Health Care Ethics 2

Front 1

Patient Bill of Rights

Back 1

1.The patient has the right to considerate and respectful care
2.The patient has the right to obtain information concerning their diagnosis and treatment.
3.The Patient has the right to make their own decisions about their care. And they have the right to refuse treatment and to know the consequences of refusing this treatment.
4.The patient has the right to an advance directive (living will, health care proxy, durable power of attorney) concerning treatment or designating a surrogate.
5.The patient has the right toe very consideration of privacy
6.The patient has the right to expect that all communications and records pertaining to their care will be treated confidentially.
7.The patient has the right to review records pertaining to their medical care.
8.The patient has the right to expect that the hospital will make reasonable response to the request of a patient for certain care and services.
9.The patient has the right to ask and be informed of the existence of business relationships among institutions that may effect their care.
10.the patient has the right to consent or decline participation in a research study.
11.The patient has the right to expect reasonable continuity of care when appropriate, and be told when care options are no longer appropriate.
12.The patient has the right to be informed of hospital policies and practices that relate to patient care. The patient has the right to be informed of available resources for resolving disputes such as ethics committees and patient representatives.

Front 2

Privacy

Back 2

The condition of not having either undocumented or documented personal knowledge about oneself possessed by others.
True privacy doesn't exist
Moral basis derivable from the principle respects of persons
An assumed right

Front 3

Autonomy

Back 3

The ability to be self-discriminating
3 Aspects of autonomy
Interferences with Autonomy
Freedom is both necessary and sufficient to be autonomous
3 Conditions of autonomy
Autonomy can be overruled by three things

Front 4

3 Aspects of Autonomy

Back 4

1. Liberty of Action
Freedom to act, we are free from the use of force by someone else on our chosen actions
2. Freedom of Choice
Autonomous person won't allow others to make their choices
More freedom = more choices
3. Effective Deliberation
Critical thinking
using ability to reason to analyze and compute all outcomes to make a valid choice

Front 5

Interferences with Liberty of Action

Back 5

1. Physical Force
2. Threat (Verbal/physical)
3. Manipulation/Deception

Front 6

Interferences with Freedom of Choice

Back 6

1. Refusing to act on another's self regarding choice
2. Withholding information regarding some other available option
3. Making someone think there's only one option

Front 7

Interferences with Effective Deliberation

Back 7

Interference with choice of one's goals. Individual not capable of choosing rational goals and/or fails to understand the implications of their choices.
Affective Impairment- condition placed on a thing to change its basic nature or appearance ie extreme pain or fear
Cognitive Impairment- permanent mental handicap

Front 8

Conditions of Autonomy

Back 8

1. Intention
2. Understanding
3. Reason
After using these three conditions the patient can give their informed consent

Front 9

Reasons we can overrule autonomy

Back 9

1. Person is contagious
2. Person is mentally handicapped
3. Person is a danger to themselves or others

Front 10

Who makes the decision to treat, or to refuse treatment?

Back 10

The patient makes their decisions about treatment if they are rational
If they are not rational...
Durable power of attorney
Spouse
Eldest Child
Other family
Surrogate

Front 11

3 Types of People Affected by LIfe-Sustaining Treatment

Back 11

1. Are now competent, and likely to remain so.
2. Are not competent, and never were
3. Were once competent, but are competent no longer

Front 12

Surrogate Decision Makers

Back 12

Means someone to stand in for you (to act on our behalf)
We can (if competent) administer a surrogate for us
Standards for surrogate decision making
Best Interest Standard
Substituted Judgment Standard

Front 13

Best Interest Standard

Back 13

Have an objective test that when applied to a situation will follow socially shared values of a reasonable person.
Decision is in person's best interests
Ability to be reasonable (stay away from extremes)
Test Considers
a. consider all benefits and risks
b. all alternative treatments should be considered
c. consider amount of pain and suffering experienced
d. evaluates loss of function and possibility of restoration of function

Front 14

Substituted Judgement Standard

Back 14

Subjective
The purpose is to attempt to decide as the principle would have decided had they been capable
Court looks at relationships and tries to determine who knows patient best
Trust becomes key
Not what "you" would decide, but as they'd decide

Front 15

How to Treat/ When to Treat/ Who to treat

Back 15

1. Who should decide
2. By what criteria should decisions be made?
3. Quality of Life
4. Considerations of technology and medicine

Front 16

Advantage and Disadvantage of Parents making the decision

Back 16

ADV: Know own social/ religious values
Know they will deal with long-term consequences of the decision
DISADV: Too close to the decision
Too emotional to think
Don't know medical terminology

Front 17

Advantage and Disadvantage of Physician making decision

Back 17

ADV: most medical knowledge, and can predict future outcome (critical thinking)
relieves patient of responsibility of making decision
not emotionally involved with the situation
DISADV: no responsibility to finances of decision or emotional/psychological consequences
don't know family's values/religious beliefs

Front 18

Advantages and disadvantages of Hospital Ethics Committee making decision

Back 18

Only advisory, cannot persuade anyone to follow their suggestions
ADV: wide range of expertise
decisions typically consistent
short-term responsibility for decision
DISADV- removed from situation, too emotionally detached
Sometimes no access to direct information
Cannot always make expedient decision

Front 19

Confidentiality

Back 19

The boundaries surrounding shared secrets and the process of guarding these boundaries
Professional Confidentiality
Principle Issues of Confidentiality
Basis of Confidentiality
Greatest value- individual benefits from confidentiality because it allows them to seek and receive help they otherwise might not ask for.
Without autonomous use of confidentiality people cannot maintain privacy or guard against danger

Front 20

Professional Confidentiality

Back 20

Two Purposes
1. Reinforce professional status
Dr.'s need 100% disclosure to enhance ability to treat
2. Strengthens capacity of professional to help clients

Front 21

Principle Issues of Confidentiality in Medical Field

Back 21

1. Proliferation of info
2. Concern for rights of those individuals/ groups that are least able to resist breaches of confidentiality
"Best healthcare if you can afford it"

Front 22

Basis of Confidentiality

Back 22

1. Respect for relationships
2. Duty to provide for those in need
3. Aid and sanctuary
Pledge of silence creates an obligation/duty which exists beyond respect for persons and relationships
4. Benefit to society in general
can avoid negative consequences with this
individual and social utility

Front 23

Obligation of Keeping a secret

Back 23

1. Pledge of Loyalty
2. Also accepted responsibility to perform acts that will safeguard what she has been told

Front 24

Informed Consent

Back 24

A decision-making process
Promotes 2 principle values
3 Components
Have a duty to respect us by fully informing us

Front 25

Informed Consent Values

Back 25

1. Personal Well-being
2. Autonomy

Front 26

Informed Consent: 3 Components

Back 26

1. Must be freely given, cannot be coericed
2. Requires all pertinent information be given to the patient
3. Requires that in the case of incompetence provisions must be made for transferring decision-making authority to a surrogate.
ALL MUST E PRESENT IN ORDER FOR CONSENT TO BE FULLY INFORMED

Front 27

Descriptive Ethics

Back 27

The kind of ethics that talks about how people DO behave in regards to one another (rather than how they SHOULD behave)

Front 28

Duty

Back 28

The special responsibilities associated with a particular societal role or professional/occupation

Front 29

Harm

Back 29

What all rational people want to avoid for themselves or for those close to them unless they have a reason for wanting it. These harms include, death, pain, disability, depriving of freedom or pleasure.
What is irrational to want for oneself is immoral to cause for another

Front 30

Ideal

Back 30

How we would like people to act, but don't think they have to act.
People are (morally) praiseworthy if they act in accord with a moral ideal; an ideal action that is morally encouraged but not morally required

Front 31

Irrationality

Back 31

The key to a system of morality. It is irrational to want harm with out reason.
It is immoral to cause what is irrational to want

Front 32

Justification

Back 32

How one explains or excuses questionable behavior.
strongly- all rational and impartial people could advocate
weakly- rational people could go either way
not- no rational or impartial people would agree

Front 33

Likely to Lead (to suffering unjustifiable harms)

Back 33

Some behaviors are morally questionable because they are likely to lead to suffering of unjustifiable harms. They include deceiving, cheating, breaking promises, breaking the law.

Front 34

Morally Encouraged

Back 34

Ways we think people should at, but don't think they should be punished if they fail to act this way

Front 35

Morally Permitted

Back 35

Behavior that is within the boundaries of the moral system. It is morally permitted to act in any way that does not cause others unjustifiable harms

Front 36

Morally Prohibited

Back 36

Behavior that is not within the bounds of the moral system.
Don't cause unjustifiable harms.