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A MY Code Blue Health Science Edition 4 C HAPTER 5.

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1 A MY Code Blue Health Science Edition 4 C HAPTER 5

2 Treating Patients With Dignity Sometimes health professionals get so wrapped up in the scientific principles of healthcare that they forget they are dealing with human beings. Human beings may be in pain, frightened or upset. Sometimes health professionals get so wrapped up in the scientific principles of healthcare that they forget they are dealing with human beings. Human beings may be in pain, frightened or upset.

3 How do We as Health Care Professionals Sometimes Dehumanize Patients? We take away their clothes and give them a generic (often immodest) hospital gown.

4 How do We as Health Care Professionals Sometimes Dehumanize Patients? We give the patient a wrist band with a number that is often a substitute for their name.

5 How do We as Health Care Professionals Sometimes Dehumanize Patients? We take away their jewelry and other personal items that set them apart as an individual.

6 How do We as Health Care Professionals Sometimes Dehumanize Patients? We sometimes unnecessarily restrict family access. We make them adjust to the hospital’s schedule, instead of the opposite. And so on. We sometimes unnecessarily restrict family access. We make them adjust to the hospital’s schedule, instead of the opposite. And so on.

7 The Inequality of Power Healthcare professionals exercise a great deal of power over patients. It is important to make sure that this power is never abused.Healthcare professionals exercise a great deal of power over patients. It is important to make sure that this power is never abused. In an attempt to protect patients, many hospitals have implemented a patient’s bill of rights.In an attempt to protect patients, many hospitals have implemented a patient’s bill of rights. Healthcare professionals exercise a great deal of power over patients. It is important to make sure that this power is never abused.Healthcare professionals exercise a great deal of power over patients. It is important to make sure that this power is never abused. In an attempt to protect patients, many hospitals have implemented a patient’s bill of rights.In an attempt to protect patients, many hospitals have implemented a patient’s bill of rights.

8 Brannan Community Hospital’s Patient Bill of Rights Let’s take a moment to review one patient bill of rights. Comment on why you think each principle is important. Let’s take a moment to review one patient bill of rights. Comment on why you think each principle is important.

9 The staff of Brannan Community Hospital realizes that patients have the following rights: The right to know the professional status of all people providing care. To know the name of their attending doctor. To receive complete information on their diagnosis and treatment. To be given the prognosis for their illness. To review all information in their medical record. To have every procedure, treatment, or drug therapy explained to them in language they understand. The right to know the professional status of all people providing care. To know the name of their attending doctor. To receive complete information on their diagnosis and treatment. To be given the prognosis for their illness. To review all information in their medical record. To have every procedure, treatment, or drug therapy explained to them in language they understand.

10 The staff of Brannan Community Hospital realizes that patients have the following rights: To know the possible risks, benefits, and costs of every procedure, treatment or drug therapy. To accept or refuse treatment. To prepare, in advance, treatment directives and to expect that these will be honored. To appoint a person to make decisions about their care if they become mentally disabled. To know the possible risks, benefits, and costs of every procedure, treatment or drug therapy. To accept or refuse treatment. To prepare, in advance, treatment directives and to expect that these will be honored. To appoint a person to make decisions about their care if they become mentally disabled.

11 The staff of Brannan Community Hospital realizes that patients have the following rights: To have personal privacy. To receive compassionate care and proper management of pain. To seek a second opinion. To ask that the hospital ethics committee review their case. To have personal privacy. To receive compassionate care and proper management of pain. To seek a second opinion. To ask that the hospital ethics committee review their case.

12 Ethics is: The study of right and wrong. A branch of human thought concerned with how human beings treat each other. The study of right and wrong. A branch of human thought concerned with how human beings treat each other.

13 Other Definitions Morals—personal standards of right and wrong. Laws—rules that enforce behavior. Just because something is legal does not necessarily mean it is moral. Morals—personal standards of right and wrong. Laws—rules that enforce behavior. Just because something is legal does not necessarily mean it is moral.

14 Throughout history, philosophers have developed many models to guide people in ethical decision making. Hobbs Hutcheson Hume BenthamRousseau PlatoSocrates

15 Some of these Models for Ethical Decision Making are Fairly Complex Theoretical perspective Relativism Utilitarian Subjectivism Egoism Golden Rule Theoretical perspective Relativism Utilitarian Subjectivism Egoism Golden Rule Universal Rule Economic efficiency Government requirement Personal values Distributive Justice Stakeholder

16 There are two schools of ethical thought Deontological School Teleological School Deontological School Teleological School

17 Deontological School The Greek word ‘deon’ means ‘duty.’ This school studies moral obligations. Followers believe in the existence of good and evil and believe that people have an obligation to do good for other people. The Greek word ‘deon’ means ‘duty.’ This school studies moral obligations. Followers believe in the existence of good and evil and believe that people have an obligation to do good for other people.

18 Teleological School The Greek word ‘telos’ means ‘end.’ This school believes that the end is all that matters, that “the end justifies the means.” The Greek word ‘telos’ means ‘end.’ This school believes that the end is all that matters, that “the end justifies the means.”

19 Bioethics... Came into existence as a discipline in about –During this period science shifted from focusing solely on science and treatment, to focusing on the patient as a human being. Came into existence as a discipline in about –During this period science shifted from focusing solely on science and treatment, to focusing on the patient as a human being.

20 What caused bioethics to become so important? New technologies that necessitated a new definition of the term “death” Revelations of abuses in the use of human subjects in medical research New technologies that necessitated a new definition of the term “death” Revelations of abuses in the use of human subjects in medical research

21 Euthanasia Abortion Organ transplants Genetic engineering Euthanasia Abortion Organ transplants Genetic engineering What caused bioethics to become so important?

22 Increasing healthcare costs, necessitating a rethinking of the allocation of healthcare resources. What caused bioethics to become so important?

23 How does all of this apply to me? Many students, upon graduating, are surprised to find that there is a great deal of ambiguity in the real world. Sometimes there are no clear cut answers. Many students, upon graduating, are surprised to find that there is a great deal of ambiguity in the real world. Sometimes there are no clear cut answers.

24 How does all of this apply to me? Healthcare personnel often find their decisions clouded by dilemmas, paradoxes, inconsistencies, and with differing expectations.

25 Applying the Model to Case Studies

26 Case Studies One way to teach health ethics is through case studies. Case studies allow the discussion of real- world situations without the stress and politics that unjustifiably influence ethical decisions. One way to teach health ethics is through case studies. Case studies allow the discussion of real- world situations without the stress and politics that unjustifiably influence ethical decisions.

27 Framework Since many ethical problems involve ambiguity, it is good to have a framework to provide structure in analyzing these situations.

28 Framework In Code Blue, we provide structure by looking at... –The stakeholders in the ethical decision. –An ethical model that includes a set of questions designed to guide the student through the analysis. In Code Blue, we provide structure by looking at... –The stakeholders in the ethical decision. –An ethical model that includes a set of questions designed to guide the student through the analysis.

29 Stakeholder A stakeholder is someone who has an interest in the outcome of a decision. In healthcare, stakeholders may include the patient, the family, the individual or insurance company paying for the care, the professionals treating the patient, and so on. A stakeholder is someone who has an interest in the outcome of a decision. In healthcare, stakeholders may include the patient, the family, the individual or insurance company paying for the care, the professionals treating the patient, and so on.

30 Our Model for Ethical Decision Making The model used in this book has been adapted for high school use from several current models used by professionals.

31 Our Model for Ethical Decision Making The author doesn’t pretend it is all inclusive, but presents it as a starting point. Students should feel free to add to, or delete from, the model proposed in reviewing the cases. The author doesn’t pretend it is all inclusive, but presents it as a starting point. Students should feel free to add to, or delete from, the model proposed in reviewing the cases.

32 The model is based on the following principles Free agency Equality Kindness Obligation to do good for others Obligation to do no harm Honesty Legality Free agency Equality Kindness Obligation to do good for others Obligation to do no harm Honesty Legality

33 Free Agency A patient has the right to make decisions about his or her own body without outside control.

34 Equality The healthcare system has an obligation to treat all patients fairly.

35 Kindness A patient has a right to expect that a healthcare worker will be merciful, kind and charitable.

36 Obligation to do Good for Others Healthcare workers are obligated to take the action that will result in the best outcome for the patient.

37 Obligation to do no Harm The first obligation of the healthcare practitioner is to avoid injury to his or her patient.

38 Honesty A healthcare worker should be honest.

39 In-class Assignment Break into groups of four to five students. Read the case studies on page Pick a case study for discussion. Break into groups of four to five students. Read the case studies on page Pick a case study for discussion.

40 In-class Assignment Using the Guidelines for Answering Bioethical Questions found on page 71 of the book, analyze the case you have chosen.

41 In-class Assignment Prepare to discuss with the class who the stakeholders are, and what the guiding ethical principles of the case are. Present the ethical solution your group has decided upon. Prepare to discuss with the class who the stakeholders are, and what the guiding ethical principles of the case are. Present the ethical solution your group has decided upon.

42 Review Discussion Questions

43 The End!


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