Chapter 01 Text Outline - 1 2 Chapter 1 Theory of Health...

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Unformatted text preview: 8/5/14 1 2 Chapter 1 Theory of Health Care Ethics 3 4 Why Study Ethics? •  Because health care is changing, you need tools for making necessary and difficult decisions. •  It will help you better understand patients, fellow professionals, and the system in general. •  It will assist you in building and maintaining your career. 5 Types of Ethics •  Normative ethics – Is the study of what is right and wrong. •  Metaethics – Is the study of ethical concepts and theories. 6 Types of Normative Ethical Theories •  Authority-based •  Egoistic •  Natural law •  Deontological •  Teleological •  Virtue 7 Ethical Relativism •  Ethical relativism purports that there is no absolute theory for ethics. •  However, this lack of a complete theory does not mean everything is relative. •  People need to make rational decisions about ethics-based issues. •  Therefore, ethics theories are useful. 8 Egoism as Ethics Theory •  Egoism is based on the idea that one’s self interest is the basis his or her ethics decisions. •  Theory is not helpful in health care ethics because professionals are taught to set aside self-interest. •  The interests of the patient should come first. 1 •  However, this lack of a complete theory does not mean everything is relative. •  People need to make rational decisions about ethics-based issues. •  Therefore, ethics theories are useful. 8 Egoism as Ethics Theory •  Egoism is based on the idea that one’s self interest is the basis his or her ethics decisions. •  Theory is not helpful in health care ethics because professionals are taught to set aside self-interest. •  The interests of the patient should come first. 9 Authority-based Ethics Theory •  Decisions about ethics (right or wrong) are based on central authority such as in a theology or an ideology. •  For health care ethics, there may difficulty deciding which authority is the correct one. •  However, knowing this view of ethics helps with understanding patients and health policy decisions. 10 Virtue Ethics Theory •  Is founded in the writings of Aristotle. •  Everything moves from potentiality to actuality. •  Character development allows you to actualize your highest good. •  Eudaimonia should be sought as the highest good. 11 Virtue Ethics Theory •  Eudaimonia means that you seek to build your character and increase virtue. •  Professional education seeks to develop people of high character. •  People who work toward eudaimonia become persons of practical wisdom. 12 Virtue Ethics Theory •  Principles of ethics can help to define your character and assist with your actions. See Chapter Two for more information. •  Virtue ethics is criticized as being elitist. •  Virtue ethics requires the balancing of conflicting obligations. •  People with practical wisdom can make appropriate ethical decisions. 13 Natural Law Theory •  It is founded in the writings of St. Thomas Aquinas 8/5/14 2 12 Virtue Ethics Theory •  Principles of ethics can help to define your character and assist with your actions. See Chapter Two for more information. •  Virtue ethics is criticized as being elitist. •  Virtue ethics requires the balancing of conflicting obligations. •  People with practical wisdom can make appropriate ethical decisions. 13 Natural Law Theory •  It is founded in the writings of St. Thomas Aquinas •  It assumes that nature is rational and orderly. •  Humans are part of the natural world and are given the ability to be rational. •  Our natural reason allows us to distinguish right from wrong. 14 Natural Law Theory •  Reason is also action in that humans can choose to do good or evil. •  The Principle of Double Effect helps us decided which action is good. •  Good is also defined as that which helps to maximize potential, such as preserving life, gaining wisdom, and knowing God. 15 Natural Law Theory •  In natural law, there are some acts that are not ethical because they violate the ability to reach one’s potential. •  People who support social responsibility can use natural law as a foundation for actions. •  Understanding natural law also assists with patient relations. 16 Deontology Theory •  Comes from the Greek word “deon” meaning “duty.” •  It is sometimes called duty-based ethics. •  One of the main theorists is Immanuel Kant. •  The world exists in the form of things we can experience directly (phenomenal world) and things that exist independently of the intellect (noumenal world). 17 Deontology Theory •  Free will makes ethics possible and without it we would not need ethics. •  Areas of character can be used for good or evil. •  Therefore, the only true good is good will. •  The ability to choose to do good is what makes us human. 8/5/14 3 •  Comes from the Greek word “deon” meaning “duty.” •  It is sometimes called duty-based ethics. •  One of the main theorists is Immanuel Kant. •  The world exists in the form of things we can experience directly (phenomenal world) and things that exist independently of the intellect (noumenal world). 17 Deontology Theory •  Free will makes ethics possible and without it we would not need ethics. •  Areas of character can be used for good or evil. •  Therefore, the only true good is good will. •  The ability to choose to do good is what makes us human. 18 Deontology Theory •  Actions are judged by their intention and not just their outcomes. •  Kant attempted to define a rational principle for making moral judgments. •  The principle is the categorical imperative. •  People can never be used as a means to an end; they must be respected. 19 Deontology Theory •  The Golden Rule is not a synonym for the categorical imperative. •  Kant believed that we must act based on duty to moral law and not on the consequences of our actions. •  Practicing this is its pure form is difficult in modern society. 20 Kant and Virtue Ethics •  Pure Kantian ethics is absolute in its definition of duty but virtue ethics allows for grey areas. •  Kant does not assist with deciding among lesser evils and greater goods •  Virtue ethics allows the use of tools to make these decisions 21 Deontology and Policy •  Health care professionals recognize a duty to the patient •  Health care managers also have a duty to the patient, but they have duties to the organization and community as well. •  Conflicting duties must be considered in policy making. 22 Non-Kantian Deontology •  Recent proponents of the deontology tradition include John Rawls and Robert Nozick. •  These theorists deal with the idea of justice through our actions. 8/5/14 4 21 Deontology and Policy •  Health care professionals recognize a duty to the patient •  Health care managers also have a duty to the patient, but they have duties to the organization and community as well. •  Conflicting duties must be considered in policy making. 22 Non-Kantian Deontology •  Recent proponents of the deontology tradition include John Rawls and Robert Nozick. •  These theorists deal with the idea of justice through our actions. •  Their thinking influences health care reform, public health, and other health areas. 23 John Rawls •  John Rawls worked to define the characteristics of a just society. •  He examined justice as fairness and applied it to societies that respect the rule of law. •  His work is based on the idea of a social contract between members of a society. 24 Self Interest and Justice •  Rawls used a hypothetical or mind experiment called the original position to explain why rational people would protect everyone’s self interests. •  In this mind experiment, he also included the concept of the veil of ignorance to help us understand why we would care about self interests. 25 Self Interest and Justice •  If we were in the original position, we would all be equal. •  Therefore, we could all be treated in the same way in a society. •  Therefore, it would be in our self interest to make sure that everyone is given an equal share of benefits and burdens. 26 Basic Principles of Justice •  The first principle of justice for Rawls is liberty. •  This principle is also a priority over all other principles of justice. •  People should have equal right to basic liberties (see the Bill of Rights). 27 Basic Principles of Justice •  The second principle for Rawls is justification of inequalities. •  He uses the difference principle to justify when social and economic inequities are appropriate. 8/5/14 5 26 Basic Principles of Justice •  The first principle of justice for Rawls is liberty. •  This principle is also a priority over all other principles of justice. •  People should have equal right to basic liberties (see the Bill of Rights). 27 Basic Principles of Justice •  The second principle for Rawls is justification of inequalities. •  He uses the difference principle to justify when social and economic inequities are appropriate. •  Physicians are a classic example of the difference principle. 28 Rawls’ Opponent •  Robert Nozick is also considered to be a deontologist. •  He represents the conservative tradition and has great influence in the debate over health care reform. •  Nozick emphasizes the autonomy and the rights of the individual. 29 Nozick and Social Goods •  For Nozick, there is no social good that requires sacrifice. •  We are only “other people”. •  We should influence people to take steps to improve their own situations. •  Theories like Rawls supports defeat voluntary agreements. 30 Nozick and Distributive Justice •  For Nozick, there is no principle of distributive justice. •  He finds justice in acquisition and owned resources. •  Historical injustices are not addressed in his theory except to suggest that society could be organized to maximize the position of the least well off. 31 Consequentialism Theory •  Through Mill’s work, this theory is also known as utilitarianism. •  For this theory, your intentions are irrelevant; all that counts is the outcome. •  Greatest Good for the Greatest Number is often used as a summary of the theory. 32 Consequentialism Theory •  Has two main types •  Classical or act utilitarianism. –  Each act considered on its own •  Rule utilitarianism. – Develop rules that net the greatest benefit 8/5/14 6 utilitarianism. •  For this theory, your intentions are irrelevant; all that counts is the outcome. •  Greatest Good for the Greatest Number is often used as a summary of the theory. 32 Consequentialism Theory •  Has two main types •  Classical or act utilitarianism. –  Each act considered on its own •  Rule utilitarianism. – Develop rules that net the greatest benefit 33 Consequentialism Theory •  Rule utilitarianism is used to make health care policy. •  Exceptions can be made under special circumstances. •  Rule utilitarianism also allows for negative consequentialism or preventing the greatest harm for the greatest number. 34 Consequentialism Theory •  Preference utilitarianism argues that good is honoring preferences and bad is frustrating preferences •  Preferences must be known or a substituted judgment can be used 35 Consequentialism Theory •  Criticisms of utilitarianism include – The minority is not protected when the greatest good for the greatest number is the goal. – Some say this theory means that the ends justifies the means. •  These criticisms are not valid because respect for autonomy and liberty is essential to the theory. 36 Use of Ethical Theories •  There is no pure ethical theory; each has strengths and weaknesses. •  However, health care professionals must make complicated ethics decisions •  The ability to understand theory enhances your decision making tool kit. 37 In Summary… 8/5/14 7 ...
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