The Ethics of Caring

1. The Ethics of Caring Beyond Personal & Professional Decision Making SE4A Conference 2009 Charleston, SC Presenters: B. Gordon & M. Dobson

2. What is ethics? • Ethics refers to well based standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues. • Ethics refers to the study and development of one's ethical standards • Is legal the same as ethical? Barbara Gordon & Molly Dobson

3. What is ethics? • The enterprise of disciplined reflection on moral intuitions and moral choices. • Moral values are examined • What ought to be done in a given situation. • Ethical principles form moral choices as persons act as moral agents. • Various Professional disciplines have individual Codes of Ethics Barbara Gordon & Molly Dobson

4. Ethics in the Service Environment • The Health Care & Human Service Environment hosts many professional disciplines. • Each discipline’s codes of ethics have similar principles and they are generally not in conflict but supportive and mutual. • Quality in the human service and healthcare service environment does not only include technical and service quality, but also ethical quality. Barbara Gordon & Molly Dobson

5. Code of Ethics • Individual/Personal value system • Personal Standards – Respect, Trust and Confidence • Professional/Discipline Code of Ethics • Based on various ethical theories • Used as tool to define and understand crisis in decision making and resolve differences. Barbara Gordon & Molly Dobson

6. Guiding Principles in Ethics • Integrity • Objectivity • Professional Confidence • Confidentiality • Professional Behavior • Technical Standards Source: Advancing Government Accountability Barbara Gordon & Molly Dobson

7. The Healthcare/Human Service Environment • “In human service/healthcare the person’s good is achieved across a spectrum of biomedical, spiritual, functional, and emotional needs. Thus, the provider addresses the physical, psychological, functional, emotional and societal needs of individuals, families, and communities. Often, ethical dilemmas arise because of the necessity for making choices in how to meet these human needs. Ethical principles & theories both contribute to systematic reasoning to achieve the good in decision making.” Barbara Gordon & Molly Dobson

8. The Healthcare/Human Service Environment • Clinical ethics versus institutional ethics • Value structure of an organization • Does not just depend on leadership • Ethics must be inherent in the organizational culture. • Holistic systems approach. Barbara Gordon & Molly Dobson

9. Organizational Culture • “In any attempt to change the values of an organization, whether it is through the education of its participants in moral principles, or the imposition of leadership committed to higher ethical principles, the contents of the existing organizational culture must be dealt with directly for positive change to occur. Ignoring culture in attempting to refocus the values orientation of an organization is similar to ignoring causes and treating symptoms.”Mary Cipriano Silva, Ph.D., RN, FAAN Barbara Gordon & Molly Dobson

10. Organizational Culture • Values and ethics are not only central to organizational culture but also to positive organizational performance. • Institutions have ethical lives and characteristics just as their individual members do. • Must disengage behaviors and practices that compromise the organizational culture or causes the organization to become ethically deviant. Barbara Gordon & Molly Dobson

11. Organizational Culture: Building an Ethics Infrastructure • Conduct a formal process to clarify and articulate the organization's values and link them to the mission and vision. • Facilitate communication and learning about ethics and ethical issues, including values clarification and reflection on their link to practice. • Create structures that encourage and support the culture. • Create processes to monitor and offer feedback on ethical performance. Barbara Gordon & Molly Dobson

12. Organizational Culture: Building an Ethics Infrastructure • To prevent deviant organizational structures, human service professionals should consider: • extending their horizons and that of their staff beyond their own discipline and attend business classes and seminars on organizational ethics, • read business journals and books on ethics and organizational structure, • understand that hidden behind many decisions they make is an ethical issue waiting to be explored, and Barbara Gordon & Molly Dobson

13. Organizational Culture: Building an Ethics Infrastructure • Healthcare and human service providers who exist within an environment with positive and effective ethical culture will typically not get caught in the cross fire of administration, rules, regulations, policies and practices, and/or funding limitations that prevent people from receiving the type of care that is available. • This type of environment will protect and defend the human dignity of the professional and re-humanize the health or human service that is being provide. Barbara Gordon & Molly Dobson

14. Making and Ethical Decision • Recognize the Ethical Issue • Get the Facts • Relevant Facts • Individuals and groups with an important stake in decision • What are the options for acting? • Evaluate Alternative Actions • Make a Decision and Test It • Act and Reflect the Outcomes Barbara Gordon & Molly Dobson

15. Approaches to Ethical Business Decision-Making • Utilitarian -Action that will result in the greatest good for greatest numbers. • Moral Rights – Moral principles, regardless of consequences. At times simply right or wrong. • Universalism- 1) Should decision apply to all and 2) Are you willing to have rule applied to you? • Cost-Benefit – Balance the costs and benefits vs. not taking any action. Source: Managementhelp.org Barbara Gordon & Molly Dobson

16. Case Scenario • Conflict between good practice and demands of the agency. • Jenny, age 50, has a client who is homebound and requires care that at times may exceed the amount of time she is allotted by her company in order to visit as many clients as possible per day. Her company is paid a certain amount per visit, plus a reduced rate for the cost of care. The company wants her to spend less time per client so she can visit more clients per day. Jenny insisted that client needs more care due to limitations, but her company says she must finish her work quickly and move on to the next client. Jenny’s job could be in jeopardy if she doesn’t comply. Barbara Gordon & Molly Dobson

17. Case Scenario • Client Needs/Rights versus Public Good • A client who visits a senior center on a regular basis has flu like symptoms and possible H1N1. She tests positive by her physician. There is concern for the clients and public who have been exposed. You must consider the health of others. How do you handle the situation? Barbara Gordon & Molly Dobson

18. Case Scenario • Conflict between co-workers due to differences in training, profession or responsibilities. • A program coordinator of the local senior community center has arranged for a large event that will be costly to operate over a one week period. The staff has developed a budget and the Finance Department has rejected the budget as too costly since the cost will exceed the amount available in the aging budget. Program staff is insistent that this event must take place to meet performance on a grant that funds the agency. If the event takes place, the agency may not have enough money to pay for the event. How should staff handle this conflict? Barbara Gordon & Molly Dobson

19. Case Scenario • Conflict between serving or discontinuing services for a client who will not follow care plan and protocols for program. • Mr. Jones is 85 years old, single, lives alone and has no family or other informal support system. He is in poor health with diagnoses of diabetes, high blood pressure, and COPD. His health has been deteriorating and his ability to care for himself has been compromised. His current care plan includes home delivered meals 7 days per week (frozen), personal care, home making and transportation to the physician. Mr. Jones has a problem with hoarding which makes it very difficult to provide care. He now has an obvious mice/rat infestation. It has been difficult convincing Mr. Jones that he needs assistance with clearing his home of clutter and addressing the mice problem. APS has been contacted on many occasions but because Mr. Jones is competent and coherent, APS has not acted to remove him from the home. “He chooses to live this way.” In-home services aides for some providers have refused to go into his home and it has become very challenging to serve him. Agency policies related to client roles and responsibilities will allow discharge of this client for services but it is the only support system currently in client’s life. How should the agency proceed with serving this client? Barbara Gordon & Molly Dobson

20. Case Scenario • Conflict between professional staff and agency on following agency policies during a disaster situation. • There has been a severe winter storm in a community that has interrupted electrical services, disrupted travel due to fallen trees and excessive snow, and prevented service agencies from providing services to vulnerable older adults in the community. The aging network has an emergency response plan that includes contacting older adult clients in the community beginning with those who are frail, elderly and living alone. Some agencies actually go door to door to check on the client lists. Staff is informed of the protocol which includes deploying seniors to emergency shelters if they do not have electricity and a safe heating mechanism. Due to the limitation of shelters who will take pets and the seniors being leery of parting with their pets by sending them to the pound or humane society, some will not leave their homes. Staff visits a client who has significant chronic health issues. Her home is below 40 degrees when she arrives. The client is under several blankets and obviously very cold. She also has a very bad cough and informs the staff that she is just getting over a bout of bronchitis. Staff tells her that she needs to go to a shelter until her electricity comes back on. She says that she can’t leave her dog “Charlie”. Barbara Gordon & Molly Dobson

21. Case Scenario – Continued • Staff says that she will try to get her into a shelter that may consider taking her dog too. She calls around and is not able to find an available spot at the small shelter that will accept pets. She then offers to take her dog to the pound or humane society until her power comes back on. The client says I can’t do that and refuses to leave unless she can keep “Charlie” with her. Staff is at an impasse because she knows that this client will not budge on this issue but she is at significant risk of endangering herself if she stays at home. She contacts APS and is told that they won’t be able to investigate for several days due to the disaster situation. Staff decides to offer to take the client home with her (she has heat) until they can remedy the situation with another plan. The client accepts. When staff returns to her office and informs supervisors of what occurred she is later reprimanded, placed on suspension and then demoted because the agency has a strict policy about transporting clients in staff vehicles as well as taking clients to staff homes. How do professional ethics weigh in this scenario from the staff’s perspective? How do professional ethics weigh from the agency’s perspective? Barbara Gordon & Molly Dobson

22. Resources Code of Ethics Websites • http://www.managementhelp.org/ethics/ethxgde.htm • http://www.babicm.org/code-of-ethics.php#manager • http://www.socialworkers.org/practice/standards/sw_case_mgmt.asp • http://ethics.iit.edu/codes/coe/nat.org.human.services.1996.html • http://www.greystoneprograms.org/code_of_ethics.htm • http://www.agacgfm.org • http://www.entrepreneur.com Barbara Gordon & Molly Dobson

23. PowerPoint & Handouts • The PowerPoint Presentations and other articles and information can be found at: www.kipda.org • Presenters Contact Information: barbara.gordon@ky.gov molly.dobson@ky.gov Barbara Gordon & Molly Dobson

24. CLOSING THANK YOU FOR PARTICIPATING! ENJOY THE REST OF THE CONFERENCE Barbara Gordon & Molly Dobson