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Ethics for Patients and Families

Explore ethical principles, autonomy, justice, and responsibilities in healthcare decision-making for patients and families. Understand consent, confidentiality, assisted suicide, and advance care planning. Learn about ethical dilemmas and conflicts, power dynamics, and professional conduct guidelines.

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Ethics for Patients and Families

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  1. Ethics for Patients and Families Regina Mc Quillan

  2. Ethics ‘That good should be done and evil avoided’

  3. Ethical Concerns • Consent • Capacity • Confidentiality • Assisted suicide, euthanasia • Advance care planning • Futility

  4. Ethics • Principle based • Values based • Utilitarian • Consequentialist • Non-consequentialist • Religious based Etc….

  5. Ethical dilemma

  6. Not a clinical dilemma

  7. Not a clinical dilemma • Antibiotics for colds

  8. Ethical dilemma • Treatment options are equivalent, or nearly equivalent • Difference in what should be provided

  9. Conflict of ethical claims • Between patient and doctor • Between patient and family • Between family and doctor • Within team

  10. Power

  11. Power • Doctors

  12. Power • Doctors • Nurses

  13. Power • Doctors • Nurses • Healthcare staff

  14. Power • Doctors • Nurses • Healthcare staff • Families

  15. Power • Doctors • Nurses • Healthcare staff • Families • Patients

  16. Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 2016

  17. Code of Professional Conduct and Ethics Nursing and Midwifery Board of Ireland (2014)

  18. Ethical duties of patients

  19. Ethical duties of patients • Participate in healthcare juristinction-contribute to taxes, health insurance etc • Maintain health • Protect health of others e.g infection • Seek and access care appropriately e.g. accept non-urgent appointments, be civil • Truthful • Compliance • Inpatient-not disruptive, not undermining • Attempt to recover • Take part in research • Citizenship-take part in society, pay tax, vote Evans 2008

  20. Ethical issues • Ethical • Clinical • Communication

  21. Ethical issues • Ethical • Clinical • Communication • Use of illegal substance- cannabis • Fair use of resources • Experimental treatment • Right to try • Hospital or hospice beds • Futile treatment • Informed decision-making • Assisted suicide/euthanasia

  22. Autonomy

  23. Autonomy • A principle, not the principle

  24. Autonomy • A principle, not the principle • Beneficence • Non-maleficence • Justice Beauchamp and Childress

  25. Autonomy • A principle, not the principle • Beneficence • Non-maleficence • Justice • Dignity • Integrity • Vulnerability BIOMED II project, Rendtorff, 2002

  26. Autonomy • A principle, not the principle • Beneficence • Non-maleficence • Justice • Dignity • Integrity • Vulnerability • Fidelity

  27. Autonomy • Self-rule • A competent or rational person making choices for reasons that reflect judgement and understanding • Credit people with capacity • Allowed exercise control over their life in terms of choices they make Farsides, 1998

  28. Autonomy • Emphasis on independence and sovereignty

  29. Autonomy • Emphasis on independence and sovereignty • A response to healthcare paternalism • Recognition of patients as rational choosers • Response to increased literacy, education and health literacy of the public

  30. Autonomy • Emphasis on independence and sovereignty • Dependent on, or influenced by others • Other values such as friendship, loyalty, faith which require us to construct relationships • Doing what is ‘right’ • Own needs vs needs of others

  31. Justice • Distributive justice - fairness, allocation of resources

  32. Justice • Distributive justice - fairness, allocation of resources • Treat equals equally, ‘unequals’ according to need

  33. Justice • Distributive justice - fairness, allocation of resources • Treat equals equally, ‘unequals’ according to need • Rights-based justice

  34. Justice • Distributive justice- fairness, allocation of resources • Treat equals equally, ‘unequals’ according to need • Rights-based justice • Respect for morally acceptable laws (democracy)

  35. Justice • Distributive justice - fairness, allocation of resources • Treat equals equally, ‘unequals’ according to need • Rights-based justice • Respect for morally acceptable laws (democracy) • Respect for ‘morally acceptable’ healthcare systems, guidelines, protocols

  36. Justice • Assisted suicide and euthanasia • Futile treatments • Objectivity and professionalism • Vulnerable people – life-style

  37. Health care worker’s responsibility • To the patient, not the family • Responsibility to the team/service, but patient central • Good communication • If no resolution • Offer second opinion • Trial of treatment/intervention • Court decision – will tend to support patient’s best interest, not just best medical interest.

  38. Ethical duties of patients • Participate in healthcare juristinction-contribute to taxes, health insurance etc • Maintain health • Protect health of others e.g infection • Seek and access care appropriately e.g. accept non-urgent appointments, be civil • Truthful • Compliance • Inpatient-not disruptive, not undermining • Attempt to recover • Take part in research • Citizenship-take part in society, pay tax, vote Evans 2008

  39. Ethical duties of patients • Power imbalance • Consensus – citizens’ engagement

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