Chapter 4 Ethical Standards

Introduction Limits to what law, regulations, and accrediting standards and requirements can govern In the absence of law, regulations, and standards, ethical principles are used to provide a framework of decision making

Ethical Overview Ethics – the study Ethical acts – the actions Morals Etiquette Law Values

Ethical vs. Legal When no obvious right or wrong When law does not serve justice When right behavior brings about wrong effect When personal sacrifice is the consequence of following ideals

Ethical Models Multiple approaches to ethical reasoning Ethical approaches may be concepts or theories –Designed to assist a person in assessing right from wrong in a particular situation

Ethical Concepts Abstract ideas or thoughts dealing with ethics Autonomy – independence, self-determination, or freedom Beneficence – qualities of kindness, mercy, and charity Nonmaleficence – prohibition against doing harm

Double Effect Principle Beneficence and nonmaleficence is part of one’s professional duty in health care Ethical choices may result in untoward outcomes Good vs. harm analysis

Ethical Concepts Best interest standard –The best interest of the individual when they cannot make such a decision themselves Fidelity –faithfulness, loyalty, and devotion to one’s obligations and duties Justice –obligation to be fair to all people; fairness, honesty, and impartiality

Justice Opinions vary considerably over concept of justice Comparative justice –Balancing the competing interests Distributive justice –Fair distribution of burdens and benefits

Distributive Justice Criteria to define just distribution where resources are limited –Need –Equity –Contribution –Ability to pay –Effort –Merit

Ethical Concepts Rights – just claim or entitlement that others are obliged to respect –Can vary according to the moral values of a given culture –Confidentiality –Privacy

Ethical Concepts Veracity – habitual truthfulness and honesty –Seen in the special relationship between patient and health care provider –Patient to inform health care provider of all relevant information and likewise, health care provider to inform the patient so informed decisions can be made Checkpoint: How does the use of placebos impact the concept of veracity? How are placebos used in research? Are there other uses for placebos?

Ethical Theories Systematic statements or plans of principles involved in dealing with ethical dilemmas Utilitarianism Deontology

Utilitarianism Everyone should make choices that promote the greatest balance of good over harm for everyone Cost/benefit analysis –All options are considered –Value of each option determined –Option with highest total value is chosen Weaknesses

Deontology Based on moral rules and unchanging principles that are derived from reason and can be applied universally Categorical imperative Weaknesses

Ethical Decision Making We all face ethical dilemmas Influencing factors Code of ethics Ethics committees Patient rights Other factors Steps in ethical decision making

Guidance Questions Analogous situations Legal implications Sensibility Feelings

Bioethical Issues Bioethics – study of ethical issues that result from technologic and scientific advances As advances in science and technology occur, ethical issues increase in number and complexity

Issues – Beginning of Life Family planning Abortion Perinatal ethics Eugenics

Issues – Quality of Life HIV/AIDS Organ transplantation Genetic science

Issues – Death and Dying Planning for the end of life Euthanasia Withholding/withdrawing life support

Challenges Ethical challenges – when no clear-cut right answer exists and a choice must be made Generalized challenges in the workplace –Conflict of interest –Substance abuse –Disparagement –Other frequent ethical challenges in the workplace

Ethics and Supervision Serve as a role model Encourage ethical behavior Monitor employee conduct

HIM Challenges Arise as a result of changes in the health care environment Related to requirements for documentation and access to and release of information Arise from developments in technology Arise from changes in reimbursement systems and their attendant coding systems