Ch 2 Making Ethical Decisions
2-2 Learning Outcomes 2.1 Describe and compare need and value development theories. 2.2 Identify the major principles of contemporary consequence-oriented, duty-oriented, and virtue ethics reasoning. 2.3 Define the basic principles of health care ethics.
2-3 Maslow s Hierarchy of Human Needs Deficiency needs (D needs) Need for basic life, food, shelter Need for safe/secure environment Need to belong and be loved Being needs (B needs) Need for esteem Need for self-actualization
2-4 Maslow s Hierarchy of Human Needs
2-5 Needs-Based Motivation The theory that human behavior is based on specific human needs that must often be met in a specific order. Abraham Maslow is the best-known psychologist for this theory.
2-6 Theory of Moral Development/Piaget Stage 1: sensorimotor Birth to 2 years Stage 2: preoperational 2 to 7 years Stage 3: concrete operational 7 to 12 years Stage 4: formal operational 12 years and older
2-7 Moral Development Theory/Kohlberg Level 1: Pre-conventional morality Level 2: Conventional morality Level 3: Post-conventional morality Stage 1: social contract and individual rights Stage 2: universal principles
2-8 Consequence-oriented Theory Also known as theological theory Judges the rightness of a decision based on the outcome Act or rule utilitarianism Principle of utility Requires the rule used to make the decision brings about positive results when generalized to wide variety of situations
2-9 Deontological/Duty-Oriented Theory Focuses on essential rightness or wrongness of act, not consequence Immanuel Kant defined categorical imperative There are no exceptions (categorical) from the rule (imperative)
2-10 Virtue Ethics Focuses on traits, characteristics and virtues a moral person should have Someone who has practical wisdom, sense of justice, and courage will make the right decision Alasdair McIntyre Critics worry that the past may not provide the right answer.
2-11 Steps in Ethical Decision-Making
2-12 Question Tell whether the following statement is true or false. A health care provider responding to a patient s plea to help him die describes the problem and collects the facts. The next step in the ethical decision making process is to make a decision and act. True False
2-13 Answer False A health care provider responding to a patient s plea to help him die describes the problem and collects the facts. The next step in the ethical decision making process is to list the options. Next the provider would evaluate the potential options, make a decision and act, and after a certain amount of time, assess the results.
2-14 Principles of Health Care Ethics Autonomy or self-determination Beneficence Nonmaleficence Confidentiality Justice Role fidelity Veracity
2-15 Autonomy or Self-Determination Capacity to be one s own person, make decisions on one s own resources, and not be manipulated or dictated to by external forces Competency Ability to act on the decision Respect for the autonomy of others
2-16 Beneficence Promote health for the patient above any other considerations. Perform acts to help people stay healthy or recover from illness.
2-17 Question Tell whether the following statement is true or false. A physician researches the best method for caring for patients with head trauma in an effort to do no harm. This health care provider is demonstrating the ethical principle of nonmaleficence. True False
2-18 Answer True A physician researches the best method for caring for patients with head trauma in an effort to do no harm. This health care provider is demonstrating the ethical principle of nonmaleficence. Technology has made this difficult to follow as many drugs and treatments have the power to heal, but also may have serious side effects.
2-19 Nonmaleficence The duty to Do no harm. Technology has made this principle difficult to follow. Many drugs and treatments have the power to heal but may also have serious side effects.
2-20 Confidentiality Health Information Portability and Accountability Act (HIPAA) Mandates privacy and confidentiality of medical records Health care professionals are in the most likely position to violate confidentiality rules.
2-21 Justice What is due an individual Many would argue that everyone is entitled to health care regardless of ability to pay for the care. Others argue that people must take responsibility for their actions before assuming they can have justice.
2-22 Conceptual Model of Law and Ethics
2-23 Role Fidelity Health care practitioners have a specific scope of practice for which they are licensed. Practitioners must be true to their roles and not practice in an area in which they are not licensed.
2-24 Veracity Truth-telling Has always had an ambiguous place in the health care practitioner s world Consider the role of placebos
2-25 Question Tell whether the following statement is true or false. The health care practitioner who refuses to give a placebo to a patient is reinforcing the principle of justice. True False
2-26 Answer False The health care practitioner who refuses to give a placebo to a patient is reinforcing the principle of veracity (truth-telling). Justice is defined as what is due an individual.
2-27 Unique Focus of Health Care Primarily because a person s health is paramount to his or her living a successful and satisfying life, health care practitioners are routinely challenged to make sound decisions. These decisions concern not only the appropriate medical care for each patient s condition but also the patient s future health and well-being, and sometimes that of the patient s family.