1. Ethics in Healthcare

2. Meet the Big 8
Aquinas
Kant
Mill
Rawls
Aristotle
Buber
Kohlberg
Frankl

3. Saint Thomas Aquinas (1225-1274)
Theory: Natural Law
God is rational and created the world rationally.
Humans can reason, therefore are capable of choosing good over evil.
Influences: Aristotle and Christian theology
Asked a lot of questions to develop theories
Gift of Free Will
Why do we do things?
The need to listen to conscience.

4. What is Good?
Humans should strive for the highest good—seeking wisdom and knowing God.
For Aquinas, good preservers life and the human race, allows us to act prudently so we can live in community, and seek the truth

5. Happiness
Pursuing our passionate appetites such as eating, drinking, physical relations, power.
We are to use restraint 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.
We must practice the cardinal virtues (prudence, temperance, courage, justice).

6. Can you limit health care based on life decisions?
Stop and Talk
Can you limit health care based on life decisions?
What are the cost factors for the health care system?
What is the healthcare obligation to those who do not make rational choices?

7. Immanuel Kant (1724-1804) Theory: deontology (duty-based ethics)
Everything in society has relative value.
The only true good is good will.
All human beings have worth.
People are not just tools to achieve societal or organization goals.
Categorical imperative helps make decisions.

8. Why would a pure Kantian practice be practical in healthcare?
Stop and Talk
Are all people valuable no matter how they contribute to the bottom line?
Why would a pure Kantian practice be practical in healthcare?

9. Theory: Utilitarianism produces utility (benefit) and/or avoids harm.
John Stuart Mill ( )
Theory: Utilitarianism produces utility (benefit) and/or avoids harm.
Influential in American healthcare ethics.
People can be a means to an end, but the end must be __________.

10. Act Utility Rule Utility Each decision based on its own merit.
Types of Utility
Act Utility
Each decision based on its own merit.
Rule Utility
Consequences help to form rules.
Rules are then used for decisions.

11. What are the limitations of utilitarianism?
Stop and Talk
What are the limitations of utilitarianism?
How can it help you make decisions?
How can it help you make policies?

12. John Rawls ( )
Theories: original position and veil of ignorance.
If the concepts were true, we would create rules to live in a just society.
What is a just society?
These rules would lead to social contract.
Social contract = equal basic rights including protecting those in lesser positions (in your self interest). The advantaged have the responsibility to carry out this mandate.

13. Stop and Talk
Societies are judged by how it treats the least well off? How would America be judged?
His theories cause ethics concerns in healthcare because they ask for a balance of mission and profit. How do you see this in hospitals?

14. Aristotle (384 BC – 322 BC) Virtue Ethics What makes a good person
Practical wisdom and eudaimonia.
A character trait that you are willing to ACT on
Includes thinking emotions, choices, values
If you have virtue, you will act on it even when it is difficult.

15. Practical Wisdom or Phronesis
Practical Wisdom means you think about how and why to act.
The ability to decide what is best for a situation.
Rational thought is achieved by experience AND education.

16. Happiness or flourishing. Only possible with humans.
Eudaimonia
Happiness or flourishing.
Only possible with humans.
Living a life devoted to virtues and not just to external rewards such as money or pleasure.

17. What kind of employees do you want to hire?
Stop and Talk
What kind of employees do you want to hire?
What are the benefits of eudaimonia?

18. Ethics is about relationships and forms a hierarchy
Martin Buber ( )
Ethics is about relationships and forms a hierarchy
I-I—person does not exist.
I-IT—people as property.
I-YOU—people are whole and have ideas
I-THOU—highest moral relationship; agape.

19. What would happen if you treated people as I-YOU? I-IT?
Stop and Talk
What would happen if you treated people as I-YOU? I-IT?

20. Lawrence Kohlberb (1927-1987) Ethical Development Stage Theory
Pre moral (before moral reasoning) or
Pre Conventional, its about YOU.
Level one—avoid punishment
Level two—personal rewards
Exernally controlled morals (Rules by others)
Level three—please people
Level four—law is obeyed
Principled morals (Rules by higher authority)
Level five—common rights
Level six—universal rights and laws

21. Analyze your own moral stages What is your role in society's eyes
Stop and Talk
Analyze your own moral stages
What is your role in society's eyes

22. Victor Frankl (1906-1997) Search for meaning
You are Mind/Body/Spirit (noös) and unique in the universe.
Finding meaning in life and work is key.
You have choices but with choice comes responsibility.
There is super meaning that knows the answers. Consequence is key to your choices and keeps you from the existential vacuum.

23. Do you accept responsibility for your choices?
Stop and Talk
Do you accept responsibility for your choices?

24. Application to Health Care
Think of the theories we have just reviewed. How can we use them in health care?
What does the word ethics mean to you?
How does knowing about the Big 8 help you understand ethics?