Ethics

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Ethics Quality

• NAHQ Annual Educational Conference
• September 17-20, 2006
• Jason E. Gillikin, CPHQ

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Agenda

• Introductory comments
• A bit about ethics
• Challenges for application
• Basic principles of ethical theory
• Strategies for linking ethics quality
• Open discussion

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Introductory Comments

• About your presenter
• About Spectrum Health
• State of the industry
• Moral philosophy
• Healthcare quality

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A Bit about Ethics

• What ethics is NOT
• Compliance
• Teamwork
• Psychology
• Social work
• Trendy leadership fad
• Manipulation tool

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A Bit About Ethics

• Ethics moral philosophy is a branch of
  value theory that addresses the methods by which
  value-laden decisions are made among several
  possible outcomes
• Principles of conduct (process) versus principles
  of value (outcome)

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Challenges for Application

• State of academic moral philosophy
• Low degree of public knowledge about the
  essentials of moral theory
• Belief that anyone can speak with authority about
  ethical issues

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Initial Concepts

• Metaethics
• What is the source of ethics?
• How do we know what is ethical?
• How rigidly do ethical rules/norms apply?

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Initial Concepts

• Evaluation criteria for moral theories
• Consistency (usefulness)
• Determinacy (usefulness)
• Livability (usefulness)
• Publicity (usefulness)
• Coherence (correctness)
• External support (correctness)

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Initial Concepts

• Absolutism (principles processes)
• Agency
• Autonomy does it matter?
• Determinism/free will
• Externalism (moral beliefs dont moviate moral
  actions) v. internalism

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Initial Concepts

• Fact-value fallacy
• Heroism
• Instrumental value
• Moral facts quasirealism
• Perfection of duty
• Projectivism

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Ten Major Systems

• Egoism
• I have moral obligations only to myself.
• Varieties, e.g., superenlightened egoism
• One of the few truly self-consistent theories

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Ten Major Systems

• Relativism
• All of morality depends on the local culture.
• Denies universal truths
• Usually not considered a true theory, but rather
  an objection to theory but, often considered to
  be sufficient in itself by the uninformed
• As such, acts like egoism with a social aspect

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Ten Major Systems

• Teleology (consequentialism)
• The moral content of an action depends on its
  consequence.
• Varieties, e.g., utilitarianisms
• Usually have a few set maxims (e.g., minimize
  pain and maximize happiness) as guiding
  principles

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Ten Major Systems

• Deontology (nonconsequentialism)
• Although consequences matter, some acts are
  right or wrong independent of the outcome.
• Varieties, e.g., duty-based and rule-based ethics
• The concepts of duty, honor and obligation form
  strong aspects of deontological moral analysis

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Ten Major Systems

• Virtue Theories
• Being moral means being virtuous.
• Good character is essential and can be habituated
  into existence
• In Aristotles view, virtues are the mean between
  vices (e.g., bravery is the virtuous mean between
  fearfulness and rashfulness)
• Emphasis on character, not process/outcome

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Ten Major Systems

• Care Ethics
• Morality consists in fostering relationships
  among people, and in responding to the perceived
  needs of others.
• Foil to the justice-based perspectives of
  utilitarianism and Kantian duty ethics
• Strongly represented in medicine, pastoral care
  and social work

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Ten Major Systems

• Natural Law
• Morality consists in honoring the purposes and
  systems effected by nature.
• Strong current in Catholic moral theology
• Can, in some ways, admit to social Darwinism

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Ten Major Systems

• Divine Command
• Gods will determines what is subject to moral
  praise or blame.
• Permits a high degree of absolute thinking
• Internally self-consistent

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Ten Major Systems

• Social Contract/Rights Theories
• Man as a social animal has obligations to the
  broader society that cannot be ignored.
• Often not considered its own theory but rather a
  subset of deontology or rule utilitarianism
• Expands traditional rule/duty systems by making
  society as a whole a primary moral agent
  communitarianism with emphasis on rights

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Ten Major Systems

• Null Theory
• Ethics? Nonsense.
• Denial that ethics is possible or meaningful
• Often rooted in technical philosophy (e.g.,
  philosophy of language)
• Interesting implications for the analysis of
  sociopathic behavior

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Terri Schiavo Case Study

• Should hydration be withheld?
• Each theoretical system will provide a different
  answer, and a different justification for that
  answer
• Then whats the right answer?

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Why Link Ethics Quality?

• Whether they know it or not, people tend to adopt
  value systems that are consistent with the basic
  moral theories
• Leveraging the motivating power of an ethical
  paradigm can improve a culture of quality

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Strategies

• Include all levels of staff in the
  decision-making aspects of the quality program,
  since peoples ethical response shifts as they
  grow in involvement or familiarity

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Strategies

• Communication official and especially
  unofficial should include the core concerns of
  the major theories (e.g., process, outcomes,
  duty) as justification points

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Strategies

• HOWEVER, do not presume to tell staff what their
  moral imperatives are the locus of ethical
  decision-making is the self, not a health-care
  system lecturing breeds cynacism

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Strategies

• Respect that staff members will have a variety of
  perspectives that are worthy of toleration
• Remember that advancing one particular
  theoretical approach may alienate some staff
  members and make resolving dilemmas harder

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Resources

• Blackburn, Simon. Being Good. Oxford, 2001
• Ellin, Joseph. Morality and the Meaning of
  Life. Harcourt, 1995.
• Furrow, Dwight. Ethics Key Concepts.
  Continuum, 2005.

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Resources

• Scruton, Roger. Modern Philosophy. Penguin,
  1994.
• Timmons, Mark. Conduct Character. Wadsworth,
  1999.
• Veatch, Robert. The Basics of Bioethics.
  Prentice Hall, 2003.

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Conversation

• Questions? Comments?

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(No Transcript)