Ethics in the Practice of Health Profession

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Ethics in the Practice of Health Profession

• Josefina S. Isidro-Lapeña MD, MFM
• Associate Professor 3
• UP College of Medicine

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MY LIMITATIONS
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DEFINITIONS
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What is ETHICS ?

• Branch of philosophy that examines rights and
  wrongs, what should or ought to be done
• PL Nandi
• Not synonymous with what is legal, moral or
  standard of practice

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What is ETHICS ?

• System of thinking about choices or decisions
  based on widely accepted guidelines capable of
  working with different moral, religious and
  cultural values
• HM Mitchell

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What is ETHICS ?

• A GENERAL TERM THAT REFERS BOTH TO
• MORALITY
• and
• ETHICAL THEORY

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What is MORALITY?

• COMMON MORALITY
• Refers to social conventions about right and
  wrong human conduct that are so widely shared
  that they form a stable communal consensus

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Ethical theories

• Utilitarianism consequences based theory
• Obligation based theory
• Virtue based theory
• Rights based theory
• Community based theory
• Ethics of care relationship based
• Case based reasoning casuistry
• Principle based theories

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• CLINICAL ETHICS is grounded in the belief that
  medicine is an inherently moral enterprise. Sick
  persons ask physicians to help them get better
  and physicians profess to be morally committed
  and technically competent to help the sick.
• Panna L. Nandi
• Arch Surg, 2000 135

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Are we ETHICAL in the way we practice our
profession as health practitioners?
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The Four - Principle Approach
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The 4 Principle Approach

• Abstract rallying points for reflection
• Starting foundational points NOT solely
  sufficient nor final appeals
• Must be contextualized gives it meaning,
  implications, complexity, limits, exceptions and
  the like
• Prima facie binding unless they conflict with
  obligations expressed in another moral principle

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BASIC ETHICAL PRINCIPLES
Autonomy Non-maleficence Beneficence Justice
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RESPECT FOR AUTONOMY

• Rooted in liberal traditions of individual
  freedom
• Innate right of a person to make choices
  affecting his/her own life and welfare free of
  coercion
• NB Implications of paternalism

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NON MALEFICENCE

• Primum non nocere (Above all do no harm)
• Obligation not to inflict harm intentionally and
  not imposing risks of harm
• Negligence of Professional standards of care
  cause harm

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BENEFICENCE

• Moral obligation to act for the benefit of
  others to help others further their important
  and legitimate interests
• Distinguish ideal vs obligatory
• Y is at risk of significant loss or damage to
  life or health or some other major interest
• Xs action is needed to prevent this loss
• Xs action has a high probability of preventing
  the loss
• Xs action would not present significant risk,
  cost or burden to x
• The expected benefit for Y outweighs any harm
  cost or burden to X

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JUSTICE

• FAIR EQUITABLE AND APPROPRIATE treatment in light
  of what is due or owed to persons
• One who has a valid claim based in justice has a
  RIGHT

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Moral or Ethical Dilemma
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What to do ?
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• Health promotion
• Use of contraceptives
• Abortion
• False certificates
• Drug detailing

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ETHICAL DISCOURSE

• JUSTIFICATION
• SPECIFICATION
• BALANCING/
• OVERRIDING

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Justification

• Showing that one has sufficient reason for the
  act
• Deductive top down
• Inductive bottom up
• Coherentism achieve coherence
• All moral systems present some level of
  indeterminateness and incoherence, they do not
  have the power to eliminate various contingent
  conflicts among principles and rule.

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• Dr. G has a PhD on biochemistry and is a very
  good levelheaded researcher. Unfortunately, one
  of his children needed very expensive treatment
  that depleted family savings and there is no end
  yet to needed drugs. He was offered a rather
  enormous salary if he will be part of a team
  that will do research on developing biochemical
  weapons for warfare. Furthermore, if he will
  not agree it is likely that a fanatic will be
  asked instead.

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Specification

• If a principle lacks adequate specificity, it is
  empty and ineffectual

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Specification

• Informed consent
• Always obtain oral or written consent for any
  medical intervention with competent patients
  EXCEPT in emergencies, low risk situations and
  when patient waive the right to adequate
  information

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Balancing/over riding

• Deliberation and judgment about the relative
  weight of norms
• Prima facie obligations must be fulfilled unless
  it conflict on a particular occasion with an
  equal or stronger obligation.
• Not subjectively but with use of Relevant factual
  information

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• The decision making process claims ethical
  validity for statements that have been subjected
  to rigorous and rational analysis.
• This then becomes a better guide to action, in
  important matters than either ones initial gut
  reaction or blind adherence to pre-existing
  rules.

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Discuss it...
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The Professional

• Health professional
• Commitment to provide important services
• Distinctive education and skills that patients
  typically lack and that morally must be used to
  benefit patients
• Code of Professional Ethics
• Articulated statement of the role morality of the
  members of the profession

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Four Focal Virtues of the Health Professional

• Compassion
• Discernment
• Trustworthiness
• Integrity

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uncertainty
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• ETHICS is a system of thinking about difficult
  decisions.
• Sometimes the particulars of a given situation
  creates tension and both caregivers and patients
  will have to determine which is paramount.
• Ethical principles help us to avoid leaving
  important considerations/ persons out of the
  decision making process.
• Mitchell HR
• Health Care Ethics

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But what is TRUTH ? Is truth unchanging law We
both have truthsare mine the same as yours?
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thank you for your kind attention