MANAGEMENT AND HEALTHCARE ETHICS

LECTURE 5: ETHICS IN HEALTH CARE

PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
ETHICS IN HEALTH CARE E t h ic s
Treating patients with dignity definition
• Sometimes health professionals get so • The study of “right” and “wrong”
wrapped in the scientific principles of • A branch of human through concerned
healthcare that they forget they are with how human beings treat each
dealing with human beings. other.
• Human beings that may be in pain, Other definitions
frightened or upset. • Moral – personal standards of right and
The inequality of power wrong
• Healthcare professionals exercise a • Laws – rules that enforce behavior
great deal of power over patients. • Note: Just because something is legal
• It is important to make sure that this does not necessarily mean it is moral.
power is never abused. Question:
• In an attempt to protect patients, many • Who should practice ethical behavior?
hospitals have implemented a patient’s • Is there such as thing as ethical behavior
bill of rights. among friends?
Patient’s bill of rights • When was the importance of ethics in
It includes: healthcare first recognized?
• Right to know the professional status of all Relationship between moral values and ethics
people providing care.
• To know the name of their attending
doctor.
• To receive complete information on their
diagnosis and treatment.
• To give all prognosis for their illness.
• To review all information in their medical
record.
• To have every procedure, treatment or
Throughout history, philosophers have developed
drug therapy explained to them in
many models to guide people in ethical decision
language they understand.
making.
• To know the possible risks, benefits, and
• Plato
costs of every procedure, treatment of
• Socrates
drug therapy.
• Hippocrates
• To accept or refuse treatment.
HIPPOCRATES
• To prepare in advance treatment
• Greek
directives and to expect that these will
• Physician
be honored.
• Lived 2500 years ago
• To appoint a person to make decisions
• Wrote the Hippocratic Oath, which is still
about their care, if they become
taken by physicians today.
mentally disabled.
Some of these Models for Ethical Decision
• To have personal privacy.
Making are fairly complex
• To receive compassionate care and
• Theoretical Perspective
proper management of pain.
• Relativism
• To seek second opinion.
• Utilitarian
• To ask that the hospital ethics committee
• Subjectivism
review their case.
• Egoism
• Golden Rule
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 5: ETHICS IN HEALTH CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
Two schools of ethical thought Case studies
Deontological School • One way to teach health ethics is
• Greek word ‘Deon’ means ‘duty’ through case studies.
• Studies moral obligations. • Case studies allow the discussion of real-
• Followers believe in the existence of world situations absent the stress and
good and evil and believe that people politics that unjustifiably influence ethics
have an obligation to do good for other decisions.
people. Framework
Teleological School • Since many ethical problems involve
• Greek word ‘Telos’ means ‘end’ ambiguity (uncertainty as regarding to
• Dealing with right actions and nature of interpretation), it is good to have a
duty, without regard to the goodness or framework to provide structure in
value of motives or the desirability of the analyzing these situations.
ends of any act. The model in Healthcare is based on the
• Believes that the end is all that matters, following principles:
that “the end justifies the means.” • Free agency
B i o e t h i c s • Equality
• Came into existence as a discipline in • Kindness
about 1970. • Obligation to do good for others
o During this period, science shifted • Obligation to do no harm
from focusing solely on science • Honesty
and treatment to focusing on the • Legality
patient as a human being. FREE AGENCY
Question: • A patient has the right to make decisions
What caused bioethics to become so about his or her own body without
important? outside control.
• New technologies that necessitated a EQUALITY
new definition of the term “death” • The healthcare system has an obligation
• Revelations of abuses in the use of to treat all patients fairly.
human subjects in medical research. KINDNESS
• Euthanasia • A patient has a right to expect a
• Abortion healthcare worker will be merciful, kind
• In vitro fertilization and charitable.
• Organ transplants OBLIGATION TO DO GOOD FOR OTHERS
• Genetic engineering • Healthcare workers are obligated to
• Increasing healthcare costs take the action that will result in the best
necessitating a rethinking of the outcome for the patient.
allocation of healthcare resources. OBLIGATION TO DO NO HARM
Question: • The first obligation of the healthcare
How does all of this apply to me? practitioner is to avoid injury to his or her
• Many students upon graduating are patient.
surprised to find out that there is great HONESTY
deal of ambiguity in the real world. • A healthcare worker should be honest.
• Sometimes there are no clear cut CODE OF ETHICS
answers. • IN A NUTSHELL:
• Healthcare personnel often find their Professional associations write codes of
decisions clouded by dilemmas, ethics
paradoxes, inconsistencies, and with
differing expectations.
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 5: ETHICS IN HEALTH CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
• PURPOSE: Ethics and the law
Set standards of professional conduct Introduction
that promote the welfare of patients and • Laws are based on ethical principles.
assure high quality care • Most laws enforce ethical standards.
• Sometimes laws are in conflict with a
• QUESTION: person’s ethical principles.
Is there a professional code of ethics in • Healthcare workers should act in the best
your health profession? interest of patients and support legal
PRIMARY GOAL standards for patient care.
Primary goal of the healthcare worker: Question?
• Promote an optimal level of wellness • As a future healthcare professional do
• Preserve life you think you will ever put in a position
• Provide for a peaceful death, when where your personal ethics are in conflict
necessary with the requirements of your profession?
Code of ethics • What will you do?
HEALTHCARE WORKER SHOULD: Question?
• Respects the religious beliefs and cultural • As a healthcare professional, will you be
values of all clients. able to disengage your emotions when
• Provides adequate and continuous care dealing with ethical conflicts?
for all clients regardless of age, gender, Guiding principles
race, or nature of the illness or injury. • Ethical principles for healthcare workers
• Know the limits of practice for which and the corresponding laws that were
he/she is competent and stays within created to support them.
those limits. • Preserve life
• Maintains competence and current • Do good
knowledge by pursuing continuing • Respect autonomy
education. • Uphold justice
• Practice jurisprudent behavior at all times • Be honest
by avoiding unethical or illegal practices. • Be discreet
• Respect the dignity and rights of each • Keep promises
client by maintaining confidentiality and • Do no harm
a professional attitude regarding all EUTHANASIA
information relating to the client. • Results in death to alleviate suffering or
• Asks clarification and assistance when when there is no hope for recovery.
unsure of any aspect of care. • Many healthcare professionals feel
• Participates in professional activities and euthanasia is contrary to their
organizations to provide better professional ethics.
healthcare. • Regardless of their beliefs, healthcare
• Maintains a high standard of ethical and workers should follow laws.
legal behavior in his/her practice as well ORGAN TRANSPLANTS
as professional life.
HISTORICAL DEVELOPMENT OF THE MEDICAL • Organ donations come at a time of crisis
CODE OF ETHICS when somebody dies.
• Hippocrates – Hippocratic Oath
• Maimonides – Prayer of Maimonides
• Healthcare workers should ask about
donation.
• “Nightingale Pledge”
• Declaration of Geneva
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 5: ETHICS IN HEALTH CARE
• What should be done with fertilized
PROF: SIR RITCHIE CABURNAY frozen embryos when parents no longer
1ST SEMESTER A.Y. 2022 – 2023
want them?
• Illegal to transplant organs without patient or Incident reports
family permission. • To ensure prompt reporting and
CONCEPTION documentation of all incidents resulting
• IVF – In vitro fertilization in injury or having potential adverse
• Egg and sperm donation effects to patients, employees or visitors.
• Surrogates • To accurately document threats or
• Fertility drugs actions of violence and environmental
• What are the ethical considerations? emergencies.
QUESTION? • To accurately document incidents of
SHOULD THERE BE LIMITS TO IVF? property damage.
• Should obese people be allowed to • Follow your institution’s policies in filling-
have IVF? out and submitting incident reports.
• Should a couple be approved for IVF if • Focus on the facts.
they both smoke? • The purpose of the incident report is for
• Should a single person who is legal recordkeeping – NOT punishment.
unemployed be a candidate for IVF? • Can you think of examples of when an
CODES OF CONDUCT incident report might be completed?
• Ethical responsibilities include respecting Ethics committee
the cultural, social and ethnic • Most hospitals have ethics committee
differences of patients and other that examine ethical issues related to
healthcare workers. patient care.
• “Scope of practice” helps define the • They can advise patients, families and
code of conduct for healthcare workers. healthcare providers.
• Performing skills outside the scope of • A hospital ethics committee might
practice is illegal and unethical. decide the best action to take for a
• Ethical codes of conduct are based on terminally-ill patient on a respirator.
moral standards and society’s • An ethical committee might also be
expectations. asked to pass judgment on the actions of
Ethical dilemmas a healthcare provider.
• Advances in health care have created Professional practice
ethical dilemmas for healthcare • Use the approved methods when
providers. performing procedures.
• There are no easy answers when • Obtain proper authorization before
addressing ethical dilemmas. performing any procedure.
• The question is – what is the responsibility • Identify the patient.
of healthcare providers when addressing • Observe all safety precautions.
ethical dilemmas? LEGAL TERMONOLOGIES
QUESTIONS? CRIMINAL LAW
ETHICAL DILEMMAS • Wrongs against a person, property, or
• Should family members allowed to society; practicing health professional
discontinue life support? without having a license, misuse of
• Do parents have a religious right to refuse narcotics, theft, and murder.
life-saving blood transfusions for their CIVIL LAW
child? • Focuses on the legal relationships
• Should people be allowed to sell organs between people and protection of a
for use in transplant? person’s rights; much of civil law deals
• Should humans be cloned? with torts and contracts.
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 5: ETHICS IN HEALTH CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
• FELONY – mores serious crime than a • REASONABLE CARE – the legal obligation
misdemeanor in which the punishment is of a healthcare worker to provide
imprisonment. competent care according to the
• MISDEMEANOR – less serious offense than expected standards of practice.
a felony; may be punishable by a fine or • SLANDER – spoken misrepresentations
sentencing to a local prison for less than that are proven false and can damage
one year. another’s reputation.
• TORT – civil wrongful act causing harm or • ASSAULT – the threatening or attempt to
injury due to the healthcare not injure a person in an unlawful manner.
performing the standard of care. • BATTERY – the unlawful touching of
Legal implications in health care another that results in injury.
• MALPRACTICE – harmful, incorrect, or • LITIGATION – the determining of a
negligent practice or treatment of a person’s legal rights either by a lawsuit or
patient by a healthcare provider. some form of legal action.
• NEGLIGENCE – failure of a healthcare LEGAL DOCUMENTS IN HEALTH CARE
provider to perform his/her duties in a • ADVANCE DIRECTIVE – a written
responsible manner that results in injury to document that specifies if extraordinary
a patient. measures are to be taken to prolong life
• ILLEGAL RESTRAINT – holding a person if the patient can no longer make his/her
against his/her will by using a restrictive own decision.
device or other means. • LIVING WILL – a legal document
• INVASION OF PRIVACY – the giving out of prepared while a person is mentally
information about an individual without competent that specifies when his/her
his/her consent. wishes are regarding end-of-life care.
• LIABLE – to be legally responsible for • DURABLE POWER OF ATTORNEY – legal
failing to perform professional duties to document that designates another
meet the standards of care and/or person to make health care decisions in
causing harm or injury. the event that the person is mentally or
• LIBEL – written statement that provides physically incapable of making their
false information which can cause own.
damage to a person’s reputation. APPLICATIONS:
• CONTRACT – an agreement between DISCUSS THE LEGAL RESPONSIBILITIES IN THE
two or more parties. FOLLOWING CASES:
• CONDUCT – the manner in which a • A geriatric assistant steals an elderly
person displays his/her behavior patient’s watch.
• CONSENT – the giving of one’s permission • A surgeon operates on the wrong leg.
to another to perform a procedure or • A dental assistant slaps a screaming
action. child.
• BREACH OF CONTRACT – the breaking of • A physical therapist fractures a patient’s
a promise, agreement, or contract in leg while performing exercises.
which parties have agreed upon. • A medical assistant sends a copy of a
• LICENSURE – legal permission to perform patient’s record to an insurance
an occupation given by governmental company without the patient’s consent.
agencies. • A nurse working for a plastic surgeon tells
• PRIVILEGED COMMUNICATION – a a patient that a face lift will make the
patient’s personal information given to a patient look 10 years younger.
healthcare worker that must be kept
confidential.
•
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 5: ETHICS IN HEALTH CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
Applications:
MODERN HEALTH CARE ADVANCES HAVE
CREATED MANY ETHICS DILEMMAS:
• Is Euthanasia (assisted death) justified in
certain patients?
• Should a patient be told that the
healthcare provider has AIDS?
• Should aborted fetuses be used for
research?
• When should life support be
discontinued?
• Do parents have a religious right to refuse
life-saving blood transfusion for their
child?
• Can a health facility refuse expensive
treatment, such as a bone marrow
transplant, if a patient cannot pay for the
treatment?
• Who decides if a 75-year old patient or a
56-year old patient gets a single kidney
available for transplant?
• Should people be allowed to sell organs
for transplant?
• Should animals be used in medical
research even if it results in the death of
the animal?
•
• Should genetic researchers be allowed
to transplant specific genes to create the
“perfect” human being?
• Should humans be cloned?
• Should aborted embryos be used to
obtain stem cell for research, especially
as scientists may be able to use the stem
cells to cure diseases such as diabetes,
osteoporosis and Parkinson’s disease?