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Practical Ethics:

Practical Ethics: . A Tool for the Ombudsman? Sarah Trafton, JD Finger Lakes Health Systems Agency Rochester, NY. Presentation Outline. Why ethics? Ethical principles generally Ethical issues in long-term care Applying tools of ethics. Why Ethics? . Murky situations

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Practical Ethics:

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  1. Practical Ethics: A Tool for the Ombudsman? Sarah Trafton, JD Finger Lakes Health Systems Agency Rochester, NY

  2. Presentation Outline • Why ethics? • Ethical principles generally • Ethical issues in long-term care • Applying tools of ethics

  3. Why Ethics? • Murky situations • Conflicting interests • Ombudsman role: person who investigates complaints and mediates fair settlements, especially between aggrieved parties such as consumers and an institution

  4. What is “Ethics”? • “That branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.” “ethics” Dictionary.com. Dictionary.com Unabridged (v 1.1). Random House, Inc. http://dictionary.reference.com/browse/ethics (accessed: October 16, 2007).

  5. “Ethics”, continued… • “That branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions”

  6. Key Elements of Ethics • Values related to human conduct, with respect to: • Rightness and wrongness of actions • Goodness and badness of motives

  7. Values • Values are deeply held beliefs about what is good, right, and appropriate. • Values are deep-seated and remain constant over time.

  8. “Ethical Dilemma” • A situation that will often involve an apparent conflict between moral imperatives, in which to obey one would result in transgressing another • A moral imperative is a principle originating inside a person's mind that compels that person to act.

  9. Ethical Principles Generally • Beneficence • Nonmaleficence: Least harm • Respect for autonomy • Justice

  10. Mr. & Mrs. W______ • Shared room in locked behavioral unit • No family • Mr. W has dementia, wanders. • Mrs. W? • Language; socialization • Well-intentioned social worker

  11. Beneficence • Do what is good • Strive to achieve the greatest amount of good (utility) • Mr. & Mrs. W

  12. Nonmaleficence • Don’t intentionally inflict harm • In situations where neither choice is ideal, choose that which is the least harmful and harms the fewest people • Mr. & Mrs. W

  13. Respect for Autonomy • People should be allowed to ‘reign over themselves’ and to make the decisions that apply to their lives; control over their lives as much as possible • Paternalism (e.g. professionals) • Mr. & Mrs. W

  14. Justice • Fair, equitable and appropriate treatment in light of what is due or owed a person • Distributive justice: fair, equitable and appropriate distribution in society determined by justified norms: taxation; donated organs • Mr. & Mrs. W

  15. Ethical Issues in Long-term Care • Living options • Independence vs. safety • Capacity to make decisions • Managing finances • Patient/family/care provider interactions • Others?

  16. Applying the Tools of Ethics • Assumption: All must be legal • Step One: Analyze the Consequences • Who will be helped? • Who will be hurt? • What kinds of harms and benefits are possible? • How will this look both in the short-term and in the long-term?

  17. Applying the Tools of Ethics • Step 2: Analyze the Actions • How do they measure up against moral principles • Do any “cross the line” from simple decency to an important ethical principle? • If principles or the rights of different involved people conflict, is one principle more important than another?

  18. Applying the Tools of Ethics • Step 3: Make a Decision • Take both Step 1 and Step 2 into account

  19. Examples from Real World • Ken H. • Refuses to pay his Medicaid spend-down to NH • NH court action • No personal allowance

  20. Examples from the Real World • Mr. A, 81,stroke 2 years ago; NH rehab., now ready to go home • Wife, 55, visited seldom, “rebuilt her life”, unwilling to take Mr. A. home • Mr. A demands to go home

  21. Examples from the Real World • Ms. L, 47, unmarried, lived alone • In NH after hospitalization for MS, in wheelchair, wants to go home • Olmstead decision • Ms. L’s is MS unstable

  22. Examples from the Real World • The changing long-term care world: • Policy (e.g Point of Entry) • Case law (e.g. Olmstead) • Personal and societal values (e.g. Baby Boomers) • Others?

  23. Examples from the Real World • Your turn?

  24. Take away message: • Think: Beneficence/Nonmaleficence/ Autonomy/Justice • Analyze the consequences • Analyze the actions • Make a decision

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