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Principles of Health Care Ethics
Principles of Ethics



Extends your foundation of ethics.
Gives you ways to apply ethics to
practical situations.
The four used most often in health
care are non-maleficience,
beneficence, autonomy, and justice.
Non-maleficience




Sometimes this is translated as “do no
harm”.
Ethical theories define harm in
different ways.
Consequentialist says harm is that
which prevents good.
Natural law says harm is something
that limits our potential.
Non-maleficience



Deontologists say harm is something
that prevents you from doing your
moral duty.
Virtue ethicists say harm is something
that leads you away from practicing
high moral character.
Ethical egoists say that harm is
something that goes against your self
interest.
Harm in the Clinical
Setting




Harm is something that negatively
affects patients.
Clinically, we think of physical harm
but other harm is possible.
Harm is also caused by negligence.
Harm can be caused by violating
autonomy.
Beneficience




Beneficience comes from the Latin
“bene” and means to benefit.
Requires a decision to engage in
beneficent acts or to be altruistic.
It is a fundamental principle of health
care practice.
What theories support beneficence?
Health care and
Beneficience



The standard of altruism is higher for
health care professionals.
Altruism is expected.
Beneficience sometimes is extended to
paternalism when the health care
professional makes decisions for the
good of the patient. What is this
called?
Autonomy




Means that you can rule yourself.
Implies a respect for others.
We have a duty to treat, but not to
judge.
What are the conditions necessary for
autonomy in health care?
Specific Competence


Is defined as the ability to do some
things but not others. So, you can be
competent in a limited way.
Issues of competence and autonomy
also are part of informed consent and
other health care issues which are
discussed in later chapters
Justice



The term can be used to mean
fairness.
Aristotle thought we should treat
similar cases in a similar way unless
there was some relevant or material
difference.
Need to examine types of justice:
procedural and distributive.
Procedural Justice




Sometimes called due process.
Means that you get your turn; you are
treated like everyone else.
Procedural injustice can occur with
employee situations.
Due process is also involved with
policy making.
Distributive Justice




Involves balancing benefits and
burdens
Health care resource allocation is one
example of an injustice??
Health care is a scarce resource, so
Resource allocation issues are
common in health care; what are
some examples of these issues?
Material Reasons to
Discriminate



Basic argument is that the person
deserves it or needs it
In the U.S., if you work hard, you
deserve to be rewarded.
In contrast, if you disobey the law,
you deserve to be punished.
Discrimination based on
Need




Need can be based on misfortune or
disability.
Need can be based on special talents
or abilities and on opportunities.
Need can be based on past
discrimination.
Need can also be based on structural
social problems.
In the larger society,




There is a need to discriminate based
on material need
You are rewarded based on how much
you contribute
You are also rewarded based on how
much effort you put forth
This thinking also applies to patient
care. Give some examples?
Need based on Misfortune




Discriminate based on or against need for
care.
For example, life threatening situations are
treated before minor emergencies.
Special talents or the potential loss of
opportunity can be arguments for special
treatment.
What other groups fall into the need based
category?
Need based on past
Discrimination



Redress of past injustices may be a
reason for different treatment
The health care system has responded
to the needs of some special groups.
Structural problems have also been
considered in needs based
discrimination; what are some
examples?
Distributive Justice and
Rights



Still debating if health care is a right or
a commodity
Need to think about whether
something is a legal right or a moral
right
There are many types of right and
many overlap each other (See figure)
Legal or Positive Rights



Legal right means that someone has a
legal obligation to fulfill your right.
Positive right means that you are
entitled to something.
Sometimes legal rights become that
which you can get enforced.
Substantive Rights



Can be legal rights or not
They are right to a particular thing
such as education, health care,
minimum wage, etc.
Different nations have differing
opinions about substantive rights for
their citizens
Negative Rights




You have the right to be left alone.
The Bill of Rights lists many negative
rights.
The negative right of one person may
be in conflict with the negative right of
another (i.e. smokers).
Other negative rights include freedom
from sexual harassment, and medical
record privacy.
Process, Natural, and
Ideal Rights




You have the right of due process
Natural rights means that you respect
the attributes that people have in
nature
These rights allow humans to reach
their full potential
Natural rights express our common
morality and ideal rights inspire
Reflective Equilibrium
Model




Making ethical decisions requires
considered judgments.
These judgments require rational moral
reasoning.
Ethical theories and principles are used
to explain moral reasoning.
Reflective equilibrium model provides a
process for considering and
reconsidering decisions.
Reflective Equilibrium
Model
Considered
judgments
Common
morality
Health care issue
at hand
Ethical
principles
Ethical
theories
Reflective equilibrium at work
In Summary…

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