Ethics in Daily Practice

1
Ethics in Daily Practice

• Vicki Judd, MD., University of Utah
• Paul Myers, Ph.D., University of Portland

2
Ethics Committee Members

• Paul Myers, Director, Univ. of Portland (chair,
  voting member) (term 2008-2010)
•  
• Sam Alexander, Director, Univ. of Denver,
  (secretary, voting member) (term 2008-2010)
•   
• Cathy Felix, Director at Cal. State, Chico
  (voting member) (term 2010-2012)
•  
• John Kolligian, Exec. Director, Princeton Univ.
  (voting member) (term 2010-2012)
• Marc Hiller, Professor, Univ. New Hampshire
  (voting member) (term 2009-2011)
• Vicki Judd, Professor, University of Utah (voting
  member) (term 2008-2010)
• Chad Williams, Student, (voting member, so may or
  may not be available for the second year)
  2009-2010
• Jerry Wilmes, Director, NW Missouri State Univ.
  (voting member) 2010-2012
• Eryn Oberlander, Psychiatrist, New York City
  (voting member) 2010-2012
• Tim Crump, Liaison to ACHA Board of Directors and
  Regional Representative for the Pacific Coast
  College Health Association

3
Objectives

• Describe ACHA Ethical Principles and Guidelines
• List the changes of the ACHA Ethical Principles
  and Guidelines
• Discuss the application of the ACHA Ethical
  Principles and Guidelines to actual situations

4
Quiz

• Which two ancient philosophers were also
  physicians?

5
Hippocrates and Aristotle
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Ethics of Hippocratic Medicine

• Harnessing the principles of nature as a guide to
  healing
• Be of benefit, do no harm
• Asclepius
• Practiced medicine for those who were healthy in
  their nature but were suffering from a specific
  disease he rid them of it then ordered them to
  live as usualfor those however, whose bodies
  were always in a state of inner sickness he did
  not attempt to prescribe a regimen to make their
  life a prolonged miserymedicine was not intended
  for them and they should not be treated even if
  they were richer than Midas.
• Plato, The Republic

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Four Principles

• Establishment of 4 Principals(Beauchamp and
  Childress) 1979A Reminder of What You Already
  KnowA) BeneficenceB) Non-maleficenceC)
  AutonomyD) Justice

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Beneficence

• Obligation to preserve life, restore health,
  relieve suffering, and maintain function
• To do good
• Nonabandonment obligation to provide ongoing
  care
• Conflict of interest must not engage in
  activities that are not in students best interest

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Nonmaleficence

• Do no harm, prevent harm, and remove harm

10
Autonomy

• Right to self-determination
• Requires decision making capacity
• Lack should be proven not assumed
• Competence legal determination
• Liberty freedom to influence course of
  life/treatment

11
Justice

• Allocation of resources must be fair and
  according to need
• Should not make decisions regarding individuals
  based upon societal needs

12
Values and Ethical Priorities

• Culture bestows values
• Values set up Morals
• Ethics are rules used to assist in making good
  choices and avoiding bad choices

13
Cultural Influence on Values

• Family
• Ethnicity
• Religion
• Race
• Economic status
• Education
• Life experiences
• Sexual orientation
• Gender

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Values

• What do you value?

15
Values

• Values are things that an individual believes to
  be intrinsically worthwhile or desirable, that
  are prized for themselves (e.g. truth, beauty,
  honesty, justice, respect for people and the
  environment).

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Values Examples

• Extend hospitality to strangers and travelers
• Give alms
• Dont trust professionals
• Us and Them
• Do unto others
• Idleness is the devil..

• Penny saved is penny earned
• There but for the grace of God, go I
• Dont share the familys business
• My dad would kill me!
• And

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Be sure you are right, then go ahead. Davy
Crockett 1786-1836
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Teddy Roosevelt said, To educate a person in
mind and not in morals is to educate a menace to
society.


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Values Examples

• Education without values, as useful as it is,
  seems rather to make man a more clever devil.
  C. S. Lewis

20
President Lincoln said Honor is better than
honors.
21
When the situation needs improvement, Gandhi
offers guidance You must be the change you wish
to see in the world.
22
The reputation of a thousand years may be
determined by the conduct of one
hour. Japanese proverb
23
To see what is right and not to do it is want of
courage. (Confucius)
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Values Examples
It behooves every man who values liberty of
conscience for himself, to resist invasions of it
in the case of others or their case may, by
change of circumstances, become his own. Thomas
Jefferson

• It behooves every man who values liberty of
  conscience for himself, to resist invasions of it
  in the case of others or their case may, by
  change of circumstances, become his own. Thomas
  Jefferson

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MORALITY

• Morality involves peoples' views of what is good,
  right, or proper their beliefs about their
  obligations and their ideas about how they
  should behave.
• Morality concerns duties and obligations to one
  another and is characterized by words such as
  right, ought, just, and fair.

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Inventory of Applicable Principles

• ?

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Inventory of Applicable Principles

• Justice
• Care
• Fidelity
• Honesty
• Trustworthiness
• Personal Autonomy
• Liberty
• Accountability

• No Harm
• Happiness
• Do Good
• Role Fidelity
• Professional Autonomy
• Confidentiality
• Pain Avoidance

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ETHICS

• Ethics is the study of right and wrong, duties
  and obligations.
• Ethics involves critical reflection on morality,
  including the ability to make choices between
  values and the examination of the moral
  dimensions of relationships.

29
AHCAs Ethical Principles

• Ensure respect and autonomy
• Promote Justice
• Protect privacy

• Do no harm
• Provide beneficial and caring services

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ACHA Ethical Guidelines

• Responsibility in the Provision of Services
• Professional Responsibility and Competence
• Responsible and Ethical Relationships
• Responsibility to Ones Institution
• Responsibility to the American College Health
  Association (ACHA) and to the Field of College
  Health

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What Does a Code of Ethics Do?

• Creates a professions sense of identity
• Identifies the issues the profession cares about
  and wants new members to care about
• Communicates with those outside the profession
  what they can expect from its members

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PROFESSIONAL ETHICS

• The moral commitments of a profession that
• involve moral reflection that extends and
  enhances the personal morality practitioners
  bring to their work,
• concern actions of right and wrong in the
  workplace, and
• help individuals resolve moral dilemmas they
  encounter in their work.

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Recommendations

• ACHA members expected to uphold the principles
  and guidelines
• Use this document as a guide in day to day
  practice and when breaches in ethics are evident

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Suggested Resources

• The following are suggested reading materials
  from the Ethics Committee.  ACHA does not endorse
  or accept responsibility for the content or use
  of external websites or materials.
• Institute for Global Ethics  http//www.globalet
  hics.org
• The Ethics of Health Care A Guide for Clinical
  Practice, by Raymond S. Edge and John Randall
  Groves Foundations of Ethical Practice,
  Research and Teaching in Psychology, by Karen
  Strohm KitchenerPrinciples of Biomedical
  Ethics, 5th Edition, by Tom L. Beauchamp James
  F. Childress

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Suggested Resources

• Gough, R. W. (1998). Character is destiny.
  Rocklin, CA Prima. Kidder, R. M. (2005). Moral
  courage. New York HarperCollins Publishers
  Corey, G., Corey M.S., and Callanan, P. (2007).
  Issues and ethics in the helping professions.
  Pacific grove, CA Brooks/Cole. Callanan, P.
  (2004). The cheating culture. New York Harcourt
  Inc.
• Fadiman, A. (1998). The spirit catches you and
  you fall down A Hmong child, her American
  doctors and the collision of two cultures.
  Kidder, T. (2003). Mountains beyond mountains
  The quest of Dr. Paul Farmer. Mortenson, G.
  Relin, D.O. (2006). Three cups of tea One man's
  mission to promote peace one school at a time.

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How can ethics be used is real life situations?
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Discuss Sources of Similarity and Difference
Among Participants in Both Process and Outcomes
of These Analyses

• Small Group Discussion of Case Examples
• Principles and Guidelines Used
• Cultural, Professional Diversity Considerations
• Ethical Method Employed
• What will, or might happen?
• Large Group Sharing of Similarities and
  Differences Identified

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Small Group Discussion Time

• Pick a scribe for reporting back to large group
• Identify a case situation, unpack it
• Apply different principles and actors from
  different perspectives and backgrounds
• Track what principles or guidelines are
  applicable, or at odds with one another

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Reports to the Large Group

• What was your groups case situation?
• What were key issues/dilemmas?
• What principles were involved?
• What role did diversity play?
• Other highlights?