Ethics in Daily Practice

1. Ethics in Daily Practice Vicki Judd, MD., University of Utah Paul Myers, Ph.D., University of Portland

2. Ethics Committee Members • Paul Myers, Director, Univ. of Portland (chair, voting member) (term 2008-2010) • Sam Alexander, Director, Univ. of Denver, (secretary, voting member) (term 2008-2010) • Cathy Felix, Director at Cal. State, Chico (voting member) (term 2010-2012) • John Kolligian, Exec. Director, Princeton Univ. (voting member) (term 2010-2012) • Marc Hiller, Professor, Univ. New Hampshire (voting member) (term 2009-2011) • Vicki Judd, Professor, University of Utah (voting member) (term 2008-2010) • Chad Williams, Student, (voting member, so may or may not be available for the second year) 2009-2010 • Jerry Wilmes, Director, NW Missouri State Univ. (voting member) 2010-2012 • Eryn Oberlander, Psychiatrist, New York City (voting member) 2010-2012 • Tim Crump, Liaison to ACHA Board of Directors and Regional Representative for the Pacific Coast College Health Association • Bob Ward, Liaison to ACHA

3. Objectives • Describe ACHA Ethical Principles and Guidelines • List the changes of the ACHA Ethical Principles and Guidelines • Discuss the application of the ACHA Ethical Principles and Guidelines to actual situations

4. Quiz • Which two ancient philosophers were also physicians?

5. Hippocrates and Aristotle

6. Ethics of Hippocratic Medicine • Harnessing the principles of nature as a guide to healing • Be of benefit, do no harm • Asclepius • “Practiced medicine for those who were healthy in their nature but were suffering from a specific disease; he rid them of it …then ordered them to live as usual…for those however, whose bodies were always in a state of inner sickness he did not attempt to prescribe a regimen to make their life a prolonged misery…medicine was not intended for them and they should not be treated even if they were richer than Midas.” Plato, The Republic

7. Four Principles • Establishment of 4 Principals(Beauchamp and Childress) 1979“A Reminder of What You Already Know”A) BeneficenceB) Non-maleficenceC) AutonomyD) Justice

8. Beneficence • Obligation to preserve life, restore health, relieve suffering, and maintain function • To do “good” • Nonabandonment – obligation to provide ongoing care • Conflict of interest – must not engage in activities that are not in students best interest

9. Nonmaleficence • “Do no harm, prevent harm, and remove harm”

10. Autonomy • Right to self-determination • Requires decision making capacity • Lack should be proven not assumed • Competence – legal determination • Liberty – freedom to influence course of life/treatment

11. Justice • Allocation of resources must be fair and according to need • Should not make decisions regarding individuals based upon societal needs

12. Values and Ethical Priorities • Culture bestows values • Values set up Morals • Ethics are rules used to assist in making good choices and avoiding bad choices

13. Cultural Influence on Values • Family • Ethnicity • Religion • Race • Economic status • Education • Life experiences • Sexual orientation • Gender

14. Values • What do you value?

15. Values Values are things that an individual believes to be intrinsically worthwhile or desirable, that are prized for themselves (e.g. truth, beauty, honesty, justice, respect for people and the environment).

16. Extend hospitality to strangers and travelers Give alms Don’t trust professionals Us and Them Do unto others… Idleness is the devil.. Penny saved is penny earned There but for the grace of God, go I Don’t share the family’s business “My dad would kill me!” And…… Values Examples

17. “Be sure you are right, then go ahead.” Davy Crockett 1786-1836

18. Teddy Roosevelt said, “To educate a person in mind and not in morals is to educate a menace to society.”

19. Values Examples • “Education without values, as useful as it is, seems rather to make man a more clever devil.” C. S. Lewis

20. President Lincoln said: “Honor is better than honors.”

21. When the situation needs improvement, Gandhi offers guidance: “You must be the change you wish to see in the world.”

22. The reputation of a thousand years may be determined by the conduct of one hour. Japanese proverb

23. “To see what is right and not to do it is want of courage.” (Confucius)

24. “It behooves every man who values liberty of conscience for himself, to resist invasions of it in the case of others: or their case may, by change of circumstances, become his own.” Thomas Jefferson Values Examples • It behooves every man who values liberty of conscience for himself, to resist invasions of it in the case of others: or their case may, by change of circumstances, become his own. Thomas Jefferson

25. MORALITY • Morality involves peoples' views of what is good, right, or proper; their beliefs about their obligations; and their ideas about how they should behave. • Morality concerns duties and obligations to one another and is characterized by words such as right, ought, just, and fair.

26. Inventory of Applicable Principles • ?

27. Justice Care Fidelity Honesty Trustworthiness Personal Autonomy Liberty Accountability No Harm Happiness Do Good Role Fidelity Professional Autonomy Confidentiality Pain Avoidance Inventory of Applicable Principles

28. ETHICS • Ethics is the study of right and wrong, duties and obligations. • Ethics involves critical reflection on morality, including the ability to make choices between values and the examination of the moral dimensions of relationships.

29. Ensure respect and autonomy Promote Justice Protect privacy Do no harm Provide beneficial and caring services AHCA’s Ethical Principles

30. ACHA Ethical Guidelines • Responsibility in the Provision of Services • Professional Responsibility and Competence • Responsible and Ethical Relationships • Responsibility to One’s Institution • Responsibility to the American College Health Association (ACHA) and to the Field of College Health

31. What Does a Code of Ethics Do? • Creates a profession’s sense of identity • Identifies the issues the profession cares about and wants new members to care about • Communicates with those outside the profession what they can expect from its members

32. PROFESSIONAL ETHICS The moral commitments of a profession that: • involve moral reflection that extends and enhances the personal morality practitioners bring to their work, • concern actions of right and wrong in the workplace, and • help individuals resolve moral dilemmas they encounter in their work.

33. Recommendations • ACHA members expected to uphold the principles and guidelines • Use this document as a guide in day to day practice and when breaches in ethics are evident

34. Suggested Resources • The following are suggested reading materials from the Ethics Committee.  ACHA does not endorse or accept responsibility for the content or use of external websites or materials. Institute for Global Ethics:  http://www.globalethics.org The Ethics of Health Care: A Guide for Clinical Practice, by Raymond S. Edge and John Randall Groves Foundations of Ethical Practice, Research and Teaching in Psychology, by Karen Strohm KitchenerPrinciples of Biomedical Ethics, 5th Edition, by Tom L. Beauchamp & James F. Childress

35. Suggested Resources Gough, R. W. (1998). Character is destiny. Rocklin, CA: Prima. Kidder, R. M. (2005). Moral courage. New York: HarperCollins Publishers Corey, G., Corey M.S., and Callanan, P. (2007). Issues and ethics in the helping professions. Pacific grove, CA: Brooks/Cole. Callanan, P. (2004). The cheating culture. New York: Harcourt Inc. Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors and the collision of two cultures. Kidder, T. (2003). Mountains beyond mountains: The quest of Dr. Paul Farmer. Mortenson, G. & Relin, D.O. (2006). Three cups of tea: One man's mission to promote peace one school at a time.

36. How can ethics be used is real life situations?

37. Discuss Sources of Similarity and Difference Among Participants in Both Process and Outcomes of These Analyses • Small Group Discussion of Case Examples • Principles and Guidelines Used • Cultural, Professional & Diversity Considerations • Ethical “Method” Employed • What will, or might happen? • Large Group Sharing of Similarities and Differences Identified

38. Small Group Discussion Time • Pick a scribe for reporting back to large group • Identify a case situation, “unpack it” • Apply different principles and actors from different perspectives and backgrounds • Track what principles or guidelines are applicable, or at odds with one another

39. Reports to the Large Group • What was your group’s case situation? • What were key issues/dilemmas? • What principles were involved? • What role did diversity play? • Other highlights?