Ethics Exploring Values, Morals, and Bias

HCR 210 Ethics for the Healthcare Professional Learning Objectives: At the completion of this lecture, students will be able to: • Define values and discuss the impact of values on ethical decision making. • Differentiate between beliefs, values, and morals and how these concepts interplay and impact ethical decision making • Understand basic theories of moral development and how these impact ethical decision making • Understand how culture and spirituality effect beliefs, values, and morals in relation to ethical decision making • Understand the concept of Implicit Bias and identify one's one biases. Values and Moral Development …and why should we care? Key Terms What are beliefs? – What a person thinks is true; assumptions about the world. – Ex: Americans believe everyone has the chance to become successful if they work hard What are values? – What a person or culture thinks is important; shapes the standards to guide one's actions, judgements, and attitudes. – Ex: Americans have values in fairness, hard work, and monetary success Key Terms Covert values – Implicitly transmitted via expectations and implied through verbal and non-verbal behaviors. Overt values- Explicitly communicated through written or public discourse; seen in policies, standards, and legislation Covert Values “Can you hear me now?” Covert Values What are the covert values shown in these ads? Covert Values What are the covert values shown in these ads? Key Terms What are morals? – Principles that guide how individuals should act in society; determine right versus wrong – Example: Americans find it immoral to treat someone unfairly Beliefs shape values… and values shape morals. What you hold to be true What you think is important What you think is right vs wrong Issues of Culture …and why should we care? Culture in Ethical Decision Making Cultural sensitivity: being open to learning about other cultures Cultural competence: understanding of the diverse cultures; ability to deliver culturally appropriate and specifically tailored healthcare care to patients Implicit Bias (sometimes called unconscious bias) What is it: attitudes that are unconsciously affected by personal preferences or aversion towards a person, a group of people, a religion, or a culture. • Can shape and alter beliefs implicit bias beliefs values morals What is Implicit Bias? Immaculate perception: Jerry Kang at TEDxSanDiego 2013 The Implicit Bias Test What is this test? • Developed by Harvard University to recognize implicit biases in populations Limitations: • Test must be taken as fast as possible to be accurate • Your test results may change if you take it more than once • Critics may question the validity of the test The Doll Experiment (1940) Clark Doll Experiment from 1940: https://www.youtube.com/watch?v=PZryE2bqwdk The Doll Experiment (2010) How Does this Affect Healthcare? • Understand what values and beliefs your patients and patients’ family members have that may differ from your own • Understand your own values and beliefs and identify if you have any implicit biases Cassie’s Story Let’s take a look at Cassie: Cassie is a 46 year old female with PMH of diabetes, homelessness, and IVDU. Cassie presents to the emergency department with complaints of altered mental status. The nurse who triages Cassie know her very well as Cassie is a “frequent flier” who comes in often with annoying complaints like “I’m hungry” or asking for opioid pain meds. The nurse also notices that Cassie’s breath smells like alcohol. Cassie is acting differently than her normal self, but she obviously was using drugs and drinking. Since the emergency department is very busy, the nurse is frustrated at Cassie for wasting time. The nurse decides to triage Cassie as “not urgent” and puts her in a quiet room to let her sleep off her intoxication. Questions: What ethnicity did you picture Cassie as when I was reading the question? What gender did you picture the nurse? Does this nurse appear to have any implicit biases? What do you think are the nurse’s beliefs, values, and morals? Do you agree with the nurse’s decision? Cassie’s Story 30 minutes later, the code blue alarm goes off. Cassie had progressed to unconsciousness which was unwitnessed by any of the emergency personnel since she was put in a quiet area to “sleep off” the drugs. Now she is in cardiac arrest. What happened? How Does this Affect Healthcare? Illicit drug users are bad people Illicit drug users are trying to abuse the healthcare system Sobriety Truthfulness Sobriety is good Truthfulness is good Illicit drugs are bad How Does this Affect Healthcare? Illicit drug users are bad people Illicit drug users are trying to abuse the healthcare system Sobriety Truthfulness Sobriety is good Truthfulness is good Illicit drugs are bad A person who uses illicit drugs cannot be sober or truthful Incorrect perception: “A person who uses illicit drugs cannot be sober or truthful” Actions: • Wrong diagnosis based on implicit bias • Worse care for people who use drugs Small Groups: Cassie is a diabetic and she is homeless. She wasn’t able to afford her insulin this month. She wasn’t drinking or doing drugs, she was in DKA (uncontrolled diabetes). In DKA, your body produces alcohol in an attempt to make more sugar. This was why her breath smelled like alcohol. How Does this Affect Healthcare? How does implicit bias affect healthcare? • People of color less likely to get pain medications • People of color receive fewer cardiovascular interventions • People of color are more likely to be blamed for being too passive about their health • Women are less likely to be diagnosed with certain diagnosis • People who are overweight, drink, smoke, or do illicit drugs are also confronted with implicit bias Implicit Bias in Healthcare What can contribute to a clinician acting on their implicit bias towards patients? • Working under pressure • Dealing with complex cognitive information • Training that emphasis group level information, like population risk factors • Strong belief in their own personal objectivity because of vast knowledge of scientific data Implicit Bias in Healthcare Take the time to acknowledge and confront your biases. Issues of Spirituality …and why should we care? What is Spirituality? • • • Hard to define Sperate from the concept of religion, spirituality is “an internal perspective that inspires one to believe in a force greater than one’s self, and it serves as a guide or providing meaning to one’s life.” -(Morrison &Furlong, 2018, p. 165) Also a sense of connection to others and the world around you What is Spirituality? Spirituality and Healthcare • Healthcare has historically been closely tied to spirituality and religion (shaman, religious healers, medicine men) • In the 20th century, emphasis was placed on evidence-based medicine (EBM) rather than spirituality in an attempt to value empirical data over everything else • EBM are guidelines for care based on scientifically-proven evidence Spirituality and Healthcare • While EBM has developed standards for good quality care, this has tended to focus on empirical evidence and the concept of cure rather than the concept of healing o Calling patients by their room numbers or diagnoses instead of their names o Hyper-focusing on the patient’s complaint and ignoring other aspects of their treatment such as prevention, education, follow up etc • One attempt to bring back that sense of “healing” and treating the patient as a person is patient-centered care Why Are We Talking About This? A person’s spirituality can also affect their beliefs, values, and morals. spirituality beliefs values morals Sharon’s Story Sharon is a 38 year old African American female who worked hard and overcame multiple struggles in her life to become a successful lawyer. After noticing swelling in her legs, Sharon visits her physician and is heartbroken to discover that she has end stage chronic kidney disease and she will need to be on dialysis for the rest if her life. This has caused her career to abruptly end as she has to go to dialysis sessions 3x/week. The sessions are painful and difficult to endure, and she notices that no one seems to care about her or ask her how she is doing during the sessions. Sharon asks herself, “I worked hard and was a good person, why is this happening to me? Would anyone notice if I died?” Small Groups What appears to be Sharon’s spirituality? What are Sharon’s beliefs, values, and morals? How can a person who is taking care of Sharon at the dialysis center help her to feel better? Small Groups Sharon’s spirituality: Being a productive and hard working member of society beliefs values Good things will happen to people who are “good” and work hard • Hard work • Being a “good” person morals Good people should work hard If you don’t work hard, you are a bad person Patient Centered Care “WHO: What is peoplecentred care?” by the World Health Organization Spirituality and the Healthcare Worker • Healthcare workers also struggle with spirituality • Many people enter the healthcare work field due to a sense of “higher calling” • When people lose that, they feel demoralized and burned out Ethical Dilemma – Small Groups Sharon’s dialysis technician is a 25 year old female who is working hard to pay off her college debt. She entered the medical field because the knew that it would be a stable job that paid relatively well. She simply wants do her job well and collect her paycheck. She is a great dialysis technician, but she does not feel obligated to chat with her patients, ask how they are doing, or care for them beyond what she does as a dialysis technician. • Do you believe it is immoral to go into medicine without a “higher calling”? Use ethical theories to support your argument. • Do you believe hospitals and healthcare organizations have a responsibility to create and ensure that their healthcare workers have a sense of spirituality? Spirituality and Ethical Theories Argue For Requiring Spirituality • Natural law theorist: spirituality (“seeking God”) is one of the “basic goods” • Deontologist: admin have a moral and ethical duty to allow employees to pursue spiritual growth • Consequentialist: spirituality in healthcare leads to improved patient outcomes and worker satisfaction Spirituality and Ethical Theories Argue Against Requiring Spirituality • Deontologist: Autonomy – people should not be used as a means to an end; spirituality is not something that you can force onto someone • Consequentialist: Motivation (intention) does not matter, only consequences. If you can take good care of your patients without spirituality then it does not matter. Questions? Assignments See assignments in Canvas