Ethics Week 1 DR Aruoma Lecture

Okezie I ARUOMA
MSc PhD DSc CSci CChem FRSC MBA

School of Pharmacy and Biomedical Sciences American University of Health Sciences 1600 East Hill Street Signal Hill California, USA
E-mail: oaruoma@auhs.edu
ETHICS (Phil 304)

One should not feel guilty for the choices that are made on a daily basis, instead be aware of how filled with ethical issues in life
Let us first understand how the way the course is going to be assessed
Week Week 1 March 30th 2012 8.00 -12.00 Week 2 April 6 Week 3 April 13th 8.00-12.00 Week 4 April 20th 8.00-12.00 Week 5 April 27th 8.00-12.00 Week 6 May 4th 8.00-12.00 Week 7 May 11th 8.00-12.00 Week 8 May 18th 8.00-12.00 Week 9 May 25th 8.00-12.00 Week 10 June 1st 8.00-12.00 Week 11 June 8th 10.00-12.00
Lecture Topics Introductions. What is Ethics? Why do ethics? What is an ethical argument? Healthcare ethical and legal issues Dr Aruoma No Class Good Friday Virtue ethics, economic, Heathcare professionals ethical and legal issues Dr Chong Egoism and Utilitarianism, Employee rights and responsibilities Dr Aruoma Moral theory, End of life dilemmas Dr Aruoma Natural Law and natural rights, Governments, ethics and the law Dr Aruoma Equality and discrimination, global issues and globalization Dr Aruoma Stem cell research, cloning and genetic engineering, Healthcare ethics committees Dr Aruoma Patients consent, abuse, rights and responsibilities Dr Chong Group Presentations on thematic ethical issues through the course Dr Aruoma Final exam
Reading and Assignments MacKinnon, Chapter 1 and Chapter 2 Pozgar Chapter 1 and 10 Student group and paper assignment Self-directed study MacKinnon, Chapter 8 Pozgar Chapter 9 Quiz 1 MacKinnon, Chapter 3 and Chapter 4 Pozgar Chapter 11 Quiz 2 MacKinnon, Chapter 5 and Chapter 10 Pozgar Chapter 3 Mid-term Exam MacKinnon, Chapter 7, 14 and 15 Pozgar Chapter 7, Mackinnon, Chapter 13, Chapter 20 Quiz 3 Mackinnon, Chapter 18 Pozgar Chapter 4 Quiz 4 Pozgar Chapter, 12, 13 and 14, Pozgar Chapter 9 pp 310, 317, 324, 333, 347 Final paper submission and presentations Final Exam
1. Essay/Quizzes receiving 10% of the course grade 2. Mid-term Examination 20% of the course grade 3. Final Examination receiving 25% of the course grade 4. Group Presentation receiving 15% of the course grade 5. Group Paper receiving 20% of the course grade 6. Class participation receiving 10% of the course grade
STUDENT GROUPS
STUDENT GROUP 1 Hesselink, B.A.M., Onwuteaka-Philipsen, B.D., Janssen, A.J.G.M., Buiting, H.M., Kollau, M., Rietjens, J.A.C., Pasman, H.R.M., 2012. Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis. Journal of Medical Ethic: 38: 35-42. GROUP 1: ALAS Ann Michelle BAGAYGAY Roland James CABANILLA Aveelyn HOANG Michelle Phan LIN Chien-Hui HSIAO Tiffany
GROUP 2: ALGADO Marc A BATCHILLY Fatou GANDHI Chintan A KIM Samantha Phanang ONG Elora Liane Y CANAPI Kimberly L LUU Phillip
STUDENT GROUP 2 De Grazia, D., 2012. Genetic enhancement, post-persons and moral status: a reply to Buchanan. Journal of Medical Ethics 38: 135139.
STUDENT GROUPS
STUDENT GROUP 3 Labonte, R., Schrecker, T., 2007. Globalization and social determinants of health, Globalization and Health 3: 110 GROUP 3 ALVAREZ Paulina CASTELLANOS Yesenia GELUA Karen Cate LAM Xuyen T MOHD Yusof SREEKUMAR NAIR Swathy
STUDENT GROUP 4 VandeWoude, S., Rollin B.E., 2010. Practical considerations in regenerative medicine research: IACUCs, Ethics and the use of animals in stem cell research studies. Institute for Laboratory Animal Research Journal 51: 82-84
GROUP 4 BANGAL Audrey Rose R GARDNER Caitlin LU Kelley Nguyen NHu (Jaemee) TANG Eng HOANG Nhan
STUDENT GROUPS
STUDENT GROUP 5 Saunders, B., 2012. Opt-out organ donation without presumptions. Journal of Medical Ethics, 38: 69-72.
GROUP 5 BUI Michael Minh HUA Xuan M LUU Diana PATEL Trishila R TUDOR Stacey C ROSS Judy
STUDENT GROUP 6 Birchley, G., 2012. A clear case for conscience in healthcare practice, Journal of medical Ethics, 38: 13-17
GROUP 6 BAUTISTA Sheree T MENDEZ Maria NGUYEN Minh Yen OLIVEROS Marco PHU Ann H BROOKS Serrono
STUDENT GROUPS
STUDENT GROUP 7 Magelsen, M., 2012. When should conscientious objection be accepted? Journal of Medical Ethics, 38: 18-21.
GROUP 7 PATEL Nital PETROVIC Nicole RIVAS Mildred SITANGGAN Pongkarn Top TRUONG Danny LAPUZ Ephraim
STUDENT GROUP 8 Johnson, J., Rogers, W., 2012. Innovative surgery: the ethical challenges. Journal of Medical Ethics, 38: 9-12.
GROUP 8 TANTIONGCO Rhealyn TRUONG Kim TYRELL Monique YANG Jacqueline Zhao Na THAI Jason KHANH Mai
STUDENT GROUPS PRESENTATIONS
GROUP PRESENTATIONS OF THE PROJECTS (15 Marks) Each group will have 30 minutes to make a presentation and this will be followed by 5 minutes of questions from the rest of the class. Everyone enrolled for this course must attend. An absent will lose the entire 15 Marks
STUDENT GROUP PROJECTS

Course Paper (GROUP PROJECTS) (20 Marks) The projects are as assigned below. The report must adopt the in-house style exactly as in the sample paper provided (Journal of Medical Ethics in-house style). The report should be a maximum of 10 page including Figures, Tables and Schemes. The text should be done with a 12pt font size with single spacing. Not following the guideline (from the title page through to the listing of references) will result in an automatic deduction of 10 Marks. You are required to submit 1 hard copy of the group report and an electronic file (word document) to Dr Aruoma on or before class on Friday June 1, 2012. Late submission will incur a 10 Marks deduction. No exceptions.
How does it add up
Exam (Mid term and final combined): 45%
Student Class effort: 55%

So absolutely no excuse for not passing the class and more importantly for not getting an A grade
WEEK 1
INTRODUCTION
What is ethics? Why do ethic? What is an ethical argument Healthcare ethical and legal issues MacKinnon Chapter 1 and Chapter 2 Pozgar Chapter 1 and Chapter 10
Learning Objectives
Explain what ethics is, its importance, & application to ethical dilemmas Describe the concepts of morality, codes of conduct, & moral judgments Understand relevant ethical theories & principles Describe virtue ethics & values & how they describe moral character Explain why courage is often considered to be the ladder upon which all other virtues mount Describe why there is a declining trust in the politics of healthcare
2009 Jones & Bartlett Publishers, LLC
Learning Objectives, cont

Understand how religious ethics can affect ones moral character Explain the concept of situational ethics & how changes in circumstances can affect ones behavior Describe the concepts of ethical relativism & ones moral compass
Do what is right, legally and morally. Be willing to do what is right even when no one is looking. It is our "moral compass" an inner voice
Morality (from the Latin moralitas "manner, character, proper behavior") is the differentiation of intentions, decisions, and actions between those that are good (or right) and those that are bad (or wrong). A moral code is a system of morality (for example, according to a particular philosophy, religion, culture, etc.) and a moral is any one practice or teaching within a moral code. The adjective moral is synonymous with "good" or "right." Immorality is the active opposition to morality (i.e. good or right), while amorality is variously defined as an unawareness of, indifference toward, or disbelief in any set of moral standards or principles (wikipedia definition)
Learning Objectives
Describe the principles of medical ethics. Explain the hospitals duty to ensure the competency of physicians. Understand how ethics & the law impact physicians/nurses. Identify the variety of patient care issues that physicians and nurses face daily. Describe how practicing ones professional code of ethics can assist in resolving the day-to-day issues that arise during the care of patients. Explain the importance of understanding the physician-patient relationship. Also nurse patient relationship
Ethics and Ethical Reasoning

Why Study Ethics? There are differing views of moral rights and wrongs Matters are not always easy to judge What is Ethics?
The set of values or principles held by individuals or groups A study of the various sets of values that people do have
Ethics is a branch of philosophy; moral philosophy

Normative Ethics Metaethics Philosophical questions can be asked about many subjects Ethics and Religion
Ethics and Reasoning

Ethics and Religion Ethics and religious grounding
Religion as a motivation for morality

Ethical and Other Types of Evaluation
Descriptive judgments Normative judgments Differences between the two

Ethical Terms
Right/Wrong Good/Bad Ought/Ought not
Ethics and Ethical Reasoning

Ethics and Reasons Rational or Emotional Inituitionism or emotive Ethical Reasoning and Arguments Reasons Conclusions Premises Evaluating and Making Good Arguments Soundness Value assumptions Conceptual matters Factual assertions
So we study ethics to aid us in making: Sound judgments Good decisions Right choices (and if not right better ones) See page 3 - 6 of Pozgar and note examples given Health care industry: Recognizing health care dilemmas and making good judgments and decisions based on universal values that work in hand with the laws and the Constitution -when the law remain silent, rely on the ability of the caregiver to make the right judgment as guided by ones wisdom
The Miniature Guide to

Understanding the Foundations of
Ethical Reasoning
By Dr. Richard Paul and Dr. Linda Elder
Based on Critical Thinking Concepts & Principles
The Foundation for Critical Thinking
The world does not present itself to us in morally transparent terms. We live in a world in which propaganda and self-deception are rife. Public discussion and media communication are not neutral centers of open debate. A tremendous amount of money is spent on persuading people to see the events of the world in one way rather than another. Furthermore, depending on the society and culture in which we are raised, we ourselves are strongly pre-disposed to see some persons and nations on the side of good and other persons and nations on the side of evil. Humans typi-cally take themselves to be on the side of good and their enemies on the side of evil. We must rid the world of evil. Now is the time to draw a line in the sand against the evil ones. Across the world and across the years, we will fight the evil ones, and we will win.
You are either for us or against us. President George Bush, 2002
In the everyday world, the ethical thing to do is sometimes viewed as obvious and self-evident when it should be a matter of debate, or, conversely, viewed as a matter of debate when it should be obvious and self-evident. One and the same act is often ethically praised by particular social, religious or political groups and ethically con-demned by others. Through example and encouragement, we can cultivate important intellectual traits. We can learn to respect the rights of others and not simply focus on fulfilling our desires. The main problem is not so much distinguishing between helping and harm-ing, but our natural propensity to be focused almost exclusively on ourselves and those closely connected with us. This is clear in the behavior of national, religious, and ethnic groups. Few groups, in fact, value the lives and welfare of others (other nations, other religions, other ethnic groups) as they value those of their own. Few think about the consequences to other groups of their own groups pursuit of money, power, prestige, and property. The result is that few people (in virtually any society) act consistently on ethical principles when dealing with outsiders. A double standard in applying ethical principles to human life is virtually universal and often flagrant. In short, ethical persons, however strongly motivated to do what is ethically right, can do so only if they know what is ethically right. And this they cannot do if they systematically confuse their sense of what is ethically right with self-interest, personal desires, or social taboos. Ethically motivated persons must learn the art of self- and social-critique, of ethical self-examination. They must recognize the pervasive everyday pitfalls of ethical judgment: moral intolerance, self-deception, and uncritical conformity. Few have thought much about the difficulty of getting ethically relevant facts about the world. Few are skilled in tracing the implications of the facts they do have. And few can identify their own moral contradictions, or clearly distinguish their self-interest and egocentric desires from what is genuinely ethical. Few have thought deeply about their own ethical feelings and judgments, have tied these judgments together into a coherent ethical perspective, or have mastered the complexities of moral reasoning. As a result, everyday ethical judgments are often a subtle mixture of pseudo and genuine morality, ethical insight and moral prejudice, ethical truth and moral hypocrisy.
2005 Foundation for Critical Thinking www.criticalthinking.org
4Miniature Guide to Ethical Reasoning
Egocentrism as a Fundamental Barrier to Ethical Reasoning

The human tendency to judge the world from a narrow, self-serving perspective is powerful. Humans are typically masterful at self-deception and rationalization. We often maintain beliefs that fly in the face of the evidence. We often engage in acts that blatantly violate ethical principles. What is more, we feel perfectly confident in our righteousness. In other words, humans naturally develop into narrow-minded, self-centered thinkers. In a way, this makes perfect sense. We feel our own pain; we dont feel the pain of others. We think our own thoughts; we do not think the thoughts of others. And as we age, we unfortunately do not naturally develop the ability to empathize with others, to consider points of view that conflict with our own. Consequently, we are often unable to reason from a genuinely ethical perspective.
Nevertheless, it is possible to learn to think critically through ethical issues. With practice and sound instruction, we can acquire the disposition and skills required to analyze and evaluate situations from opposing ethical perspectives.
At the root of virtually every unethical act lies some form and degree of self-delu-sion. And at the root of every self-delusion lies some flaw in thinking. For instance, Hitler confidently believed he was doing the right thing in carrying out egregious acts against the Jews. His actions were a product of the erroneous beliefs that Jews were inferior to the Aryan race, and that they were the cause of Germanys prob-lems. In ridding Germany of the Jews, he believed himself to be doing what was in the best interest of his Germany. He therefore considered his actions to be ethically justified. His deeply flawed reasoning resulted in untold human harm and suffering. We cannot develop as ethical persons if we are unwilling to face the fact that every one of us is prone to egotism, prejudice, self-justification, and selfdeception and that these flaws in human thinking are the cause of much human suffering. Only the systematic cultivation of fair-mindedness, honesty, integrity, self-knowledge, and deep concern for the welfare of others can provide foundations for sound ethical reasoning. Ethical reasoning entails doing what is right even in the face of powerful selfish desires. To live an ethical life, then, is to develop command over our native egocen-tric tendencies. It is not enough to advocate living an ethical life. It is not enough to be able to do the right thing when we ourselves have nothing to lose. We must be willing to fulfill our ethical obligations at the expense of our selfish desires and vested interests.
EGOCENTRIC THINKING
RATIONAL THINKING
Strives to gain its selfish interests
Strives to validate its current way of thinking
Considers the rights and needs of others
Strives to see things as they are
Miniature Guide to Ethical Reasoning
Three Modes of Character Integration

(Expressed in exclusive categories for purpose of theoretical clarity. In fact, these are matters of degree).
The Uncritical Person
The Self-Serving Critical Person
The Fair-Minded Critical Person
unconcerned with the development of intellectual abilities
develops intellectual abilities to serve one's selfish interests without regard to the rights and needs of others
develops intellectual abilities to serve one's interests while respecting the rights and needs of others
manipulated by self-serving critical persons and easily indoctrinated resulting in the person being victimized or blindly led into victimizing others
manipulates less sophisticated people
acts as forthrightly as possible
resulting in those people being harmed (directly or indirectly)
resulting in people being treated reasonably and fairly
good-hearted but self-deceived
unethical self-righteous, and self-deceived
ethical, empathic and just
Miniature Guide to Ethical Reasoning 13
We Must Learn to Distinguish Among Questions of Ethics, Social Conventions, Religion and the Law
If we are ever to reach a point in human development where skilled ethical reasoning is the norm, each of us must cultivate in ourselves the ability to determine whether any belief system, practice, rule, or law is ethical. To be skilled at ethical reasoning means to develop a con-science not subservient to fluctuating social conventions, theological systems, or unethical laws. Consistently sound reasoning in any domain of thought presupposes practice in reasoning through cases and issues in that domain. As we face problems in our lives, we must dis-tinguish the ethical from the non-ethical and the pseudo-ethical, and apply appropriate ethical principles to those problems that are genuine-ly ethical problems. The more often we do so, the better we become at ethical reasoning.
Religious Questions
(divergent)
Social Questions
(divergent)
Legal Questions
(divergent)
Ethical Questions
(convergent)
deal with the nature of spirituality (and are therefore subject to unlimited theological debate)
deal with the customs, traditions, and taboos of groups (which vary enormously from group to group)
deal with what has been codified into law in particular societies (and which may or may not have an ethical basis)
deal with helpful or harmful behavior toward people or other creatures (ethical principles converge across cultures and groups)
Four Ethical Groupings (this is important to remember)

Universal Ethics helpful or harmful behavior towards living creatures Social Ethics customs & taboos Religious Ethics theological debate Legal Ethics codified laws developed from social customs Do the right thing by applying the universal morals and values
Pseudo-Ethic Groups
The Law
UniversalReligiou Social s Beliefs Ethics Rules

OneWorldInsight.com
Ethics
The connection of Ethical Theory, Ethical Principles, and Ethical Judgments Can Ethics Be Taught? A matter of knowledge A matter of motivation
Aims of Ethics Education in

Teach pertinent laws and rules Sensitive students to ethical issues Give students tools necessary to think through ethical issues: vocabulary and techniques Enable students to take part in ethical discussions about policy
Ethical reasoning is important both now as a student and as a future professional in your career
Ethics
Platos Euthyphro The First Definition of Piety The Second Definition of Piety Let us go through the handout and discuss Is the pious holy because it is loved by the gods or is it loved by the gods because it is holy?
Ethics
Stevenson - The Emotive Meaning of Ethical Terms
How can ethical questions be made clear? - The question of relevance - The question of goodness The Traditional Interest theories - Ethical terms are instruments - Emotive meaning and the dynamic use of words
Ethics
Good can triumph over evil.
Author Unknown
Words are Tools of Thought
Good vs. Evil: Example
In Disneys The Lion King, Simba represents good while Scar exemplifies evil. Most cartoons will depict a good vs. evil archetype.
The Fall: Example
In the Christian faith, Adam and Eve were the first two human creations of God. By choosing to eat the forbidden fruit, the two lost their innocence and fell out of favor with God.
Examples of Choices From the Fairy Tale Snow White

The Queen is evil and powerful but her power is temporary. Snow White is good and sweet. Snow White usurps the Queens power. Snow White becomes the hero of the story. Children identify with the hero.
Good and Evil in Cinderella
The Wicked Step-Mother and Step-Sisters are powerful in the beginning of the story. Cinderellas goodness of character is demonstrated throughout the story. Cinderella becomes the powerful hero in the end. Children identify with the hero of the story.
Fairy Tales present the polarities of character, such as good and evil, and this allows the child to comprehend easily the differences between the two.
Examples From Fairy Tales
Snow White, Cinderella, and Mufaros Beautiful Daughters show how characters overcome isolation and loneliness. Each character succeeds and becomes an example to the reader that goodness can triumph over evil. The next slide puts his into context
Aligning Fairy Tales with State Standards
Fairy Tales help students understand plot, setting, and character. Fairy Tales help students understand beginning, middle and ending in stories. Fairy Tales can be used to develop critical thinking skills.
Words are Tools of Thought

As with the principles of learning a new language or the study any new subject: New vocabulary & an understanding of abstract theories & principles of ethics will be necessary. Such knowledge will arm the decision-maker with the information necessary to help make difficult care decisions.
So we can recall What is Ethics?

A moral philosophy that helps us to distinguish right from wrong, good from bad. It involves the study of morality, virtues, & values & how they affect ones character. It involves how individuals decide to live within accepted boundaries & how we live in harmony with one another & nature.
Scope of Ethics
Micro-ethics: individuals view of right & wrong. Macro-ethics: global view of right & wrong.
Ethics from Various Perspectives

Ethics used in different but related ways philosophical ethics, which involves inquiry about ways of life & rules of conduct a way of life (e.g., religious ethics) moral codes
Why Study Ethics?

To recognize health care dilemmas. To provide tools for constructive deliberation & conflict resolution. To make sound judgments. To better understand the goodness & badness of motives & ends.
Morality
Aim above Morality. Be not simply good; be good for something. Henry David Thoreau
What is Morality? (see page 5 of Pozgar)

A code of conduct. Implies quality of being in accord with standards of right & good conduct. Describes class of rules held by society to govern the conduct of its individual members.
Morals
Ideas about what is right & wrong. Guides to behavior that rational persons put forward for governing their behavior. describing a class of rules held by society to govern the conduct of its individual members
Note: what rule that are considered right varies from nation to nation, culture to culture, religion to religion and from one person to another Also note that morals should not be confused with cultural habits or customs such as wearing a certain type of clothing
Fundamental Questions About Moral Relativism
If, as it appears, most of us belong to a number of competing cultures, then the claim that cultures are so isolated that we cannot understand and make judgments about another culture is false. In fact, it is common for us to make judgments among several cultural influences, and to decide which moral principles we prefer.
Questions About Moral Relativism: Why Should Moral Values Hold such Special Place (A Sacred Cow)
When cultures hold differing scientific views, e.g., the world is flat/the world is round, we do not hesitate to say one culture is wrong. If some culture holds, contrary to the values of almost all cultures, that enslaving a particular ethnic group or killing all Jews is morally good, isnt it just as logical to say that culture holds false moral principles?
Ethical Relativism
to expand on previous two slides

What is Ethical Relativism? - No objective right or wrong - Compared to objectivism Two Forms of Ethical Relativism Individual Ethical Relativism Cultural Ethical Relativism
Ethical Relativism
Are These Reasons Convincing? The Diversity of Moral Views How widespread and deep is the disagreement? What does such disagreement prove? Moral Uncertainty the complexity and difficulty - The view of skepticism - The form of subjectivism
Ethical Relativism
Moral Realism Realism the view of the relation between science and nature Are moral properties supervenient? Moral Pluralism Is there one good moral principle or a variety of equally moral principles?
Ethical Relativism
Reading: Trying Out Ones New Sword Moral isolationism in practice The symbolism of the Samurai sword The liability of the isolating barriers between cultures The effect of moral isolationism on moral reasoning
Ethical Relativism
Reading: Master and Slave Moralities Master moralities - Description of good and bad - The noble type of person feels himself as a determining value Slave moralities - Description of good and evil - The longing for freedom
Codes of Ethics Provide for

Standards as guides to human conduct. Principles describe responsibilities. Rules of expected conduct no allowance for individual judgment.
Moral Judgments
Judgments concerned with what an individual or group believes to be right or proper behavior in a given situation.
Involves assessment of another persons moral character based on how he or she conforms to moral convictions established by the individual &/or group.
Moral Judgments, cont

Lack of conformity typically results in: moral censure condemnation possibly derision of the violators character What is considered right varies from nation to nation, culture to culture, religion to religion, person to person . . . .
Moral Judgments, cont

No universal morality. Whatever guide to behavior an individual regards as overriding & wants to be universally adopted is considered that individual's morality.
Moral Dilemmas
Moral dilemmas arise when values, rights, duties, & loyalties conflict. A caregiver must not only examine what he or she considers the right thing to do, but what are the alternatives, & what are the patients known wishes.
Morality Legislated
Law is distinguished from morality in that
the law has explicit rules, penalties, & officials who interpret the laws & apply the penalties.
Laws are created to set boundaries for societal behaviour.
laws are enforced to ensure that expected behavior happens.
Ethics
Ethics, too, are nothing but reverence for life. This is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil. -Albert Schweitzer
Theories of Ethics
Ethical theories attempt to introduce order into the way people think about life & action.
Normative Ethics
Attempt to determine what moral standards should be followed so that human behavior & conduct may be morally right. General normative ethics is
the study of major moral precepts of what things are right
Consequential Ethics
The morally right action involves maximum balance of good over evil The rightness or wrongness of an action is based on the consequences or effects of the action.
Utilitarianism
A form of consequentialism philosophy that advocates the greatest good for the greatest number everyone is obligated to do whatever will achieve the greatest good for the greatest number.
Deontological Ethics
Focuses on duty to others rights of others Forms Religious Ethics
based on religious beliefs

Secular Ethics
based on codes developed by societies that have relied on customs
Non-Consequential Ethics
Rightness or wrongness of an action is based on properties intrinsic to the action. not on its consequences
Virtue Ethics & Values

Virtue ethics focuses on the inherent character of a person rather than on the specific actions he or she performs. A virtue describes moral excellence & that which has beneficial quality. Virtues are habits. Once acquired, they become characteristic of a person
Moral Value
Is the relative worth placed on some virtuous behavior. What has value to one person may not have value to another.
Values
Values represent a standard of conduct. they are used for judging the goodness or badness of an action.
Intrinsic & Instrumental Values

Intrinsic Value something that has value in & of itself Instrumental Value something that helps to give value to something else
money is valuable for what it can buy)
Virtues & Values (see page 26 of Pozgar Pillars of

Moral strength)
Courage Wisdom Temperance Commitment
Virtues & Values, continued

Compassion Conscientiousness Cooperativeness Discernment
Virtues & Values, continued

Fairness Fidelity Freedom Honesty/Trustworthiness/Truth-Telling
Virtues & Values, continued (Class Discussion)

Integrity Nearly all men can stand adversity, but if you want to test a mans chararcter, give him power Abraham Lincoln Kindness-When you carry out acts of kindness, you get a wonderful
feeling inside. It is as though something inside your body responds and says, yes, this is how I ought to feel Harold Kushner
Respect respect for oneslves guides our morals, respect for others guides our manners Laurence Sterne Hopefulness Hope is the last thing that dies in a man; and thought it
be exceedingly deceitful, yet it is of this good use to us, that while we are traveling through life, it conducts us in an easier and more pleasant way to our journeys end F de la Rochefoucauld
Courage
Courage is the greatest of all virtues, because if you havent courage, you may not have an opportunity to use any of the others. SAMUEL JOHNSON
What is Courage?
Courage is the mental or moral strength to persevere & withstand danger. Courage is the ladder on which all the other virtues mount. Courage involves balancing fear, self-confidence, & values. Without courage, we are unable to take the risks necessary to achieve the things most valued.
The Courageous Person

A courageous person has good judgment, a clear sense of his or her strengths, correctly evaluates danger, & perseveres until a decision is made & the right goal that is being sought has been achieved.
Values May Change

If ones basic needs for food, water, clothing & housing have not been met, ones values may change in such a way that a friendship, for example, might be sacrificed if ones basic needs can be better met as a result of the sacrifice.
Values Can Change

People make value judgments & choices among alternatives. Values one so dearly proclaims may change as needs change. Motivating power of a person's actions are a necessity for survival. Values give purpose to each life. They describe ones moral character.
Differing Values
If moms estate is being squandered at the end of life a family member financially well-off may want to hold on to mom despite the financial drain on her estate. Another family member financially struggling to survive may more readily see the futility of expensive medical care & find it easier to let go.
Religious Ethics
Religion provides a moral code for appropriate behavior. The prospect of divine justice helps us tolerate the injustices in life. There is a need to better understand cultural diversity & the importance of religion in the healing process.
Spirituality
Spirituality in the religious sense implies that there is purpose & meaning to life; spirituality generally refers to faith in a higher being.
Varying Religious Beliefs

Judaism Hinduism Taoism Zen Christianity Islam
Secular Ethics
Secular ethics is based on codes developed by societies that have relied on customs to formulate their codes. Code of Hammurabi
Atheism
Rejection of belief in God Claims the existence of God cannot be scientifically proven. Belief that ethics is the product of culture & politics
Principles of Health Care Ethics

Autonomy right to make ones own decisions Beneficence to do good Nonmaleficence avoid causing harm
Principles of Health Care Ethics, cont

Justice obligation to be fair in the distribution of benefits & risks
distributive Justice
requires that all individuals be treated equally

justice & government spending
change is coming
Injustice for the Insured

Even if youre insured, getting ill could bankrupt you. Hospitals are garnishing wages, putting liens on homes & having patients who cant pay arrested. Its enough to make you sick. Sara Austin, SELF, October 2004, 247
Age & Justice

Should an 89 year old patient get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a ten year old girl?
Age & Justice, cont

Should a pregnant 39 year old single parent get a heart transplant because he or she is higher on the waiting list to receive a heart transplant than a ten year old boy?
Which Disaster Patients Get Treated First?

Room #1: Severely injured patients not expected to live. Room #2: Severely injured patients most likely to live if treated. Room #3: Injured patients will live but will suffer varying degrees of disability if not treated promptly.
Emergency Care
Two patients in critical condition, who gets treated first: 1st patient who walks through door Younger patient Patient most likely to survive Patient who can pay for services Patient with most serious condition
Scarce Resources
What happens when resources are scarce & only one of two patients can be treated? What should be the determining factors age position in life patient wishes . . .
Situational Ethics
Situational ethics refers to a particular view of ethics, in which absolute standards are considered less important than the requirements of a particular situation. The importance of a particular value may vary as ones situation changes.
Situational Ethics, cont

Moral character can be compromised when faced with difficult choices.
Good people behave differently in different situations.
Situational Ethics, cont

Good people sometimes do bad things. Ones moral character can sometimes change as circumstances change. thus the term situational ethics.
The Creation of Ignorance Situational Ethics

How Common is the Creation of Ignorance? Its pretty common. I mean in terms of sowing doubt, certainly global warming denialists who for years have managed to say, well the case is not proven. We need more research. And whats interesting is that a lot of the people working on that were also the people working on Big Tobacco.
Interview with Robert Proctor, Professor Standford University Discover 2008
The Creation of Ignorance Discussion

1. Why do people who do bad things in one job repeat their pattern of doing bad in another? What is their motive? 2. Why do people watch bad things happen & then deny they are happening? Explain. 3. What is often referred to as being the root of all evil? How does it apply in this case.
Sustaining Life: Situational Ethics

A decision not to use extraordinary means to sustain life of an unknown 84 year old may result in a different decision if the 84 year old is ones mother.
Ethical Decision-Making
Ethical decision-making is the process of deciding, what the right thing to do is in the event of a moral dilemma.
Case: High in the Andes

Those who survived the plane crash high in the Andes Mountains were faced with some difficult survival decisions. Their need to survive illustrates to what lengths one may go in certain situations in order to survive .
72 - Days of ordeal, Nando Parrado and other survivors of a plane crash in the Andes had to endure before being rescued. Flying over the mountains on a Friday the 13th, the young men and their families who boarded the charter plane joked about the unlucky day when the plane's wing hit the slope of the mountain and crashed. On impact, 13 passengers were instantly dead while 32 others were badly wounded. Hoping to be rescued, the survivors waited in the freezing -37C temperature, melting snow for drinks and sleeping side by side to keep themselves warm. Food was so scarce, everyone had to pool whatever food they can find for a rationed pool. 9 days after the crash, due to dire desperation and hunger, the survivors called for an important meeting. One member proposed that they eat the dead. The 2 hours meeting ended with a conclusion. If any of them died in the Andes, the rest had the permission to use the corpse as food. After 2 weeks, their hope of being found dashed when they found out via their radio transistor that the rescue effort was called off.
High in the Andes, cont

How might you change as circumstances change? Describe how your consultative advice might change based on the patients needs, beliefs, & family influences.
Ethical & Legal Issues

Ethical issues Autonomy Paternalism Legal issues Informed consent
Ethical Relativism
Theory that holds that morality is relative to the norms of one's culture. An action can be considered right or wrong depending on the accepted norms of the society in which it is practiced. For example, slavery may be considered an acceptable practice in one society & unacceptable in another.
Lack of a Moral Compass

Hartford Police Chief questions the citys moral compass a week after bystanders & drivers maneuvered around the motionless body of 78-year-old victim of a hit-&-run crash. Review the hand out
Lack of a Moral Compass Discussion

1. What moral principles might the sheriff have been referring to when he questioned the citys lack of a moral compass? Explain. 2. Discuss your thoughts as to why society in general is losing its moral compass.
Alert! STRESS Attack!
DEFINITIONS and reviewing what we have been discussing
Morals
Ethics
MORALS
Refers to Rightness or Wrongness
Of Something
Based on... What people BELIEVE
Values vs Preference Implies...
To be Good or Right In Conduct or Character
Conformity with the Generally Accepted Standard Of Goodness or Rightness In BEHAVIOR
ETHICS
Discipline of dealing with what is good & bad... Your Moral Duty & Obligation
Set of... Moral Principles & Values Conforming to... Professional Standards of Conduct Principles of Conduct... Governing an Individual or Group
SYNONYMS
Two or More Words with Basically the Same Meaning
That Which Is . . .
MORAL... Is Conformity to a Standard of what is Good & Right. ETHICAL... Asks the difficult question... What is Right & Fair?
YOUNG PEOPLE AND ETHICS

70% 60% 50% 40% 30% 20% 10% 0% Have you ever stolen Have you cheated on a If there are pressures in
any from a store before exam the Job/school, I will cheat to survive
Age 15-18 Age 19-24 Age 25+
Where Do Our Values Come From?

Parents, Family Members, Teachers, Mentors, Laws, World View, Personal Values Spiritual Teaching & Upbringing Basic National Values, AF Traditional & Core Values Unit Operating Values Other Areas
Integrity - Service - Excellence
Orders, AF Instructions, Tech Orders
HISTORICAL EXAMPLES OF ETHICAL VALUES

THE TEN COMMANDMENTS
1-4 5 6 7 8 9 10 Deal with Ones Relationship with God Honor... YOUR FATHER AND MOTHER Do Not... MURDER Do Not... COMMIT ADULTRY Do Not... STEAL Do Not... LIE OR GIVE FALSE TESTIMONY Do Not... Covet Envy your neighbors wife/husband or belongings
HISTORICAL EXAMPLES OF ETHICAL VALUES

Continued
THE GOLDEN RULE

DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU!
Found in . . . HINDUISM - JUDAISM BUDDHISM - ISLAM - CHRISTIANITY

ACTIVE (Religious) BELIEFS = How One Lives & Treats Others
RECENT EXAMPLE OF ETHICAL VALUES

COVEYS UNIVERSAL VALUES
Stephen R. Covey
FAIRNESS DIGNITY INTEGRITY QUALITY
PATIENCE KINDNESS CHARITY HONESTY SERVICE
Your Ethical Responsibility

to Your Unit & People... Being... A Role Model Promoting... Character Development
with Your Subordinates & Peers
Creating... A Climate at Work

that Promotes Trust and Professional Commitment
Be... A Role Model

Exhibit Ethical Behavior... The way you live!
Who likes?... Do what I say! Not what I do!

Use Wisdom When your Ethical standards are not the same as others. Let Credibility Soar Flee Double Standards! Excel as a Role Model Give your Unit an example of great leadership to follow.
Promote...
Character Development With Subordinates & Peers
Personal Contact... One on One! Know Your People!
Share with Your Subordinates Let them know what you are Thinking!
Teach Them... The Process To Make the Right Decisions
Create...
A Work Climate Promoting Trust and Professional Commitment
HOW?
Be Honest... LACK OF Ethical Clarity, Incompetence, Conflicting Policies & Decisions SENDS the wrong message Reward... CORRECT Ethical BEHAVIOR Establish... A SENSE OF PURPOSE in the organization Stick Up... FOR YOUR PEOPLE Set Expectations... MAKE them CLEAR Speak through Actions... AS WELL AS Words
Create... A Work Climate Promoting Trust And Professional Commitment Continued
WHY Does the Ethical Climate Fall Apart? Peer Pressure Lack of Understanding... Of what is EXPECTED of them Ignorance of Rules WITHIN Organization, Wing, AF
Ignorance of Your Responsibility... AS a LEADER

Unhealthy Competition & Fear... OF the UNKNOWN
The Ethical Decision Making Process
1st - Recognize... You have a Problem 2nd - Analyze... The Moral Values, Principles or Rules that Relate to the Problem 3rd - Seek... Counsel or Spiritual Guidance
4th - Choose... A Course of Action that Results in the Highest Moral Good
YOUR MORALS, VALUES & WORLD VIEW SPIRITUAL TEACHING

UPBRINGING
ETHICAL PROBLEMS
BASIC NATIONAL VALUES
ETHICAL REASONING
DECISION RESPONSE
PEER TRADITIONAL PRESSURE & AF CORE UNIT ORDERS VALUES REGULATIONS OPERATING VALUES TECH ORDERS
Failure to Respond to Emergency Call

We use the next set of slides to look at healthcare ethical and legal issues: Expanded in Chapter 10 of Pozgar Dr Chong will expand on the various scenarios during lecture Week 3 13th April lecture. Physicians on emergency call are expected to respond to requests for assistance. Failure to respond is grounds for negligence should a patient suffer injury.
Emergency Department Care

Mr. Doe arrived in the ED at 12:00 AM complaining to the desk clerk of right face & arm numbness that had persisted since the day before. The clerk asked Mr. Doe to have a seat in the waiting area & that a triage nurse would be with him shortly. At 12:31 AM, Mr. Doe was taken to a triage room. Mr. Does vital signs were taken. His blood pressure was 190 over 119. After being triaged Mr. Does was asked to have a seat in the waiting area until he was called for treatment.
2009 Jones & Bartlett Publishers,
Emergency Department Care, cont

At 1:09 AM, Mr. Doe was taken to a treatment room. At 1:40 AM, the ED physician ordered blood work & a CT scan. At 2:30 AM, Mr. Doe had his CT scan. At 3:10 AM, the nurse conducted a reassessment & noted that the patients speech was slightly slurred with his mouth slightly off center. At 3:15 AM, Mr. Does CT results indicated suspicion for small infarcts.

The treating physician was interviewed as to the patients presenting symptoms (e.g., right sided numbness in face & arms), recorded vital signs (e.g., 190/119), & timeliness of care. The physician claimed that he was not concerned about the any delay in the patients treatment due to the patients symptoms or vital signs.

The nurse stated that there was no stroke protocol for use of TPA. The physician stated there were very few strokes in his community & that the jury was still out on the value of TPA in treating ischemic strokes.
How the Courts View Poorly Conducted H&Ps

J.D. felt a severe headache. Paramedics took J.D.'s history, which included hypertension. His blood pressure was high, ranging from 200/120 to 170/130. At the hospital, J.D.s vital signs were reassessed. His blood pressure was recorded at 170/130. Dr. M examined J.D. Dr. M sent J.D. for x-rays. J.D. was diagnosed with a pinched nerve. He told J.D. he was being discharged with a muscle relaxant & an antiinflammatory painkiller. Dr. M did not know J.D.'s blood pressure when he treated him & did not review the ambulance records or the E.R. form.
How the Courts View Poorly Conducted H&Ps, cont

The next morning, J.D. was found unconscious on the floor. An ambulance crew responded & took J.D.'s blood pressure four times between 7:16 & 7:50 a.m. The readings were extremely high (e.g. 220/120). At the hospital, a neurosurgeon diagnosed a hemorrhagic stroke. Excess fluid in JDs brain caused JD to lapse into a coma. The neurosurgeon believed that had he been called, he would have stopped bleeding by the time he arrived at the emergency room the first day.
How the Courts View Poorly Conducted H&Ps, cont

Mr. M was determined to have been "grossly negligent" because he " assessed, treated & discharged J.D. without knowing his blood pressure" & because he "did not actively seek out information about the blood pressure & medical history which might have led him to the correct diagnosis." Dr. M failure to ascertain & assess information about a patient in order to adequately prepare a patient history fell below the standard of care for an ED physician & constituted gross negligence.
Moheet v. State Board of Registration for the Healing Arts, No. WD63543 (Mo. Ct. App. 2004).
Failure to Read Nursing Notes

A surgeon breached his duty of care owed to the patient by failing to read the nurses notes. Testimony convinced the court that the surgeon chose not to review the nurses observations. The surgeons failure to review nursing notes exacerbated an already critical condition & deprived the patient of a chance of survival.
Quizzes Questions are designed to test students knowledge and comprehension
In knowledge base, the student is required to recognize both legal and ethics terminology and their application For comprehension, the student is required not only to demonstrate knowledge about the law and ethics but also to demonstrate a degree of understanding of the material involved in the question. This is accomplished by questions that have more than one right answer, thus requiring the student to select the best answer. Throughout the course we will practice the types of questions that embrace knowledge and comprehension.
Question 1 The branch of philosophy that deals with values relating to human conduct A. B. C. D. E. morality ethics values virtues paternalism
Question 1 The branch of philosophy that deals with values relating to human conduct A. B. C. D. E. morality ethics values virtues paternalism
Question 2 An individuals view of what is right and wrong A. B. C. D. E. Macro-ethics Ethical theory Micro-ethics Consequential ethics Moral values
Question 2 An individuals view of what is right and wrong A. B. C. D. E. Macro-ethics Ethical theory Micro-ethics Consequential ethics Moral values
Question 3 Ethics primarily concerned with establishing standards or norms for conduct A. B. C. D. E. Normative ethics Distributive Fidelity Beneficence Nonmaleficence
Question 3 Ethics primarily concerned with establishing standards or norms for conduct A. B. C. D. E. Normative ethics Distributive Fidelity Beneficence Nonmaleficence
Question 4 The critical study of major moral precepts, such as, what things are right and what things are good is referred to as A. B. C. D. E. Morality General normative ethics Distributive justice Morality Virtues
Question 4 The critical study of major moral precepts, such as, what things are right and what things are good is referred to as A. B. C. D. E. Morality General normative ethics Distributive justice Morality Virtues
Question 5 The application of normative theories to practical moral problems is referred to as? A. B. C. D. E. Normative ethics Distributive justice Secular ethics Applied ethics Nonmaleficience
Question 5 The application of normative theories to practical moral problems is referred to as? A. B. C. D. E. Normative ethics Distributive justice Secular ethics Applied ethics Nonmaleficience
Question 6 The ______ theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. A. B. C. D. E. Non-consequential Religious Secular Consequential Normative
Question 6 The ______ theory of ethics emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil. A. B. C. D. E. Non-consequential Religious Secular Consequential Normative
Question 7 The ethical theory that denies that the consequences of an action or rule are the only criteria for determining the morality of an action or rule. A. B. C. D. E. non-consequential consequential normative distributive paternalism
Question 7 The ethical theory that denies that the consequences of an action or rule are the only criteria for determining the morality of an action or rule. A. B. C. D. E. non-consequential consequential normative distributive paternalism
Question 8 The theory of ethics that focuses on ones duties to others A. B. C. D. E. Discernment Normative Teleological Consequential Deontological
Question 8 The theory of ethics that focuses on ones duties to others A. B. C. D. E. Discernment Normative Teleological Consequential Deontological
Question 9 Ones need to survive can change his or her ______character in order to survive. A. B. C. D. E. Paternalistic Moral Normative Virtuous Deontological
Question 9 Ones need to survive can change his or her ______character in order to survive. A. B. C. D. E. Paternalistic Moral Normative Virtuous Deontological
Question 10 The ___ ___were a turning point where essential commands such as "thou shalt not kill" or "commit adultery" were accepted as law. A. B. C. D. E. Normative ethics Ten Commandments Virtuous morals Code of Hammurabi) None of the above
Question 10 The ___ ___were a turning point where essential commands such as "thou shalt not kill" or "commit adultery" were accepted as law. A. B. C. D. E. Normative ethics Ten Commandments Virtuous morals Code of Hammurabi) None of the above
Question 11 Ethics that are based on codes (e.g., Code of Hammurabi) developed by societies which have relied on customs to formulate their codes. A. B. C. D. E. compassion religious secular deontological morality
Question 11 Ethics that are based on codes (e.g., Code of Hammurabi) developed by societies which have relied on customs to formulate their codes. A. B. C. D. E. compassion religious secular deontological morality
Question 12 One who has control over his/her own actions is

A.Virtuous B.Ethical C.Compassionate D.Autonomous E.Hopeful
Question 12 One who has control over his/her own actions is

A.Virtuous B.Ethical C.Compassionate D.Autonomous E.Hopeful
Question 13 _____________ said, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body..."
A. B. C. D. E.
William the Philosopher Justice Brenner Moses Hammurabi Justice Carodozo
Question 13 _____________ said, "Every human being of adult years and sound mind has a right to determine what shall be done with his own body..."
A. B. C. D. E.
William the Philosopher Justice Brenner Moses Hammurabi Justice Carodozo
Question 14 _____________ describes the principle of doing good, demonstrating kindness, and showing compassion, and helping others. A. B. C. D. E. Beneficence Nonmaleficence Justice Compassion Virtue
Question 14 _____________ describes the principle of doing good, demonstrating kindness, and showing compassion, and helping others. A. B. C. D. E. Beneficence Nonmaleficence Justice Compassion Virtue
Question 15 A form of beneficence that may involve, for example, withholding information from a person because of the belief that it is in the best interest of that person. A. B. C. D. E. Paternalism Justice Autonomy Deontology Normative
Question 15 A form of beneficence that may involve, for example, withholding information from a person because of the belief that it is in the best interest of that person. A. B. C. D. E. Paternalism Justice Autonomy Deontology Normative
Question 16 .An ethical principle that requires caregivers to avoid causing patients harm.
A. B. C. D. E.
Beneficence Justice Nonmaleficence Medical paternalism Consequential
Question 16 .An ethical principle that requires caregivers to avoid causing patients harm.
A. B. C. D. E.
Beneficence Justice Nonmaleficence Medical paternalism Consequential
Question 17 The obligation to be fair in the distribution of benefits A. B. C. D. E. Beneficence Autonomy Justice Nonmaleficence Responsibility
Question 17 The obligation to be fair in the distribution of benefits A. B. C. D. E. Beneficence Autonomy Justice Nonmaleficence Responsibility
Question 18 Justice that implies that all are treated fairly. A. B. C. D. E. Moral Disproportional Conditional Distributive Common
Question 18 Justice that implies that all are treated fairly. A. B. C. D. E. Moral Disproportional Conditional Distributive Common
Question 19 Ones moral character can sometimes change as circumstances change, thus the term __________ ethics.
A. B. C. D. E.
Discerning Integrity Compassionate Normative Situational
Question 19 Ones moral character can sometimes change as circumstances change, thus the term __________ ethics.
A. B. C. D. E.
Discerning Integrity Compassionate Normative Situational
Question 20 If the ethical responsibilities of caregivers involves respecting a patients right to make his or her own decision, the ethical principle of _______ is being practiced is? A. B. C. D. E. Integrity Normative ethics Justice Beneficence Autonomy
Question 20 If the ethical responsibilities of caregivers involves respecting a patients right to make his or her own decision, the ethical principle of _______ is being practiced is? A. B. C. D. E. Integrity Normative ethics Justice Beneficence Autonomy
Question 21 Gen. Nguyen Ngoc Loan, chief of South Viet Nams national police, walked up and shot a prisoner in the head. His reason: The prisoner, a Viet Cong lieutenant, had just murdered a South Vietnamese colonel, his wife and their six children. Assuming this is out of ones moral character, what ethical theory might apply. A. B. C. D. E. Beneficence Normative ethics Religious ethics Situational ethics Autonomy
Question 21 Gen. Nguyen Ngoc Loan, chief of South Viet Nams national police, walked up and shot a prisoner in the head. His reason: The prisoner, a Viet Cong lieutenant, had just murdered a South Vietnamese colonel, his wife and their six children. Assuming this is out of ones moral character, what ethical theory might apply. A. B. C. D. E. Beneficence Normative ethics Religious ethics Situational ethics Autonomy
Question 22 What Christian religious group believes it is a sin to accept a blood transfusion. A. B. C. D. E. Taoist Jew Jehovahs Witness Methodist Islam
Question 22 What Christian religious group believes it is a sin to accept a blood transfusion. A. B. C. D. E. Taoist Jew Jehovahs Witness Methodist Islam
Question 23 A person is one who has moral integrity and has a strict regard for doing what is considered the right thing to do. A. B. C. D. E. Virtuous Conscientious Committed Compassionate Ethical
Question 23 A person is one who has moral integrity and has a strict regard for doing what is considered the right thing to do. A. B. C. D. E. Virtuous Conscientious Committed Compassionate Ethical
Question 24 A physician who falsifies entries on a patients medical record A. Does it intentionally B. Does it to avoid liability for ones medical negligence C. Risks losing credibility with a jury should a case go to trial D. Does it to protect a patient from harm E. A and C above
Question 24 A physician who falsifies entries on a patients medical record A. Does it intentionally B. Does it to avoid liability for ones medical negligence C. Risks losing credibility with a jury should a case go to trial D. Does it to protect a patient from harm E. A and C above Please note that the answer can also be all of the above since B and D may also be applicable under certain circumstances
Question 25 Misdiagnosis may involve diagnosis & treatment of
A. A disease different from that which patient actually suffers B. A disease that the patient does not have C. Symptoms of a disease but not the underlying disease D. A & c above E. All of the above
Question 25 Misdiagnosis may involve diagnosis & treatment of
A. A disease different from that which patient actually suffers B. A disease that the patient does not have C. Symptoms of a disease but not the underlying disease D. A & c above E. All of the above See page 372 of Pozgar
Question 26 The surgeon in a Long Beach case failed to read nursing notes in a patients record A. The surgeon breached his duty of care owed to the patient by failing to read nursing notes B. Testimony convinced a Long Beach Court of Appeal that the surgeon chose not to take advantage of nurses observations C. The surgeons medical malpractice exacerbated an already critical condition D. The surgeons failure to read the nursing notes deprived the patients chance of survival E. all of the above
Question 26 The surgeon in a Long Beach case failed to read nursing notes in a patients record A. The surgeon breached his duty of care owed to the patient by failing to read nursing notes B. Testimony convinced a Long Beach Court of Appeal that the surgeon chose not to take advantage of nurses observations C. The surgeons medical malpractice exacerbated an already critical condition D. The surgeons failure to read the nursing notes deprived the patients chance of survival E. all of the above (See page 367369 of Pozgar)
Question 27 Evidence of a disruptive physician or duty nurse A. Can have negative impact on staff B. Can affect quality of care C. Is disruptive to ensuring patient welfare D. Can support denial of privileges E. All of the above
Question 27 Evidence of a disruptive physician or duty nurse A. Can have negative impact on staff B. Can affect quality of care C. Is disruptive to ensuring patient welfare D. Can support denial of privileges E. All of the above
Question 28 The Hippocratic Oath provides that a physician A. Follow regimen I consider for the benefit of my patient B. Give no deadly medicine to any one if asked C. Not give to a woman a pessary to produce abortion D. Will abstain from seduction of females or males E. All of the above
Question 28 The Hippocratic Oath provides that a physician A. Follow regimen I consider for the benefit of my patient B. Give no deadly medicine to any one if asked C. Not give to a woman a pessary to produce abortion D. Will abstain from seduction of females or males E. All of the above see page 532 of Pozgar
Question 29 In Tarasoff v. Regents of the University of California A. A former patient allegedly did not kill a third party after revealing his homicidal plans to his therapist B. The therapist made effort to inform the victim of the patients intentions. C. A former patient allegedly killed a third party after revealing his homicidal plans to his therapist D. There is no duty to exercise reasonable care to protect the foreseeable victims & to warn them of any impending danger E. All of the above
Question 29 In Tarasoff v. Regents of the University of California A. A former patient allegedly did not kill a third party after revealing his homicidal plans to his therapist B. The therapist made effort to inform the victim of the patients intentions. C. A former patient allegedly killed a third party after revealing his homicidal plans to his therapist D. There is no duty to exercise reasonable care to protect the foreseeable victims & to warn them of any impending danger E. All of the above
The Law and Counseling

Confidentiality
is the ethical duty to fulfill a contract or promise to clients that the information revealed during therapy will be protected from unauthorized disclosure.
Privacy
is a legal concept that recognizes individuals rights to choose the time, circumstances, and extent to which they wish to share or withhold personal information.
Privileged communication
regulates privacy protection and confidentiality by protecting clients from having their confidential communications disclosed in court without permission.
Exceptions to Confidentiality
When a client is a danger to self or others In cases of child abuse or neglect When vulnerable adults are being abused When a client is considering committing a crime When a client has been a victim of a crime During court-ordered psychological evaluations For the purposes of involuntary hospitalization When a client raises the issue of mental condition in legal proceedings
Tarasoff v. Board of Regents of the University of California (1976)
Prosenjit Poddar
Tatiana Tarasoff
Tarasoff v. Board of Regents of the University of California (1976)

Prosenjit Poddar told the student health center that he wanted to kill Tatiana Tarasoff. The psychologist told the supervising psychiatrist, who told campus cops, who detained Poddar but then let him go. Poddar killed Tatiana two months later. Her parents sued for failure to warn. The Trial Court said that no such duty existed. The CA Supreme Court cited Simenson v. Swensen and ordered a trial. The case was heard twice:
Tarasoff I: Privilege ends where public peril begins Tarasoff II: A therapist has an obligation to use reasonable care to protect potential victims
Question 30 At the beginning of a physicianpatient relationship, the physician must understand A. Patients complaints B. Underlying feelings C. Goals D. Expectations E. All of the above
Question 30 At the beginning of a physicianpatient relationship, the physician must understand A. Patients complaints B. Underlying feelings C. Goals D. Expectations E. All of the above
Ethical or Unethical
1.) You are a successful counselor. One of your clients tells you that you have been very, very helpful to him, and in order to show his appreciation to you, he gives you a $10,000 diamond ring as a gift. You accept the ring. 2.) A client cannot afford to pay for one of her counseling sessions with you. In lieu of payment, you ask her to babysit your 2-year-old son at your home a few times.
3.) One of your clients feels sexually attracted to you, and tells
you this. Immediately following the termination of counseling, you and the client mutually agree to start a dating relationship.
Ethical or Unethical
4.) You and your friends have a dinner at your home. One of your friends tells you that he is emotionally disturbed by some conflict in his marriage. You take your friend into the next room and provide him with a brief counseling session there. 5.) You go to lunch with another counselor. In the restaurant, you each talk about some of your cases to learn from each other. Neither of you mentions the names of any of your clients.
Definitions
Ethics
Making decisions of a moral nature about people and their interactions with society A philosophical discipline that is concerned with human conduct and moral decision making Professional behavior
Morality
Judgment or evaluation of action Right and wrong behavior
Law
The precise codification of governing standards that are established to ensure legal and moral justice Government behavior
ETHICS (Phil 304) ENJOY

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Ethics Week 1 DR Aruoma Lecture

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Okezie I ARUOMA

MSc PhD DSc CSci CChem FRSC MBA

ETHICS (Phil 304)

STUDENT GROUPS PRESENTATIONS

STUDENT GROUP PROJECTS

How does it add up

Exam (Mid term and final combined): 45%

Student Class effort: 55%

2009 Jones & Bartlett Publishers, LLC

Learning Objectives, cont

2009 Jones & Bartlett Publishers, LLC

Ethics and Ethical Reasoning

Ethics is a branch of philosophy; moral philosophy

Ethics and Reasoning

Religion as a motivation for morality

Descriptive judgments Normative judgments Differences between the two

Right/Wrong Good/Bad Ought/Ought not

Ethics and Ethical Reasoning

The Miniature Guide to

Based on Critical Thinking Concepts & Principles

The Foundation for Critical Thinking

2005 Foundation for Critical Thinking www.criticalthinking.org

4Miniature Guide to Ethical Reasoning

Egocentrism as a Fundamental Barrier to Ethical Reasoning

Strives to gain its selfish interests

Strives to validate its current way of thinking

Considers the rights and needs of others

Strives to see things as they are

2005 Foundation for Critical Thinking www.criticalthinking.org

Miniature Guide to Ethical Reasoning

Three Modes of Character Integration

The Uncritical Person

The Self-Serving Critical Person

The Fair-Minded Critical Person

unconcerned with the development of intellectual abilities

manipulates less sophisticated people

acts as forthrightly as possible

resulting in those people being harmed (directly or indirectly)

resulting in people being treated reasonably and fairly

good-hearted but self-deceived

unethical self-righteous, and self-deceived

ethical, empathic and just

2005 Foundation for Critical Thinking www.criticalthinking.org

Miniature Guide to Ethical Reasoning 13

2005 Foundation for Critical Thinking www.criticalthinking.org

Four Ethical Groupings (this is important to remember)

UniversalReligiou Social s Beliefs Ethics Rules

Aims of Ethics Education in

Words are Tools of Thought

2009 Jones & Bartlett Publishers, LLC

Good vs. Evil: Example

The Fall: Example

Examples of Choices From the Fairy Tale Snow White

Good and Evil in Cinderella

Examples From Fairy Tales

Aligning Fairy Tales with State Standards

Words are Tools of Thought

So we can recall What is Ethics?

2009 Jones & Bartlett Publishers, LLC

2009 Jones & Bartlett Publishers, LLC

Ethics from Various Perspectives

2009 Jones & Bartlett Publishers, LLC