ethics in daily practice vicki judd, md., university of utah paul myers, ph.d., university of...
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Ethics in Daily PracticeEthics in Daily Practice
Vicki Judd, MD., University of UtahVicki Judd, MD., University of Utah
Paul Myers, Ph.D., University of Paul Myers, Ph.D., University of PortlandPortland
Ethics Committee MembersEthics Committee Members Paul Myers, Director, Univ. of Portland (chair, voting member) (term 2008-2010)Paul Myers, Director, Univ. of Portland (chair, voting member) (term 2008-2010) Sam Alexander, Director, Univ. of Denver, (secretary, voting member) (term 2008-Sam Alexander, Director, Univ. of Denver, (secretary, voting member) (term 2008-
2010)2010) Cathy Felix, Director at Cal. State, Chico (voting member) (term 2010-2012)Cathy Felix, Director at Cal. State, Chico (voting member) (term 2010-2012) John Kolligian, Exec. Director, Princeton Univ. (voting member) (term 2010-2012)John Kolligian, Exec. Director, Princeton Univ. (voting member) (term 2010-2012)
Marc Hiller, Professor, Univ. New Hampshire (voting member) (term 2009-2011)Marc Hiller, Professor, Univ. New Hampshire (voting member) (term 2009-2011)
Vicki Judd, Professor, University of Utah (voting member) (term 2008-2010)Vicki Judd, Professor, University of Utah (voting member) (term 2008-2010)
Chad Williams, Student, (voting member, so may or may not be available for the Chad Williams, Student, (voting member, so may or may not be available for the second year) 2009-2010second year) 2009-2010
Jerry Wilmes, Director, NW Missouri State Univ. (voting member) 2010-2012Jerry Wilmes, Director, NW Missouri State Univ. (voting member) 2010-2012
Eryn Oberlander, Psychiatrist, New York City (voting member) 2010-2012Eryn Oberlander, Psychiatrist, New York City (voting member) 2010-2012
Tim Crump, Liaison to ACHA Board of Directors and Regional Representative for the Tim Crump, Liaison to ACHA Board of Directors and Regional Representative for the Pacific Coast College Health AssociationPacific Coast College Health Association
Bob Ward, Liaison to ACHABob Ward, Liaison to ACHA
ObjectivesObjectives
Describe ACHA Ethical Principles and Describe ACHA Ethical Principles and Guidelines Guidelines
List the changes of the ACHA Ethical List the changes of the ACHA Ethical Principles and GuidelinesPrinciples and Guidelines
Discuss the application of the ACHA Discuss the application of the ACHA Ethical Principles and Guidelines to Ethical Principles and Guidelines to actual situationsactual situations
QuizQuiz
Which two ancient philosophers Which two ancient philosophers were also physicians?were also physicians?
Hippocrates and AristotleHippocrates and Aristotle
Ethics of Hippocratic MedicineEthics of Hippocratic Medicine Harnessing the principles of nature as a guide to Harnessing the principles of nature as a guide to
healinghealing Be of benefit, do no harmBe of benefit, do no harm AsclepiusAsclepius ““Practiced medicine for those who were healthy in Practiced medicine for those who were healthy in
their nature but were suffering from a specific their nature but were suffering from a specific disease; he rid them of it …then ordered them to live disease; he rid them of it …then ordered them to live as usual…for those however, whose bodies were as usual…for those however, whose bodies were always in a state of inner sickness he did not attempt always in a state of inner sickness he did not attempt to prescribe a regimen to make their life a prolonged to prescribe a regimen to make their life a prolonged misery…medicine was not intended for them and misery…medicine was not intended for them and they should not be treated even if they were richer they should not be treated even if they were richer than Midas.”than Midas.”Plato, The RepublicPlato, The Republic
Four PrinciplesFour Principles
Establishment of 4 PrincipalsEstablishment of 4 Principals(Beauchamp and Childress) 1979(Beauchamp and Childress) 1979“A Reminder of What You Already “A Reminder of What You Already Know”Know”A) BeneficenceA) BeneficenceB) Non-maleficenceB) Non-maleficenceC) AutonomyC) AutonomyD) JusticeD) Justice
BeneficenceBeneficence
Obligation to preserve life, restore Obligation to preserve life, restore health, relieve suffering, and health, relieve suffering, and maintain functionmaintain function
To do “good”To do “good” Nonabandonment – obligation to Nonabandonment – obligation to
provide ongoing careprovide ongoing care Conflict of interest – must not engage Conflict of interest – must not engage
in activities that are not in students in activities that are not in students best interestbest interest
NonmaleficenceNonmaleficence
““Do no harm, prevent harm, and Do no harm, prevent harm, and remove harm”remove harm”
AutonomyAutonomy
Right to self-determinationRight to self-determination Requires decision making capacityRequires decision making capacity
• Lack should be proven not assumedLack should be proven not assumed Competence – legal determinationCompetence – legal determination Liberty – freedom to influence course Liberty – freedom to influence course
of life/treatmentof life/treatment
JusticeJustice
Allocation of resources must be fair Allocation of resources must be fair and according to needand according to need
Should not make decisions regarding Should not make decisions regarding individuals based upon societal individuals based upon societal needsneeds
Values and Ethical PrioritiesValues and Ethical Priorities Culture bestows Culture bestows
valuesvalues
Values set up MoralsValues set up Morals
Ethics are rules used Ethics are rules used to assist in making to assist in making good choices and good choices and avoiding bad choicesavoiding bad choices
Cultural Influence on ValuesCultural Influence on Values
FamilyFamily EthnicityEthnicity ReligionReligion Race Race Economic statusEconomic status EducationEducation Life experiencesLife experiences Sexual orientationSexual orientation GenderGender
ValuesValues
What do you value?What do you value?
ValuesValuesValues are things that an Values are things that an individual believes to be individual believes to be intrinsically worthwhile or intrinsically worthwhile or desirable, that are prized for desirable, that are prized for themselves (e.g. truth, beauty, themselves (e.g. truth, beauty, honesty, justice, respect for honesty, justice, respect for people and the environment).people and the environment).
Values ExamplesValues Examples
Extend hospitality Extend hospitality to strangers and to strangers and travelerstravelers
Give almsGive alms Don’t trust Don’t trust
professionalsprofessionals Us and ThemUs and Them Do unto others…Do unto others… Idleness is the Idleness is the
devil..devil..
Penny saved is Penny saved is penny earnedpenny earned
There but for the There but for the grace of God, go Igrace of God, go I
Don’t share the Don’t share the family’s businessfamily’s business
““My dad would kill My dad would kill me!”me!”
And……And……
“Be sure you are right, then go ahead.”
Davy Crockett
1786-1836
Teddy Roosevelt said, “To educate a person in mind and
not in morals is
to educate a menace
to society.”
Values ExamplesValues Examples ““Education without values, as useful Education without values, as useful
as it is, seems rather to make man a as it is, seems rather to make man a more clever devil.” more clever devil.” C. S. LewisC. S. Lewis
President
Lincoln said:
“Honor is
better than
honors.”
When the situation needs improvement, Gandhi offers guidance: “You must be the change you wish to see in the world.”
The reputation of a thousand years may be determined by the conduct of one hour.
Japanese proverb
“To see what is right and not to do it is want of courage.” (Confucius)
Values ExamplesValues Examples
It behooves every man who values It behooves every man who values liberty of conscience for himself, to liberty of conscience for himself, to resist invasions of it in the case of resist invasions of it in the case of others: or their case may, by change others: or their case may, by change of circumstances, become his own. of circumstances, become his own. Thomas JeffersonThomas Jefferson
“It behooves every man who values liberty of conscience for himself, to resist invasions of it in the case of others: or their case may, by change of circumstances, become his own.” Thomas Jefferson
MORALITYMORALITY Morality involves peoples' views of Morality involves peoples' views of
what is good, right, or proper; their what is good, right, or proper; their beliefs about their obligations; and beliefs about their obligations; and their ideas about how they should their ideas about how they should behave.behave.
Morality concerns duties and Morality concerns duties and obligations to one another and is obligations to one another and is characterized by words such as characterized by words such as rightright, , oughtought,, just, just, and and fairfair..
Inventory of Applicable PrinciplesInventory of Applicable Principles
??
Inventory of Applicable PrinciplesInventory of Applicable Principles
JusticeJustice CareCare FidelityFidelity HonestyHonesty TrustworthinessTrustworthiness Personal AutonomyPersonal Autonomy LibertyLiberty AccountabilityAccountability
No HarmNo Harm HappinessHappiness Do GoodDo Good Role FidelityRole Fidelity Professional Professional
AutonomyAutonomy ConfidentialityConfidentiality Pain AvoidancePain Avoidance
ETHICSETHICS
Ethics is the study of right and Ethics is the study of right and wrong, duties and obligations.wrong, duties and obligations.
Ethics involves critical Ethics involves critical reflection on morality, reflection on morality, including the ability to make including the ability to make choices between values and choices between values and the examination of the moral the examination of the moral dimensions of relationshipsdimensions of relationships..
AHCA’s Ethical PrinciplesAHCA’s Ethical Principles
Ensure respect and Ensure respect and autonomyautonomy
Promote JusticePromote Justice Protect privacyProtect privacy
Do no harmDo no harm Provide beneficial Provide beneficial
and caring servicesand caring services
ACHA Ethical GuidelinesACHA Ethical Guidelines
Responsibility in the Provision of Services Professional Responsibility and Competence Responsible and Ethical Relationships Responsibility to One’s Institution Responsibility to the American College Health
Association (ACHA) and to the Field of College Health
What Does a What Does a Code of Ethics Do?Code of Ethics Do?
Creates a profession’s sense of identityCreates a profession’s sense of identity
Identifies the issues the profession cares about Identifies the issues the profession cares about and wants new members to care aboutand wants new members to care about
Communicates with those outside the Communicates with those outside the profession what they can expect from its profession what they can expect from its membersmembers
PROFESSIONAL ETHICSPROFESSIONAL ETHICS
The moral commitments of a profession that:The moral commitments of a profession that: involve moral reflection that extends and involve moral reflection that extends and
enhances the personal morality enhances the personal morality practitioners bring to their work, practitioners bring to their work,
concern actions of right and wrong in the concern actions of right and wrong in the workplace, and workplace, and
help individuals resolve moral dilemmas help individuals resolve moral dilemmas they encounter in their work.they encounter in their work.
RecommendationsRecommendations
ACHA members expected to uphold ACHA members expected to uphold the principles and guidelinesthe principles and guidelines
Use this document as a guide in day Use this document as a guide in day to day practice and when breaches in to day practice and when breaches in ethics are evidentethics are evident
Suggested ResourcesSuggested Resources
The following are suggested reading materials from the The following are suggested reading materials from the Ethics Committee. ACHA does not endorse or accept Ethics Committee. ACHA does not endorse or accept responsibility for the content or use of external websites or responsibility for the content or use of external websites or materials.materials.
Institute for Global Ethics: http://www.globalethics.orgInstitute for Global Ethics: http://www.globalethics.org
The Ethics of Health Care: A Guide for Clinical Practice, by The Ethics of Health Care: A Guide for Clinical Practice, by Raymond S. Edge and John Randall Groves Raymond S. Edge and John Randall Groves
Foundations of Ethical Practice, Research and Teaching in Foundations of Ethical Practice, Research and Teaching in Psychology, by Karen Strohm KitchenerPsychology, by Karen Strohm Kitchener
Principles of Biomedical Ethics, 5th Edition, by Tom L. Principles of Biomedical Ethics, 5th Edition, by Tom L. Beauchamp & James F. ChildressBeauchamp & James F. Childress
Suggested ResourcesSuggested ResourcesGough, R. W. (1998). Character is destiny. Rocklin, CA: Prima. Gough, R. W. (1998). Character is destiny. Rocklin, CA: Prima.
Kidder, R. M. (2005). Moral courage. New York: HarperCollins Kidder, R. M. (2005). Moral courage. New York: HarperCollins Publishers Publishers
Corey, G., Corey M.S., and Callanan, P. (2007). Issues and ethics in Corey, G., Corey M.S., and Callanan, P. (2007). Issues and ethics in the helping professions. Pacific grove, CA: Brooks/Cole. the helping professions. Pacific grove, CA: Brooks/Cole.
Callanan, P. (2004). The cheating culture. New York: Harcourt Inc.Callanan, P. (2004). The cheating culture. New York: Harcourt Inc.
Fadiman, A. (1998). The spirit catches you and you fall down: A Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors and the collision of two cultures. Hmong child, her American doctors and the collision of two cultures.
Kidder, T. (2003). Mountains beyond mountains: The quest of Dr. Kidder, T. (2003). Mountains beyond mountains: The quest of Dr. Paul Farmer. Paul Farmer.
Mortenson, G. & Relin, D.O. (2006). Three cups of tea: One man's Mortenson, G. & Relin, D.O. (2006). Three cups of tea: One man's mission to promote peace one school at a time.mission to promote peace one school at a time.
How can ethics be used is real life How can ethics be used is real life situations?situations?
Discuss Sources of Similarity and Difference Discuss Sources of Similarity and Difference Among Participants in Both Process and Among Participants in Both Process and
Outcomes of These AnalysesOutcomes of These Analyses Small Group Discussion of Case ExamplesSmall Group Discussion of Case Examples
• Principles and Guidelines UsedPrinciples and Guidelines Used• Cultural, Professional & Diversity Cultural, Professional & Diversity
ConsiderationsConsiderations• Ethical “Method” EmployedEthical “Method” Employed• What will, or might happen?What will, or might happen?
Large Group Sharing of Similarities and Large Group Sharing of Similarities and Differences IdentifiedDifferences Identified
Small Group Discussion TimeSmall Group Discussion Time
Pick a scribe for reporting back to Pick a scribe for reporting back to large grouplarge group
Identify a case situation, “unpack it”Identify a case situation, “unpack it” Apply different principles and actors Apply different principles and actors
from different perspectives and from different perspectives and backgroundsbackgrounds
Track what principles or guidelines are Track what principles or guidelines are applicable, or at odds with one applicable, or at odds with one anotheranother
Reports to the Large GroupReports to the Large Group
What was your group’s case What was your group’s case situation?situation?
What were key issues/dilemmas?What were key issues/dilemmas? What principles were involved?What principles were involved? What role did diversity play?What role did diversity play? Other highlights?Other highlights?