Health care

1. INTRODUCTIONS TOFOUNDATIONS IN CLINICAL
MEDICINE AND HEALTH CARE ETHICS FCM 401
MS ROSE NG’ANDU

2. WHAT IS IN HERE?
• COURSE CONTENT (Check from main curriculum)
• AIM AND OBJECTIVES
• DURATION OF THE COURSE : SIX WEEKS BLOCK

3. HEALTH CARE ETHICS
WELCOME,
Like any other courses or topics we come to yet
another interesting course, which deals with ourselves,
the people we serve but what matters most is how we
save them.
We are looking at belief systems, human rights why do
what we do and why it is prescribed as right or wrong.
In this cause we may have different beliefs, religion or
non religion and we have to respect that knowing that
every thing has its on place.

4. COURSE AIM
To examine critically central issues concerned with health care ethics.

5. LEARNING OUT COMES
On successful completion of the course the student should be able to:
1. Demonstrate appropriate professional attitude and conduct.
2. Express an understanding of the nature of health care ethics;
3. Demonstrate knowledge of different ethical theories;
4. Demonstrate knowledge of different healthcare-based code of ethics
5. Outline the major health care ethical issues
6 . Analyse critically principles used in ethical decision-making in health
care issues
7. Evaluate clinical situations and formulate an ethical position based
on the principles of ethics and codes of ethics.

6. INTRODUCTIONS
• Medicine and health care deals with human health, life and death
• Health care ethics deal with the norms for the practice of medicine
and health care or how it ought to be done.
• Physicians, nurses and other health workers commonly encounter
ethical and legal issues in their practice

7. ETHICS
• Ethics are moral principles that govern a person’s behaviour or the
conducting of an activity
• A branch of knowledge dealing with moral principle
• The word "ethics“ comes from the Greek Ethikos, Which means
character
• While the word "moral“ comes from the Greek word Mos, Which
means custom.

8. ETHICS
• Ethics also known as moral philosophy explores principles that guide
Human behaviour, determining what is right or wrong, good or bad
And how to live a meaningful life.
Ethics examines moral values, obligations and principles that govern
The evaluation of conduct, character trait.
it is concerned with what is good for an individual and society ( moral
Philosophy)

9. What are moral principles then?
• These are social norms that indicate what people should do or what
they should avoid.
• They also determine which actions should be promoted or recognized
and which should be criticized or punished.

10. MORAL PRINCIPLES CONTN
• Morality refers to a group's cultural and religious beliefs, which
determine what is right and what is wrong.
• Morality offers a set of rules as to what is right or right for any
situation.

11. MORAL PRINCIPLE CONTN
• In other words, moral behaviour responds to a set of customs
established by a group of individuals
• Ethical behaviour is defined by the character of an individual.

12. Examples of morals
Tell the truth
• One of the maxims (sayings or adages) of morality is honesty, telling
the truth at any time. However, telling the truth is not always the right
thing to do.
• Take the following example: if a stalker asks you if you know where a
youngster has fled, the most correct would be to say"no“ yet and if
you knew where the young man in question is.

13. Do not cheat
• In our daily conduct, we must be honest to ourselves and to other
people.
• Cheating is the opposite of honest behavior, which is why we should
avoid this type of behavior in order to live morally.

14. Respect our lives and the lives of others
• In Christianity, one of the commandments of God's law is "you shall
not kill."
• This means we must respect the lives of other people, as well as ours.
• It should be noted that there are cases, as in euthanasia, in which this
principle generates conflicts.

15. Be generous
• Generosity is a moral value that refers to the ability of human beings
to share what they have, not only material possessions but also
immaterial aspects such as joy and optimism.

16. Be loyal
• Loyalty is one of the most beautiful virtues of human beings, since it
involves being faithful, honest and noble

17. To live according to the rules of society
• Our society creates rules for every aspect of our life.
• For example: how we should behave in our homes, at school, at
work, among others. Following these rules makes us moral being
(people).

18. Do not envy
• Envy is the discomfort generated by the desire that a person can have
for the assets of another individual.
• Can you think of any example where envy can be positive?

19. • In your class there could be some students you admire for hard word
and would like to emulate them.
• In this sense, moral behaviour moves away from envy(as negative);
On the other hand, one wants to be happy for the welfare of other
people.
• This means you celebrate their abilities and would want to work hard

20. Altruism
• Being altruistic means helping others without expecting anything in
return.

21. Ethical altruism
• Ethical altruism holds that people (moral agents) have an obligation to
help others.

22. To live according to the will of God
• For Christians, to live according to the will of God is the highest
principle of morality.
• In this sense, the Ten Commandments of God's law are rules that
regulate morality in human beings.
• This is connected to Divine command which we shall discuss later

23. Do not do to others what we would not like them to do to us
• ’’Doing to others what we would not like them to do to us“ is a
phrase we hear from various people and we have also used it, which
summarizes moral principles.
• If we want others to be generous to us, let us begin by being
generous; If we want them to respect us, respect them first.

24. Examples of ethics
• What are the examples of ethical principles

25. Moral right
• People have moral rights to refuse medical treatment.
• The corresponding moral rule prohibits health professional to treat
patient against their will
• The health care provider have a professional moral obligation not to
perform medical intervention on people with their permission or
consent.

26. Ethical principle
As earlier defined,
Ethics is a branch of philosophy that is
responsible for studying the
principles that govern the conduct of
an individual.
Ethical principles depend on the
situation in which a person
encounters and varies from one
individual to another.

27. Acceptance
• One of the ethical principles is acceptance of everything that is
different.
• In this sense, racism and xenophobia are unethical behaviours.

28. Charity
• Charity is a virtue that involves benevolence towards other
individuals.
• Doing good, rendering a helping hand

29. Respect
• Respect is the courtesy that one has towards other people.
• due regard for the feelings, wishes, or rights of others.
• is a positive feeling or action shown towards someone or something
considered important, or held in high esteem or regard.
• it is also the process of honouring someone by exhibiting care,
concern, or consideration for their needs or feelings.*

30. Compassion
• Compassion is the feeling of commiseration towards the sufferings of
another person. For example, a person with terminal cancer may
request euthanasia.
• Morality tells us that we should not attempt against the life of
another person. However, in some cases, professional ethics allow
assisted suicide( death) to be applied.

31. Responsibility
• Responsibility is an ethical principle of each individual that refers to
the fulfilment of an acquired commitment and the fact of responding
for our actions.
• It is the duty one has to account for or having control over

32. Empathy
• The empathy is the ability of human beings to "connect "affectively
with another individual, to share and understand their emotions and
feelings.
• Being empathic allows us to understand the behaviour of other
people.

33. EMPATHY CONTN

34. Equality
• Equality means that people are treated in a way that all can
achieve the same results regardless of the particular factors
that condition each individual.

35. Integrity
• An honest person is the honest person whose behaviour is both
ethical and moral, who does what he says and does not try to take
advantage of others.

36. Justice
• Justice is a virtue that states that each person should receive what
he deserves.

37. Transparency
• Transparency is an ethical principle that relates to
honesty.
• For example, if it is your job to interview a friend to offer
a job and give him the job even though he does not meet
the requirements, your procedure will not be transparent
but biased.

38. Summary of introduction to health care ethics
• AS we practice we ought to uphold human rights, law of the land and
ethical practices.
• Human rights and medical ethics are complementary and use of the
Two together maximises the protection available to vulnerable patients
Human rights and ethical practices ensure patients’ well-being and
autonomy, guiding health providers to act with beneficence,
respect,non-maleficence, justice etc.

39. PHILOSOPHICAL BASES OF HEALTH CARE
ETHICS
• UTILITARIANISM
• KANTIANISM
• EGOISM
• DEONTOLOGY

40. MORAL OBLIGATIONS, RIGHTS DUTIES BASED
ON PHILOSOPHICAL BASES OF ETHICS
• Daily people make decisions, take actions which they evaluate or
others evaluate them as right or wrong.
• Doing good or wrong can be based on the law, technical basis, or
ethical issues

41. Reflection
• How would you evaluate the following statement:
‘The nurse did a good job of informing the patient about the reasons
for instituting intravenous fluid therapy’

42. Possible answers
• It could mean the nurse did a good job legally; that is, the nurse
fulfilled the law.
• It could mean the nurse did a good job psychologically; that is act
produced a good psychologic impact on the patient.
• It could mean that the nurse did a good job technically; that is, every
relevant piece of information was conveyed accurately.
• It could mean that the nurse did a good job ethically; that is, the
nurse did what was morally required

43. THEORIST OF DEONTOLOGY.
• Deontology is a theory of moral obligation, and it encompasses moral
theories that emphasize a person's rights and duties.
• The term was coined by Jeremy Bentham in 1814, and he believed
that deontology was a way to for people to act for the general good
• Bentham believed that following a strict moral code of behaviour was
in fact for the general good of humankind.

44. Deontology contn
• The theory of deontology states that when we have to make ethical
decisions, our first thoughts are on our duties and obligations.
• Duties drive how we act in different situations.
• E.g we may make a decision based on following the law or based on
our loyalty toward friends or family members.(visiting, sending a gift)

45. Deontology contn
• Deontology (or Deontological Ethics) is the branch of ethics in which
people define what is morally right or wrong by the actions
themselves.
• The word deontology comes from the Greek root ‘deon’, which
means duty, and logos, which means science. Thus, deontology is the
"science of duty.“
• It is sometimes described as duty-, obligation-, or rule-based ethics.

46. Deontological moral system
• Deontological moral systems are characterized by a focus upon and
strict adherence to independent moral rules or duties.
• To make the correct moral choices one must understand what those
moral duties are and what correct rules exist to regulate those
duties.
• When the deontologist follows his or her duty, he or she is by
definition behaving morally.
• Failure to follow one's duty makes one immoral.

47. Deontological moral system contn
• In a deontological system, duties, rules, and obligations are
determined by an agreed-upon code of ethics, typically those defined
within a formal religion.
• Being moral is thus a matter of obeying the rules laid out by that
religion. E.g in Christianity ‘you shall not kill’
• OR you shall not lie

48. The Motivation of Moral Duty
• Deontological moral systems typically stress the reasons why certain
actions are performed. Simply following the correct moral rules is often
not sufficient.
• Correct motivations as well are needed
A deontologist is not considered immoral even though they have broken
a moral rule, as long as they were motivated to adhere to some correct
moral duty (and presumably made an honest mistake).
e.g you shall not kill (abortion) but at times you may induce abortion to
save the mother.

49. The Motivation of Moral Duty contn
• Nevertheless, a correct motivation alone is never a justification for an
action in a deontological moral system.
• It cannot be used as a basis for describing an action as morally
correct.
• It is also not enough to simply believe that something is the correct
duty to follow.
• So there is need for balance between morally right and correct motive

50. The Motivation of Moral Duty contn
• Duties and obligations must be determined objectively and absolutely,
not subjectively.
• There is no room in deontological systems of subjective feelings.
Example In the midst of wound debridement the patient begs you to
just stop doing it. As much as you can understand their pain you should
not stop otherwise the there be sepsis which may lead to amputation

51. Deontology as a the Science of Duty
• In most deontological systems, moral principles are absolute (total
outright).
• In particular, that means that moral principles are completely
separate from any consequences which following those principles
might have.
• Thus, if the set of values says it is a sin to lie, then lying is always
wrong.

52. Weakness of Deontology
• There is no standard for what a person’s duties and obligations are.
• Philosophers who don’t agree with this theory believe that everyone’s
duties are different
• It is difficult to know what drives a person to make a particular
decision.

54. questions
is it always bad to lie?
• Yes or no, give example and stimulate a discussion

55. Some response to ‘is lying always bad’
• In the bible some people lied and saved themselves and others –Rahab
Joshua 2 :1-24
• A deontologist following such strict religious principles would be acting
immorally because Rahab lied to king of Jericho about where Israelites
were hiding.
• The question is if the king of Jericho wanted to kill the Israelite spies and
you show them because it is wrong to lie is it morally correct?
• A deontologist following such strict religious principles would be acting
immorally if she lied to king of Jericho about where Israelite spies were
hiding.

56. Key questions which deontological ethical
systems ask include
• What is the moral duty?
• What are my moral obligations?
• How do I weigh one moral duty against another?
• When am carrying out my duty what are the consequences I should
look out for?

57. Some examples of deontological action
• A group of terrorists is holding two hostages and threatening to kill
them both unless you kill a third person.
• The Consequentialist would kill the third person because by doing so
you minimize the outcome (fewer dead people).
• The Deontologist would not kill the third person because it is never
right that you should kill anyone, regardless of the outcome.

58. Some examples of deontological action
You are walking in the woods and you have snake venom antidote in your
backpack. You come across a person who has been bitten by a snake and you
recognize the person as one proven to be responsible for a series of rapes and
killings in your country.
• The Deontologist gives the antidote to the person because it saves a life; (moral
duty & obligation to save lives as a medical personnel)
The Consequentialist withholds the medication because to do so potentially saves
many others from the rapist and killer.
The rapist would be dead and no more killings or rape cases.

59. Deontological actions contn
• Your mother has Alzheimer's disease and every day she asks you if she
has Alzheimer's disease.
• Telling her "yes" makes her miserable for that day, then she forgets
what you told her and asks you again the next day.
• The Deontologist tells her the truth because lying is always wrong; the
Consequentialist lies to her because they will both enjoy that day as
the mother would not be miserable for being told the truth

60. Conflicting Moral Duties
• As you practice Medicine or any other duties you may come into
conflict in choosing an action without injuring the other person
• A common criticism of deontological moral systems is that they
provide no clear way to resolve conflicts between moral duties.

61. Conflicting moral duties
• In the situation involving Nazis and Jews, how is a person to choose
between those two moral duties?
• If the Nazis come and ask you to show them where the Jews are
hiding would it be wrong to show them (tell the true)
• A deontologist following such strict religious principles would be
acting immorally if she or he lied to Nazi about where Jews were
hiding

62. Conflicting moral duties contn
• One response to that might be to simply choose the "lesser of two
evils.“
• However, that means relying on knowing which of the two has the
least evil consequences.
• Therefore, the moral choice is being made on
a consequentialist rather than a deontological basis.

63. Questioning moral duties
• According to this argument, duties, and obligations set forth in
deontological systems are actually those actions which have been
demonstrated over long periods of time to have the best
consequences.
• Eventually, they become enshrined in custom and law.

64. Questioning moral duties
• People stop giving them or their consequences much thought—they
are simply assumed to be correct.
Things change with time old moral duties and obligations may change

65. Questioning Moral Duties
• A second criticism is that deontological moral systems do not readily
allow for gray areas where the morality of an action is questionable.
• They are, rather, systems which are based upon absolutes—absolute
principles and absolute conclusions.

66. • In real life, however, moral questions often involve grey areas rather
than absolute black and white choices.
• We typically have conflicting duties, interests, and issues that make
things difficult.
• Deontology is patient-centered, while utilitarianism is society-
centered

67. Sources
• Brook, Richard. "Deontology, Paradox, and Moral Evil." Social Theory
and Practice 33.3 (2007): 431-40.
• Dougherty, Tom. "Agent-Neutral Deontology." Philosophical
Studies 163.2 (2013): 527-37.

68. TYPES OF ETHICAL THEORIES
• Philosophers today usually divide ethical theories into three general
subject areas:
• metaethics
• normative ethics,
• and applied ethics.

69. ETHICAL THEORIES CONTN
Ethical theories can be further be categories as
Normative Ethics-They can be general or applied or practical
normative have either moral principles as standards of right action
OR
virtues as standards of good character in terms of which right action can be known
eventually

70. APPLIED NORMATIVE ETHICS
• In applied normative ethics as opposed to general normative
ethics, the task is to resolve particular moral problems e.g.
Is abortion morally justifiable

71. Descriptive ethics
• Descriptive ethics is an objective study of the ethics of a particular
group or some set of ethics standard.
• It asks empirical questions such as how do people think they ought to
act in a particular situation. Eg is killing always wrong?
• So it uses scientific technique to study how people reason and act.

72. Meta ethics
• Metaethics is a branch of philosophical inquiry which involves
analysis of the language, concepts and methods of reasoning in
normative ethics
• e.g. addressing the meanings of the terms such as right, obligation,
permissible, virtue, justification….
• So metaethics is the study of just what “ethics” means and to what
degree ethical claims can ever be justified and how.

73. • A meta-ethical study would be concerned, amongst other things,
with determining the meaning and objectivity of moral concepts of
right and wrong, or good and bad

74. APPLIED ETHICS
• Applied ethics is just the application of normative ethics to particular
issues of practical concern such as abortion, euthanasia, cloning,
animal rights and criminal punishment.

75. TYPES OF NORMATIVE ETHICS
• Kantianism- with the categorical imperative as the fundamental
moral principle (being rational, doing right because its right thing)
• Utilitarianism- with the principle of utility as the basic moral principle
(greatest good for greatest number over pain)
• Virtue ethics with virtues as its focus.

76. UTILITARIANISM
• Jeremy Bentham is the founder of utilitarianism
• He described utility as the sum of all pleasure that results from an
action, minus the suffering of anyone involved in the action.

77. What would you say about this?
• Julie walks into a hostage situation. There are 20 hostages and she is
told that if she shot one hostage, she will save the lives of the other
19.
• Utilitarianism would support Julie’s killing of one of the hostages
because the other 19 lives are a greater benefit, regardless of the fact
that the cost would be one person’s life.

78. Utilitarianism
• According to the theory of utilitarianism, people choose their actions
based on how their decisions will benefit the most people.
• You make a decision that will be best for everyone involved.
• Act utilitarianism says you will make decisions based on helping
others, while rule utilitarianism says you will act out of fairness.

79. UTILITARIANISM CONTN
• Look at the potential consequences of each available choice
• Pick the option that either does the most to increase happiness or
does the least to increase suffering.
• Utilitarianism, also known as consequentialism, is often summed up
as a philosophy of "The greatest good for the greatest number’’

80. • Utilitarian ethical theories are based on one’s ability to predict the
consequences of an action.
• The choice that yields the greatest benefit to the most people is said
to be ethically correct

81. TYPES OF UTILITARIANISM
• Act utilitarianism-This is about performing the acts that benefit the most
people, regardless of personal feelings or the societal constraints such as
laws.
• An act utilitarian decision maker is concerned with achieving the
maximum good.
• One individual’s rights may be infringed upon in order to benefit a greater
number of people

82. • Classical utilitarianism says that the right action is that which
produces the greatest balance of overall happiness.
• By saying that happiness is the only determinant of the rightness of
an action,

83. RULE UTILITARIANISM
• Takes into account the law and is concerned with fairness.
• Seeks to benefit the most people but through the fairest and
most just means available.

84. THINK ABOUT THIS CONCERNING
UTILITARIALISM
What are we to conclude in all who are in any way affected?
If only the greatest number deserves to get the greatest happiness and
pleasure then how about when ten men obtain maximum sexual
pleasure by raping a single young virgin?
Does it really matter how happiness is derived and distributed?

85. KANTIANISM
• Philosopher behind this was Immanuel Kant (1788)
• The categorical imperative is basically a principle of consistency,
demanding that we act on reasons which is universally acceptable

86. • Kantianism revolves entirely around duty rather than emotions or
end goals.
• Kant's ethics are founded on view of rationality as the ultimate good.
• Belief that all people are fundamentally rational beings who need to
be respected

87. Contractarianism
• Contractarianism—An action is morally right if it is in accordance with
the rules that people would agree to observe upon entering into a
social relationship (contract) for mutual benefit.
• This is also sometimes referred to as Contractualism.
• As Medical personnel you will be engaging in such relation to patient
care.

88. Egoism

89. Egoism
•Egoism is the philosophy concerned with the role of
the self, or ego, as the motivation and goal of one's
own action.

90. EGOISM CONTN
Medical Definition of egoism
•a doctrine that individual self-interest is the actual
motive of all conscious action
a doctrine that individual self-interest is the valid end
of all actions

91. EGOISM CONTN
•Actions are morally right because they are best
promoting one’s self interest.
•example: a person who owes money to a friend and
decides to pay the friend back not because that
person owes money, but because it is in his best
interest to pay his friend back so that he does not lose
his friend.

92. EGOISM CONTN
•The concepts of ethical egoism were first introduced
by Henry Sidgwick in a book published in 1874
entitled The Methods of Ethics.
•Egoism, Sidgwick argues, focuses on maximizing the
pleasure of the individual.

93. TYPES OF ETHICAL EGOISM
• Individualistic Egoism.
•This form of ethical egoism would promote the self-
interest of each individual, encouraging everyone to
make the best possible choices for themselves at all
times

94. ETHICAL EGOISM CONTN
•Personal Egoism. This form of ethical egoism promotes
personal self-interest without attempting to influence
others to do the same.
•Universal Egoism. This form of ethical egoism would
promote that everyone should act in a way that is in
their own self-interest.

95. ETHICAL EGOISM CONTN
• Although it might seem to imply otherwise, ethical egoism theory
does not require individuals to harm the interests of others when
making a moral decision.
• That harm may occur as a consequence of pursuing one’s own
interest, but it does not promote foolishness.
• It does not promote always doing what one wants to do either.

96. Justifications for Ethical Egoism
• The primary justification for ethical egoism is that each person has a
natural desire to fulfil their own wants and needs.
• Each person is also placed into a position where they can pursue
those wants and needs with whatever energy they desire
• Cain’s response is defiant. “I don’t know. Am I my brother’s keeper?”
(Christianity genesis)
• In ethical egoism, the idea is that each person knows what is best for
their short-term and long-term wants and need

97. JUSTIFICATION OF MORAL EGOISM
• Ethical Egoism also eliminates the concept of altruism. This is usually
exampled by hunger.
• If you eat a sandwich in front of someone who is hungry, it would be
considered an immoral indulgence because you are meeting your
needs, but ignoring the needs of someone else.
• Yet it would be a moral indulgence to solve hunger in someone else,
but creating hunger in oneself.

98. JUSTIFICATION OF MORAL EGOISM
• Ethical egoism solves that problem by directing each individual to
solve their own hunger problem instead of relying on someone else to
do it for them.(building self reliance)
• Example patients and doctors have their duty to play Doctor sees
patient for a good salary patient should take drugs for their own
health

99. Divine Command Theory: A Higher Power
Ralph Cudworth popularized divine command theory
This theory states that God is the ultimate arbiter of what constitutes
morality, and that without God we have no clear way of telling right
from wrong.
Divine command theorists, therefore, believe that the best way to live
a moral life is to act in accordance with Scripture

100. Divine Command Theory cont
• Those who believe in this theory generally look to the Bible, a
religious leader or someone they have considered to be a prophet in
order to make their judgments.
• This is one of the most controversial moral theories.

101. What is your opinion?
• In relation to divine command discuss the issue of not working on
Sabbath
• Comment on admiring your neighbor’s prosperity is it right or wrong?
Defend your answer by basing it on the theory

102. Suggested moral aspect of divine command
theory
• If God commands people not to work on sabbath, then people act
rightly if they do not work on Sabbath because God has commanded
that they do not do so.
• If they do not work on Sabbath because they are lazy, then their
action is wrong, even though the actual physical action performed is
the same.
• If God commands not to covet a neighbor's goods, this theory holds
that it would be immoral to do so, even if coveting provides the
beneficial outcome of a drive to succeed or do well.

103. permissible or not
• to kill one person to harvest his organs in order to save the lives of
five others.
• to divert a car that has lost control go towards immobile person
stand-by to avoid killing five immobile people stand-by.

104. Permissible versus non permissible
• Principle of Permissible Harm explains the moral difference between
these and other cases, and that at times we may not act to bring
about good ends—such as in the organ harvesting case.
• Permissible harm is an attempt to provide a deontological
prescription for determining the circumstances in which people are
permitted to act in a way that harms others.

105. RELATIVISM THEORY
• Relativism determines morals and ethics according to the society that
is being observed.
• Relativism argues that every society and culture believes differently
and thus, each culture must be evaluated according to its particular
cultural patterns and influences.

106. Relativism: A Theory Based on Experiences
• Moral relativism is a theory which states that no one person's morals
are better or worse than any other.
• Relativists argue that a person's moral code is shaped by the society
in which he is raised as well as their culture, and it states that no
society is inherently better or worse than any other

107. Relativism contn
• Relativism is a moral philosophy that could, therefore, be different
depending on where you grow up, and what may be right in your society,
could be very wrong in another person's society
• For example, in American culture cannibalism is considered taboo, while
in other cultures the act of consuming other human flesh is accepted as a
sacrifice or ritual.