1. E THICS IN H EALTHCARE CTE Online Shelby County ATC Health Science

2. M EET THE B IG 8 Aquinas Kant Mill Rawls Aristotle Buber Kohlberg Frankl

3. S AINT T HOMAS A QUINAS (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. W HAT IS G OOD ? 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. H APPINESS Pursuing our passionate appetites such as eating, drinking, physical relations, power. enjoy ruled 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. S TOP AND T ALK 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. I MMANUEL K ANT (1724-1804) Theory: deontology (duty-based ethics) relative 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. S TOP AND T ALK Are all people valuable no matter how they contribute to the bottom line? Why would a pure Kantian practice be practical in healthcare?

9. J OHN S TUART M ILL (1806-1873) 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. T YPES OF U TILITY Act Utility Each decision based on its own merit. Rule Utility Consequences help to form rules. Rules are then used for decisions.

11. S TOP AND T ALK What are the limitations of utilitarianism? How can it help you make decisions? How can it help you make policies?

12. J OHN R AWLS (1921-2002) 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. S TOP AND T ALK 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. A RISTOTLE (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. P RACTICAL W ISDOM OR P HRONESIS 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. E UDAIMONIA 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. S TOP AND T ALK What kind of employees do you want to hire? What are the benefits of eudaimonia?

18. M ARTIN B UBER (1878-1956) 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. S TOP AND T ALK What would happen if you treated people as I-YOU? I-IT?

20. L AWRENCE K OHLBERB (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. S TOP AND T ALK Analyze your own moral stages What is your role in society's eyes

22. V ICTOR F RANKL (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. S TOP AND T ALK Do you accept responsibility for your choices?

24. A PPLICATION TO H EALTH C ARE 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?