HIM 226 CH. 5

placebos

medically inert substances that are used as a control in testing the effective of another, medicated substance.

justice

obligation to be fair to all people -fairness, honesty, and impartiality -although requires no person be favored over another, it does not require all persons be treated the same. -what one person considered fair may not be fair to another -the same disagreement exists to a lesser extent over ideas of impartiality and entitlement -SUBDIVIED INTO TWO PARTS ===Comparative justice and Distributive justice -fairness to all people -access to health care services.

patient rights

often addressed in terms of confidentiality and privacy

ethical theories

refer to systematic statements or plans or principles used to deal with ethical dilemmas -exist so that individuals, organizations, and groups can act consistently and coherently when making ethical decisions -2 main _______ _______ exist -utilitarianism -deontology

confidentiality

referes to the obligation of the health care provider to maintain patient information in a manner that will not permit dissemination beyond health care provider.

veracity

refers to habitual truthfulness and honesty. -opposite of the practice of intentionally deceiving or misleading. -patient provider relationship

privacy

refers to the right to be left alone or the right to control person information

ethics

formal study of moral choices that conform to standards of conduct -derived from greek word ethos -listening to ones conscience or -making judgement between right and wrong -basis: philosophy -judgements of right and wrong

Best- interest Standard

-Determining what is in the best interest of a person who cannot make such decision alone -The ability to make a decision is greenly determined by Competency. -this standard often applies to persons who were once met the competency standard but are now considered Incompetent due to illness or injury -people who are mentally retarded cannot meet criteria of competence as a matter of law. -in healthcare most often seen when decision needs to be made about patients treatment or pt is unable to provide informed consent-----HC provides may look at patients expressed wishes such as living will or power of attorney for health care. if those documents don't exist they will look to family members and guardians for guidance. -if these don't help health care providers will turn to the judicial system

rights

-a just claim or entitlement that others must respect. -confidentiality and privacy - derives from concept of justice because they both involve obligations. but ____ does not always encompass fairness, honesty, and impartiality -relates to autonomy because of self-determination -considers actions as they relate to affirming or violating basic human rights. -vary according to moral values of a given culture

Autonomy

-independence, self determination, or freedom -ex.---informed consent -derives from Greek: autos--self and nomos--goverance -Respect for person and an expectation that a person will make decisions in accordance with the person plan of choice 3 main elements -the ability to decide - the power to actualize or implement a decision -a respect for autonomy of others EACH must be present for autonomy to exist -not absolute, but rather a freedom that is subject to some level of restrictions.

Beneficence

-kindness, mercy, charity -Hippocratic Oath. -means the qualities of kindness, mercy and charity -refers to obligation to do good in all circumstances. -positive perspective -oath contains this in that physicians will apply "Measures to benefit the sick" creating an obligation to promote the health and welfare of the patient above other considerations -maximize the good for the patient

Nonmaleficence

-prohibition against doing harm -Hippocratic Oath -refers to obligation to prevent evil or harm. -negative prospective -Oath contains this by stating physician will keep patient "from harm and injustice" and will refrain from "all intentional injustice" -minimize harm to patient

Double-effect principle

-reconciling the existence of unfortunate events and outcomes with both concepts (beneficence and nonmalficence) can be accomplished by applying this. -refers to principle that recognizes ethical choices may result in untoward outcomes. -one may proceed with an ethical choice presenting a double effect if the untoward outcome is not intended outcome but a secondary outcome and is outweighed by the intended positive or neutral outcome (harm vs. benefits.) -because the provider did not intend harm in cases where nosocomial infections and adverse drug reactions occur and the patient had consented to treatment resulting in side effects after gaining thorough understanding of associated risks and benefits, the health care provider will be considered to have acted ethically.

distributive justice

-referes to the fair distribution of burdens and benefits using an independent standard. -concept posits that all persons have an equal opportunity to resources and requires that those in a position of authority provide the service that is due to others ex. ______________ ______________ is applied in the legal sense is shown by the rule that all are innocent until proven guilty 6 criteria--- need, equity, contribution, ability to pay, effort and merit.

comparative justice

-refers to balancing the competing interests of individuals and groups against one another, with no independent standard used to make this comparison. -concept posits that because the needs or interests of some persons and groups are greater than the needs or interests of the others, it is acceptable for the individuals or groups with the greater need./ interest to receive more resources than those with the lesser needs/ interests ex, a person close to death and needs a transplant would be greater need than person just diagnosed with a disease but not near death.

Fidelity

-similar to autonomy -means faithfulness, loyalty and devotion to ones obligation/ duties. -most often seen in context of agreements and commitments between persons -concept undergirds concept of accountability because accountability is often measured by the level to which a person adheres to her responsibilities and obligations -operating within acceptable practice constraints -multiple professionals attend to patient care, each operates within constraints of acceptable practices, some imposed by law and some imposed by custom. -working with these constraints requires health care professionals to exercise __________. to her role in treating the patient

Law

A body of rules of action or conduct prescribed by a controlling authority that has a binding legal force. -created to control behavior and protect public from danger -closely related to ethics -where law only express minimum level of ones expectations of right and wrong, leaving ethics to fill the void.

incompetent

A person who is unable or not fit to make decisions

values

Concepts that give meaning to an individuals life and serve as framework for decision making basis--society, religion, and family -Lifes meaning examples: cleanliness, genuineness, honesty, hard work, sincerity -assist in decision making process everyday life.

ethical concepts

abstract ideas or thoughts that deal with ethics -these ideas and thoughts serve as part of the values that undergird the decision making process -multiple approaches to ethical reasoning -CONCEPTS INCLUDE autonomy, beneficence and nonmalficence, best interest standard, fidelity, justice, rights and veracity

cost benefit analysis

all possible options are considered, the utility and value of each option is determined and the option that poses highest total utility is chosen -net benefits are compared against cost to reach decision -the option that offers society the best benefits at the least cost or offers business the greatest return for the lowest costs is seen as the logical choice.

utilitarianism

sometimes referred to as Consequentialism -proposes that everyone, individuals, organizations, and society in general, should make choices that promotes the greatest balance of good over harm for everyone -promotes greatest balance of good over harm for everyone -advancing the public good -cost benefit analysis (application) -group benefit valued (strength) -end justifies means (weakness) developed by Jeremy Bentham and John stuart mill. -posits that an act is right when it is useful in bringing about a desirable or good end -encourages the effects of actions on everyone involved in a situation, not just merely on an individual -used to justify capitation approach of managed care organizations

Deontology

sometimes referred to as Formalism or Duty Orientation -asserts that ethical decision making is based on moral rules and unchanging principles that are derived from reason and can be applied universally. -Developed by Immanuel Kant ---fundamental principle of deontology is Categorical Imperative

Etiquette

the principles of how human beings relate to one another under certain circumstances. -social code---of customs and rituals. -society is basis -associated with ceremonial behavior -examples---polite, proper dress, courtesy

morals

the principles or fundamental standards of "right" conduct that a person internalizes. -from Latin word Mores -right moral conduct -based on traditional religion teachings and personal moral choices. -related to ethics in that ethics puts personal moral principles and standards into practice in the manner of making judgments with clarity and consistency

Categorical Imperative

which means a command derived from a principle does not allow exception. -requires application of unconditional commands in a similar manner in all situations without exception.