Ethical principles law_and_cultural_diversity


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  • Different cultures have different moral codes. Thus, there are no universal truths in ethics because it is difficult to say that customs are either correct or incorrect.
  • Today federal and state governments have constitutional authority to create and enforce laws.
  • Some examples of laws that protect society are DUI laws, safety belts, child car seats and bicycle helmets.
    Laws that have governed the practice of medicine are exemplified in obtaining and maintaining licensure.
    Also, the Hippocratic oath is an example of the intersection of ethics and the law.
  • Medicine and technology are rapidly changing and offer choices to individuals. Although challenging and even exciting, the choices can be difficult for each of us.
    For example should medications known to be effective, be withheld from homeless or incompetent people because they don’t have the means to store or manage the medication properly?
  • There are penalties for failing to follow the law. This includes professional practice acts.
    Although there are no penalties for not following the principles of ethics, there are consequences to self, organizations and the community at-large.
  • Update examples for this slide as current issues arise.
    Select questions of your choice for class discussion.
  • There are certain ethical theories that are employed that serve as a framework to respond to a myriad of ethical questions which we will explore in the next several slides.
  • The problem with employing Utilitarian theories is determining who decides the definition of “greatest” and “good”. The difficulty with Intuitionism is in deciding who’s moral position is more valid. For example, even though abortion is legal and considered ethical (upholds the principles of autonomy (self) and privacy rights) in most states, people still have a moral ambivalence in their “gut” about the law and are actively working towards overturning th law.
  • Who determines what kind of person one ought to be? Consider the values of some of the world’s leaders, do you agree with their actions or values?
  • Why increase interest and respect for diverse societal values?
    Civil Rights Movement
    Feminist Movement
    Gender Equity
    Affirmative Action
    Interaction-exposure among diverse groups (fertilization of new ideas)
    Increase access of diverse populations to health care
    Greater access to higher education amongst minorities and various socio-economic groups and faculty members.
  • An example of stereotyping is all Latinos are loud, all Irish people are alcoholics, all New Yorkers are crass and loud, all Southerners are prejudiced, all Sicilians are not members of the Mafia.
  • Ethnicity can misleading as for example all Latinos do not necessarily share the same cultural values as they come from different countries. Even though one may identify with a certain cultural group, they may not share all the values often associated with that group. For example all Italians are not Catholic.
  • An example of a misunderstanding which may be a barrier to healthcare is assuming that all people of color have poor dietary habits that lead to poor health, (hypertension, obesity and stroke).
  • All Chinese have very similar physical appearances, however, their views about their government and procreation may differ.
  • I need a note.
  • Why is there a renewed focus on privacy and confidentiality? This has arisen due to the electronic sharing of data of client records and the increased risk of sharing client information. For example, employees in the hospital could access anyone’s records for personal use. Ie: fraud and abuse through identity stealing,celebrities or local public figures and selling personal information to the media. Because insurance companies are accumulating data bases, there is a potential for misuse of client information.
  • Day to day operations in healthcare facilities are impacted by this law. Examples of potential violations of the law include: Unauthorized personnel overhearing telephone conversations and leaving client records unattended in visual sight of unauthorized personnel. Student or professional abuses may include the unauthorized duplication of client records and inappropriate discussion of client data. Teaching rounds can create potential violations.
  • There are many more ethical questions and dilemmas we have to deal with today and none has an easy answer.
  • Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE) Decision Making Model
    This model was developed as an on-going evaluation tool. The strategic plan is an ongoing living process. As soon as the organization initiates the assessment process and, therefore, determines the needs of the organization (diagnosis), it is time to move on to the planning phase where the stake holders determine (plan) the strategies to meet the needs of fixing or addressing the problems within the organization (diagnosis). After this phase is completed, it is time to put into action the plans (implement) determined by the organization’s stake holders. It is then imperative to see if the organization has met the goals of the plans and programs that were implemented (evaluate). Upon finishing the evaluation and discovering the success and failures of the implemented plans, (take note already a new organization is emerging), it is time to begin assessing the new organization with it’s new strengths and weaknesses that are a net result of implementing the initial ADPIE process. To do this effectively, it is necessary to initiate the ADPIE process again. At the end of this next ADPIE process, the result will again be a new organization with its new strengths and weaknesses that are a net result of implementing the second ADPIE process. ADPIE then starts again, and so on and so on…. This process is ongoing through out the life of the organization. This helps to prevent inertia, stagnation, and non-growth which is inherent in many organizations who have not put in place an on-going evaluation processes to use as a metric for the on-going outcomes measurements needed for the on-going success of the organization.
  • When communicating with patients it is helpful to approach the subject in an orderly systemic manner. An example of Feature Benefit Check can be identified in this example of a nurse communicating with a patient.
    “Good morning Mr. Gonzales. I would like to give you and injection that will help fight your infection.(Feature) As your infection clears up your fever will go away and you’ll start to feel better. (Benefit). May I proceed with the injection? (Check).
  • Ethics consults are confidential. Any recommendations made are purely advisory in nature. Patients, family members, and health care providers remain responsible for making their own decisions.
  • Ethics consultation services are not intended to replace the normal lines of communication among health care providers, patients, and families. An ethics consult may be helpful when:
    A patient or family member want help in “talking through” ethical issues involved in patient care.
    There is a serious ethical disagreement between healthcare providers, among family members, between health care providers and a patient or between health care providers and family members.
    Ethically, the case is unusual, unprecedented, or very complex.
    A patient, family member or health care provider would like to have the benefit of other perspectives in working through an ethical problem.
  • The importance that ethics committees have attained is indicated by the mention of them as a mechanism for protecting patients’ rights in the standards for patient care developed by the Joint Commission on Accreditation of Health Care Organizations (JCAHO)
  • Ethical principles law_and_cultural_diversity

    1. 1. Objectives: To Understand: • The dynamics between ethics and the law. • How to implement contemporary ethical principles by examining the difference between ideas(duties). • Actions (consequences) as they pertain to the principles and principles of ethics. • The common terms and principles of modern bioethics. 1
    2. 2. Objectives Continued • Why ethics may differ among different cultures and why this knowledge is important. • Why bioethics needs to be integrated through conscious design in order for the health care provider to deliver ethical care. • The importance of ethics in modern medicine in today’s culturally diverse health care environment. 2 To Understand:
    3. 3. Objectives Continued • The case study method of examining everyday bioethical problems to enhance the student’s understanding and implementation of contemporary bioethic principles and principles. • How to utilize ethical principles as guidelines for decision making when caring for clients. 3 To Understand:
    4. 4. Objectives Continued • How to recognize and utilize a decision making model approach to solving ethical dilemmas. • How to identify the ethical duties and actions of the health care professional when obtaining an informed consent from a client/family. 4 To Understand:
    5. 5. Objectives Continued • How to explore positive communication techniques which can be used in obtaining informed consent (feature benefit check)! • How to recognize the health care providers ethical responsibilities in safe guarding the contents of medical records. 5 To Understand:
    6. 6. Objectives Continued • Why ethics may differ among different cultures and why this knowledge is important. • Why bioethics needs to be integrated through conscious design in order for the health care provider to deliver ethical care. • The importance of ethics in modern medicine in today’s culturally diverse health care environment. 6 To Understand:
    7. 7. Ethics and Morality • Ethics is a set of moral principles and a code for behavior that govern an individual’s actions with other individuals and within society. • Morality is what people believe to be right and good, while ethics is a critical reflection about morality. 7
    8. 8. Law • Laws are brought about by tension, agitation and conflict by dramatic situations. • Laws are societal rules or regulations that are obligatory to observe. 8
    9. 9. Law Continued • Laws protect the welfare and safety of society, resolve conflicts, and are constantly evolving. • Laws have governed the practice of medicine for over one hundred of years. 9
    10. 10. Bioethics • Bioethics refers to the moral issues and problems that have arisen as a result of modern medicine and medical research. • Issues in bioethics are usually life- and-death issues! • Ethical and bioethical principles can be personal, organizational, institutional or worldwide. 10
    11. 11. Comparing Law and Ethics • Law, ethics, and bioethics are different but related concepts. • Laws are mandatory to which all citizens must adhere or risk civil or criminal liability. • Ethics relate to morals and help us organize complex information and competing values and interests to formulate consistent and coherent decisions. 11
    12. 12. 12 Value conflicts, no clear consensus as to the “right” thing to do. A conflict between moral obligations that are difficult to reconcile and require moral reasoning. Ethical Dilemma:
    13. 13. 13 Situations necessitating a choice between two equal (usually undesirable) alternatives. Ethical Dilemma:
    14. 14. Ethical Issues in Modern Healthcare In modern healthcare and research, value conflicts arise where often there appears to be no clear consensus as to the “Right thing to do.” These conflicts present problems requiring moral decisions, and necessitates a choice between two or more alternatives. Examples: • Should a parent have a right to refuse immunizations for his or her child? • Does public safety supersede an individual’s right? 14
    15. 15. Ethical Questions, Cont. • Should children with serious birth defects be kept alive? • Should a woman be allowed an abortion for any reason? • Should terrorists be tortured to gain information possibly saving hundreds of lives? • Should health care workers be required to receive small pox vaccination? • Who should get the finite number of organs for transplantation? 15
    16. 16. Ethical Theories: Ideas and Actions • Deontology (duty) • Consequentialism (actions) • Virtue Ethics/Intuition (morals and values) Beliefs • Rights Ethics (individuality and the American culture) 16
    17. 17. Ethical Theories • Deontology /Nonconsequentialism: Derived from the Greek word, Deon, meaning duty. Considers that some acts are right or wrong independent of their consequences. Looks to one’s obligation to determine what is ethical and answers the question: What should I do and why should I do it? 17
    18. 18. An Individual’s Ideas and Actions Deontology: A duty Example: Zelda, a practitioner, believes she has a duty to give cardiac clients detailed information on the pathology involved in their condition even though the client has indicated that they are not ready or may be terrified to hear the information causing the client distress. 18
    19. 19. Ethical Theories Continued • Consequentialism: Also called Teleological, Greek word, Telos, meaning end or consequence. Actions are determined and justified by the consequence of the act. Consequentialists consider all the consequences of what they are about to do prior to deciding a right action. This also answers the question: What should I do and why should I do it? 19
    20. 20. An Individual’s Ideas and Actions Consequentialism: Action Example: Had Zelda respected the wishes of her clients, she would have given them only the information which would have been a benefit to them and not caused them undue stress. She would have been motivated by her desire to do good (beneficence), rather than her sense of duty. This is a Deontological betrayal. 20
    21. 21. Ethical Theories Continued • Utilitarian Ethics: Considers the greatest good for the largest number of people. Also answers the question: What should I do and why should I do it? • Intuitionism: Resolves ethical dilemmas by appealing to one’s intuition, a moral faculty of a person which directly knows what is right or wrong. (A gut feeling of knowing what is right). 21
    22. 22. Ethical Theories Continued • Rights: This popular American theory resolves ethical dilemmas by first determining what rights or moral claims are involved and take precedence, (consider the abortion debate- personal – mom vs. fetus/child, societal- women’s choice vs. murder. 22
    23. 23. Ethical Theories Continued • Virtue Ethics: Contrary to other ethical theories, virtue ethics tells us what kind of person one ought to be, rather than what they do. The focus is on the character (goodness) of the person. 23
    24. 24. Two questions when faced with a dilemma: • Behavior: What should I do? • Motivation: Why should I do it? 24
    25. 25. The Identity Argument • Premise 1: What is understood to be morally right depends (at least in part) on one’s identity as a moral person. • Premise 2: Ones’ race ethnicity and culture is central to one’s identity as a moral person. • Conclusion: Thus, what is understood to be morally right by an individual depends (at least in part) on that person’s race, ethnicity, and culture. 25
    26. 26. Cultural Diversity and Ethics • Increased recognition,interest and respect for diverse societal values. Why? • Fundamental question: What place, if any, do race, ethnicity, and culture have in moral theory? 26 Why Now?
    27. 27. What exactly do we mean by race, ethnicity and culture? – Race –Genetically there is only one race, which is the human race. Society makes judgments about the varieties of biological characteristics. Eventually, biological characteristics are seen as socially constructed which often leads to stereotyping. 27
    28. 28. What exactly do we mean by race, ethnicity and culture? – Ethnicity - An individual’s identification with a particular cultural group to which they are biologically related. 28
    29. 29. What exactly do we mean by race, ethnicity and culture? – Culture - A set of beliefs, values and traditions that are socially transmitted from one generation to another. It defines a group’s norm’s or community’s identity. 29
    30. 30. Cultural Assimilation • A process by which persons of different backgrounds adopt Another group’s main values, traditions and mores. • Cultural Assimilation: – Often occurs in different stages. – It may never be complete due to the group’s efforts in maintaining their identity. – May occur in degrees by choice. 30
    31. 31. Cultural Differences • Value the family over the individual. • Engage and expect the family’s support in their self- care. • Value the institution’s that are sensitive to their cultural needs. 31 MAY INCLUDE:
    32. 32. Cultural Differences – Liberal visiting hours and an un- limited number of visitors (Family based care). – Incorporation of religious beliefs and cultural traditions in tandem with Western medicine. 32
    33. 33. Cultural Differences • Can effect the quality of client care • Can have a negative effect on the family • Should be evaluated carefully to improve healthcare outcomes and prevent: – Misunderstandings – Stereotyping – Barriers – Conflict 33
    34. 34. Stereotypes: Are oversimplifications to conceptions or images of what a particular group or person should look like, or how they should act by disregarding each person’s uniqueness. – Represent the end-point of one’s understanding (all members of a particular group fit the same pattern or mold). – Do not encourage further exploration of the individual or assimilation into the majority group. 34
    35. 35. Generalizations • Generalizations – Statements that represent common trends in a group with the understanding that further information needs to be gathered to verify its application to a particular person. – Represent a starting point and have been used by anthropologists whenever they see broad patterns of similarities among groups of people. – May lead to inaccuracies in their application to a specific client 35
    36. 36. Generalizations • Can assist the health care professional to introduce open- ended guiding questions. This may help the healthcare professional to identify the individual’s values and cultural needs. This may profoundly improve healthcare outcomes. 36
    37. 37. Diversity & Bioethics Contemporary bioethical principles are all derived, directly or indirectly from the principle of autonomy. Within the world, no two people are exactly alike. Therefore, their values, motivations, moral beliefs, and moral characters may differ much more than their physical appearances. 37
    38. 38. Organizational Ideas and Actions • Cultural Relativism: “Everyone does it.” • Cheating • Stealing office supplies • Conducting personal business at work 38
    39. 39. Organizational Ideas and Actions Although “everyone does it”, it still comes down to an individual’s decision about how one is going to act using or not using ethical principles. 39
    40. 40. What Are Ethical Principles, and How Do They Help With Decision Making? 40
    41. 41. Ethical Principles Conflict is inevitable. Ethical principles provide the framework/ tools which may facilitate individuals and society to resolve conflict in a fair, just and moral manner. 41
    42. 42. Ethical Principles • Autonomy/Freedom • Veracity • Privacy/Confidentiality • Beneficence/Nonmaleficence • Fidelity • Justice 42
    43. 43. Autonomy • The right to participate in and decide on a course of action without undue influence. • Self-Determination: which is the freedom to act independently. Individual actions are directed toward goals that are exclusively one’s own. 43
    44. 44. Veracity • The duty to tell the truth. Truth-telling, honesty. 44
    45. 45. Privacy/Confidentiality • Respecting privileged knowledge • Respecting the “self” of others. 45
    46. 46. Beneficence/Nonmaleficenc • The principle and obligation of doing good and avoiding harm. • This principle counsels a provider to relate to clients in a way that will always be in the best interest of the client, rather than the provider. 46
    47. 47. Fidelity • Strict observance of promises or duties. • This principle, as well as other principles, should be honored by both provider and client. 47
    48. 48. Justice • The principle that deals with fairness, equity and equality and provides for an individual to claim that to which they are entitled. – Comparative Justice: Making a decision based on criteria and outcomes. ie: How to determine who qualifies for one available kidney. 55 year old male with three children versus a 13 old girl. – Noncomparative Justice: ie: a method of distributing needed kidneys using a lottery system. 48
    49. 49. Why Employ Ethical Principles? 49
    50. 50. Respect for the Individual • In our pluralistic society individuals often misunderstand each other. • Even when they do understand each other, it is possible for them to disagree. • The Healthcare arena, in common with every other segment of society has found it necessary to find ways to create understanding and agreement.50
    51. 51. How to Create Understanding and Agreement? • Common ground must be created or found. • A function of Ethics, in our society, is to make agreement possible. • As healthcare professionals and patients meet, they meet as strangers from diverse backgrounds therefore, their ways of looking at and approaching the world are usually quite different. 51
    52. 52. Creating Harmony is Difficult In The Healthcare Arena. • Power • Self esteem • Communication • Personality/Attitude • Education Level • Socioeconomic Class • Culture (which constitutes the most profound difference). • Values 52
    53. 53. Changing Healthcare Environment • Managed Care • Increased Healthcare Costs • Technology • Baby Boomers • Young and Old Life Spans • Decrease in Healthy Lifestyles • Lack of Healthcare Access/Insurance • Feelings of Entitlements for Healthcare at a minimal personal co 53
    54. 54. External Forces • Political Influences/Forces – Immigration/Migration of the elderly – Medicare/Prescription drugs – life style driven – Decrease in extended families – Decrease in resources • Work force • Family Caretakers • Support/Finances Services in the Community • Socio-economic Disparities – healthcare right or privilege? 54
    55. 55. How May Harmony Be Achieved? • Through ethical principles/behaviors, because they: – Provide a unique opportunity for personal fulfillment and self respect. – Serve to make it possible for professionals to deal with each other on a human level with respect across all disciplines. 55
    56. 56. Ethical Principles/Behaviors Continued: – Serve to make it possible for professionals and clients to deal with each other on a human level with respect across all cultures and communities. – Make it possible for strangers to achieve understanding (if agreement is not reached, toleration may be achieved). 56
    57. 57. Ethical Principles/Behaviors Continued: – May make it possible for professional and clients to agree on and respect each others rights. – May make it possible for this agreement to carry over into other aspects of life outside the healthcare setting where the idea of Ethics may be first introduced to the professional. – May make it possible for provider and patient to interact on the basis of shared goals. 57
    58. 58. How Ethical Principles and Law Interface • Patient Self Determination Act of 1990 (PSDA) • Health Insurance Portability and Accountability Act of 1996 (HIPPA) (Implementation April 2003) 58
    59. 59. HIPAA Health Insurance Portability and Accountability Act of 1996 (Implementation April 2003) • Ensures privacy and confidentiality of medical records (a legal document that identifies the patient, diagnoses, and justification for treatment). • Healthcare providers are responsible for hiring, and educating personnel to be knowledgeable of HIPAA rules and regulations governing privacy and security of medical records. 59
    60. 60. HIPAA - Continued • Holds all healthcare providers accountable for non-consented release of medical information. • Healthcare providers are responsible for hiring and educating personnel to be knowledgeable about HIPAA rules and regulations governing privacy and security of medical records. 60
    61. 61. Research Driven Ethical Issues With the advent and benefits of modern research, moral conflict is inevitable now and in the future. • Stem Cell Research • Research Cloning • Genome Project Results • Fertility Research 61
    62. 62. Ethical Questions for Discussion • Should children with serious birth defects be kept alive? • Should a woman on Medicaid be allowed an abortion for any reason? • Should organs for transplantation be able to be purchased? 62
    63. 63. Ethical Questions for Discussion • Should people suffering from a genetic disease, where future misery is predicted, be allowed to have children? • Should individuals be allowed to use scarce healthcare resources when death is inevitable? 63
    64. 64. An Example of A Decision Making Model (ADPIE) • Assessment – Gather the facts/collect information from a variety of sources • Diagnosis – Identify the problem or issue 64
    65. 65. • Plan – Explore alternatives and/options. – Identify the consequences of actions/non-actions. – Analyze the values and professional issues at stake. – Select the course of action/make a decision. – Justify the decision. 65
    66. 66. ADPIE Continued • Implementation – Carry out the plan. • Evaluation – Determine how this ethical problem could possibly have been prevented. – Lessons learned. – Assessment of outcomes. 66
    67. 67. Decision Making Model: (ADPIE) 67 Assessment Evaluate Diagnose Planning Implementation On-going Assessment On-going Diagnosis On-going Planning On-going Implementation On-going Evaluation
    68. 68. Ethical Communication • How to explore positive communication techniques which can be used in obtaining consent for treatments (Feature Benefit Check)! 68
    69. 69. Ethics Committees • Decision making in health care often involves more than just medical facts of the case • Ethical principles and values will be the determining factor in which course of action to take. • Many health care facilities have established Ethics committees. 69
    70. 70. Ethics Committees • Found in most health care facility’s • Usually twelve to fifteen members • Multidisciplinary members – A representative from the Board of Trustees – The facility administrator – The facility’s director of Nursing – A staff nurse – A physician – An area clergy – A Social Worker – An Attorney – An Ethic ist (Usually a philosophy or theology professor) – Lay persons from the community 70
    71. 71. Functions of the Committee • Education – To committee members themselves – Continuing education and inservice to facility’s staff – To the community 71
    72. 72. Functions continued • Development and review of laws, standards of care, institutional policies and guidelines – About withdrawing and withholding nutrition and hydration – Do Not Resuscitate – Utilization of facility’s/communities resources 72
    73. 73. Functions continued • Case Consultation with: – Family members – Patients – Health care providers – Staff – And their own clergy 73
    74. 74. Case Consultation May: – Provides information about ethical principles relevant to the case under discussion – Help clarify what options are open – Provide information about relevant policies of the facility – Make a recommendation that is advisory in nature 74
    75. 75. Changing Scope of Ethics Committees • Committees are expanding their scope of their activity to include organizational ethics, considering questions regarding: – Finances – Administration – Organization – Human Resource 75
    76. 76. Expanding Scope In the future, ethics consults may provide for the management of a health care facility just as ethics consults are now available to patients, family members, and staff for particular medical treatment decisions. 76