Ethical Decision Making in Health Care

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Ethical Decision Making in Health Care

• Betty Johnson, MHS
• Dennis Wissing, PhD
• LSU Health Sciences Center
• Shreveport

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Why study ethics, morality, and values in todays
health care environment?
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Your World View

• Absolutist
• Legal
• Process
• (Using abortion as an examplesee graph)

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Some Definitions

• 1. Morality values duties character traits
• 2. Values objects or things a person holds dear
• 3. Duties actions in response to claims on you
  that are either self imposed or imposed by others
• 4. Character traits dispositions

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Challenge recognizing and accepting the
personal morality of patients, co-workers and
families you deal with in the health care setting
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Moral Life

• Concerned with relationships between people and
  how, ultimately they can best live in peace and
  harmony
• GOAL protect a high quality of life for an
  individual or the community as a whole

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Personal Morality

• Virtues
• Values and duties adopted as relevant
• Customs
• Laws
• Rules
• Beliefs
• the way things are done

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Societal Morality

• A common denominator of shared beliefs about
  values and duties
• Generated by culture, ethnicity of the group and
  geography
• Springs from deeper religious, philosophic or
  anthropologic beliefs about humans, their
  relationship with God (gods) or each other

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Group Morality

• Health professionals and their institutions moral
  values and duties that dont apply to others
• Confidentiality
• Help another in need
• Non-judgmental of character

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Code of Behavior Hippocratic OathYour
professional Code of Ethics
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Four Ways to Make Moral Decisions

• Principles (autonomy, beneficence, justice)
• Consequences
• Virtue
• Moral Sentiment
• OToole, B. Four Ways to Approach Ethics. Health
  Progress. Nov/Dec 1998, 38-41

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• Case Questions

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Ethical Problem a situation that presents
serious challenges or threats to your values,
dispositions, and duty

• Components of Ethical Problem
• A the moral agent
• C - course of action
• O - desired outcome

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Examples to Identify A-C-O

• Refusal of passengers who are ill onto an
  commercial airplane
• West Nile virus spreading via organ transplant
• Heart transplant for a prisoner
• Should we be able to choose our kids?

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Ethics a systematic study of and reflection on
morality

• Systematic uses specific methods
• Reflective consciously calls into question
  assumptions about existing components of our
  moralities (habits, customs, traditions)

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What do human dignity and respect demand in the
health care setting?

• Discussion Question

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Three Prototypes (ethical situations)

• 1. Ethical Distress
• challenge to maintain your integrity or the
  integrity of the
  profession
• (Barriers - barrier keeping you from doing
  what you know is right or a barrier of knowing
  something is wrong, but you are not sure what)

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• 2. Ethical Dilemma
• Two courses of action diverging
• with 2 or more morally correct courses of
  action that cannot both be followed
• Paternalism what is best for the patient
• Justice seeking allocation of societal
  benefits and burdens fairly and equitably

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Examples of An Ethical Dilemma
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• 3. Locus of Authority
• Who should have authority to make ethical
  decisions?
• 1. expertise
• 2. traditional practice
• 3. policies
• 4. experience

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Is expertise and experience the same thing?
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The Story of Beulah Watson and Tiffany Bryant
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Bioethical Principles

• Autonomy-Self Rule
• Respect the capacity of the client to choose
  their own values goals to decide for themselves
  what happens to their body lives

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Bioethical Principles

• Nonmaleficence
• Above all, Do no harm
• Avoid potentially harmful care
• Issues
• Killing or letting go
• Withholding therapy
• Judging quality of life

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Bioethical Principles

• Beneficence
• Commitment to do good
• Promote well being
• Balancing benefits harm

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Bioethical Principles

• Veracity
• Commitment to tell the truth
• Obligates both HCW and client
• Disclosure

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Side Bar

• How does the timeliness quality of the
  physician's communication about a medical error
  influence a patients response?

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Bioethical Principles

• Justice
• Commitment to fairness
• Right to a reasonable level of health care
• Allocation
• Rationing
• (Post Katrina/Rita?)

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Side Bar

• Studies show obese patients are treated
  differently during primary care visits.
• Intoxicated MVC patients are shown bias in the ED

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Side Bar

• DNR orders for terminally ill children may not be
  honored in public schools

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HCW-Client Rules

• Confidentiality
• Balanced against rights of others
• Fiduciary responsibilities
• Conflict of interest
• Duty to self family
• Pediatric/family issue

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The Story of Ronald Rachels, Pam Faden, and
Metsui Hasagawa
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Six Step process to address an ethical issue

• Identify the problem
• Get the story straight
• Use ethical principles in analyzing the problem
• Explore practical alternative
• Complete the action
• Evaluate the process and outcome
• adapted from Ethical Dimensions in the Health
  Professions by Ruth Purtilo 4th edition

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Informed Consent The mechanism that shows
respect through Patient autonomy
Parts of Informed Consent
Disclosure Is it comprehensible By the patient?
Consent (by the patient) Is it voluntary? Is the
patient able to understand the information?
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Other Issues

• Ethics and professional life
• Ethics of growing old
• Technology