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Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals.

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Presentation on theme: "Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals."— Presentation transcript:

1 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals

2 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals

3 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals From :Robert Veatch, Models for Medicine in a Revolutionary Age “One of the impacts of the biological revolution is to make the physician a scientist…” This role model values precision, technology and clinical expertise. Specialized surgery is its hallmark, and clearly is in high esteem in American medicine today.

4 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals As Chief Engineer, the physician is the head of a clinical team where nurses and other support members have specialized roles as “technicians” who share the same values, including an objective and non-judgmental attitude toward the patient. The negative aspect of this model is that it engenders a detachment from the patient as a person, and de- emphasizes “bed-side manner” (“The kidney in Rm. 302a is complaining again…”)

5 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals

6 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals The Priestly model is the traditional one wherein the patient implicitly trusts the authority of the physician to make the correct decisions for them. The relationship is a personal one, but tends to be paternalistic. “The doctor’s office or the hospital room… have somewhat the aura of a sanctuary” and the physician is given the status of a priest or confessor (re: Hippocratic Oath and confidentiality) – or higher (!)

7 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals Nurses and other support clinicians in this model fill the role of the “surrogate mother” not only to the patient, giving ‘care’ in the full sense of the word, but they are also the complimentary (and secondary) role to the Fatherly/Priestly figure. While care is emphasize, this too is an hierarchical, “top-down” team structure of “father knows best.” The clinicians values and judgment are not to be questioned, second opinions are not encouraged.

8 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals

9 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals This is a Collegial model, wherein the health care team views themselves in a collegial relationship with the patient in common pursuit of eliminating illness and preserving health. In this contractual relationship the patient is the consumer requesting services, and ultimately “calls the shots”

10 Ethical principles may serve as a foundation for various views on Health Care delivery... Role Models for Health Care Professionals While more cooperative and less authoritarian or hierarchical than the other models, it too has problems. In recognizing the autonomy of the patient, it tends to let the least knowledgeable member of the team (regarding health care information) make the key decisions. Is the customer always right? Fully educating the patient is ideal, but that of course takes time – a rapidly diminishing resource.

11 So… What’s YOUR view? What role do you value most? Is that view shared by clinical colleagues or those that provide you medical care? What happens when views conflict? Can you “mix & match”? Do views change over time?

12 So… What’s YOUR view?

13 Notes:  The values of the role model are related to the values emphasized by the Ethical System it rests on (and the ethical views are consistent with a Worldview)  The models are stereotypical, and are only as helpful as describing a stereotypical democrat, republican, independent, etc  Each role has its advantages and disadvantages, and as long as the recipient and provider of health care are in agreement regarding their relationship, problems and conflicts are reduced.

14 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals On the negative side, the Utilitarian aspect of “dealing with the problem” of AIDS initially was either dismissive (‘it’s not a problem for the majority of us’) or restrictive (suggestions for ‘isolating’ AIDS patients to specific health care settings, even a suggestion that Cruise ships be converted for that purpose (!)

15 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals On the positive side, the Utilitarian attitude recognizes that all of us need health care at some time, and that’s precisely when the majority should help the minority. Further, dealing with the issue of the spread or the treatment of AIDS proved both beneficial and cost effective for all. (the current Crisis in Africa is the toll of not treating such diseases seriously

16 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals The Natural Law perspective initially offered a poor attitude of righteous indignation, implying that AIDS was the ‘natural result of unnatural behavior’ The attitude of disease as the punishment for the wages of sin has long been entrenched in the popular perspective, and it was sad to see it surface in the profession as well.

17 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals On the positive side, it was the spiritualistic perspective that first responded to the need to address the care of those suffering form AIDS. Religious organizations as well as health care organizations recognized that we are obliged to treat the sick without prejudice; if all life is sacred, it is wrong to judge one life as worth more or less than another.

18 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals The Idealistic perspective would demand equal treatment, but negative attitudes still appeared early on, demanding that “everyone be tested so we can root out and eliminate the disease”. This would be the medical equivalent of a witch-hunt

19 The role models have positive and negative traits regarding health care delivery. AIDS engendered both… Role Models for Health Care Professionals Fortunately, the correct application of Kant’s principles demands universal equal treatment. In effect, as long as every patient is treated with “Universal Precautions” (H.C.P.s using gloves, gowns, goggles if necessary, etc) then there is no need to discriminate among the ill.

20 Aids is a “test case” for patient’s rights: Whatever the rights of an AIDS patient are, those are every patient’s rights:  Respect  Equal Treatment and Access  Confidentiality Since these were implied, but not guaranteed in the past, and since the advent of AIDS and other aspects of the current health care crisis,these right have been often bypassed or violated, we now have legislative efforts to encode these expectations into law as a “Patient’s Bill of Rights”


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