HEALTHCARE ETHICS (LESSON 2)

Theories and principles of healthcare ethics

 Ethics and healthcare

o Patient protection and affordable care act of 2010 (aca 2010) - an era, wherein managers of
healthcare organizations will find resources to carry out multiple changes and differences

 Foundation of ethics
o Ethical theories
o Ethical decision making
o Assessing choices
o Emphasis on patient - centered care.
o Cultural competency
 Philosophy
o Chaos of thoughts, beliefs, assumptions, values and superstition
o Intense and critical examination of beliefs and assumptions.
o It offers principles for deciding what actions and qualities are most applicable
 morals and ethics
o moral philosophy is the philosophical discussion of what is considered good or bad or wrong in
terms of moral issues.
o Ethics is considered with the study of social morality and philosopnical reflection on society's norms
and practices.

• philosophy of basis of ethical theory

o The nursing code of ethics guides nurses in their relationship with patients, colleagues, the profession,
and society. Specific code of ethics were developed by the american nurses association (ana) canadian
nurses association (cna), and international council of nurses (icn) serve as guides for nurses in
practice.

• ethical theories: school of thoughts

o Naturalism
o A view of moral judgement that regards ethics as dependent on human nature and psychology.
o Rationalism
o They are not dependent on human nature. They argue that it depends upon the origin and can
be known to humans through process of reasoning.

 theories of ethics
o Deontology
 greek word =" deon" or duty
 known as formalism
 concerned with behaving etically
 Originates from german philosopher kant
 You are using deontic principles when:
 you maintain confidentiality, you advocate for a patient, you keep promises, you
tell the truth, and you practice with expert skills
o Immanuel kant
 german philosopher
 honigsberg, prussia in 1724
 asserted that moral rules are absolute and applicable to all people, at all in all situation,
at all times,
 Proposed 2 types of duties:
 Categorical imperative
 “you should not lie”
 Refers to morals, rules that do not admit exceptions
 Based on reason
 Practical imperative
 “do not lie”
 Makes his or her ends your own good
 There is an inherent recognition that all people are equal and equally
competent in making decision
o Teleology
 Consequentialism, sometimes called teleology, using the greek term "telos" refers to
"ends." thus, often stated as the greatest good for the greatest number.
 Consequentialist evaluates morality actions in terms of progress toward a goal or end.
The consequences of the action are what matters,not their intent.
 Two issue in teleology: whether the act is leading to good or bad outcomes and whether
the person carrying out the act should be praised or not.
o Utilitarianism
  A moral theory is that an action is judged as good or bad concerning the consequence,
outcome, or result that is derived from it
 The right action is that which has the greatest utility or usefulness.
 Epicurus (200-300 b.c.e)
 Greek philosopher
 Believed that both good and evil lie in sensation, pleasure being good, pain being
evil.
 Jeremy bentham
 “father of modern utilitarianism”
 "principle of utility":
 by utility is meant that property in any object, whereby it tends to produce
benefit, advantage, pleasure, good or happiness or to prevent the
happening of mischief, pain, evil, or unhappiness to the party whose
interest is considered.
 Bentham mentioned 6 characteristics to measure the pleasure:
intensity, propinquity, duration, fecundity, certainty, purity
o Jonn stuart mill (1806-1873)
 British moral philosopher
 Classical utilitarianism, associated with the british philosopher. Developed the theory
from a pleasure-maximizing version put forward by his professor bentham.
 Not all pleasures were equally worthy.defined the "good" in terms of well-being and
distinguished
 Mill is closer to the virtue theory idea of eudaimonia as a goal.
 Described greatest sources of physical and mental suffering as indigence, disease,
unkindness, worthlessness, premature loss, and objects of affection
 Mill believed utilitarianism to be in the spirit of the golden rule
o Types of utilitarianism
 Act utilitarianism
 Each act is considered based on its net effect. Suggests that people choose
actions that will in any given circumstance increase
the overall good.
 Rule utilitarianism
 The decision makers develop rules that will have the greatest net benefit.
Suggests that people choose rules, that when they followed consistently will
maximize the overall good. It is the basis for many policy-level decisions about
the distribution of healthcare services.
 Virtue ethics: overview
o Sometimes called as character ethics. "ethics " was derived from aristotle's word "ethika" which
refers to matters having to do with character. First noted in the writings of homer, and
subsequently in the works of plato, aristotle, and early christian thinkers. Western moralism
emerged with the idea of cardinal virtues: wisdom, courage, temperance, justice, generosity,
faith, hope, and charity.
o Modern and contemporary writers also include: honesty, compassion, trustworthiness, and
prudence.
o Moral virtue is a character trait that is morally valued such as truthfulness, kindness, or honesty.
o Aristotle (384 - 332 b c-e)
 Considers goodness of character to be produced by the practice of virtuous behavior.
 Virtues are tendencies to act, feel, and judge that are developed from a natural capacity
by proper training and exercise. He also believed in equality of excellence of character
which depends on motivation, deliberation, clear judgement, selt -control and patience
o Aristotle traits of a virtous character; provided three criteria
 Virtuous acts must be chosen for their own sake.
 The choice must proceed from a firm and unchangeable character.
 Virtue is a disposition to choose the man.
 Philippa ruth foot (1920-2010)
o Virtue lies not only in engaging virtuous acts but also in a will. Will is "that which is wished for as
well as what is sought.”
o Foot said that virtue is not like a skill or an art. In other words, an act, though kind or generous,
for example, cannot be considered to be virtuous if the intention is not good
 Beauchamp and childress (2001)
o They proposed four focal virtues which can characterize a virtue of a person:
 Compassion → "golden rule"
 Discernment → sensitive insight
 Trustworthiness
 Integrity → cardinal virtues
 virtue ethics in nursing: how does virtue ethics fit with nursing?
o Nightingale's pledge implies virtues of character as nurses promise: purity, faith. Loyalty,
devotion, trustworthiness, and temperance