2. Medical Ethics  A set of guidelines concerned with questions of right & wrong, of duty & obligation, of moral responsibility.  Ethical dilemma is a predicament in which there is no clear course to resolve the problem of conflicting moral principles  Often involve life or death issues

3. Seven Principles  Autonomy (Freedom)  Veracity (Truth)  Beneficience (do good)  Nonmaleficence (do no harm)  Justice (fairness)  Confidentiality (privacy)  Fidelity

4. Autonomy  Freedom to influence course of life/treatment Requires the person to be competent in decision making capacity  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

5. Preservation of Autonomy  Living Will ○ Takes effect when terminally ill and lacking decision making capacity  DNR – Do not resuscitate (refers to CPR only)  Surrogate Decision Makers Represents patient’s interest  The primary responsibility of the physician is to serve the patient’s interest

6. The patient self determination act of 1990  At the time of admission, information regarding the patients’ right to refuse care or create an advance directive must be dispensed

7. Informed Consent  Patient is presented all alternatives so they can make a decision.  Requirements Decision making capacity – patient must be competent Voluntary  Respect refusal  Required for all surgical and experimental procedures

8. Implied Consent  Invoked when in emergency situations when harm would result without urgently needed intervention

9. Beneficience  Obligation to preserve life, restore health, relieve suffering and maintain function  Non-abandonment – obligation to provide ongoing care  Requires the health professional to go beyond doing no harm  Actively contributing to the health and well being of the patients served. = To do “good”  Ex. In an emergency, when a patient is incapacitated, the health care worker assumes the person would want to be treated. This is also implied consent.

10. Nonmaleficence  “Do no harm” – Hippocratic oath  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.

11. Justice  Allocation of medical resources must be fair and according to need  Physicians should not make decisions regarding individuals based upon societal needs

12. Veracity/Honesty  Truth telling on part of physician is an integral part of patient autonomy  The physician has a duty to tell the truth to the patient, without deceit.  Veracity is an important component of building trusting relationships.

13. Confidentiality  Obligation of physician to maintain information in strict confidence Ex: HIPAA law  Breaching patient confidentiality may be merited only: When ordered by court of law – a court case Where statutory requirement – public health laws Where required in health professional’s defense – malpractice suit (but that’s a discussion for another day…) Where necessary for appropriate patient care- speaking to another provider in the medical care system

14. Fidelity  Strict observance of promises or duties  Loyalty  Accountability

15. Ethical Dilemas  The worst news you will ever hear The worst news you will ever hear  Euthanasia Legally prohibited in the US except in Oregon which permits MD assisted suicide  Destroying Frozen Embryos

16. 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

17. Ethical decision making process  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

18. 4 questions to ask… 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.