PHILOSOPHICAL FOUNDATIONS OF ETHICS

PHILOSOPHY

• The love of wisdom and the pursuit of knowledge concerning humankind, nature and
reality.

ETHICS

• disciplines of philosophy

• moral principle that supplements the golden rule and can be summed up by a
commitment to respect the humanity in persons

ETHICAL DILEMMAS OF PRACTICE

The twenty-first century has brought

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Respiratory therapist work in complex health care settings, making it difficult to predict
definitely the range of ethical dilemmas likely to be experienced on a regular basis. The
clinical aspects and the management aspects of health care are rife with possibilities for
ethical dilemmas.

Over the past decade, there has been an almost complete change from a relatively open
fee-for-service system to one in which care is managed in some fashion, and the fees are
in some form of capitated payment.
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❖ Essential part of any profession that claims to be self-regulating.

❖ May try to limit competition, restrict advertisement, or promote a particular image

• Adopted a Statement of Ethics and Professional Conduct.

• Represents a set of general principles ad rules that have been developed to help ensure
that the health needs of the public are provided in a safe, effective and caring manner.

ETHICAL THEORIES AND PRINCIPLES

• It is from this principle that rules about informed consent are derived.

• Autonomy • Beneficence

• Veracity • Confidentiality

• Nonmaleficence • Justice
 • Role fidelity

Veracity
• often linked to autonomy, especially in the area of informed consent

• binds the health care provider and the patient to tell the truth

• both parties involved are best served in an environment of trust and mutual sharing of all
information

• benevolent deception

• the truth is withheld from the patient for his or her own good

Nonmaleficence
• obligates health care providers to avoid harming patients and to prevent harm actively
where possible

• helping actions inevitably have both a good and a bad effect, or double effect
• If the first intent is good, the harmful effect is viewed as an unintended result.
• Brings the essence of dilemma

Beneficent
• requires that health care providers go beyond doing no harm and contribute actively to
the health and well-being of their patients

Confidentiality
• founded in the Hippocratic Oath
 • reiterated by the World Medical Association in 1949

• It obliges health care providers to “respect the secrets which are confided even after the
patient has died”.

• considered a qualified, rather than an absolute, ethical principle in most health care
provider- patient relationship

• harm principle; requires that practitioners refrain from acts or omissions in which
foreseeable harm to others are vulnerable to risk

Justice
• involves the fair distribution of care.

• distributive justice.

• compensatory justice.

• DISTRIBUTIVE JUSTICE
• Balance must be found between health care expenses and the revenue available to
pay for them.

• Efforts to achieve this balance will inevitably to pay for them.

• COMPENSATORY JUSTICE

• call for the recovery for damages that were incurred as a result of the action of
others.

Role Duty
• modern health care is a team effort by necessity.

• Each of allied health professions has its own practice niche, defined by tradition or by
licensure law.
• Practitioners have a duty to understand the limits of their role and to practice with
fidelity.
 Ethical Viewpoints and Decision Making

Four different viewpoints:

2. Consequentialism

3. Virtue ethics

4. Intuitionism

FORMALISM

• Formalist
• believed that certain feature of an act determine its moral rightness

• right and wrong are described in term of rules or principle

• emplies that act is considered morally justifiable only if it upholds the rules and
principles that apply

• Limitation = Inconsistency

• critics of formalist reasoning insist that no principle or rule can be framed that
does not have exception
 • it claims that no principle or rule can be framed that does not conflict with other
rule

CONSEQUENTIALISM
• Consequentialist
• act is judged to be right or wrong based on its consequences

• it is according to the principle of utility

Principle of utility
• aims to promote greatest general good for most people

• Limitations/critics
• Calculus involved in projecting and weighing the amount of good over evil that
might occur is not always possible

• Reliance on the principle of utility to the exclusion of all else can result in actions
that are incompatible with ordinary judgment about right and wrong

Mixed Approaches
• Capitalized on the strengths inherent in these major line of ethical thought

Rule utilitarianism
- variation of consequentialism

“which rule would promote the greatest good rather than which act has the greatest utility”

- it is the approach most useful to health care professionals

Virtue ethics
-it evolves based in part on the limits of both formalism and consequentialism

-it is not about rules or consequences but rather in personal attributes of character or virtue
Intuitionism
- it holds that there are certain self-evident truths

Eight key for decision making:

1.Identify the problem or issue 6.Consider alternatives

Comprehensive Decision-Making Models

List Alternatives

Make Choice
 Frame ethical statement
1.Condition 1.reconsider
2.Who 2.restate
3.What

List consequences
1.imediate
2.long range

inconsistent
For each consequences
1. list of personal values
2. compare to consequences

Consistent

Consider all consequences

Ethical statement is valid