Regina Mc Quillan Ethics That good should be done and evil avoided Ethical Concerns Consent Capacity Confidentiality Assisted suicide euthanasia Advance care planning Futility Ethics ID: 784636
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Slide1
Ethics for Patients and Families
Regina Mc Quillan
Slide2Ethics
‘That good should be done and evil avoided’
Slide3Ethical Concerns
Consent
Capacity
Confidentiality
Assisted suicide, euthanasia
Advance care planning
Futility
Slide4Ethics
Principle based
Values based
Utilitarian
Consequentialist
Non-consequentialist
Religious based
Etc….
Slide5Ethical dilemma
Slide6Not a clinical dilemma
Slide7Not a clinical dilemma
Antibiotics for colds
Slide8Ethical dilemma
Treatment options are equivalent, or nearly equivalent
Difference in what should be provided
Slide9Conflict of ethical claims
Between patient and doctor
Between patient and family
Between family and doctor
Within team
Slide10Power
Slide11Power
Doctors
Slide12Power
Doctors
Nurses
Slide13Power
Doctors
Nurses
Healthcare staff
Slide14Power
Doctors
Nurses
Healthcare staff
Families
Slide15Power
Doctors
Nurses
Healthcare staff
Families
Patients
Slide16Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 2016
Slide17Code of Professional Conduct and Ethics
Nursing and Midwifery Board of Ireland (2014)
Slide18Ethical duties of patients
Slide19Ethical duties of patients
Participate in healthcare
juristinction
-contribute to taxes, health insurance
etc
Maintain health
Protect health of others
e.g
infection
Seek and access care appropriately e.g. accept non-urgent appointments, be civil
Truthful
Compliance
Inpatient-not disruptive, not undermining
Attempt to recover
Take part in research
Citizenship-take part in society, pay tax, vote
Evans 2008
Slide20Ethical issues
Ethical
Clinical
Communication
Slide21Ethical issues
Ethical
Clinical
Communication
Use of illegal substance- cannabis
Fair use of resources
Experimental treatment
Right to try
Hospital or hospice beds
Futile treatment
Informed decision-making
Assisted suicide/euthanasia
Slide22Autonomy
Slide23Autonomy
A principle, not
the
principle
Slide24Autonomy
A principle, not
the
principle
Beneficence
Non-maleficence
Justice
Beauchamp and Childress
Slide25Autonomy
A principle, not
the
principle
Beneficence
Non-maleficence
Justice
Dignity
Integrity
Vulnerability
BIOMED II project, Rendtorff, 2002
Slide26Autonomy
A principle, not
the
principle
Beneficence
Non-maleficence
Justice
Dignity
Integrity
Vulnerability
Fidelity
Slide27Autonomy
Self-rule
A competent or rational person making choices for reasons that reflect judgement and understanding
Credit people with capacity
Allowed exercise control over their life in terms of choices they make
Farsides, 1998
Slide28Autonomy
Emphasis on independence and sovereignty
Slide29Autonomy
Emphasis on independence and sovereignty
A response to healthcare paternalism
Recognition of patients as rational choosers
Response to increased literacy, education and health literacy of the public
Slide30Autonomy
Emphasis on independence and sovereignty
Dependent on, or influenced by others
Other values such as friendship, loyalty, faith which require us to construct relationships
Doing what is ‘right’
Own needs vs needs of others
Slide31Justice
Distributive justice - fairness, allocation of resources
Slide32Justice
Distributive justice - fairness, allocation of resources
Treat equals equally, ‘unequals’ according to need
Slide33Justice
Distributive justice - fairness, allocation of resources
Treat equals equally, ‘unequals’ according to need
Rights-based justice
Slide34Justice
Distributive justice- fairness, allocation of resources
Treat equals equally, ‘unequals’ according to need
Rights-based justice
Respect for morally acceptable laws (democracy)
Slide35Justice
Distributive justice - fairness, allocation of resources
Treat equals equally, ‘unequals’ according to need
Rights-based justice
Respect for morally acceptable laws (democracy)
Respect for ‘morally acceptable’ healthcare systems, guidelines, protocols
Slide36Justice
Assisted suicide and euthanasia
Futile treatments
Objectivity and professionalism
Vulnerable people – life-style
Slide37Health care worker’s responsibility
To the patient, not the family
Responsibility to the
team/service,
but patient central
Good communication
If no resolution
Offer second opinion
Trial of treatment/intervention
Court decision – will tend to support patient’s best interest, not just best medical interest.
Slide38Ethical duties of patients
Participate in healthcare
juristinction
-contribute to taxes, health insurance
etc
Maintain health
Protect health of others
e.g
infection
Seek and access care appropriately e.g. accept non-urgent appointments, be civil
Truthful
Compliance
Inpatient-not disruptive, not undermining
Attempt to recover
Take part in research
Citizenship-take part in society, pay tax, vote
Evans 2008
Slide39Ethical duties of patients
Power imbalance
Consensus – citizens’ engagement
Slide40