Principles of Health Care Ethics

Rels 300 / Nurs 33025 Sep 2014

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Shouldering the Burden of Care• TW, a fifty-two-year-old Ohio woman, cares daily for her

elderly mother … TWs mother requires constant supervision, so she came to live with TW and her family.

• Since TW could not afford a home health aid during the day, she reduced her hours and now works part time…

• In recent months, TWs mother has declined rapidly…• TW's mother told TW on many occasions that she never

wanted to be placed in a nursing home…TW faces a dilemma. She can place her mother in a nursing home to ease her own burdens… Alternatively, she can respect her mother's stated wishes by continuing to care for her at home…

Sanders, S. J., & Eva, F. K. (2005). Shouldering the burden of Care/commentary/commentary. The Hastings Center Report, 35(5), 14-5.

Retrieved from http://search.proquest.com/docview/222398618?accountid=13803

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What can a feminist ethic of care offer in response to this dilemma? The subordination of women is morally wrong and harms both

women and men. Both men and women should be treated as equals Both are deserving of justice rather than discrimination or

privilege Moral obligations arise out of our relationships with others

and our mutual duties of caring Human persons are interdependent and formed through

personal relationships. Maintain caring relations Avoid harm; Respond to need Recognize and respond to vulnerability

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One Feminist Analysis: Eva Feder Kittay

“[C]aregiving is a human capacity, not a gendered one”• For caregivers to be able to express love, they “need

to be able to maintain [their] own selves from which our gift can flow”

• “Imagine a world where familial caregiving was remunerated through paid family leave policies and funds to provide care”

• “If nursing homes were personalized and varied places… then they would not be a dreaded specter hovering over old age”

• “distribute the burden of caregiving more equitably…if her brother cannot contribute time, he must assist in other ways, such as contributing funds for home assistance”“To continue the current situation can only further

embitter TW, alienating her from her mother and her family, and this fracturing of relations would be the

most injurious of all outcomes.”

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Principles of BioethicsSynthesizing and applying a range of moral theories

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Moral Principles• Not tied to any one moral theory• Emerged from critical analysis of medical

research which was proven to violate the human dignity of the research subjects

• Developed as an attempt to provide a common language for healthcare professionals, researchers and members of the public

• Goal = to provide a means of determining & identifying morally right and morally wrong attitudes, actions and behaviours▫ Within contexts of both clinical care and research

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4 Principles of Bioethics

•Can be evaluated within a virtue, deontological, utilitarian, natural law, feminist or care framework

•But the 4 principles form the ground rules for the moral alternatives considered by the health care team

•People can use any form of moral reasoning and still discuss each of these principles

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The 4 Principles are:

1. Autonomy

2. Beneficence

3. Non-maleficence ▫(also called non-malfeasance, but this

term is not generally used in Canada)

4. Justice

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1. Autonomy

auto / nomos = self / rule

respect the right of competent persons to make their own decisions

respect the personal dignity and worth of persons

respect the right of persons to be free to act without external restraints or manipulation

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2. Beneficencehealthcare professionals have a duty to

promote the health and well-being of the patientContribute to their benefit

healthcare professionals have a duty to further the important and legitimate interests of others

patients may not be treated in ways that only bring benefit to others

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3. Non-maleficence

healthcare professionals have a duty to refrain from injuring or inflicting harm

minimize the pain and suffering caused by disease and medical treatment

“First, do no harm”

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4. Justice

everyone has a duty to ensure fair treatment of patients

equals should be treated equally and unequals unequally

healthcare resources should be distributed in a fair manner

persons should not experience prejudice, discrimination or bias

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What’s the value of adding another theoretical approach?

Whether on deontological grounds, or according to utilitarian reasoning, or according to any other moral theory (i.e. virtue, natural law, care ethics), everyone is in agreement that patient autonomy must be respected▫reasons for respecting autonomy may differ

according to moral perspectives, but all agree that it must be respected in providing health care for patients

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Case Study #1

Ms. Jones, a 28-yr-old woman, comes to her primary care physician for advice.

Her 25-yr-old brother, her only sibling, has developed renal failure.

He & her parents, as well as the nephrologist, have urged her to be tested for suitability as a kidney donor.

She is extremely anxious and says that while she feels guilty, she does not want to be a donor.

How can the doctor help her make a decision? How can this decision be communicated to her

parents and brother?

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Case Study #2

Mr. Minto is a 67-yr-old man who has been institutionalized for mental retardation since he was 1 year old.

His mental age is estimated at a 3-yr-old level, and his IQ is 20.

He develops acute nonlymphoblastic leukemia.His guardian says, “His life is of such poor quality.

Why should we try to extend it when medical treatment would be painful? He wouldn’t understand what was going on.”

How should the nurse respond to this?How can she articulate her perspective and/or

concerns?

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Case Study #3A frail patient recovering from recent surgery

has been receiving intra-muscular antibiotic injections four times a day.

The injection sites are very tender, and though the patient now is able to eat without problems, the intern refuses to change the order to an oral antibiotic because the absorption of the medication would be slightly less.

What should the nurse do?How can he explain his ethical concerns to

the intern?

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What Connections do you see between the Principles and these Moral Theories

• AUTONOMY

• BENEFICENCE

• NON-MALEFICENCE

• JUSTICE

• UTILITARIANISM

• DEONTOLOGY

• VIRTUE

▫NATURAL LAW

• FEMINIST / CARE

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AUTONOMY

•Why would the utilitarian support or limit patient autonomy?

•Why would the deontologist support or limit patient autonomy?

•Why, or how, would the virtue ethicist support patient autonomy?

•Why, or how, would patient autonomy be respected by the care and/or feminist ethicist?