Ethics in Primary Care Catharine A Kopac, PhD, GNP Associate Professor Nurse Ethicist

What is Ethics? Ethics is concerned with doing good and avoiding harm. Ethics is concerned with doing good and avoiding harm. Health care professionals have the power to do good or harm their patients. Health care professionals have the power to do good or harm their patients. Possibilities of good or harm depend partly on factual knowledge and partly on values. Possibilities of good or harm depend partly on factual knowledge and partly on values. Both must be consciously and critically evaluated for their potential of good or harm to human beings, well or sick. Both must be consciously and critically evaluated for their potential of good or harm to human beings, well or sick.

Examples A presumed good in health care would be to prescribe the appropriate medication and educate the patient regarding the appropriate diet. A presumed good in health care would be to prescribe the appropriate medication and educate the patient regarding the appropriate diet. A presumed harm is to avoid and thus deny care for patients with complicated care needs, e.g., persons with developmental disabilities, the aged, Medicare or Medicaid patients. A presumed harm is to avoid and thus deny care for patients with complicated care needs, e.g., persons with developmental disabilities, the aged, Medicare or Medicaid patients.

Ethical Principles Respect for autonomy-(a norm of respecting the decision making capacities of autonomous persons) Respect for autonomy-(a norm of respecting the decision making capacities of autonomous persons) Nonmaleficence-(a norm of avoiding the causation of harm) Nonmaleficence-(a norm of avoiding the causation of harm) Beneficence-(a group of norms for providing benefits and balancing benefits against risks & benefits) Beneficence-(a group of norms for providing benefits and balancing benefits against risks & benefits) Justice-(a group of norms for distributing benefits, risk, and costs fairly) Justice-(a group of norms for distributing benefits, risk, and costs fairly)

A Framework for Ethical Analysis The Glaser Model Three Realms of Ethics: Three Realms of Ethics: Individual-The good and virtuous individual Individual-The good and virtuous individual Organizational-The good and virtuous institution Organizational-The good and virtuous institution Society-The good and virtuous society Society-The good and virtuous society

Individual Ethics Deals with the good and goodness of individuals. Deals with the good and goodness of individuals. Attends to the balance and right relationships among various dimensions of a single individual (spiritual, mental, physical, emotional, etc.) as well as the rights and duties that exist between separate individuals. Individual ethics tends to deal with the behaviors and virtues of individuals. Attends to the balance and right relationships among various dimensions of a single individual (spiritual, mental, physical, emotional, etc.) as well as the rights and duties that exist between separate individuals. Individual ethics tends to deal with the behaviors and virtues of individuals.

Organizational Ethics Deals with overall & long-term good and goodness of institutions (families, agencies, corporations). Deals with overall & long-term good and goodness of institutions (families, agencies, corporations). Attends to the health, vigor, balance and equity of the institution’s keys systems and structures so that the institution can accomplish its mission while attending to it rights and duties vis a vis the individuals who make it up and the larger society in which it exists. Attends to the health, vigor, balance and equity of the institution’s keys systems and structures so that the institution can accomplish its mission while attending to it rights and duties vis a vis the individuals who make it up and the larger society in which it exists.

Societal Ethics Deals with the common good-the overall & long- term good and goodness of a society (city, state, country). Deals with the common good-the overall & long- term good and goodness of a society (city, state, country). Attends to the health, vigor, balance, and equity of society’s key systems and structures–political, economic, legal, educational, etc.—so that society increasingly is and continues to be an environment in which persons can be born, grow, labor, love, flourish, age and die as humanely as possible. Attends to the health, vigor, balance, and equity of society’s key systems and structures–political, economic, legal, educational, etc.—so that society increasingly is and continues to be an environment in which persons can be born, grow, labor, love, flourish, age and die as humanely as possible.

The Heart of Practice! A sacred bond….. The Clinician-Patient Relationship! A matter of trust…. Always remember: Clinician is an expert with power over someone seeking help.