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Chapter03

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Chapter03

  1. 1. Chapter Three Basic Principles of Health Care Ethics
  2. 2. Morality and Ethics <ul><li>Morality </li></ul><ul><ul><li>What is believed to be right and good </li></ul></ul><ul><li>Ethics </li></ul><ul><ul><li>Generic term for the study of how we make judgments in regard to right and wrong </li></ul></ul><ul><ul><li>Offers a way of examining the moral life </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  3. 3. Professional Ethics <ul><li>Applied ethics, designed to bring about ethical conduct </li></ul><ul><li>Differing professions have different views as to what constitutes the end good or major purpose </li></ul><ul><li>These views shape the application of the basic ethical principles </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  4. 4. Hierarchy of Reasoning by Values Copyright ©2009 Delmar, Cengage Learning. All rights reserved. World View Basic Principles Rules Codes Decisions
  5. 5. Universal Principles Copyright ©2009 Delmar, Cengage Learning. All rights reserved. veracity autonomy confidentiality Role Fidelity beneficence justice nonmaleficence
  6. 6. Autonomy <ul><li>From the Greek (self-governance) </li></ul><ul><ul><li>Ability to decide </li></ul></ul><ul><ul><li>Power to act </li></ul></ul><ul><ul><li>Respect for the autonomy of others </li></ul></ul><ul><li>Informed consent </li></ul><ul><li>Autonomy vs. paternalism </li></ul><ul><ul><li>Therapeutic privilege </li></ul></ul><ul><ul><li>Benevolent deception </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  7. 7. Veracity <ul><li>Health care provider can be of little assistance if patient lies </li></ul><ul><li>Patient cannot be autonomous if health care provider lies </li></ul><ul><li>Lying damages health care process </li></ul><ul><ul><li>What is to be done about placebos? </li></ul></ul><ul><ul><li>Can a lie be justified? </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  8. 8. Beneficence <ul><li>Every patient has the right to assume that the health care provider is actively seeking their good </li></ul><ul><ul><li>One ought to prevent evil or harm </li></ul></ul><ul><ul><li>One ought to remove evil or harm </li></ul></ul><ul><ul><li>One ought to do or promote good </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  9. 9. Nonmaleficence <ul><li>One of the first principles of health care is the admonition: “primum non nocere” (first do no harm) </li></ul><ul><li>What to do when seeking to do good, if there is a harmful secondary effect? </li></ul><ul><ul><li>Principle of double effect </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  10. 10. Principle of Double Effect Guideline Elements <ul><li>The course chosen must be good, or at least morally neutral </li></ul><ul><li>The good must not follow as a consequence of the secondary harmful effects </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  11. 11. Principle of Double Effect Guideline Elements (continued) <ul><li>The harm must never be intended, but merely tolerated with the good intended </li></ul><ul><li>The good must outweigh the harm </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  12. 12. Confidentiality <ul><li>If patients begin to believe that we do not protect their confidentiality, then they will cease to tell us what we need to know </li></ul><ul><li>Confidentiality is a central element of the therapeutic relationship </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  13. 13. Justice <ul><li>Deals with concepts of fairness, just desserts, entitlements </li></ul><ul><li>What is most just method for distributing the limited resources of health care? </li></ul><ul><li>Place of compensatory justice, when a patient is harmed? (Retribution?) </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  14. 14. Methods Used in the Distribution of Scarce Goods and Services <ul><li>How to distribute health care? </li></ul><ul><ul><li>To each an equal share </li></ul></ul><ul><ul><li>To each according to need </li></ul></ul><ul><ul><li>To each according to effort </li></ul></ul><ul><ul><li>To each according to contribution </li></ul></ul><ul><ul><li>To each according to merit </li></ul></ul><ul><ul><li>To each according to ability to pay </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  15. 15. Role Fidelity <ul><li>Each health care specialty has a particular and designated role to play in health care practice </li></ul><ul><li>Role is often outlined by the legislative specialty practice act </li></ul><ul><li>Obligation to faithfully practice within the constraints of the role </li></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  16. 16. Basic Principles <ul><li>Review the now infamous “Tuskegee Study” case. Each basic principle of health care ethics was breached by the health care providers involved. </li></ul><ul><ul><li>Provide an example from the case that shows the breaking of each principle </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  17. 17. Key Concepts <ul><li>Morality and ethics defined </li></ul><ul><li>Basic principles </li></ul><ul><ul><li>Autonomy </li></ul></ul><ul><ul><li>Veracity </li></ul></ul><ul><ul><li>Beneficence </li></ul></ul><ul><ul><li>Nonmaleficence </li></ul></ul><ul><ul><li>Justice </li></ul></ul><ul><ul><li>Role fidelity </li></ul></ul><ul><ul><li>Confidentiality </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
  18. 18. Key Concepts (continued) <ul><li>Paternalism defined </li></ul><ul><li>Principle of double effect: </li></ul><ul><ul><li>Course chosen good, or at least morally neutral </li></ul></ul><ul><ul><li>Good must not follow as a consequence of secondary harmful effects </li></ul></ul><ul><ul><li>Harm must never be intended </li></ul></ul><ul><ul><li>The good must outweigh the harm </li></ul></ul>Copyright ©2009 Delmar, Cengage Learning. All rights reserved.

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