Moral Beliefs Questions Name the individual who has had the greatest influence on your understanding of right & wrong. Why? What do you value most? Why? What do you use as a benchmark for making moral decisions? Where did it come from? Who is your personal hero? Why? Who is your professional hero? Why? State 3 qualities you consider important in order to maintain professional integrity and why.

Medical Ethics

Ethics Ethics is a set of principles relating to what is morally right or wrong, providing guidelines for acceptable behavior. Ethical decisions are based on moral values formed through influence of family, culture and society

ethics The standards of behavior required by a health care provider to carry out their duties: Confidentiality Accuracy Honesty dependability

Ethics Professional ethics should NOT differ from personal ethics

Ethics Formalized codes of ethics: DO not deliver solutions, but act as a guide for ethical and moral conduct: Govern behavior of health care members Increases level of competence Provides standards of care within the profession

Talking Points and Notes for Presenter Hippocratic Oath “I swear by Apollo the Physician…to keep according to my ability and judgment the following oath” “I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone” The Oath of Hippocrates of Kos, 5th Century BC Talking Points and Notes for Presenter The Hippocratic Oath established the Western paradigm of a profession as a “morally self-regulating” discipline. Authorship of the Oath is sometimes attributed to Hippocrates of Kos, but the document itself dates from anywhere between the fifth and third centuries BC. The most substantive section of the Hippocratic Oath focuses on prohibiting certain conduct such as “prescribing a deadly drug” or giving “advice which may cause his death.” Thus, the medical profession is commonly considered by many to be guided by the Hippocratic maxim, “first do no harm” (which does not appear in the Oath itself but rather elsewhere in the Hippocratic corpus). Reference: 1. Orr RD, Pang N, Pellegrino ED, Siegler M. Use of the Hippocratic oath: a review of twentieth century practices and a content analysis of oaths administered in medical schools in the US and Canada in 1993. J Clin Ethics. 1997;8:377-388.

Basic rules of ethics Put saving of life and promotion of health above all else Treat all patients equally Maintain competent level of skill consistent with occupation Maintain confidentiality and respect for privacy of others

Basic rules of ethics Refrain from immoral and illegal practices Show loyalty to patients, co-workers, and employer Be sincere, honest, and caring

The Final Chapter Why are advance directive important? What is the #1 fear of dying patients? What is their 2nd greatest fear? Why is mercy killing so controversial? What is an alternate to mercy killing? Why is this alternative a viable option?

Right to Die Issue Came about with ability to sustain life of terminally ill Conflict occurs between ethical concerns of promotion of life & allowing pts to die

Laws Allowing “Right to Die” Patient Self Determination Act of 1990: Established advance directives Living Will: DNR (Do Not Resuscitate) Durable power of Attorney Supportive care Providing oxygen Food and fluids Medication for pain, nausea, and other discomforts Physical care and personal hygiene

Advanced Directives

Will is a document that states who will get your money and property after you die.

Living Will is a legal document stating a person’s wishes regarding life-prolonging medical treatments

Healthcare Power of Attorney A document which allows you to appoint someone to make health care decisions for you if you’re incapacitated

Revocation of Power of Attorney A document which allows you to revoke a power of attorney document

General Power of Attorney Authorizes your Agent to act on your behalf in a variety of different situations.

“Durable” A document which will remain in effect if you become mentally incompetent by adding the word “durable” to other documents.

Do not resuscitate (DNR) A document filled out by the physician, patient, and family in cases where quality of life is severely decreased

Suicide Self-inflicted, self-intentional cessation of life Victims: Adolescents: 3rd leading cause of death White, male, >45, divorced, separated, or widowed Causes: Social isolation Inability to cope Fear Illness/ mental status

Suicide Signals of possible suicide: Verbal statements “When I’m gone” “I won’t be around then” Personality changes Deep depression Apathy Giving away personal possessions Places to call for help Telephone hot lines Mental health associations, clinics Counselors, Teachers ,Parents

Euthanasia Comes from Greek meaning “easy death” Common term: mercy killing Painlessly put to death pt who is terminally ill

Euthanasia Performed in 2 ways: Active euthanasia Passive euthanasia: An intentional act designed to bring about death When pt takes own life or assisted Illegal Example: lethal injection Passive euthanasia: Allows pt to control dying experience Allowed by law through advance directives

Role of the Health Care Provider First understand own personal feelings about death & come to terms with these feelings Response should be consistent and guided by patient’s attitude and care plan Should be open and responsive to patient’s attitude about terminal illness Never try to force your own ideas about death on the patient

Hospice Care Philosophy Hospice care is provided by teams who working with the terminally ill person and the family The team: Physician Nurse Nursing assistant Social workers Clergy

Hospice Care Philosophy Goals of hospice care include: Control of pain Coordinate psychological, spiritual and social support service for the patient and family Counseling for family for up to 1 year