1. Medical Therapeutics Ms. Maury Rich
ethics
Medical Therapeutics
Ms. Maury Rich
Bioethics or biomedical ethics is a specialized branch of ethics that is concerned with human behavior within the context of modern medicine.

2. Bell Work Vocabulary: Look up definition and then define in own words:
Ethics
Morals
Laws
Nonmaleficence
Beneficence
Autonomy
Distributive justice
Paternalism
Veracity
Fidelity

3. Learning Objectives
Standard 3: Analyze specific laws and ethical issues that impact professional practice such as confidentiality, informed consent, and patient self-determination. Citing specific textual evidence to support analysis, debate these issues in an oral or written format.
At the conclusion of class today I CAN:
Identify the structure of an ethical dilemma
Define key terms related to bioethics and use them in context
Describe the importance of understanding ethical issues in health care

4. Ethics and Morals
Morals—personal beliefs of right and wrong behavior based on religious beliefs, cultural norms, family customs, and past experiences
Ethics—human behavior and its effect on society, more concerned with the big picture as well as the immediate situation
Morals and ethics are terms that are sometimes used interchangeably because they are based on values regarding human conduct.

5. Laws and Ethics
Laws can be made to designate actions that are right and wrong even though the same action may not be viewed as unethical
Another action may be viewed by some as ethical but is considered illegal
Although a behavior may be deemed unethical by some individuals, it is not necessarily illegal.

6. Susan is a respiratory therapist at a large hospital
Susan is a respiratory therapist at a large hospital. It was discovered that Susan had an affair with the chief of staff at the hospital. She was later fired by the board of the hospital. Were Susan’s actions illegal or unethical?
Illegal: go to the right side of the room by the window
Unethical: go to the left side of the room by the door
Both: go to the back of the room

7. Bioethics
Specialized branch of ethics concerned with human behavior within the context of modern medicine
Medical research develops new technology and advances at a rapid rate
Human cloning, stem cell research, and euthanasia are examples
The number and variety of situations that confront health care providers are many. Therefore, it is not possible to predict them or to explain what ought to be done in every case.

8. Ethical Principles Ethical rules regarding people’s behavior
Ethical reasoning process
Seem simple and straightforward, may be complicated
Nonmaleficence
Beneficence
Autonomy
Distributive justice
Paternalism
Veracity
Fidelity
Ethical principles are rules about how people ought to behave. An understanding of these principles is necessary to understand the ethical reasoning process.

9. Nonmaleficence Pertains to health-care workers “Do no harm”
Hippocratic Oath, professional codes
In medicine there is always a potential to do harm
Nonmaleficence refers to the duty of health-care providers to “do no harm.”

10. Beneficence
Health-care workers aim to provide benefit in addition to avoiding harm
Medications are proven to be safe before they are released
Medications and treatments should have a reasonable likelihood of being helpful
Risks should be made known to patients
Health care providers must aim to provide benefit for their clients in addition to avoiding doing harm.

11. Autonomy Right of patients for self-determination Freedom of choice
Patient’s right to refuse or accept medical treatment
Obtain informed consent before treatment or procedures
Autonomy is the patient’s right to freedom of choice.

12. Should minors be allowed to make their own medical decisions?
Yes: go to the right side of the room by the window
No: go to the left side of the room by the door

13. Distributive Justice Includes concept of fairness
Fair allocation of scarce resources
People waiting for transplant organs
Who decides who receives the organ and who does not
Distributive justice is founded on the concept of fairness. Such decisions must be made to maximize the good for the greatest number of people, while minimizing harm to all.

14. Paternalism
“Father” role is taken on by health-care provider, judge, or other person or entity who makes the decision for a person based on his or her best interests
Right to autonomy is denied
Parent makes decisions for minor child
Paternalism is when another person or health care provider makes decisions for the patient.

15. Veracity Duty to be honest
Is there an appropriate time to withhold information from a patient?
Is there such a thing as the acceptable “little white lie”?
Veracity is the quality of truthfulness.

16. Fidelity The duty to keep reasonable promises and to meet obligations
Clients have a right to expect health-care workers to keep their information private
Reasonable expectations and unreasonable expectations
Fidelity refers to faithfulness, the duty to keep reasonable promises and meet obligations.

17. Anatomy of an Ethical Dilemma
A decision must be made
The outcome will have profound consequences
There is a disagreement among involved parties about right course of action
What may seem to be an ethical dilemma is really just a situation in which miscommunication has occurred or inadequate information is available. Therefore, the first steps in addressing a potential ethical dilemma are to gather data and seek clarification of all relevant issues.

18. Ethical Decision Making
Bias—response based on previous experience
Uses ethical reasoning process
Thoughtful decision making based on solid understanding of ethical principles and careful reasoning
Ethical decision making may be difficult. How is a reasonable decision made? A person’s response must be based on thoughtful reflection, not on emotions and personal beliefs.

19. Ethics Committees Serve as resource to health-care organizations
Formulate institutional policies
Provide education for staff
Serve as consultant role between patients and providers
Ethics committees formulate institutional policies and provide education for health care staff and, possibly, community members.

20. Would you want to serve on an ethics committee?
Yes: go the right side of the room by the window
No: go to the left side of the room by the door

21. Health care Ethical Behavior
Trust and loyalty
Confidentiality
Respect and dignity
Commitment to professional development
Medical assistants are obligated to behave professionally and ethically in the medical office. Medical assistants must act in a manner consistent with their own professional code of ethics and with the expectations of their employers.

22. Differentiate morals and ethics Differentiate unethical and illegal
Discussion
Differentiate morals and ethics
Differentiate unethical and illegal
Define bioethics and identify if you have been exposed to a situation when bioethics was an issue

24. Scenarios
An adult Jehovah’s Witness patient because of acute massive bleeding which cannot be rapidly stopped requires life saving blood transfusion but is awake and refuses blood transfusions based on the patient’s religion. The patient is informed that with the transfusion, the patient will live and the underlying bleeding problem can be resolved with no long term medical consequences. Without the transfusion, the patient could most likely die. The patient still refuses but the physician, as the patient is beginning to lose consciousness, violates the patient’s autonomous demand and begins the blood transfusions. Is what the physician did ethical?

25. Scenario
Brain surgery of lesions is often performed on conscious patients to establish safe dissection around motor and sensory areas. A patient with skull opened and brain exposed demanded the surgeon to stop the operation at once despite understanding the consequences of fully terminating the surgery at this point and leaving the skull open. Instead of stopping, the surgeon had the patient anesthetized to allow proper closure of the skull thus was violating the patient's demand. Is what the surgeon did ethical?