1. © 2010 Jones and Bartlett Publishers, LLC A Practical Approach For Decision Makers SECOND EDITION EILEEN E. MORRISON

2. © 2010 Jones and Bartlett Publishers, LLC Class One: Ethics Theories

3. © 2010 Jones and Bartlett Publishers, LLC Agenda Welcome and traditions Welcome and traditions Syllabus and online site review Syllabus and online site review Definitions of ethics Definitions of ethics Introduction to the global four Introduction to the global four Homework Homework Summary Summary

4. © 2010 Jones and Bartlett Publishers, LLC Class Traditions Begin the tradition of communities. Begin the tradition of communities. Divide into communities and seating areas. Divide into communities and seating areas. Shake the hand of your community members. Shake the hand of your community members. Tell me about your community. Tell me about your community.

5. © 2010 Jones and Bartlett Publishers, LLC Review of Syllabus and Online This course touches all of the other courses you will study. This course touches all of the other courses you will study. Review the syllabus: where are we going? Review the syllabus: where are we going? Review the online site. Review the online site.

6. © 2010 Jones and Bartlett Publishers, LLC Why Study Ethics? You need it as part of your base for successful practice. You need it as part of your base for successful practice. Health care is always changing and challenging. Health care is always changing and challenging. Answers not always black and white. Answers not always black and white. The community expects much from you. The community expects much from you.

7. © 2010 Jones and Bartlett Publishers, LLC Ethics Definitions Ethics is a way to study moral behavior. Ethics is a way to study moral behavior. It is more than obeying the law. It is more than obeying the law. There are different types of the ethics such as There are different types of the ethics such as Normative or organizational ethics. Normative or organizational ethics. Professional ethics. Professional ethics. Personal ethics. Personal ethics.

8. © 2010 Jones and Bartlett Publishers, LLC Welcome to the Global Four Global Issues in Ethics Global Issues in Ethics –Aquinas –Kant –Mill –Rawls

9. © 2010 Jones and Bartlett Publishers, LLC St. Thomas Aquinas (1225- 1274) His theory is called natural law. His theory is called natural law. God is rational and created the world rationally. God is rational and created the world rationally. Humans can reason, therefore are Humans can reason, therefore are Capable of choosing good over evil. Capable of choosing good over evil.

10. © 2010 Jones and Bartlett Publishers, LLC St. Thomas Aquinas (1225- 1274) Aristotle and Christian theology influenced him. Aristotle and Christian theology influenced him. He asked questions to develop his theory. He asked questions to develop his theory. God is rational and created the world rationally. God is rational and created the world rationally. Humans can think/reason and have the potential to choose good over evil. Humans can think/reason and have the potential to choose good over evil. Do we always do this? The gift of free will? Do we always do this? The gift of free will? Need to listen to our conscience. Need to listen to our conscience.

11. © 2010 Jones and Bartlett Publishers, LLC What is Good? Humans should strive for the highest good-- seeking wisdom and knowing God. Humans should strive for the highest good-- seeking wisdom and knowing God. For Aquinas, good preserves life and the human race, allows us to act prudently so we can live in community, & seek the truth. For Aquinas, good preserves life and the human race, allows us to act prudently so we can live in community, & seek the truth.

12. © 2010 Jones and Bartlett Publishers, LLC Happiness is not in… Pursuing our passionate appetites such as eating, drinking, sex, power. Pursuing our passionate appetites such as eating, drinking, sex, power. We are to use temperance in these things, so that we can enjoy them without being ruled by them. We are to use temperance in these things, so that we can enjoy them without being ruled by them. To be ethical, we must allow others to gain their best human potential. To be ethical, we must allow others to gain their best human potential. We must practice the cardinal virtues (prudence, temperance, courage, justice) We must practice the cardinal virtues (prudence, temperance, courage, justice)

13. © 2010 Jones and Bartlett Publishers, LLC Application: Stop and Talk What happens if evil is chosen over good? What happens if evil is chosen over good? Cost factors for the health care system? Cost factors for the health care system? What is your obligation to those who do not make rational choices? What is your obligation to those who do not make rational choices? Can you limit health care based on life decisions? Can you limit health care based on life decisions?

14. © 2010 Jones and Bartlett Publishers, LLC Immanuel Kant (1724-1804) His theory is deontology or duty-based ethics. His theory is deontology or duty-based ethics. Everything in society has relative value. Everything in society has relative value. The only true good is good will. The only true good is good will. All human beings have worth. All human beings have worth. People are not just tools to achieve societal or organization goals. People are not just tools to achieve societal or organization goals. Categorical imperative helps make decisions. Categorical imperative helps make decisions.

15. © 2010 Jones and Bartlett Publishers, LLC Application: Stop and Talk All people are valuable no matter how they contribute to the bottom line. All people are valuable no matter how they contribute to the bottom line. Categorical imperative helps with decisions. Categorical imperative helps with decisions. Examine application of Kant to policies. Examine application of Kant to policies. Pure Kantian practice is not always practical in health care, but it does give you tools and questions. Pure Kantian practice is not always practical in health care, but it does give you tools and questions. What questions would you ask yourself? What questions would you ask yourself?

16. © 2010 Jones and Bartlett Publishers, LLC John Stuart Mill (1806-1873) He is influential in American health care ethics. He is influential in American health care ethics. Utilitarianism impacts policy development. Utilitarianism impacts policy development. Good=produces utility (benefit) and/or avoids harm. Good=produces utility (benefit) and/or avoids harm. People can be a means to an end, but the end must be___. People can be a means to an end, but the end must be___.

17. © 2010 Jones and Bartlett Publishers, LLC Types of Utility Act Utility Act Utility –Each decision based on its own merit. Rule Utility Rule Utility –Consequences help to form rules. –Rules are then used for decisions.

18. © 2010 Jones and Bartlett Publishers, LLC Applications: Stop and Talk What are the limitations of utilitarianism? What are the limitations of utilitarianism? How can it help you make decisions? How can it help you make decisions? How can it help with policies? How can it help with policies?

19. © 2010 Jones and Bartlett Publishers, LLC John Rawls (1921-2002) What is a just society? What is a just society? Rawls sets up hypothetical concepts called the original position and veil of ignorance. Rawls sets up hypothetical concepts called the original position and veil of ignorance. If the concepts were true, we would create rules that to live in a just society. If the concepts were true, we would create rules that to live in a just society. These rules would lead to a social contract. These rules would lead to a social contract.

20. © 2010 Jones and Bartlett Publishers, LLC John Rawls Social contract includes equal basic rights. What do you think these should be? Social contract includes equal basic rights. What do you think these should be? It also includes protecting those in lesser positions (in your self interest). It also includes protecting those in lesser positions (in your self interest). The advantaged have a responsibility (difference principle). The advantaged have a responsibility (difference principle).

21. © 2010 Jones and Bartlett Publishers, LLC Application: Stop and Talk Public health and other organizations based on social justice. Public health and other organizations based on social justice. America is judged by how it treats the least well off—Examples? America is judged by how it treats the least well off—Examples? Political issues around social justice? Political issues around social justice? His theory causes ethics concerns with balancing mission and margin; huge issue for health care. His theory causes ethics concerns with balancing mission and margin; huge issue for health care.

22. © 2010 Jones and Bartlett Publishers, LLC In summary… What does the word ethics mean to you? What does the word ethics mean to you? How does knowing about the Big 8 help you understand ethics? How does knowing about the Big 8 help you understand ethics?