ethics and law chapter 1

applied ethics

practical application of moral standards to the conduct of individuals involved in organizations

amoral

lacking or indifferent to moral standards

bioethicists

persons who specialize in the field of bioethics

bioethics

the moral dilemmas and issues of advanced medicine and medical research

comparable worth

theory that extends equal pay requirements to all persons doing equal work, aka pay equity

compassion

ability to have a gentle, caring attitude toward patients and fellow employees

cost/benefit analysis

an ethical approach in which the benefit of the decision should outweigh the costs; also called utilitarianism

due process

the entitlement of all employees to have certain procedures followed when they believe their rights are in jeopardy

duty-based ethics

focuses on performing one's duty to various people and institutions

empathy

the ability to understand the feelings of another person without actually experiencing the pain or distress that a person is going through

ethics

branch of philosophy relating to morals and moral principles

fidelity

loyalty and faithfulness to others

indigent

a person who is impoverished and without funds

integrity

the unwavering adherence to one's principles; dedication to maintaining high standards

justice-based ethics

based on the moral restraint of the veil of ignorance

laws

rules or actions prescribed by a governmental authority that have a binding legal force

litigious

excessively inclined to sue

medical ethics

moral conduct based on principles regulating the behavior of healthcare professionals

medical etiquette

standards of professional behavior that physicians use for conduct with other physicians

medical practice acts

laws established in all 50 states that define the practice of medicine as well as requirements and methods for licensure in a particular state

morality

the quality of being virtuous or practicing the right conduct

precedent

a ruling of an earlier case that is then applied to subsequent cases

principle of autonomy

the right to make decisions about one's own life

principle of beneficence

action of helping others and performing actions that result in the benefit to another person

principle of justice

warns us that equals must be treated equally

principle of nonmalfeasance

means, "first, do no harm

quality assurance

gathering and evaluating information about the services provided as well as the results achieved and comparing this information with an accepted standard

rights-based ethics

a natural rights ethical theory that places the primary emphasis on an individuals rights

sanctity of life

sacredness of human life; all human beings must be protected

sexual harassment

unwelcome sexual advances or requests for sexual favors

sympathy

pity for someone else

tolerance

a respect for those whose opinions, practices, race, religion, and nationality differ from our own

utilitarianism

an ethical theory based on the principle of the greatest good for the greatest number

virtue-based ethics

a character trait based on a concern for the person

to promote good patient care and protect patients from harm

what is the primary duty of healthcare workers?

it can help protect you and your employer from being sued;
helps the medical professional in making sound decisions based on reason and logic instead of emotion or gut feeling

why study medical ethics and law?

medical law

category of law the addresses legal rights that affect patients and protect individual rights, including those of healthcare employees

unethical

in general, an illegal act is always.......

no

is an unethical act always illegal?

defensive medicine

form of medicine where physicians may order unnecessary tests and procedures in order to protect themselves from a lawsuit

the law allows many actions that are morally offensive

what is the problem with measuring our actions only using the law and not considering the ethical aspects of an issue?

negative; positive

the requirements of the law tend to be .............; while the standards of morality are seen to be ......................

reactive

laws are often ...........and may lag behind the moral standard of society

reason; logic

ethics uses ........... and ........... to analyze problems and find soluctions

improving the welfare of people in a moral way

ethics is concerned with the actions and practices directed at what?

people

ethics always involves .......

the interests of others in deciding how to act or behave

ethics involves the formal consideration of .......

teological theory

ethical theory that asserts an action is right or wrong depending on whether it produces good or bad consequences

utilitarianism

example of a teological ethical theory

deontological theory

ethical theory that asserts that at least some actions are right or wrong and, thus, we have a duty to perform them or refrain from them

duty-based ethics

example of a deotonlogical ethical theory

utilitarianism

-rightness or wrongness of act is determined by its consequences
-the ends justify the means
-cost/benefit analysis justifies the means of achieving a goal

-some people will fall through the cracks
-can result in a biased allocation of resources, ignoring the rights of some vulnerable people

two problems with utilitarianism

-Medicare system
-organ distribution when there is a limited supply

examples of utilitarianism

rights-based ethics

-rights belong to all people purely by virture of them being human
-due process

protects the individual from injury (i.e. OSHA laws)

strength of rights-based ethics

incidents of individualistic selfish behavior that is independent of the outcomes (i.e. unions protecting other union members while excluding the rights of nonunion members)

weakness of rights-based ethics

duty-based ethics

-actions should be universal
-everyone should act the same way with the same set of circumstances

-conflicting opinions about what our duty or responsbility is in particular circumstances
-conflict when employers asks you to do something you feel is wrong or unethical
-people from different cultures may have a different sense of what duty means

problems with duty-based ethics

justice-based ethics

-based on the "veil of ignorance"
-no one person is advantaged or disadvantaged
-every citizen should have equal access to medical care
federal single-payer health system

veil of ignorance

all social contracts should be handled so that no one knows the gender, age, race, health, number of children, income, wealth, or any other arbitrary personal information about an individual

virtue based ethics

-emphasis is on persons and not necessarily the decisions or principles involved
-seek the "good life"
-Aristotle
-goal of life is happiness
-happiness is not solely on what we gain in life but also on who we are
-based on belief that we have a duty or re

-causes emotional or physical harm to someone else
-goes against one's deepest beliefs
-makes a person feel guilty or uncomfortable about a particular action
-breaks the law or traditions of their society
-violates the rights of another person

an action is considered wrong or unethical if it:

beneficance, fidelity, gentleness, humility, justice, perseverance, responsbility, sanctity of life, tolerance, and work

the 10 most respected virtues

beneficance

the action of helping others and performing actions that would result in benefit to another person

gentleness

a mild, tenderhearted approach to other people

humility

-acquiring an unpretentious and humble manner
-requires that we recognize our own limits

justice

-fairness in all our actions with other people
-same rules apply to everyone

perseverance

-persisting with a task or idea even agains obstacles
-steady determination to get the job done

responsbility

-a sense of accountability for one's actions
-implies dependability

work

an effort applied toward some end goal

respect, integrity, honesty, fairness, empathy, sympathy, compassion, loyalty

8 virtures of interpersonal ethics

respect

the ability to consider and honor another person's beliefs and opinions

honesty

quality of truthfulness, no matter what the situation

fairness

-treating everyone the same
-implies an unbiased impartiality and a sense of justice

loyalty

sense of faithfulness or commitment to other persons

privacy, due process, sexual harassment, and comparable worth

specific issues that affect the workplace

privacy

the ability to safeguard another person's confidences or information

both a legal and ethical issue

what kind of issue is violating patient confidentiality?

-protect's the worker's state certification, license, or registration to practice
-worker must receive notice of charges, an investigation of the allegations, and a hearing if necessary

why is due process importat for healthcare workers?

objective

what must the decision maker always be when making ethical decisions?

-three-step model
-seven-step decision model
-Bernard Lo clinical model

three decision-making models that can be helpful when making ethical decisions

Blanchard-Peale Model

alternative name for the three-step ethics model

-is it legal?
-is it balanced?
-how does it make me feel?

three steps in the three-step ethical model

-makes sure that there is not an imbalance so that one person or group suffers or benefits more than another as a result of your action

what is the purpose of step 2 (is it balanced?) in the 3-step ethical model?

a "yes" to questions 1 and 2 and a "good" to question 3

what answers in the 3-step ethical model indicate that the action is ethical?

analysis

the ability to carefully take apart issues, restate them in your own words, and offer an interpretation or criticism of them

1. determine the facts
2. define the precise ethical issue
3. identify the major principles, rules, and values
4. specify the alternatives
5. compare values and alternatives
6. assess the consequences
7. make a decision

what are the 7 steps in the 7-step ethical model?

- what do we need to know
- who is involved in the situation
-where does the ethical situation take place?
-when does it occur?

what questions need to be answered to determine the facts in the 7-step ethical model?

to determine if one principle or value is so compelling that the proper alternative is clear

why should we compare values and alternatives in the 7-step ethical model?

look at short-term, long-term, positive, and negative consequences of major alternatives

how are consequences assessed in the 7-step ethical model?

seven-step decision model

ethical model that forces us to closely examine the facts before making an ethical decision and has many sub-decision questions to answer

Bernard Lo clinical model

decision making model developed to ensure that no important considerations relating to patient care are overlooked

1. gather information
2. clarify the ethical issues
3. resolve the dilemma

what are the 3 steps of the Bernard Lo clinical model?

-meet with patient and healthcare team
-list alternatives of care
-negotiate a mutually acceptable decision

how is an ethical dilemma resolved in the Bernard Lo clinical model?

Bernard Lo clinical model

ethical model that is most widely used in a hospital or clinical setting

reason; fact

ethics must be grounded in ........... and ............

1. principle of autonomy
2. principle of beneficance
3. principle of nonmalfeascance
4. principle of justice

four principles that serve as guidelines when confronting bioethical dilemmas

principle of autonomy

informed consent"; patients must be informed and understand what they are told before they can provide consent for treatment

principle of beneficance

-we must not harm patients while trying to help them
-medical science must do what is best for each individual patient

principle of nonmalfeascance

-taken from the latin Primum non nocere
-not only do good for the patient, but do no harm in the process
"first, do no harm

principle of justice

-equals must be treated equally
-same treatments must be given to all patients no matter their demographics

when patients are unable to provide their personal wishes

when are the four bioethical guidelines most useful?

ethics committees

what do hospitals have to examine ethical issues relating to patient care?

-serve in an advisorry capacity to patients, family, and staff for case review of difficulty ethical issues
-develop and review health policies and guidelines regarding ethical issues
-determines recommendations based on predetermined criteria

what is the role of the ethics committee?

-patient complaints relating to confidentiality
-errors in dispensing medication
-errors in labeling of lab speciments
-adverse reactions to treatments or medications
-inability to obtain venous blood on the first attempt
-safety and monitoring practices

types of issues reviewed by a QA committee

-phone calls to fellow doctors will be taken promptly
-doctors wil be seen immediately when visiting another doctor's office
-physicians should be referred to as Doctor

examples of medical etiquette