilibrium model provides a process for:
considering and reconsidering decisions
the principle of double effect
distinguishing between good and evil
what do you need to determine the answers to the following issues? - physicians deciding how much time to spend with patients - nurses deciding how quickly to respond to patients - which employees deserve a pay raise? - Texas department of health public hearing re: HIV/AIDS funding cut
distributive justice
non-maleficence
duty to do no harm
what is an example of a distributive justice principle?
egalitarianism
What human beings have a right to as a matter of _______ is not necessarily the same as what they have a right to as a matter of _______.
ethics; law
________ remains a foundation for law, and often provides a justificatory basis for legal ________
ethics; norms
the original position
hypothetical or mind experiment by Rawls to explain why rational people would protect everyone's self interests - if we were in the original position, we could all be equal and treated the same in society, and therefore it would be in our best interest to make sure everyone was given an equal share of benefits and burdens
veil of ignorance
forgetting everything about you and your situation to make a clear, moral decision - useful when you have a patient who cannot make a decision for themselves
examples of need based on past discrimination
groups who have been discriminated/treated poorly in the past which have led to downfalls in their lives today whether it be SES, education, housing, transportation, etc.
example of a positive right
health care
beneficence is a fundamental principle of _______
health care practice
Fairness - question
how can I act equitably and balance all interests?
Empathy - question
how would I respond if I cared deeply about those involved?
best interest or reasonable person decision
if patient is incompetent, professional must make the decision that a reasonable person would choose in his/her best interest
procedural injustice most frequently occurs when
in employee situations (who is going to get fired if economic reasons arise)
competence and autonomy are part of _______
informed consent
legal and positive rights
legal rights: someone has legal obligation to fulfill your right, whatever it happens to be positive right: example of a legal right because it is a specific social good
the right to privacy is a ______ right but not a ______ right
legal; positive
ethical theories and principles are used to explain _______ reasoning
moral
- we have the freedom to pursue our lives as we see fit - we have the right to not have smokers in our workplace - privacy protections under HIPAA - sexual harassment protections These are all examples of which type of rights?
negative
malfeasance
neglect of fiscal responsibility and actions that conflict with policy or the law
portability
no lapse of healthcare coverage occurs when a person changes from one job to another, even when insurance carriers change
public good
nonexcludable (no one can be excluded from consumption, irrespective of individual contributions to provision) and nonrival (consumption by some does not reduce the benefits of consumption accrued by others)
intermittent competence
patient is able to make decision one hour and the next hour is incompetent
procedural justice vs distributive justice
procedural: were the procedures put in place fair and were they followed as they should be?; aka due process distributive: balancing benefits and burdens; resource allocation issues in health care are always present
getting treated in the ER regardless of whether you are able to pay or not is an example of what kind of right?
substance
Ethical decision-making frameworks provide ________ and _______ approaches to the analysis of ethical _______ and _______
systematic and practical; issues and questions
what is harm in the clinical setting?
that which worsens the condition of the patient
preference utilitarianism
the good is the fulfillment of preferences and the bad is frustrating preferences; good at individual level but has less value as a policy statement for everyone