Ethical Dimensions in the Health Professions

by Purtilo, Ruth

• ISBN13: 9780721677996
• ISBN10: 0721677991
• Edition: 3rd
• Format: Paperback
• Copyright: 1998-12-01
• Publisher: SAUNDERS W B CO

Summary

This highly successful text has earned widespread acclaim for its versatility and simple, straightforward suggestions for ways to approach the analysis of ethical issues. Assists health professionals in ethical decision making and introduces a sound foundation in basic ethical theory, a familiarity with the terms and concepts of ethics, and an acquaintance with issues that health care professionals often face. This 3rd Edition is updated to reflect the most current issues, such as the cost of healthcare and the increase of managed care, the changes in the sites that offer healthcare, and the concerns associated with AIDS and infectious disease.

Table of Contents

SECTION ONE Introduction to Ethical Dimensions in the Health Professions	1	(90)
Morality and Ethics: What Are They and Why Do They Matter?	3	(18)
Objectives	3	(3)
Morality and Moral Values	6	(6)
Personal Morality	8	(1)
Societal Morality	9	(1)
Group Morality: The Health Professions and Their Institutions	9	(2)
Summary	11	(1)
Ethics: Reflecting on Morality	12	(3)
Moral Judgments, Ethical Issues, and Ethical Problems	13	(1)
The Moral and Ethical Thing to Do	13	(1)
Using Ethics in Practical Situations Involving Morality	14	(1)
Ethics Research	15	(1)
Morality---Ethics and Following Your Own Conscience	15	(4)
The Principle of Material Cooperation	16	(1)
Protection Through Laws and Policies	17	(2)
Limits of Protection	19	(1)
Summary	19	(1)
Questions for Thought and Discussion	19	(2)
All You Need to Know about Ethics Approaches and Theories---I: Background Information and Case-Driven Approaches	21	(22)
Objectives	21	(2)
Becoming a Part of the Ethics Conversation	23	(2)
Deductive and Inductive Theories and Approaches	23	(1)
To Do or To Be?	23	(1)
Individuals or Communities as Units of Concern?	24	(1)
Reason or Emotion for Reliable Moral Judgment?	24	(1)
Summary	25	(1)
Parts of Ethical Study	25	(5)
Metaethics	26	(1)
Normative Ethics	27	(3)
Case-Driven Approaches: The Story Itself Is Central	30	(7)
Narrative Approaches	30	(1)
Approaches Emphasizing Relationship	31	(2)
Feminist Ethics and Postmodernism: All Those Voices and the Social Context Besides	33	(2)
Care: A Silver Thread in Relationships	35	(2)
Approach---Casuistry	37	(1)
Summary	38	(1)
Questions for Thought and Discussion	39	(4)
All You Need to Know about Ethics Approaches and Theories---II: Means, Ends, Principles, and Virtues	43	(23)
Objectives	43	(3)
Deontological Theories	46	(2)
Teleological Theories	48	(1)
Duties and Consequences in Tension	49	(1)
Principles as Guides: How to Express Respect for Others	50	(11)
Nonmaleficence and Beneficence	51	(2)
Autonomy	53	(4)
Fidelity	57	(1)
Veracity	57	(1)
Justice	58	(2)
Absolute, Prima Facie, and Conditional Principles	60	(1)
Virtue Theory	61	(2)
Character Traits and Moral Character	61	(2)
Summary	63	(1)
Questions for Thought and Discussion	64	(2)
Prototypes of Ethical Problems	66	(13)
Objectives	66	(3)
Common Components of the Three Prototypes	69	(1)
A---The Moral Agent	69	(1)
C---The Course of Action	70	(1)
O---The Desired Outcome	70	(1)
Ethical Distress: Barriers to Agency	70	(2)
Type A: There is a Barrier Keeping You from Doing What You Know Is Right	71	(1)
Type B: There Is a Barrier Because Something Is Wrong, but You Are Not Sure What It Is	71	(1)
Ethical Dilemma: Two Courses Diverging	72	(3)
The Special Case of Paternalism	74	(1)
The Special Case of Distributive Justice	75	(1)
Locus of Authority Problem	75	(3)
Summary	78	(1)
Questions for Thought and Discussion	78	(1)
A Six-Step Process of Ethical Decision Making for You to Follow	79	(12)
Objectives	79	(2)
The Six-Step Process	81	(8)
Step 1. Get the Story Straight: Gather Relevant Information	82	(2)
Step 2. Identify the Type of Ethical Problem	84	(2)
Step 3. Use Ethics Theories or Approaches to Analyze the Problem(s)	86	(1)
Step 4. Explore the Practical Alternatives	86	(1)
Step 5. Complete the Action	87	(1)
Step 6. Evaluate the Process and Outcome	88	(1)
Summary	89	(1)
Questions for Thought and Discussion	89	(2)
SECTION TWO Ethical Dimensions of Professional Roles	91	(54)
Surviving Student Life Ethically	93	(15)
Objectives	93	(1)
Special Challenges of Student Life	94	(2)
Using What You Have Learned and Acknowledging Student Limitations	96	(2)
Taking Responsibility	98	(6)
Abstaining from Wrongdoing	102	(1)
Righting Wrongdoing You Have Committed	102	(1)
Addressing Others' Wrongdoing Constructively	103	(1)
Summary	104	(1)
Questions for Thought and Discussion	105	(3)
Surviving Professional Life Ethically	108	(13)
Objectives	108	(2)
You Owe It to Yourself	110	(2)
The Responsibility to Maintain Personal Integrity	112	(5)
Opportunities to Strengthen Your Personal Integrity	113	(3)
Societal Safeguards Revisited	116	(1)
Personal Integrity and Personal Vigilance	116	(1)
The Responsibility to Improve Yourself	117	(2)
The Charge to Remain Competent Professionally	117	(1)
The Charge to Improve Yourself Personally	117	(2)
Challenges Regarding Personal Integrity: Vigilance Revisited	119	(1)
Summary	119	(1)
Questions for Thought and Discussion	120	(1)
Support and Challenges as a Member of the Health Care Team	121	(24)
Objectives	121	(1)
Support Among Team Members	122	(3)
Friendship and Favoritism	125	(5)
Peer Evaluation	130	(3)
Blowing the Whistle on Unethical or Incompetent Colleagues	133	(1)
Gather Relevant Information	134	(5)
Identify the Type of Ethical Problem	135	(1)
Use Ethics Theory or Approaches to Analyze the Problem	136	(1)
Explore the Practical Alternatives	137	(1)
Complete the Action and Evaluate It	138	(1)
Summary	139	(1)
Questions for Thought and Discussion	139	(6)
SECTION THREE Ethical Dimensions of the Professional-Patient Relationship	145	(104)
Confidentiality	147	(16)
Objectives	147	(3)
What Is Confidential Information and Confidentiality?	150	(2)
Keeping Confidences	152	(2)
Breaking Confidences	154	(3)
Confidentiality and Medical Information	157	(2)
Confidentiality and Genetic Information	159	(1)
Summary	160	(1)
Questions for Thought and Discussion	160	(3)
Information Disclosure: Truth Telling	163	(22)
Objectives	163	(3)
An Argument Against Disclosure	166	(1)
Arguments Favoring Disclosure	167	(7)
Applying the Six-Step Process of Decision Making	174	(5)
Gather Relevant Information	174	(1)
Identify the Type of Ethical Problem	175	(1)
Determine the Ethics Approach to Be Used	175	(1)
Explore the Practical Alternatives	176	(2)
Complete the Action	178	(1)
Evaluate the Process and Outcome	179	(1)
Truth, Truth Telling, and Deceit	179	(1)
Placebos: A Special Case of Information Disclosure	180	(3)
Summary	183	(1)
Questions for Thought and Discussion	183	(2)
Informed Consent	185	(20)
Objectives	185	(3)
Informed Consent in Health Care Decisions	188	(1)
Legal and Ethical Principles Supporting Informed Consent	189	(3)
Legal Principles	189	(1)
Ethical Principles	190	(2)
The Process: Disclosure Issues	192	(3)
Voluntariness	193	(1)
Competence Issues	194	(1)
The Special Challenge of the Incompetent or Incapacitated Person	195	(1)
Informed Consent in Research	196	(4)
Sensitivity to Cultural and Other Differences	200	(2)
Summary	202	(1)
Questions for Thought and Discussion	203	(2)
Ethical Issues in End-of-Life Care	205	(28)
Objectives	205	(3)
Demonstrating Care in End-of-Life Treatment	208	(3)
Three Faces of Compassion	209	(1)
Individualized Care	210	(1)
The Duty of Fidelity	211	(10)
Abandonment v. Abiding with the Patient	212	(1)
Informed Consent in End-of-Life Care	213	(3)
Honoring Proper Moral Limits of Medical Intervention: Ordinary and Extraordinary Means	216	(4)
Mechanisms for Applying the Ordinary-Extraordinary Distinction	220	(1)
The Duty Not To Harm	221	(6)
Withdrawing and Withholding Life Supports	222	(1)
Palliative Care	223	(3)
Principle of Double Effect	226	(1)
Clinically Assisted Suicide	227	(2)
Summary	229	(1)
Questions for Thought and Discussion	229	(4)
Special Challenges: ``Difficult'' Patients and Patients in Suicidal Crisis	233	(16)
Objectives	233	(1)
What Is a ``Difficult ``Patient?	234	(7)
The Gomer, the Gork, and the Crock	236	(1)
Social Factors Engendering Negative Attitudes	237	(2)
``Difficult'' Patients: Coping Ethically	239	(2)
The Patient in Suicidal Crisis	241	(4)
Common Explanations for Suicide	242	(2)
Summary	244	(1)
Responding Ethically to Suicidal Crisis	245	(1)
Questions for Thought and Discussion	245	(4)
SECTION FOUR Ethical Dimensions of the Social and Institutional Contexts of Health Care	249	(56)
Distributive Justice: Clinical Sources of Claims for Health Care	251	(16)
Objectives	251	(4)
The One and the Many: Fairness Considerations	255	(2)
Allocations Among Groups: Justice Considerations	257	(4)
Health Care As a Right	258	(1)
Health Care As Response to Basic Need	259	(1)
Health Care As Commodity	259	(2)
Rationing-Allocation and Dire Scarcity	261	(2)
Criteria for a Morally Acceptable Approach to Rationing of Health Care Resources	261	(1)
Tragic Choices	262	(1)
Summary	263	(1)
Questions for Thought and Discussion	264	(3)
Compensatory Justice: Social Sources of Claims for Health Care	267	(16)
Objectives	267	(3)
Distributive and Compensatory Justice	270	(2)
Compensation and Company Policy	272	(1)
Reasons Offered for Providing Health Care Coverage	273	(1)
The Resulting Distribution of Medical Resources	274	(2)
Caveats Regarding Labeling	275	(1)
Private or Public Funds	275	(1)
Social Justice and the Patient's Responsibility for Health Maintenance	276	(4)
Summary	280	(1)
Questions for Thought and Discussion	281	(2)
Living Ethically within the Organizations of Health Care	283	(13)
Objectives	283	(2)
Living with Mission Statements	285	(2)
Living Ethically with Policies and Administrative Practices	287	(1)
Obligations to Honor Policies	288	(1)
Obligations of Organizations to Individuals	289	(3)
The Opportunity to Become Involved in Policy	290	(1)
The Assurance of Relevant Policies	290	(1)
Administrative Commitment to Creating a Humane Organization	291	(1)
Living with the Business Aspects of Health Care	292	(1)
Summary	293	(1)
Questions for Thought and Discussion	293	(3)
Good Citizenship and Your Professional Role: Life As Opportunity	296	(9)
Objectives	296	(2)
Professional Autonomy and Good Citizenship	298	(1)
Professional Responsibilities and Good Citizenship	299	(2)
Social Responsibility and Good Citizenship	301	(1)
Caring---Key to Good Citizenship	302	(1)
Questions for Thought and Discussion	303	(2)
Index	305