Theories of Ethics

DEONTOLOGICAL ETHICAL THEORIES

• People should always be treated as ends and never as means.
• Human life has value.
• One is always to tell the truth.
• Above all in health care, do no harm.
• All people are of equal value

• Theological Ethics

• Categorical Imperative

• individuals possessed a special sense that would reveal ethical truth to them. That ethical truth is thought to be inborn and causes humans to act in the proper manner.
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  TELEOLOGICAL ETHICAL THEORIES

• Utilitarianism
•  consequential ethics
•  situational ethics

Who decides what is good or best for the greatest number?

Is it society, the government, or the individual? 

For the rest of the people, are they to receive some of the benefits, or is it an all or nothing concept? 

How does "good" become quantified in healthcare in such concepts as good, harm, benefits, and greatest? Where does this leave the individual trying to make healthcare decisions?

Existentialism

One modern teleological ethical theory is existentialism. In its pure form, no one is bound by external standards, codes of ethics, laws, or traditions.

Pragmatism

To the pragmatist, whatever is practical and useful is considered best for both the people who are problem solving and those who are being assisted.

This ethical model is mainly concerned with outcomes, and what is considered practical for one situation may not be for another. Pragmatists reject the idea that there can be a universal ethical theory; therefore, their decision-making process may seem inconsistent to those who follow traditional ethical models.

 It is not the action, but the intent or motive of the individual that is of importance. 

The motivist would say that there are no theoretical principles that can stand alone as a basis for ethical living

The nontheistic believer, on the other hand, develops understanding from within, through intuition and reason with no belief rooted in God. In either case natural law is said to hold precedence over man-made law.

To some, it is also a rather cold-hearted approach-not making decisions with an individual, but for the individual based upon what others believe to be good for that person. The principle of paternalism would fit within this context.

The concept of transcultural nursing was penned by M. Leninger and focuses on a comparative analysis of differing cultures, health-illness values, patterns, caring behavior, and nursing care. Decisions are made on the basis of the value or worth of someone by the quality of interrelationships.

Western society largely operates on a basis of facts, conclusions, and predetermined, agreed-upon solutions based upon male Anglo-American ideals.

Ethical Relativism/Multiculturalism

The ethical theory of relativism/multiculturalism falls under the postmodernist philosophical perspective and may be referred to as moral relativism [5]. Multiculturalism promotes the idea that all cultural groups be treated with respect and equality [7]. According to ethical relativists, ethical principles are culturally bound and one must examine ethical principles within each culture or society [5]. The question then becomes how ethical principles that are primarily deontological and rooted in Western values are applicable in other societies. The challenge of ethical relativism is how to determine which values take precedent 

Though not an inherent gift, moral reasoning is required to reach ethically sound decisions. This is a skill, and moral reasoning must be practiced so it becomes a part of any healthcare professional's life.

 For example, a healthcare professional assigned to care for a patient in the terminal stages of acquired immune deficiency syndrome (AIDS) might have strong fears about contracting the disease and transmitting it to his or her family. Is it ethical for him or her to refuse this assignment?

 on the basis of utilitarianism would weigh the good of their family members against the good of the patient. Based on the greatest good principle, it would be ethical for the healthcare provider to refuse to care for the patient. 

• Collection of a database
• Case presentation
• Identification of medical problems
• Identification of psychological problems
• Identification of an ethical dilemma
• Identification of legal or policy issues
• Discussion of ethical issues
• Suggestions for approaches to problems
• Discussion with initiator, patient, if possible, and other individuals directly involved with specific patient or problem
• Documentation of issues discussed and suggested approaches to be placed in the patient's chart

A person who becomes a healthcare worker accepts the obligations and duties of the role. Caring for patients with infectious diseases is one of those obligations; therefore, refusal would be a violation of this duty. 

Medical Facts

• What is the patient's current medical status?
• Are there other contributing medical conditions?
• What is the diagnosis? The prognosis? How reliable are these?
• Has a second opinion been obtained? Would it be helpful?
• Are there other tests that could clarify the situation?
• What treatments are possible?
• What is the probable life expectancy and what will be the general condition if treatment is given?
• What are the risks and side effects of treatment?
• What is the probability that treatment will benefit the patient?
• What benefits will treatment provide?

Patient Preferences

• Is the patient competent? Does he or she understand the need for medical care, the options that are available, and the probable results of choosing each of the various available courses of action?
• Has the patient been informed about his or her condition?
• How was the patient informed?
• Have all the treatment alternatives and their possible consequences been discussed with the patient?
• Has the patient had time to reflect upon the situation and upon the possible options?
• Has the patient made a clear statement about his or her wishes? If so, what are they?
• Has the patient discussed the situation thoroughly with someone other than the members of the immediate healthcare team?
• If the patient is not currently competent, is he or she expected to regain competence?
• If the patient is incompetent, did he or she ever make a clear statement that would indicate his or her wishes in these circumstances?
• Is there an advance directive for this patient, and is it available to the healthcare team?
• If the patient has not made any clear statement and does not have an advance directive, is there information from anyone regarding what the patient might have wanted or might reasonably be assumed to have wanted?

Views of Family

• Are there family members and who are they? Are they available to the healthcare team?
• Do they fully understand the patient's condition?
• What are their positions?
• Do they agree with one another?
• Are there any reasons to question their motives?
• Has one person been identified as having the primary responsibility for communication and decision making?
• Does anyone have legal custody of the patient (guardianship)?
• If the patient is a minor, are the legal guardian(s) choosing a course of action that is clearly in the child's best interests?
• If there are problems in communicating with the family, can someone be found (e.g., translator, minister) who could be helpful as a liaison between the family and the healthcare team?

Views of the Caregivers

• Are the caregivers fully apprised of the facts?
• What are their views?
• If the caregivers disagree, what accounts for the disagreements? Can they be resolved?

Legal, Administrative, and External Factors

• Are there state statutes or case law that apply to this situation?
• What potential liability might be present with respect to the hospital, to the providers, and to the parent or guardian?
• Are there hospital policies or guidelines that apply and would they be helpful in this situation?
• Are there other persons (in or outside the institution) who should be given information or asked for an opinion?
• Would it help to consult the literature for any aspect of this case?
• Is expense to the patient and/or family a factor?

Initiate and act because ethics without action is just talk