22 september 2006 c. fox, wsu-college of health professions creating moral space the proactive role...

22 September 200622 September 2006 C. Fox, WSU-College of Health ProfessionsC. Fox, WSU-College of Health Professions

CreatingCreatingMoral Space Moral Space The Proactive Role The Proactive Role

of Ethics Committeesof Ethics Committees

Kansas Health EthicsDeveloping Ethics

Committees

Charles R. Fox, OD, PhDAssociate Dean Academic Affairs & ResearchCollege of Health ProfessionsWichita State University


Ethical Resource SaturationEthical Resource Saturation

We are saturated with resources designed We are saturated with resources designed to educate the conscienceto educate the conscience

We have more ethical resources than we We have more ethical resources than we know what to do withknow what to do with

- - Ethics CommitteesEthics Committees (13,100,000 hits)(13,100,000 hits)

- - Ethics EducationEthics Education (58,800,000 hits)(58,800,000 hits)

- - Ethics InstitutesEthics Institutes (27,300,000 hits)(27,300,000 hits)

- - Health Care EthicsHealth Care Ethics (49,200,000 hits)(49,200,000 hits)


Resources are ubiquitous Resources are ubiquitous

Ethics Teachers, Advisers, ConsultantsEthics Teachers, Advisers, Consultants Ethics Institutes & CommitteesEthics Institutes & Committees Ethics Books, Journals & Web SitesEthics Books, Journals & Web Sites Ethics Is A Stated Priority Of:Ethics Is A Stated Priority Of:

SchoolsSchools UniversitiesUniversities Professional AssociationsProfessional Associations BusinessesBusinesses GovernmentsGovernments

22 September 2006 C. Fox, WSU-College of Health Professions


Birth of Ethics CommitteesBirth of Ethics Committees

January 1992 January 1992 JCAHO JCAHO requires health care requires health care organization establish organizational organization establish organizational mechanisms for formulating ethics policy mechanisms for formulating ethics policy and addressing ethical conflicts within the and addressing ethical conflicts within the institutional settinginstitutional setting

– SO –

???Why Aren’t We More Ethical???


Ethical FailureEthical Failure

Wealth Of Resources Wealth Of Resources Ethical SuccessEthical Success

More Likely:More Likely:

Ironic Symptom Of Ethical FailureIronic Symptom Of Ethical Failure

– SO – So Why Are We Failing?


Resources Are Resources Are Poorly DesignedPoorly Designed

QuantityQuantity Of Resources Of Resources NotNot The Problem The Problem student honor codesstudent honor codes industry standardsindustry standards professional assoc codesprofessional assoc codes ethics lawsethics laws ethics committeesethics committees

QualityQuality Is The Problem Is The Problem


Bioethics:Bioethics:A Committee ApproachA Committee Approach

Brendan Minogue (1995)Brendan Minogue (1995)

““When health care providers When health care providers seek adviceseek advice, , the ethics committee convenes and the ethics committee convenes and discusses the cases …” discusses the cases …” (p. xvii)(p. xvii)

Q: “What then is a hospital ethics committee?”Q: “What then is a hospital ethics committee?” A: “… a group … who meet regularly to address A: “… a group … who meet regularly to address

ethical problems that ethical problems that emergeemerge … … (p. 2)”(p. 2)”

Oh - OK

We are failing because we take a We are failing because we take a REACTIVE APPROACHREACTIVE APPROACH


A Modest ProposalA Modest Proposal(with apologies to J. Swift)(with apologies to J. Swift)

Ethics Committees should Ethics Committees should proactivelyproactively create a Moral Environment create a Moral Environment

i.e., Quality Improvement (CQI)i.e., Quality Improvement (CQI)


Creating Moral SpaceCreating Moral Space

Moral reasoning is:Moral reasoning is: basically a communal and a collaborative basically a communal and a collaborative

affairaffair An external scaffoldingAn external scaffolding

allowing human social cognition and the allowing human social cognition and the development of ‘moral space’development of ‘moral space’

Discursive Construction Of Moral Space Discursive Construction Of Moral Space


Moral DiscourseMoral Discourse As Process As Process

Moral ground comes into viewMoral ground comes into viewas an object of human cognitionas an object of human cognition

Moral discourse both creates & navigates Moral discourse both creates & navigates moral spacemoral space

Dialogue creates new domainsDialogue creates new domains e.g., Cruzan Casee.g., Cruzan Case


Cruzan vs MissouriCruzan vs Missouri

The right to refuse medical treatmentThe right to refuse medical treatment even when necessary to prolong lifeeven when necessary to prolong life

Dialogue created whole new moral domainDialogue created whole new moral domain the right to die claimthe right to die claim

Reframed moral landscape from:Reframed moral landscape from:Physician-assisted suicide as moral issuePhysician-assisted suicide as moral issue

– – TO TO ––Rights basedRights based argument re: physician-assisted suicide argument re: physician-assisted suicide

Re-shaped moral spaceRe-shaped moral space Made it accessible to reasonMade it accessible to reason


Discursive Construction ofDiscursive Construction of Moral Space Moral Space

Public moral discussionPublic moral discussioncreates moral sensitivitycreates moral sensitivity

AnalogyAnalogy (Andy Clark)(Andy Clark)

50 yrs ago, financial landscape very different50 yrs ago, financial landscape very differentNew financial institutions creates the space for New financial institutions creates the space for individuals to trade in stocks, futures, etc.individuals to trade in stocks, futures, etc.General public much more sensitive to General public much more sensitive to financial landscapefinancial landscape


Reactive EthicsReactive Ethics

Rules, maximums & guidelines that Rules, maximums & guidelines that characterize reactive ethics never display characterize reactive ethics never display the full, rich content of an ethical culturethe full, rich content of an ethical culture

At bestAt best they play a facilitating role / they play a facilitating role / provide reference points to allowprovide reference points to allow collaborative moral reasoning & discussioncollaborative moral reasoning & discussion deeper & more penetrating moral thoughtdeeper & more penetrating moral thought


Bioethics:Bioethics:A Committee ApproachA Committee Approach

Brendan Minogue (1995)Brendan Minogue (1995)

“… “… such committees have an educational such committees have an educational function.”function.” … … policies that are not taught are frequently policies that are not taught are frequently

not used not used (if not used) ethics policies can never be (if not used) ethics policies can never be

evaluated and rewrittenevaluated and rewritten This educational function is necessaryThis educational function is necessary

BUT NOT SUFFICIENTBUT NOT SUFFICIENT


Proactive EthicsProactive EthicsJob of Ethics Committees Is To Job of Ethics Committees Is To ProactivelyProactively Create Moral Space Create Moral Space

Do This ByDo This By

Creating An Environment WhereCreating An Environment WhereMoral Discourse OccursMoral Discourse Occurs


QUESTIONS?QUESTIONS?

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22 september 2006 c. fox, wsu-college of health professions creating moral space the proactive role...

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