Prototypes of Ethical Problems

Recognize Ethical questions, distinguish between clinical or legal one.Identify three components of an ethical problem.Two varieties of moral distress.Keeping emotions under check.Four criteria to decide who has authority to make ethical decision.

Prototypes continued… Is the problem a clinical, legal or ethical in nature? Clinical example: Can a patient with Dementia

operate a vehicle? NoLegal example: Do patients with a Dementia

diagnosis need to listen to their Doctors advice to not drive? Yes

Ethical question example: Should people with Dementia who refuse to take on road assessment be allowed to drive? If so under what circumstance?

Questions like this place the focus on the role as a moral agent, aspects arise such as; moral values, duties, and quality of life to arrive at a caring response.

Three Prototypes of Ethical ProblemsMoral Distress-experience

appropriate emotional or cognitive discomfort with makes you want to do something about fixing the problem.

Two or more morally correct courses as action created by two diverging courses.

The outcome two or more ways to handle the dilemma.

Locus of Authority Who has the authority to make an ethical decision? In a Clinical

situation, The rightful agent: Professional expertise as a team of

interdisciplinary principles. An example: Mr. Smith has been falling at the nursing home, what can be done to avoid falls? As a team the Clinical, Therapy, Social Services and Housekeeping tackle this dilemma by suggesting ways to help make the patient. Clinical suggests getting an order from the physician to see if there is a medical reason through testing why the patient is falling…such as mini-strokes, or by ordering special socks for the patient to wear with grips for walking. Therapy may be asked to assess the patient for muscle weakness so they can start working with the patient to help them become stronger. Housekeeping may be asked to make sure there are no obstacles in the patients room such as extra furniture or slippery floors. Social Services may do a BIM or Mood assessment to see if there is a change in the patients cognition or mood do to a specific diagnosis such as Dementia.

Traditional Arrangements

The physician in a traditional setting is the authority t make decisions because of their position in Health Care. The Physician can and may ask advice from other clinical professionals such as nurses or other colleagues.

Institutional ArrangementsThis is done by delegating within

a committee.Designated individuals within the

committee are given task to complete to help solve the dilemma.

Sometimes the resolution is voted on by committee members to resolve the issue.

Authority of ExperienceThe voice of experience that comes from

working in the field for many years or dealing with solving ethical situations.

There may be professional expertise approaches and they may be different.

The outcome from using any of the above mentioned locus's may be used depending on the ethical issue.

The end result should be to achieve a consistent and caring response.

Ethical Reasoning Norms and Values, what is wrong or right. This is

also Clinical reasoning. What are the facts, apply your experience and skills to meet desired goal of a caring response.

Metaethics: try to discover the nature and meaning of ethical reason for validity to make them moral. How do we know there are truths about morality? This is moral judgment. Is the Patient Spiritual?

Normative: concrete questions related to morality such as. What we be a proper expression of care toward someone who has a language barrier? The answer: see if there is an interpreter available to help you communicate and so the patient can communicate their needs.

Narrative EthicsA story’s characteristics, events and the

order of the events , this may be referred to as a case.

Observation of humansHow they communicateBody languageCultureReligionCan be based on relationshipsAll components need to be considered

when listening to patients to provide a caring response.

Care Approach EthicsWhat are the areas of moral relevance?What are the moral concepts of paying

attention the story that the patient is telling you?

Be attentive and use eye contact.Appreciate the power of the setting you may

in such as a Hospital setting for patient ethical professionalism.

Treat the patient as a person.Be trustworthy to the patient so they will

share information with you. Show Compassion.

Virtue Theory Character traits play an important part for ethical

decision making. Honesty-not lying, but telling the truth. Courage-taking responsibility to do they right thing or

admitting to not doing the right thing and apologizing.

Compassion-putting yourself in the situation of the patient and feeling what they must be going through.

Experience-skills and knowledge from being in a similar situation related to own personal experience

Empathetic-feeling what the patient feels, emotionally.

Environment or community of health care professionals’

Nonmaleficence

Traditional health care ethics “First do no harm”.

The caring response should be built an the base of “First do no harm”.

Prevent harmRemove harm when it is being

inflicted.Bring about positive good.

AutonomyWell-being-healthy, happy and prosperous.Self-determination- the right of the patient to

be able to chose.Fidelity- 1. being faithful to the patient served and

respecting the patients rights and as an individual.

2. Be competent.3. Adhere to the code of ethics.4. Follow policies and procedures.5.Honor what you agree to do for the patient.

ReferencesPurtillo, R.B., Doherty, R. F. (2011).

Ethical dimensions in the health professions (5th ed.) Elsevier Saunders. ISBN 978-1-4377-0896-7

WordIQ.com. http://www.wordiq.com/definition/

Merriam-Webster. 20214. Dictionary. Merriam-Webster, INC. http://www.merriam-webster.com/dictionary/self-determination?show=0&t=139128