Dynamics of Care in Society Ethical Issues in Health Care

1. Dynamics of Care in Society Ethical Issues in Health Care 1

2. Objectives… Recognize ethical issues and the moral implications of individual and collective decisions. Analyze the fundamental question & implications of selected ethical issues in health care. Propose & defend one’s own position & judgment in the analysis & deliberative resolution of ethical dilemmas.

3. Laws …are mandatory to which all citizens must adhere or risk civil or criminal liability. Contracts …are agreements between two or more parties. Torts …are wrongful acts that do not involve a contract, a “civil wrong” a breach of legal duty.

6. Ethics Unit - The Law Term Definition or Example • Assault • Battery • False imprisonment • Invasion of privacy • Defamation of character • Negligence • Malpractice • Reporting Abuse • Protecting Patients’ Rights • Confidentiality and HIPAA • Threatening or attempting to touch a patient without their permission • A non-consenting patient is touched • Any attempt to restrain or restrict a patient’s freedom • Intentionally & unreasonably exposes a patient’s body or personal information without consent • Libel (written) or Slander (spoken) false or malicious statements about a person’s character • Careless or senseless behavior resulting in harm • Illegal, unethical, negligent, or immoral behavior. Results in failure of duties or responsibility • Mandatory • Ex: Consent (informed and implied) • Protection of patient’s personal health information (handout of this)

7. Abuse (physical, sexual, verbal or psychological) – any mistreatment of people who are unable to protect themselves must be reported by health care providers. • Federal laws require the reporting of threats to a child’s mental or physical well-being. • Advocacy – supporting the best interests of all patients, and helping them to secure quality care. • Confidentiality and HIPAA • Consent- • Informed • Implied

8. Ethics… • A set of guidelines concerned with questions of right & wrong, of duty & obligation, of moral responsibility.

10. Morals • An individual’s own code for acceptable behavior involving traditions of belief. • They arise from an individual’s conscience • They act as a guide for individual behavior • They are Learned 60 minutes Baby Lab (13 min) http://www.cbsnews.com/8301-18560_162-57551557/babies-help-unlock-the-origins-of-morality/

11. Bioethics… • … the moral issues and problems that have arisen as a result of science, modern medicine and medical research. • Issues in bioethics are often life-and-death issues!

12. 7 Ethical Principles • Autonomy/Freedom • Veracity • Privacy/Confidentiality • Beneficence • Nonmaleficence • Fidelity • Justice

13. 1. AUTONOMY (self-determination) ETHICAL PRINCIPLES • The right to participate in and decide on a course of action without undue influence. To act independently. • Healthcare providers need to respect patient’s rights to make choices about healthcare, even if the healthcare providers do not agree with the patient’s decision. • Ex: informed consent, treatment planning, AMA, AD

14. 2. BENEFICENCE (do good) Requires the health professional to go beyond doing no harm Actively contributing to the health and well being of the patients served. Ex. In an emergency, when a patient is incapacitated, the health care worker assumes the person would want to be treated.

15. 3. NONMALEFICENCE (do no harm) • Requires the health practitioner to first do no harm and to actively prevent harm when possible. • To protect individuals who are unable to protect themselves • Ex. An x-ray tech fails to provide safety precautions so a patient does not fall off the table. Remember the Hippocratic Oath for physicians…

16. 4. JUSTICE (fairness) • The principle that deals with fairness, equity and equality and provides for an individual to claim that to which they are entitled.Ex: equal access to services

17. 5. VERACITY (honesty) • The physician has a duty to tell the truth to the patient, without deceit. • Veracity is an important component of building trusting relationships.

18. 6. CONFIDENTIALITY • Respecting privileged knowledge. • Respecting the “self” of others.Ex; HIPAA • The only times this principle may be violated are: • If patients may indicate harm to themselves or others • If the patient gives permission for the information to be shared

19. 7. FIDELITY Strict observance of promises or duties. Loyalty Accountability

20. Ethical Dilemma: A need to know the worst news you will ever hear - CBS News 8 min Situations necessitating a choice between two equal (often undesirable) alternatives. • examples • Genetic testing • 23andMe: Could mass DNA testing change health care? - CBS News 9 min • Stem cell research • Cloning • Physician-assisted suicide

21. Ethical Decision-Making • Rational & systematic • Based on ethical principles, not emotions or intuition • Serves patient’s best interest • Preserves integrity of all involved

22. Why call an Ethics Consult? • Ethics Consult can help: • Discover and understand the issues • Serves as a forum for sharing of concerns and questions • Identifies possible treatment alternatives • Provides guidance to the staff, patient, and family members • Multidisciplinary teams • Resolves conflicts • Required by Joint Commission for all health care institutions

23. Ethical Decision Making Process (handout of this) • Describe the problem • Gather the facts • Clarify values • Note reactions • Identify ethical Principles • Clarify legal rules • Explore options and alternatives • Decide on a recommendation • Develop an action plan • Evaluate the plan

24. Four Questions to always ask in an ethics analysis…(handout of this) 1. Ethical Questions: These are about what a person should do, how people ought to interact, what sort of person one should be, and what kind of communities it would be good to live in. 2. Relevant Facts: These are the biological, psychological, sociological, economic, and historical facts you need for thinking carefully about the ethical question and answering it. 3. Who or What Could Be Affected: The people and entities affected by ethical decisions are considered stakeholders. Stakeholders are not always human beings or human organizations; animals, plants, organisms, or the environment might be affected by the way an ethical issue is decided, so they can also be stakeholders. 4. Relevant Ethical Considerations: These are particular concepts in ethics that can help you analyze a case.

25. ACTIVITIES: • Pre quiz on patient rights • What type of question….ethical vs. legal, scientific, personal preference • Review the following: AD Informed Consent HIPAA Patient Bill of Rights x2 Good Samaritan Law PPT slides on Law, ethical decision making, 4 questions ethical analysis Case Studies (Dying to breathe, consent, medical morals, case no 1-6, Carl’s case, other) • Movie notesMajor ethical dilemmas in nursingChapter 3 wrap up • Ethics Project – Role Play

26. Lung Transplant Patient Selection Criteria (John Hopkins Transplant Center) Lung Transplant Patient Selection Criteria | Johns Hopkins Comprehensive Transplant Center • Absolute Contraindications • Absolute contraindications for adults and children include, but may not be limited to: • Age appropriateness • 65 years of age for single lung (must be evaluated before 63rd birthday) • 65 years of age for double lung transplant • 55 years of age for heart/lung transplant • Active smoker (less than 6 months since quitting) • Active substance abuse • Chronic mechanical ventilation (unless tolerating 3 hours of physical therapy/day and is free of bacterial colonization) • Previous lung transplant (rare exceptions for John Hopkins Hospital primary transplant patients) • Severe Diffuse Coronary artery disease (especially with poor EF) • End-stage renal disease (creatinine clearance < 40 mg/min) • End-stage liver disease • Bone marrow dysfunction • HIV • Severe local or systemic infection • Severe neurologic deficits • Untreatable psychiatric • continue next page

27. Relative Contraindications Relative contraindications for adults and children include, but may not be limited to: Morbid obesity (BMI>30) Severe malnutrition/cachexia Chronic prednisone use > 20 mg / day Symptomatic osteoporosis Psychiatric / social problems (including non-compliance) Financial problems (no prescription coverage) Previous thoracic surgery / procedure Lack of family or social support Cancer in the last 5 years except localized skin (never melanoma) Colonization with resistant organisms

28. ETHICS IN HEALTH CARE HIGHLIGHTS Ethics…A set of guidelines concerned with questions of right & wrong, of duty & obligation, of moral responsibility. Ethical Dilemma…Situations necessitating a choice between two equal (often undesirable) alternatives. • Ethical Decision Making Process • Describe the problem • Gather the facts • Identify ethical Principles • Clarify legal rules • Explore options and alternatives • Decide on a recommendation • Develop an action plan • Evaluate the plan 7 Ethical Principles • Autonomy ( _______________ ) • Veracity ( _______________ ) • Confidentiality ( _______________ ) • Beneficence ( _______________ ) • Non-maleficence ( _______________ ) • Fidelity ( _______________ ) • Justice ( _______________ )