Principles of Health Care Ethics Chapter 2 Principles of Health Care Ethics

Principles of Ethics Extends your foundation of ethics. Gives you ways to apply ethics to practical situations. The four most often used in health care are nonmaleficience, beneficence, autonomy, and justice.

Nonmaleficience Sometimes this is translated as “first do no harm”. Ethical theories define harm in different ways. Consequentialist says harm is that which prevents good. Natural law says harm is something that limits our potential.

Nonmaleficence Deontologists say harm is something that prevents you from doing your moral duty. Virtue ethicists say harm is something that leads you away from practicing high moral character. Ethical egoists say that harm is something that goes against your self interest.

Harm in the Clinical Setting Harm is something that negatively affects patients. Clinically, we think of physical harm but other harm is possible. Harm is also caused by negligence. Harm can be caused by violating autonomy.

Beneficience Beneficence comes from the Latin word for good- “bene”- and means to benefit. Requires a decision to engage in beneficent acts or to be altruistic. It is a fundamental principle of health care practice. What theories support beneficence?

Health care and Beneficience The standard of altruism is higher for health care professionals. Altruism is expected. Beneficence sometimes is extended to paternalism when the health care professional makes decisions for the good of the patient. What is this called?

Autonomy Autonomy means that you can rule yourself. It implies a respect for others. In health care, we have a duty to treat, but not to judge. What are the conditions necessary for autonomy in health care?

Specific Competence Is defined as the ability to do some things but not others. So, you can be competent in a limited way. In issues where a person is not competent, the concept of substitute judgment can be used. This is also involves the idea of reasonable person’s decision.

Specific Competence Coercion can also affect a person’s ability to exercise autonomy. Issues of competence and autonomy also are part of informed consent and other health care issues which are discussed in later chapters.

Justice The term can be used to mean fairness. Aristotle thought we should treat similar cases in a similar way unless there was some relevant or material difference. We need to examine types of justice: procedural and distributive.

Procedural Justice This is sometimes called due process. It means that you get your turn; you are treated like everyone else. Procedural injustice can occur with employee situations. Due process is also involved with policy making in procedural justice.

Distributive Justice This form of justice involves balancing benefits and burdens. Health care resource allocation is one example of an distributive injustice? Health care is a scarce resource, so Resource allocation issues are common in health care; what are some examples of these issues?

Material Reasons to Discriminate Basic argument is that the person deserves it or needs it In the U.S., if you work hard, you deserve to be rewarded. In contrast, if you disobey the law, you deserve to be punished.

Discrimination based on Need Need can be based on misfortune or disability. Need can be based on special talents or abilities and on opportunities. Need can be based on past discrimination. Need can also be based on structural social problems.

In the larger society… There is a need to discriminate based on material need. You are rewarded based on how much you contribute. You are also rewarded based on how much effort you put forth. This thinking also applies to patient care. Can you give some examples?

Need based on Misfortune Misfortune can lead to discriminate based on or against need for care. For example, life threatening situations are treated before minor emergencies. Special talents or the potential loss of opportunity can be arguments for special treatment. What other groups fall into the need based category?

Need based on past Discrimination Redress of past injustices may be a reason for different treatment. The health care system has responded to the needs of some special groups. Structural problems have also been considered in needs based discrimination; what are some examples?

Distributive Justice and Rights We are still debating if health care is a right or a commodity. Need to think about whether something is a legal right or a moral right. There are many types of right and many overlap each other (See figure in text).

Legal or Positive Rights Legal right means that someone has a legal obligation to fulfill your right. Positive right means that you are entitled to something. Sometimes legal rights become that which you can enforce.

Substantive Rights Can be legal rights or not. They are right to a particular thing such as education, health care, minimum wage, etc. Different nations have differing opinions about substantive rights for their citizens.

Negative Rights You have the right to be left alone. The Bill of Rights lists many negative rights. The negative right of one person may be in conflict with the negative right of another (i.e. smokers). Other negative rights include freedom from sexual harassment, and medical record privacy.

Process, Natural, and Ideal Rights You have the right of due process. Natural rights means that you respect the attributes that people have in nature. These rights allow humans to reach their full potential. Natural rights express our common morality and ideal rights inspire.

Reflective Equilibrium Model Making ethical decisions requires considered judgments. These judgments require rational moral reasoning. Ethical theories and principles are used to explain moral reasoning. Reflective equilibrium model provides a process for considering and reconsidering decisions.

Reflective Equilibrium Model

How can you Use the Model in Practice? Describe a situation where making an ethics choice might be difficult. Now, use Reflective Equilibrium Model to assist you in deciding the most ethical decision to make. Why is this model not in common practice in health care?

In Summary…