Week 1 - Foundations of Ethics: Concepts and Theories

HCR 210 Ethics for the Healthcare Professional Learning Objectives: At the completion of this lecture, students will be able to: • Define the concept of ethics and differentiation from morals • Understand the basic theories underlying the study of ethics ? What is Ethics …and …andwhy whyshould shouldwe wecare? care? ? What is Ethics? …and why should we care? Key Terms What is ethics? Key Terms Metaethics – Normative ethics – Applied ethics – Key Terms What is reflective equilibrium? Normative Ethical Theories Virtue Authority based Egoistic Natural Law Deontological Teleological Authority Based Concepts of right and wrong are based on authority figures. • Governmental institutions, faith based in religion, parents, cultural traditions, or even an ideology such as capitalism • How can you determine which authority is correct? The White House Authority Based Ethics Why should a healthcare provider care? • Many patients have religious authority based beliefs • Religious and governmental based authority also play a large role in the development of healthcare policy Ethical Egoism • Based on the idea that people make decisions to act in their own self-interests • Different from selfishness • Not applicable to healthcare professionals Virtue Ethics • Developed by Aristotle (384-322 BCE) • Eudaimonia: being virtuous and living a happy and fulfilled life by building your character • Everyone should strive for eudaimonia • A person who has achieved eudaimonia will know what is right and wrong Mother Theresa Virtue Ethics How does this relate to healthcare providers? • Professional training in medicine attempts to develop people of high character • A good physician should be a “good” person • May require the balancing of conflicting obligations Virtue Ethics Some may criticize virtue ethics as being “elitist”. Natural Law • • • • Based on St. Thomas Aquinas theories Nature is rational and orderly Humans are a part of nature and are also able to be rational All humans know and seek the “basic goods” (life, reproduction, seeking God, educate offspring, live in society, avoid offense, shun ignorance) Natural Law • Since all humans know the “basic goods” they can use reasoning to know the rules of the natural law and what is good vs bad • Acts that violate the ability of another to achieve the “basic goods” are immoral • People may do immoral acts when they are “ignorant” or “emotional” Natural Law – Trolley Problem What would you do if you were the person in the middle? A. Nothing (let the trolley move forward; 5 people die) B. Pull the lever (switch the trolley to the other tract; 1 person dies) Natural Law • Theory of Double Effect helps distinguish moral vs immoral in difficult situations (greater good and lesser evil) o The act must be good o Only the good effect is intended o The good outweighs the bad o The bad effect is the not way the good effect is produced Natural Law – Trolley Problem What would you do if you were the person in the middle? A. Nothing (let the trolley move forward; 5 people die) B. Push Mario into the tract (kill 1 person to stop trolley) Theory of double effect: “The bad effect is the not way the good effect is produced” Natural Law How does this relate to healthcare providers? • Theory of Double Effect can be used in some situations to help make decisions • Natural law places emphasis on allowing people to reach their potentials, and violating that is immoral – this can be used in healthcare policy in the idea that everyone deserves quality healthcare Deontology “With great power comes great responsibility.” - Uncle Ben from Spiderman • Duty-based ethics (deon- “duty” in Greek) • Actions are judged by intentions and not outcomes Spider-Man Deontological theories Kantism John Rawls Thomas Nozick Kantianism • Immanuel Kant (1724-1804) • Main theory that people had free will and the ability to chose to do good or evil • Categorical Imperatives – moral obligations for one to act in a way in that one believes things ought to be • Autonomy – people can never be used as a means to an end Kantianism How does this relate to healthcare? • Health care professionals have a duty to their patients, their professions, and their organizations • Health care administrators have conflicting duties to the patients, the organization, and the community • Policymaking has to take into account conflicting duties John Rawls • Believed in “justice as fairness” and that society has to have the infrastructure and a system of rights to protect the minority • How do you decide “what is fair”? o Thought experiment called the Original Position and the Veil of Ignorance John Rawls So what are the rules a person would make while in the Original Position with a Veil of Ignorance? • Basic Principles of Justice o Political liberty o Freedom from arbitrary arrest and seizure o Freedom of person and property o Freedom of speech and assembly o Liberty of conscience and freedom of thought • The Difference Principle: socioeconomic inequalities are only appropriate if they are arranged so that the inequalities help the less fortunate/minority John Rawls How does this relate to healthcare? • People who are unable to make healthcare decisions for themselves are in the Original Position • Healthcare providers must ensure that they are best and most reasonable decision when caring for people who are in the Original Position Robert Nozick • Drew heavily on Kant’s idea of Autonomy – people should never be used as a means to an end • In this sense, it is immoral to ask someone to make a sacrifice for a social good • Did believe that society should attempt to maximize the status of the least well off however did not believe that a person who benefitted had an obligation to help others • Emphasis on free market and meritocracy Rawls vs Nozick Robert Nozick Free market private health insurance John Rawls National health insurance Teleological • Also known as consequentialism or utilitarianism • These theories believe that intent does not matter, only the consequences of the action • Opposite from deontology Teleological theories Classical Utilitarianism Rule consequentialism Classical Utilitarianism • • • • Created by Mill (1806-1873) Not supported by modern ethicists Each act should be evaluated based on its outcome (cost vs benefits) “Greatest good for the greatest number” • Problems: o Outcomes are not always clear especially before the act is performed o “Ends justify the means” Rule Consequentialism • Ties in with virtue ethics; a person who has achieved practical wisdom evaluates actions based on their most likely outcomes • Persons of practical wisdom can also decide on special circumstances • Negative consequentialism – alleviation of suffering is more important than maximization of pleasure • Used by healthcare administrators and government officials for the development of healthcare policies Small Groups • Discuss which ethical theories you identify with the most and explain why • Are there parts of the ethical theory that you disagree with? Small Groups Ethical Dilemma: Sarah is a social worker who is working during the COVID-19 pandemic. However, Sarah has recently been concerned about her personal health issues and thinks that she would like to take a break. When she brings this up to her manager, she is told that taking a break would be acting immorally – there are too many patients that need her and no one who can replace her. Sarah is conflicted because she wants to take care of herself, but she doesn’t want to abandon her patients. What should Sarah do? Identify different solutions to this problem using the different ethical theories. Small Groups Ethical Dilemma: Sarah is a social worker who is working during the COVID-19 pandemic. However, Sarah has recently been concerned about her personal health issues and thinks that she would like to take a break. When she brings this up to her manager, she is told that taking a break would be acting immorally – there are too many patients that need her and no one who can replace her. Sarah is conflicted because she wants to take care of herself, but she doesn’t want to abandon her patients. What should Sarah do? Now what would you do? Small Groups Ethical Dilemma: Matthew is a respiratory therapist working in the ICU during the COVID-19 pandemic. He has two patients with difficulty breathing, one is an otherwise healthy 28 year old male and another is a 78 year old female with chronic medical problems. Despite Matthew’s best efforts, both patients are getting worse and need to be intubated. There is only one ventilator. What should Matthew do? Identify different solutions to this problem using the different ethical theories. Small Groups Ethical Dilemma: Mathew is a respiratory therapist who is working during the COVID-19 pandemic. Mathew currently has two patients who are struggling to breath. One of the patients is an otherwise healthy 28 year-old male and the other is a 78 year-old female with many chronic illnesses. Despite all of Mathew’s best efforts, both patients are rapidly progressing to requiring a ventilator. There is only one ventilator left in the ICU. What should Mathew do? Now what would you do? Reflective Equilibrium Definition: what you just did! Questions? Assignments See assignments in Canvas • APA quiz due Sunday • Do not attempt Quiz 1 yet (contains material from next week)