ETHICS AND HEALTHCARE
Chapter 9
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Learning Objectives (1 of 2)
9.1 Define relevant ethical terms.
9.2 Discuss ethical theories that shape health care decisions.
9.3 Explain the ethical principles that are important to the health care
provider.
9.4 Summarize the rights Canadians have with respect to health care.
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Learning Objectives (2 of 2)
9.5 Describe ethical behaviour expected of health care professionals.
9.6 Explain ethical considerations relating to end-of-life issues.
9.7 Discuss ethical considerations relating to the allocation of
resources in health care.
9.8 Briefly discuss the moral and ethical issues related to abortion and
genetic testing.
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Ethics is the study of standards of right and
wrong in human behaviour
The term ethics also refers to a code of
behaviour or conduct
ETHICS
It’s neither a religion nor always
determined by religion
Though closely connected it remains
separated from the law
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Morality and Morals
Morals are what a person believes to be right and wrong regarding
how to treat others and how to behave in an organized society
Moral may define persons character, and ethics is the collection of
morals
Morality extends from a system of beliefs about what is right and
wrong, encompassing a person’s values, beliefs, and sense of duty and
responsibility
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Morals, Morality And Ethics
• The Taylor’s and their physician have agreed to apply a do-not-resuscitate (DNR)
status to their infant son because of his clinical condition, which is incompatible
with life.
• The baby has at best a few days to live. Amy, a registered nurse working in the
neonatal intensive care unit, does not morally agree with the decision, believing
that all attempts to save the infant’s life should be taken, including
cardiopulmonary resuscitation (CPR).
• However, ethically (i.e., out of respect for the parent’s choice, and their autonomy)
Amy must abide by the decision the parents and the doctor made, and refrain
from initiating CPR should she be present when the infant has an arrest.
• Health care providers who understand their own values and moral standards
come better prepared to deal with issues that may arise in their professional role.
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Values, things important to an
individual, guide a person’s conduct and
the decisions he or she makes
People can have personal values, social
VALUES values, and work values
Context may also influence values and,
therefore, behaviour
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Tony, an occupational therapy student, clearly values
professional conduct at work more than he does personal
conduct at school
At work, he maintains an excellent attendance record, is never
late, and does his job well
However, at school, he talks in class, hands in assignments
late, does not study for tests, and has a poor attendance -
CASE specially on Friday afternoons.
EXAMPLE As well, he often misses a day of class prior to an exam or
9.1 test.
He may place more importance on work for several reasons,
including earning money for rent and other amenities.
He may not value his education or see it as an as a mean to an
end - that is establishing a carrier and becoming financially
secure
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CASE EXAMPLE 9.2
Jennifer seeks an abortion to terminate a pregnancy resulting from rape.
Her primary nurse Sanga (a new graduate), cannot understand how Jennifer could
make that decision.
Sanga values life more than that anything. Had it been her, abortion would have
been out of question, regardless of the circumstances.
However, Sanga also values trust, respect for others, and integrity.
For that reason, she can give Jennifer the care and support she needs and respect
Jennifer's right to make the decision best for her.
She realizes that caring for Jennifer in a respectful manner does not compromise
her own values and beliefs.
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Sense of Duty
Duties are obligations a person has in response to another’s claims on
him or her
A duty may result from a professional or personal obligation or may
relate to one’s own morals or values
Health care professionals have a moral and ethical duty to care for their clients in a
competent manner, as well as a legal obligation called the “duty of care”
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Ethical Theories: The Basics
Teleological theory defines an action as right or wrong depending on the
results it produces
Deontological theory demands that a moral and honest action is taken,
regardless of the outcome
Virtue ethics theory states that a person of moral character will act
wisely, fairly, and honestly and will uphold the principles of justice
Divine command ethics follows philosophies and rules set out by a
higher power
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CASE EXAMPLE 9.3
• Post surgery, it is discovered that a sponge was left inside a patient.
• the patient, a man with metastatic cancer, has limited life expectancy.
• The staff members present, along with Nima, an operating room technician, decide
it is in everyone‘s best interest to say nothing.
• The sponge will not hurt the man but opening him up and removing it would
hasten his death and cause him more pain.
• The family, already trying to cope with the man's impending death, would be
distressed over the incident.
• It’s a simple mistake why getting the surgeon and nurses into trouble?
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What The Teleological Theory Would Say?
To say nothing was the group's ethical decision
The individuals involved determined what did they think would be
best result and make their decisions accordingly
To them, concealing the truth was least important
Here, the outcome of the action is going to determine weather it was
right or wrong
Anyway, by law, in most jurisdictions the patient must be told
when a medical error has occurred
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What The Deontological Theory Would Say?
If team used the deontological approach and
did the “right” thing, they would have
removed the sponge, or they would have
told the family what had happened, explain
the risks, and allowed them to make the
decision
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What The Virtue Ethics Theory Would Say?
This theory look at the ethical or moral character of the person rather than his or her reasoning
So, it is assumed that a person of moral character will act wisely, fairly, and honestly and will uphold the
principle of justice
In the team there were several people involved. Person A may have decided not to divulge the truth for
everyone's best interest, Person B may have decided to expose the incident
Each person would make an individual decision based on his or her moral values . A common decision often
however must be reached
When people disagree, the majorities opinion will rule or someone with authority’s decision will be
considered
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What The Divine Command
Theory Would Say?
Followers of divine command ethics
would without question decide that
the incident should be reported
because honesty makes up a significant
part of divine command theory
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Ethical Principles and the Health Care Profession
Principles that are relevant to
health care:
Ethical principles provide
guidance for decision making
and form the basis of ethical ✔ Beneficence
study ✔ Nonmaleficence
✔ Double effect
✔ Respect
✔ Autonomy
✔ Truthfulness
✔ Fidelity
✔ Justice
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Clients’ Rights in Health Care
Rights in health care are things that can and should be
expected of health care professionals and the health care system
Rights may be tangible or intangible
Clients’ rights fall into three categories:
• The rights Canadians have within health care
• The right to health care
• The right to timely health care
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Duties and Rights
If a client has a right within health care or to
health care, for the most part, the health care
professional has the duty to grant that right
To fulfill one’s duty to honour clients’ rights, the
health care professional must either act to carry
out a responsibility or refrain from acting or
interfering in a situation
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Autonomy and the Client
The principle of autonomy serves as the basis for the principles
involved in informed consent and self-determination regarding
treatment choices
The original Hippocratic Oath placed physicians in the
position of the informed authority whose ethical and
professional responsibility was to-
• Do their best for the client
• Preserve life at all costs
• Make decisions in the best interest of the client
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CLIENT AUTONOMY
• Attitudes toward client autonomy have changed over the years,
resulting in a revised version of the Hippocratic Oath (see Box 9.1,
pp. 333–34)
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Truthfulness/Veracity
• All clients have a right to the truth, and health care professionals
have a duty to provide it
• In the past, physicians, often at the request of family members, would
withhold information that might upset a client
• The modern, client-focused approach to treatment requires
physicians to keep the client fully and truthfully informed
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PARENTAL RIGHTS AND THE LAW
• When a client is considered an adult, self-determination takes
precedence over paternalistic intervention, even when the
client’s life is at stake
• When children are involved and parents reject medical
intervention, the provincial or territorial courts almost always
obtain legal custody for the child and allow the recommended
treatment
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ETHICS AT WORK
• All regulated health care professions have Codes of Ethics, as
do many places of employment
• It is a formal statement of an organization’s or profession’s
values regarding professional behaviour, a code of ethics
provides guidance for-
✔ Ethical decision making
✔ Self-evaluation
✔ Best practices policies
✔ Professional conduct
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THE ETHICS COMMITTEE
• An ethics committee consists of a group of people who
• Listen to, evaluate, and make recommendations about acts
perceived as unethical
• Provide health care professionals with guidance in making
controversial medical decisions
• Compile research for policy development within the facility
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END-OF-LIFE ISSUES
• End-of-life issues that raise ethical concerns
include-
• clients’ wishing to withdraw life-saving
measures
• issuing do-not-resuscitate (DNR) orders,
and
• requesting supportive or palliative care in
the face of a terminal illness
https://www.youtube.com/watch?v=q3jgSkxV1rw
EUTHANASIA
• The purpose of euthanasia is to deliberately end a life in order to
relieve pain and suffering due to an incurable disease
• Various categories of euthanasia exist:
1. Voluntary euthanasia
2. Involuntary euthanasia
3. Active euthanasia
4. Passive euthanasia
5. Physician-assisted suicide (later named MAID)
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Euthanasia
Except for passive euthanasia, the act of ending or assisting to end a
person’s life is illegal in most countries, including Canada
On February 6, 2015, the Supreme Court of Canada passed a verdict
on removing the restrictions on ‘Physician Assisted Suicide’ and later
it became legal in Canada from 2016!
Preparation for End-of-Life Decisions
A person entering a health care facility can request a do not
resuscitate order (DNR)
Health care providers are legally bound to honour such requests.
A person can reverse his or her DNR request at any time.
Advanced directives specify the nature and level of treatment a person
would want to receive if he or she becomes unable to make those
decisions later.
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Preparation for End-of-Life Decisions
Levels of care reflects a choice of end-of-life interventions usually
assigned to nursing in long-term care facilities
• Level 1 –The resident wishes to stay in their home (e.g., long-term care or
nursing home), receiving comfort and supportive measures only (like- pain
control, not i/v therapy).
• Level 2 – The resident wants to stay in the facility and receive all treatments,
medications, and interventions that are possible at that facility
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Preparation for End-of-Life Decisions
Levels of care reflects a choice of end-of-life interventions usually
assigned to nursing in long-term care facilities
• Level 3 – The resident would be transferred to an acute care facility and
receive treatment excluding CPR protocol, or transfer to the intensive care unit
• Level 4 – The resident would be transferred to an acute care facility for all
active measures required to sustain life
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The Right to Die
Mentally competent adult clients have the right to-
• Refuse medical treatment
• Request a do-not-resuscitate (DNR) order
• Ask for only comfort measures
Health care professionals are legally bound to honour such
requests
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The Right to Die
A person can reverse his or her DNR request at any time
Advanced directives specify the nature and level of treatment a
person would want to receive if he or she becomes unable to
make those decisions later
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Palliative Care
Palliative care addresses the physical and emotional needs
of those who are dying
Teams of experts work with clients and their families to
manage physical discomfort and psychological distress
and to meet spiritual needs
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palliative care
When individuals do not want any interference with natural course
of death, palliative care can facilitate a peaceful and painless natural
death
It can be provided in a hospital, in a hospice or at home to any
person at any age at any stage of life-threatening illness
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Allocation of Resources
The term allocation of resources refers to who gets what, when, and for
what reason
Rising health care costs, expensive technologies, and limited access to
many services have made the allocation of resources an increasing concern
in the health care industry
This can be explained by the case example on following slide
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CASE EXAMPLE OF ORGAN TRANSPLANTATION
The transplant team at a large hospital just received word that a liver has become
available. The list of approved critical candidates includes both Joe and Olga.
Joe despite living a very healthy lifestyle, suffer from an autoimmune disease that has
destroyed his liver.
Olga, an alcoholic, has advanced liver disease and generally very poor health. Her
history suggests that she remains at high risk for returning to drinking – a setback that
would surely damage the new liver should she receive one.
All other things being equal (age, family situation, finances).
Which candidate do you think should get the liver?
Should Olga be considered a less desirable candidate than Joe because of her disease?
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CASE DISCUSSION
• In this case Olga has been unable to overcome the disease of alcoholism. Although
she has managed to give up drinking for limited periods of time, her ability to
maintain sobriety remains questionable. A return to drinking would sharply
decrease her chances of maintaining even reasonable health with a transplanted
liver.
• Should she therefore be denied a chance add a new life?
• Joe on the other hand, lives a healthy lifestyle yet has contracted a disease typically
considered less preventable than alcoholism.
• But what if, as is debated in modern medicine, alcoholism were more commonly
considered a disease, rather than a moral failing?
• Would Olga then be in a more favorable position to compete for the liver? Would
she be on equal footing with Joe?
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Abortion
Abortion has been legal without restrictions in Canada since 1984
Since health care professionals are not obliged to perform abortions,
many will opt not to because of religious or moral beliefs,
providing clients some limitations on access
Canadians in northern and other remote regions usually must travel
long distances at their own expense to access abortion services
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Abortion
The moral and ethical issues around abortion
concern two main issues:
• The right of the fetus to life
• The right of women to make decisions that
involve their own bodies
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Genetic Testing
Advances in genetic testing allow people to learn whether
they carry any genes that put them at a higher risk for
disease, such as certain types of cancer
Similarly, carrier testing determines whether the potential
exists to pass on a genetic disease to offspring
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Genetic testing
Prenatal diagnostic screening can-
• Determine a fetus’s risk for certain genetic disorders
• Aid in earlier diagnosis of fetal abnormalities
• Provide prospective parents with important information for making informed
decisions about a pregnancy
Canadians are encouraged to think carefully before having
genetic testing for presumed or established conditions
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THANK YOU
