comp2 unit8a lecture slides

The Culture of Healthcare

Ethics and Professionalism

Lecture a

This material (Comp2_Unit8a) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Ethics and ProfessionalismLearning Objectives

• Provide an orientation to ideas about medical ethics and professionalism (Lecture a)

• Explore the relationships among ethical ideals, professionalism, and legal duties (Lecture a, b)

• Apply the general principles of ethics and professionalism to specific topics (Lecture c, d)

• Examine ethical issues in health informatics (Lecture d)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Ethics and Professionalism

Lecture a

What Is Meant by Ethics and Professionalism?

• Ethics is the study of what people think is right and wrong

• Professionalism means that a person acts in a way that meets the standards of their profession– Training and skills– Ethical principles



Lecture a

4 Basic Principles

Plus concern for the scope

of application

of these principles

8.1 Figure: Four basic principles of healthcare (CC BY-NC-SA 3.0, 2012).



Lecture a

Respect for Autonomy• Autonomy = self-governance• Respect for autonomy = patients have the right

to make their own decisions without undue influence– Healthcare decisions are voluntary

• Foundation of “informed consent”



Lecture a

Beneficence

• The idea that actions of healthcare providers should benefit people– Prevent problems that may occur – Treat problems that have occurred

• Widely accepted as an appropriate goal of healthcare

• Applied at individual level and population-wide level



Lecture a

Non-Maleficence• The obligation not to intentionally create

unnecessary harm or injury to the patient• Applies to both commission and omission

8.2 Table: Non-Maleficence (CC BY-NC-SA 3.0, 2012).



Lecture a

Commission Omission Act that causes harm For example,

performing needless surgery

Failure to act when one should act

For example, intentionally withholding a helpful drug

Justice• Justice in the medical ethics setting means

fairness• Includes the concepts that:

– All people have the right to be treated equally– If there is not enough to go around, what is

available should be distributed fairly



Lecture a

“Concern for theScope of Their Action”

• Who are healthcare professionals responsible to?– Everyone in their community?– Everyone in the country?

• How far does respect for autonomy go?– Do animals have rights?– Does the environment have rights?



Lecture a

The Principles in Action• Respect for autonomy

– Informed consent– Medical confidentiality

• Beneficence and non-maleficence– Requires that treatments be designed to maximize

benefits and minimize risks• Justice

– The risks of medical research should not fall disproportionally on one group of people



Lecture a

Prima facie Duties• Prima facie = “at first view” or self-evident• Each ethical principle is binding unless it

conflicts with another principle• When the principles conflict, a person must

decide which one to act on • The theory of the 4 principles does not give

guidance about which one to choose or how to prioritize them



Lecture a

Ethical Dilemma

Justice Occurs when someone must choose between conflicting ethical principles

8.3 Figure: Ethical dilemma (CC BY-NC-SA 3.0, 2012).



Lecture a

Obligation and Aspiration

• Obligation = minimum standard necessary to meet professional obligation– Provide competent medical care to individual patients– Make sure patients understand the risks and benefits

of treatment• Aspiration = standard that one should strive to

achieve, but is not always attainable– Providing equal worldwide access to healthcare– Find cures for currently incurable conditions



Lecture a

Ethics Committee• Group of people who meet to discuss ethical

dilemmas• All accredited hospitals must have a process for

resolving ethical questions• Membership is usually diverse and may include:

– Doctors and nurses– Social workers and lawyers– Religious professionals– Members of the community



Lecture a

Codes of Ethics

Examples:•American Medical Association•International Council of Nurses•American Health Information Management Association •American Medical Informatics Association



Lecture a

Hippocratic Oath• A historical foundation of medical ethics• States a moral obligation to maximize benefits

of treatment and minimize harms of treatment• Much of the original oath is not relevant today• Modernized versions of the oath are used at

some, but not all, medical schools



Lecture a

Professionalism• Profession = an occupation that:

– Requires special knowledge and training– Has standards for behavior

• Healthcare professional = a person who, by training and experience, has the knowledge to provide some aspect of healthcare delivery

• Professionalism means:– Acting in a way that meets standards– Knowing ethical obligations and trying to meet them



Lecture a

Core Medical Professional Responsibilities (1 of 2)

• Professional competence• Honesty with patients• Patient confidentiality• Appropriate relations with patients• Improving quality of care



Lecture a

Core Medical Professional Responsibilities (2 of 2)

• Improving access to care• Fair distribution of limited resources• Scientific knowledge• Managing conflicts of interest• Maintaining professional responsibilities



Lecture a

Ethics and Professionalism Summary – Lecture a

• People in the healthcare profession have duties based in the 4 core principles of medical ethics:– Respect for autonomy– Beneficence– Non-maleficence– Justice

• Healthcare professionals must consider how broadly their ethical duties extend (“scope of their action”)

• Professionalism requires that people in the healthcare industry act in accord with certain standards



Lecture a

Ethics and Professionalism References – Lecture a

References• American Board of Internal Medicine Foundation [Internet]. Cassel CK. 21st century medical professionalism:

renewing the social contract [13 pages]. Available from: http://www.abimfoundation.org/Resource-Center/~/media/2%20_010809_Cassel_professionalism.ashx.

• American Board of Internal Medicine Foundation [Internet]. Undated [cited 2011 Dec 20]. Medical professionalism in the new millennium: a physician charter [2 pages]. Available from: http://www.abimfoundation.org/Professionalism/~/media/F8B71F15DE8B486599F13E662603F25D.ashx.

• Aulisio MP, Arnold RM. Helping to address value conflicts or uncertainties: role of the ethics committee. Chest. 2008;134;417-424.

• Ethics Resource Center [Internet]. Ethics glossary. May 29, 2009 [cited 2011 Dec 19]. Ethics glossary [5 pages]. Available from: http://www.ethics.org/resource/ethics-glossary.

• Gillon R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184-188.

• Gillon R. Ethics needs principles: four can encompass the rest—and respect for autonomy should be “first among equals.” J Med Ethics. 2003;29(5):307-312.



Lecture a

http://www.abimfoundation.org/Resource-Center/~/media/2%20_010809_Cassel_professionalism.ashx

Ethics and Professionalism References – Lecture a (continued)References (continued)• The Hastings Center [Internet]. 2007 [cited 2011 Dec 20]. Jennings B, Baily MA, Bottrell M, Lynn J, eds. Health Care

Quality Improvement: Ethical and Regulatory Issues [188 pages]. Available from: http://www.thehastingscenter.org/uploadedFiles/Publications/Special_Reports/Health%20Care%20Quality%20Improvement.pdf.

• History of Medicine Division, National Library of Medicine, National Institutes of Health [Internet]. Updated June 24, 2010 [cited 2011 Dec 20]. Greek medicine: the Hippocratic oath [1 page]. Available from: http://www.nlm.nih.gov/hmd/greek/greek_oath.html.

• Kirk LM. Professionalism in medicine: definitions and considerations for teaching. Proceedings (Bayl Univ Med Cent). 2007;20:13-16.

• University of Washington School of Medicine [Internet]. Updated April 11, 2008 [cited 2011 Dec 19]. McCormick TR. Ethics in medicine: principles of bioethics [4 pages]. Available from: http://depts.washington.edu/bioethx/tools/princpl.html

• University of Washington School of Medicine [Internet]. Updated November 1, 2010 [cited 2011 Dec 19]. Pearlman RA. Ethics in medicine: ethics committees and ethics consultation [3 pages]. Available from: http://depts.washington.edu/bioethx/topics/ethics.html.



Lecture a

Ethics and ProfessionalismReferences – Lecture a (continued)Charts, Tables, Figures• 8.1 Figure: Four basic principles of healthcare (CC BY-NC-SA 3.0, 2012).• 8.2 Table: Non-Maleficence (CC BY-NC-SA 3.0, 2012).• 8.3 Figure: Ethical dilemma (CC BY-NC-SA 3.0, 2012).



Lecture a

comp2 unit8a lecture slides

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