Part II

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  • These theories combined with four generally accepted principles of medical ethics constitute the framework from which ethical deliberation and decision-making originate
  • No doubt to injure others is incidentally to fail to do them good; but it seems to me clear that non-maleficence is apprehended as a duty distinct from that of beneficence, and a duty of a more stringent character
  • No doubt to injure others is incidentally to fail to do them good; but it seems to me clear that non-maleficence is apprehended as a duty distinct from that of beneficence, and a duty of a more stringent character If two values conflict but both achieve an equal level of good but one produces a lesser amount of evil, this choice is more morally sound
  • Coherentist -- moved by desires they are helpless to resist Reason – Responsive Whether the relevant reasons are grounded in facts about her own desires and interests, or whether they have some independent source, the idea is that someone is not qualified to govern herself if she cannot understand what she has reason to do, or (if this is a distinct handicap) is incapable of being moved by these reasons. to appreciate the reasons she has responsiveness to reasoning accounts, the essence of self-government is the capacity to evaluate one's motives on the basis of whatever else one believes and desires, and to adjust these motives in response to one's evaluations someone whose education consisted of a method of indoctrination that deprived her of the ability to call her own attitudes into question would, in effect, be governed by her “programmers,” According to this incompatibilist conception of autonomy, autonomy is incompatible with determinism
  • What attitudes do you carry with regard to homosexuals; persons of other cultures / races / gender? We all have biases against other people – I am not sure we can eliminate them but we can at least be aware when they impede or cloud our judgment. We owe this to our patients at least!!
  • Truth telling and full disclosure are important portions of the trust between patient and provider. What does it mean to have accomplished informed consent?
  • Perspectives comment. Also keep your supervising physician appraised of your plan and treatment. DO NOT ALLOW YOUR SUPERVISING PHYSICIAN TO BE SURPRISED because you failed to communicate. YOU ARE NOT THE PHYSICIAN!!!!
  • Know your limits!!! Be secure in what you can do, DO NOT GET IN OVER YOUR HEAD!! ASK FOR HELP!! YOU OWE YOUR PATIENTS (AND SUPERVISOR) THAT MUCH!!!!
  • Truth telling becomes the basis for trust between all parties!! Do not abuse it!
  • HIPPA regulations!! Learn early not to discuss patient care with ANYONE not directly invovled in that patients care!! Especially your significant other!! Know what information you may be required to release given the context of your practice – blood alcohol levels in ER
  • As a professional, it is incumbent on you to remain up to date!!
  • Abuse of patients; malpractice; inappropriate behavior; sexual relationships; abandonment; illegal drug use/abuse, etc.
  • Research; payment in kind by drug / pharmaceutical companies / medical device companies / bonus checks
  • Part II

    1. 1. Medical Ethics for PA Students Charles Walker, PA-C, PhD Department of Orthopaedic Surgery LSU Health Sciences Center Shreveport, LA. July 2005 ortho.sh.lsuhsc.edu/Downloads/Downloads.html
    2. 2. Ethical Theories <ul><li>Deontological Theory </li></ul><ul><ul><li>Immanuel Kant </li></ul></ul><ul><ul><li>Duty </li></ul></ul><ul><li>Teleological (Consequentialist or Utilitarian) Theory </li></ul><ul><ul><li>J S Mill and Jeremy Bentham </li></ul></ul><ul><ul><li>Goal oriented </li></ul></ul>
    3. 3. Principles of Medical Ethics <ul><li>Beneficience -- Do Good; Provide a medical benefit to the patient </li></ul><ul><ul><li>Deontological – a duty to do make better </li></ul></ul><ul><ul><li>Teleological – a value to be maximized </li></ul></ul>
    4. 4. Principles of Medical Ethics <ul><li>Non-Maleficience -- &quot;First, do no harm&quot; Primum non nocere </li></ul><ul><ul><li>Deontological – a more stringent duty than beneficience </li></ul></ul><ul><ul><li>Teleological – maximizing good while minimizing evil </li></ul></ul>
    5. 5. Principles of Medical Ethics <ul><li>Autonomy -- To be autonomous is to be a law to oneself; autonomous agents are self-governing agents </li></ul><ul><ul><li>Coherentist </li></ul></ul><ul><ul><li>Reasons-responsive </li></ul></ul><ul><ul><li>Responsiveness to reasoning </li></ul></ul><ul><ul><li>Incompatabilist </li></ul></ul>
    6. 6. Principles of Medical Ethics <ul><li>Justice – Treat others fairly </li></ul><ul><ul><li>Egalitarian </li></ul></ul><ul><ul><li>Resource Based </li></ul></ul><ul><ul><li>Welfare Based </li></ul></ul><ul><ul><li>Desert Based </li></ul></ul><ul><ul><li>Libertarian Principles </li></ul></ul><ul><ul><li>Feminist Principles </li></ul></ul>
    7. 7. Case Discussions <ul><li>Advanced Directives </li></ul><ul><li>Truth Telling </li></ul><ul><li>Cultural Issues </li></ul>
    8. 8. Additional Topics <ul><li>Patient Self Determination Act 1991 </li></ul><ul><li>Truth Telling </li></ul><ul><li>Ethics Committees </li></ul><ul><li>PA Patient Relationships </li></ul>
    9. 9. Physician Assistant Code of Ethics <ul><li>I.    Physician Assistants Shall be committed to providing competent medical care, assuming as their primary responsibility the health, safety, welfare and dignity of all humans . </li></ul>
    10. 10. Physician Assistant Code of Ethics <ul><li>II.    Physician Assistants Shall extend to each patient the full measure of their ability as dedicated, empathetic health care providers and shall assume responsibility for the skillful and proficient transactions of their professional duties. </li></ul>
    11. 11. Physician Assistant Code of Ethics <ul><li>III.    Physician Assistants Shall deliver health care services to health consumers without regard to sex, age, race, creed, socio-economic and political status. </li></ul>
    12. 12. Physician Assistant Code of Ethics <ul><li>IV.    Physician Assistants Shall adhere to all state and federal laws governing informed consent concerning the patient's health care. </li></ul>
    13. 13. Physician Assistant Code of Ethics <ul><li>V.    Physician Assistants Shall seek consultation with their supervising physician, other health providers, or qualified professionals having special skills, knowledge or experience whenever the welfare of the patient will be safeguarded or advanced by such consultation . Supervision should include ongoing communication between the physician and the physician assistant regarding the care of all patients. </li></ul>
    14. 14. Physician Assistant Code of Ethics <ul><li>VI.    Physician Assistants Shall take personal responsibility for being familiar with and adhering to all federal/state laws applicable to the practice of their profession. </li></ul>
    15. 15. Physician Assistant Code of Ethics <ul><li>VII.    Physician Assistants Shall provide only those services for which they are qualified via education and/or experience and by pertinent legal regulatory process. </li></ul>
    16. 16. Physician Assistant Code of Ethics <ul><li>VIII.    Physician Assistants Shall not misrepresent in any manner, either directly or indirectly, their skills, training, professional credentials, identity, or services. </li></ul>
    17. 17. Physician Assistant Code of Ethics <ul><li>IX.    Physician Assistants Shall uphold the doctrine of confidentiality regarding privileged patient information, unless required to release such information by law or such information becomes necessary to protect the welfare of the patient or the community. </li></ul>
    18. 18. Physician Assistant Code of Ethics <ul><li>X.    Physician Assistants Shall strive to maintain and increase the quality of individual health care services through individual study and continuing education . </li></ul>
    19. 19. Physician Assistant Code of Ethics <ul><li>XI.    Physician Assistants Shall have the duty to respect the law, to uphold the dignity of the physician assistant profession and to accept its ethical principles. The physician assistant shall not participate in or conceal any activity that will bring discredit or dishonor to the physician assistant profession and shall expose, without fear or favor, any illegal or unethical conduct in the medical profession . Physician Assistants, ever cognizant of the needs of the community, shall use the knowledge and experience acquired as professionals to contribute to an improved community. </li></ul>
    20. 20. Physician Assistant Code of Ethics <ul><li>XII.    Physician Assistants Shall place service before material gain and must carefully safeguard against conflicts of professional interest . </li></ul>
    21. 21. Physician Assistant Code of Ethics <ul><li>XIII.    Physician Assistants Shall strive to maintain a spirit of cooperation with their professional organizations and the general public. </li></ul>

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