Module 6
Ethics and Liability
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Ethical Principles
Traditional Principles
There are two fundamental tenents of the traditional approach to ethics:
Paternalism - the role of father (i.e. father knows best model) - the need to protect
someone from his or her own judgements.
Reparation - the obligation to repair any harm caused to others accidentally or on
purpose.
Contemporary Principles
These principles are described in Egan's - key components of each principle is the professional
duty required to uphold each principle, and the patient right that is the foundation of each
principle.
Autonomy
Duty: informed consent - provide information to patient about care
Patient right: to decide their own course of treatment and to follow a plan which they
freely agree to.
Veracity (Truth-telling)
Duty: health care provider and patient must tell the truth - carries over into
documentation and medical record keeping
A patient who withholds information, or provides untrue information, places self at
risk - and makes the health care provider job difficult
Patient right: The right to be told the truth. Benevolent deception, while seemingly
well intentioned, often creates more problems than it solves.
Nonmaleficence
Duty: to avoid harming patients and to actively prevent harm when possible
Double effect: Action can have both a good and harmful effect - does the good
outweigh the bad - is the intentional good more desireable than avoiding the
unintentional bad?
Patient right: the right not to be harmed by the care provider
Beneficence
Duty: provider actively contributes to the health and well-being of the patient
Quality of Life: Beneficence is often the basis for quality of life dilemmas - Should
we do everything possible regardless of the eventual outcome? Would it be more
beneficient not to do everything?
Advanced directives: Patient Self-Determination Act of 1990. Places decisions
regarding end of life care in the hands of the patient. Does the patient fully
understand the consequences of their choices? When do these decisions apply?
When will they be ignored? Even patients with chronic disease who have living
wills have to receive appropriate care for acute, immediately life threatening
conditions that are unrelated to the chronic condition.
Patient Right: right to have their health and well-being promoted
Confidentiality (qualified rather than an absolute principle)
Duty: provider must not share information about patient unless with others involved in
their care
Harm Principle: does the confidentiality of information result in placing other
vulnerable individuals @ risk? Decision may be pre-empted by law: i.e. reporting
of child abuse, communicable diseases, injuries due to violence, etc.
Patient right: to have their information protected from those who do not need to know
it
Justice: fair distribution of care - act or process of providing equal care to all
Duty: give same quality of care to every patient regardless of socio-economic status.
Patient right: at the heart of the current health care reform debate!
distributive justice equal and fair, rationed, or with-held?
compenstory justice compensation for damages as the result of negligence or
malpractice
Role Duty:
Duty: understand the limits of their role and practice with fidelity.
Patient Right: to be cared for by professionals competent in their field and who
function within their scope of practice
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Date last modified: November 18, 2009.
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