ethics

1. ethics Medical Therapeutics

2. Bell Work Vocabulary: Look up definition and then define in own words: • Ethics • Morals • Laws • Nonmaleficence • Beneficence • Autonomy • Distributive justice • Paternalism • Veracity • Fidelity

3. Learning Objectives • Standard 3: Analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. Citing specific textual evidence to support analysis, debate these issues in an oral or written format. • At the conclusion of class today I CAN: • Identify the structure of an ethical dilemma • Define key terms related to bioethics and use them in context • Describe the importance of understanding ethical issues in health care • https://www.youtube.com/watch?v=2D-K2twZwr8

4. Ethics and Morals • Morals—personal beliefs of right and wrong behavior based on religious beliefs, cultural norms, family customs, and past experiences • Ethics—human behavior and its effect on society, more concerned with the big picture as well as the immediate situation

5. Laws and Ethics • Laws can be made to designate actions that are right and wrong even though the same action may not be viewed as unethical • Another action may be viewed by some as ethical but is considered illegal

6. Susan is a respiratory therapist at a large hospital. It was discovered that Susan had an affair with the chief of staff at the hospital. She was later fired by the board of the hospital. Were Susan’s actions illegal or unethical? • Illegal: go to the right side of the room by the window • Unethical: go to the left side of the room by the door • Both: go to the back of the room

7. Bioethics • Specialized branch of ethics concerned with human behavior within the context of modern medicine • Medical research develops new technology and advances at a rapid rate • Human cloning, stem cell research, and euthanasia are examples

8. Ethical Principles • Ethical rules regarding people’s behavior • Ethical reasoning process • Seem simple and straightforward, may be complicated • Nonmaleficence • Beneficence • Autonomy • Distributive justice • Paternalism • Veracity • Fidelity

9. Nonmaleficence • Pertains to health-care workers • “Do no harm” • Hippocratic Oath, professional codes • In medicine there is always a potential to do harm

10. Beneficence • Health-care workers aim to provide benefit in addition to avoiding harm • Medications are proven to be safe before they are released • Medications and treatments should have a reasonable likelihood of being helpful • Risks should be made known to patients

11. Autonomy • Right of patients for self-determination • Freedom of choice • Patient’s right to refuse or accept medical treatment • Obtain informed consent before treatment or procedures • https://www.youtube.com/watch?v=LSeiur_-0IU

12. Should minors be allowed to make their own medical decisions? • Yes: go to the right side of the room by the window • No: go to the left side of the room by the door

13. Distributive Justice • Includes concept of fairness • Fair allocation of scarce resources • People waiting for transplant organs • Who decides who receives the organ and who does not

14. Paternalism • “Father” role is taken on by health-care provider, judge, or other person or entity who makes the decision for a person based on his or her best interests • Right to autonomy is denied • Parent makes decisions for minor child

15. Veracity • Duty to be honest • Is there an appropriate time to withhold information from a patient? • Is there such a thing as the acceptable “little white lie”?

16. Fidelity • The duty to keep reasonable promises and to meet obligations • Clients have a right to expect health-care workers to keep their information private • Reasonable expectations and unreasonable expectations

17. Anatomy of an Ethical Dilemma • A decision must be made • The outcome will have profound consequences • There is a disagreement among involved parties about right course of action

18. Ethical Decision Making • Bias—response based on previous experience • Uses ethical reasoning process • Thoughtful decision making based on solid understanding of ethical principles and careful reasoning

19. Ethics Committees • Serve as resource to health-care organizations • Formulate institutional policies • Provide education for staff • Serve as consultant role between patients and providers

20. Would you want to serve on an ethics committee? • Yes: go the right side of the room by the window • No: go to the left side of the room by the door

21. Health care Ethical Behavior • Trust and loyalty • Confidentiality • Respect and dignity • Commitment to professional development

22. Discussion • Differentiate morals and ethics • Differentiate unethical and illegal • Define bioethics and identify if you have been exposed to a situation when bioethics was an issue

24. Scenarios • An adult Jehovah’s Witness patient because of acute massive bleeding which cannot be rapidly stopped requires life saving blood transfusion but is awake and refuses blood transfusions based on the patient’s religion. The patient is informed that with the transfusion, the patient will live and the underlying bleeding problem can be resolved with no long term medical consequences. Without the transfusion, the patient could most likely die. The patient still refuses but the physician, as the patient is beginning to lose consciousness, violates the patient’s autonomous demand and begins the blood transfusions. Is what the physician did ethical?

25. Scenario • Brain surgery of lesions is often performed on conscious patients to establish safe dissection around motor and sensory areas. A patient with skull opened and brain exposed demanded the surgeon to stop the operation at once despite understanding the consequences of fully terminating the surgery at this point and leaving the skull open. Instead of stopping, the surgeon had the patient anesthetized to allow proper closure of the skull thus was violating the patient's demand. Is what the surgeon did ethical?