Part I: Foundations<\/span><\/h2>\n

Sample Answer for Part I: Foundations Included After Question<\/strong><\/h2>\n

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Topic: The reflective equilibrium is an ethical decision-making model. \u00a0List three (3) ways that this model can assist you in making ethics-based decisions in health care settings. Do you find any of the other models mentioned useful?<\/p>\n

Chapter Two Principles of Health Care Ethics Spring 2023 Compounding Effects of Ethics \u2022 Ethical choices at the individual level often permeate well beyond the scope of our individual realms. \u2022 This diagram also reflects how change (good or bad) occurs. Societal Organizational Clinical Professional Individual Principles of Ethics The four principles: \u2022 Provide context to the foundational theories \u2022 Assist to apply ethical decision making to situations \u2022 What is legal is not always right, but what is right is not always legal \u2022 Each principle is an obligation beneficence: to do good nonmaleficence: to do no harm autonomy: to permit an individual selfgovernance justice: to give to each his or her due Beneficence \u2022 The obligation \u2022 to do good \u2022 to take positive & direct steps to help others \u2022 The underlying principle of Consequentialism \u201cgreatest good for the greatest number\u201d \u2022 Basis to see every patient as a unique person who has worth \u2022 The common morality & fundamental principle of healthcare \u2022 Altruism is expected \u2022 Expectation to act with beneficence in all daily activities Nonmaleficence \u2022 The obligation to do no harm \u2022 Qualified by the Rule of Double Effect \u2022 Harm \u2022 defined differently by the different theories \u2022 can have various shapes and sizes \u2022 is not simply physical \u2022 2 types of harm 1. Omission \u2013 appropriate actions not taken to cause; negligence 2. Commission \u2013 actions taken to cause Harm as a Violation of Autonomy \u2022 Omission \u2022 Commission \u2022 Substituted Judgement decisions are made from discussion(s) with the person prior to becoming incompetent \u2022 Best interest \/ Reasonable person decision decisions are made for the incompetent person, without earlier discussions, based on what a reasonable person in that situation would choose Autonomy \u2022 The obligation to permit an individual self-governance \u2022 Implication of a respect for others \u2022 Prevents paternalism & paternalistic healthcare \u2022 Healthcare duty is to treat without judgement \u2022 2 key autonomy conditions: \u2022 Is the patient competent to make their own decisions? \u2022 Is the patient free of coercion to make decisions? \u2022 Specific competence = the ability to do some things, but not others \u2022 Basis for informed consent Justice \u2022 The obligation to give each his or her due \u2022 equal share OR \u2022 according to need \u2022 according to effort \u2022 according to contribution \u2022 according to merit \u2022 2 types: \u2022 Procedural justice \u2022 Distributive justice \u2022 Aristotle believed in treating similar cases alike except when there are relevant or material differences in the cases. Procedural Justice \u2022 Focus on procedures \u2013 existence of & adherence to \u2022 \u201cDue process\u201d \u2022 When you get your turn, you are treated like everyone else \u2022 Typically found in \u2022 employee relations \u2022 health policy hearings Distributive Justice \u2022 Focus on resource allocation, balancing benefits & burdens \u2022 Occurs at all levels of an organization \u2022 Examples: \u2022 standards of care \u2022 patient rounds \u2022 sequencing of COVID vaccines \u2022 salaries \u2022 provider schedules Material Reasons to Discriminate Two concepts: \u2022 the person deserves it because of one\u2019s contribution or results & efforts \u2022 the person needs it because of \u2022 circumstances characterized as misfortune \u2022 mental or physical disabilities (unequal natural endowments) \u2022 special talents or abilities \u2022 opportunities they might have or lose \u2022 past discrimination perceived as negative effects on the present \u2022 structural social problems perceived as restricting opportunity or motivation \u2022 In the larger society, discrimination is based primarily on market contributions, results, & effort Discrimination Based on Need \u2022 Need based on misfortune \u2022 triage \u2022 disasters & emergencies \u2022 genetics \u2022 special talent \u2022 Need based on past discrimination \u2022 redress of past injustices \u2022 special health systems (Veterans Health Administration, Indian Health Service) \u2022 transportation, poverty, housing, education, language barriers Distributive Justice and Rights \u2022 Is healthcare a right or a privilege? \u2022 (the debate continues\u2026) \u2022 Moral vs legal right \u2022 Many types of rights, some even share characteristics Legal and Positive Rights \u2022 Legal right = \u2022 someone has a moral obligation to fulfill your right \u2022 voting, not discriminated against \u2022 Positive right = \u2022 subset of legal rights \u2022 social \u201cgoods\u201d \u2022 written into law\u2026 entitlement \u2022 education, due process Substantive Rights \u2022 May or may not be legal rights \u2022 Rights to a particular thing: \u2022 education \u2022 minimum wage \u2022 safe streets \u2022 clean environment \u2022 emergency medical care \u2022 welfare \u2022 Nations differ in their opinions about substantive rights for citizens Negative Rights \u2022 The right to do anything not strictly forbidden by the law \u2022 Examples: \u2022 live a life as we individually see fit \u2022 privacy (HIPAA) \u2022 protection from sexual harassment & hostile work environment \u2022 Negative rights may conflict among individuals \u2022 Bill of Rights lists many of these Process, Natural, and Ideal Rights \u2022 Process rights = \u2022 legal rights \u2022 right to due process \u2022 Natural rights = \u2022 respect for attributes humans have by nature \u2022 express our common morality \u2022 life, liberty, & pursuit of one\u2019s full potential \u2022 Ideal rights = \u2022 statement of a right that is meant to be motivational, such as a goal to seek \u2022 guide organizations, communities, & nations to attain higher standards Reflective Equilibrium Decision-Making Model \u2022 A continual thought process for considering and reconsidering decisions \u2022 Considered judgements = \u2022 ethical intuitions (moral reasoning) \u2022 what individuals who make decisions about what to do use \u2022 requirement for ethical decisions \u2022 Require moral reasoning based on ethical theories & principles Beauchamp & Childress\u2019 Ethical Decision-Making Model 1. Apply the principles: a. Respect for Autonomy b. Beneficence c. Nonmaleficence d. Justice 2. Specify the principles 3. Balance the principles 4. Decide Twadell-Soleri & McDermott\u2019s Model for Making Ethical Decisions 1. Gather the facts 2. Determine the ethical issues 3. What norms\/principles\/values have bearing on this case? 4. List the alternatives 5. Compare the alternatives with the norms\/principles\/values 6. Weigh the consequences 7. Make a decision Weber, Leonard J. (2001) Business Ethics in Healthcare: Beyond Compliance. Indiana University Press. page 19 Conclusion \u2022 One has no rights if they are not legal rights \u2022 Ethical decision-making can be messy & errorprone \u2022 The process matters as much or more than the product \u2022 Ethics is not neutral Chapter One Theory of Health Care Ethics Spring 2023 2 Why Study Ethics? \u2022 Healthcare is consistently changing \u2022 Tools to make necessary and difficult decisions. \u2022 To better understand patients, fellow professionals, and the HC system in general. \u2022 To assist in building and maintaining your career. Types of Ethics Normative ethics: Metaethics: the study of what is right and wrong. the study of ethical concepts and theories. 3 Types of Normative Ethical Theories Egoistic Authoritybased Virtue Natural law Teleological Deontological 4 5 Ethical Relativism \u2022 Ethical relativism reasons that there is no absolute theory for ethics \u2013 \u201cit\u2019s all relative\u201d. \u2022 However, this would mean there are no real right, wrong, good, or bad decisions & action. \u2022 Rational ethics-based decisions must still be made \u2022 These theories help to affect the health, well-being, and lives of patients. 6 Egoism as Ethics Theory \u2022 One\u2019s self interest is the basis of one\u2019s ethical decisions \u2022 Not helpful in healthcare ethics professionals are taught to set aside their self-interest. \u2022 The interests of the patient should come first \u2013 patientcentered care. 7 AuthorityBased Ethics Theory \u2022 Based on a central authority such as: \u2022 religion \u2022 tradition \u2022 elders of a culture \u2022 ideology (communism, capitalism, etc.) \u2022 Difficult to distinguish as normative, due to conflicting beliefs \u2022 Which authority is correct? \u2022 Helpful to understand patients & health policy 8 Virtue Ethics Theory (1\/2) \u2022 Founded in the writings of Aristotle & Plato \u2022 Everything moves from potentiality to actuality \u2022 Asks, \u201cwhat is the proper behavior?\u201d \u2022 Character development leads to your highest good \u2022 Eudaimonia: \u2022 you seek to build your character and increase virtue. \u2022 should be sought in life \u2022 persons of practical wisdom develop from those who practice 9 Virtue Ethics Theory (2\/2) \u2022 Professional education seeks to develop people of high character. \u2022 Principles of ethics can help to define your character and assist with your actions. \u2022 Criticized as being elitist \u2022 Requires balance of conflicting obligations. \u2022 People with practical wisdom should be better prepared to make ethical decisions. 10 Natural Law Theory (1\/2) \u2022 Founded in the writings of St. Thomas Aquinas & believed by the Greeks \u2022 Assumes nature is rational and orderly in accordance with God\u2019s wisdom \u2022 Humans are part of the natural world and are given the ability to be rational \u2022 Natural reason allows us to: \u2022 distinguish right from wrong \u2022 choose to do good or evil 11 Natural Law Theory (2\/2) \u2022 A foundation for social responsibility & social justice movements \u2022 Social & political factors that prevent actualizing potential: \u2022 poverty \u2022 ignorance \u2022 unhealthy living conditions \u2022 human rights \u2022 public health 12 Principle of Double Effect \u2022 Helps us decide which action is good. \u2022 4 key points : 1. act must be good, or morally neutral, independent of its consequences 2. agent intends only the good (not the bad) effect(s) 3. bad effect(s) is not a means to the good effect(s) 4. good effect(s) must outweigh the bad effect(s) \u2022 Good = that which helps to maximize potential (preserve life, gain wisdom, & know God) 13 Deontology Theory \u2022 Derives from the Greek word \u201cdeon\u201d = duty \u2022 Also named duty-based ethics \u2022 Main theorists: \u2022 Immanuel Kant \u2022 John Rawls \u2022 Robert Nozick \u2022 Healthcare professionals & administrators have a duty to the patient \u2022 HC administrators also have duties to the organization & community \u2022 Policy addresses conflicting duties 14 Immanuel Kant \u2022 All experiences are subject to causation, which undermines free will \u2022 Free will is essential to & for ethics \u2022 Character attributes can be used for good or evil \u2022 The only true good is good will \u2022 The ability to choose is what makes us human \u2022 Actions: \u2022 are judged by their intention, not just their outcome(s) \u2022 must be based on duty to moral law, not the consequences \u2022 Practicing this in its pure form is difficult in modern society 15 Categorical Imperative \u2022 Kant\u2019s rational principle for making moral judgments \u2022 Act in a way that your action could become a universal law \u2022 The Golden Rule is not a synonym \u2022 People are not a means to an end; they are the end (so should be respected) 16 Kant and Virtue Ethics \u2022 Pure Kantian ethics is absolute in its definition of duty, but virtue ethics allows for grey areas \u2022 Kant does not assist with deciding among lesser evils and greater goods \u2022 Virtue ethics allows the use of tools to make these decisions 17 NonKantian Deontology \u2022 Recent proponents \u2022 Deal with the idea of justice through our actions \u2022 Their thinking influences: \u2022 health care reform \u2022 public health \u2022 other health areas 18 John Rawls (1\/2) \u2022 Worked to define the characteristics of a just society \u2022 \u201cJustice as fairness\u201d \u2022 His work is based on the idea of a social contract between members of a society \u2022 The Original Position \u2013 \u2022 explanation of why rational people would protect one\u2019s self-interests \u2022 we would all be equal & could all be treated in the same way in a society \u2022 it would be in our self-interest to make sure everyone is given an equal share of benefits and burdens 19 John Rawls (2\/2) \u2022 The Veil of Ignorance \u2013 explanation of why we care about self-interests \u2022 Basic Principles of Justice: \u2022 Liberty \u2022 priority over all other principles of justice \u2022 people should have equal right to basic liberties (Bill of Rights) \u2022 Inequalities \u2022 Difference Principle \u2022 used to justify when social & economic inequities are appropriate \u2022 inequities are used to help the lesser fortunate (physicians) 20 Robert Nozick (1\/2) \u2022 Represents the conservative tradition \u2022 Great influence in the debate over health care reform \u2022 Emphasized autonomy & rights of the individual \u2022 \u201cIndividuals have rights, and there are things no person or group may do to them (without violating their rights).\u201d \u2022 No social good requires sacrifice \u2022 Everyone should influence others to take steps to improve their own situations 21 Robert Nozick (2\/2) \u2022 Does not believe in principle of distributive justice \u2022 Justice is in acquisition and owned resources \u2022 Historical injustices are not addressed, except to suggest that society could be organized to maximize the position of the least well off. 22 Teleological Theories \u2022 Derived from the Greek word \u201ctelos\u201d = ends \u2022 Ethics of a decision are dependent on the consequences or effects of the action \u2022 Goal: the greatest good for the greatest number \u2022 2 types: \u2022 Classical Utilitarianism \u2022 Rule Consequentialism \u2022 Consequentialism = Utilitarianism 23 Types of Teleological Theories \u2022 Classical Utilitarianism \u2013 each act is considered based on its net benefit \u2022 Rule Consequentialism \u2013 \u2022 the decision maker will develop rules that net the greatest benefit (health policy) \u2022 2 Types: \u2022 Negative Consequentialism preventing the greatest harm for the greatest number \u2022 Preference Consequentialism \u2013 \u2022 good is honoring preferences and bad is frustrating preferences \u2022 Preferences must be known, or a substituted judgment can be used 24 Consequentialism Theory \u2022 Due to Jeremy Bentham & Stuart Mill\u2019s, this theory is also known as utilitarianism \u2022 Your intentions are irrelevant; all that matters is the outcome \u2022 Criticisms of the theory: \u2022 the minority is not protected when the greatest good for the greatest number is the goal \u2022 this theory means that the ends justifies the means **these criticisms are invalid since respect for autonomy and liberty are essential to the theory 2 5 \u2022 There is no pure ethical theory; each has strengths and weaknesses Conclusion \u2022 Health care professionals must make complicated ethical decisions \u2022 The ability to understand theory enhances your decision-making tool kit<\/p>\n

A Sample Answer For the Assignment: Part I: Foundations<\/strong><\/h2>\n

Title: <\/strong>\u00a0<\/strong>Part I: Foundations<\/h2>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Part I: Foundations Sample Answer for Part I: Foundations Included After Question Description Topic: The reflective equilibrium is an ethical decision-making model. \u00a0List three (3) ways that this model can assist you in making ethics-based decisions in health care settings. Do you find any of the other models mentioned useful? Chapter Two Principles of Health […]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-30932","post","type-post","status-publish","format-standard","hentry","category-nursing-papers"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"yoast_head":"\n