Ethics in Daily PracticeEthics in Daily Practice

Vicki Judd, M.D., University of UtahVicki Judd, M.D., University of Utah

Sam Alexander, M.D., University of Sam Alexander, M.D., University of DenverDenver

Ethics Committee MembersEthics Committee Members Sam Alexander, Exec. Director, Univ. of Denver, (chair)Sam Alexander, Exec. Director, Univ. of Denver, (chair)

Paul Myers, Director, Univ. of Portland Paul Myers, Director, Univ. of Portland

Cathy Felix, Director at Cal. State, ChicoCathy Felix, Director at Cal. State, Chico

John Kolligian, Exec. Director, Princeton Univ. John Kolligian, Exec. Director, Princeton Univ.

Marc Hiller, Professor, Univ. New HampshireMarc Hiller, Professor, Univ. New Hampshire

Vicki Judd, Professor, University of UtahVicki Judd, Professor, University of Utah

Jerry Wilmes, Director, NW Missouri State Univ. Jerry Wilmes, Director, NW Missouri State Univ.

Eryn Oberlander, Psychiatrist, Columbia Univ.Eryn Oberlander, Psychiatrist, Columbia Univ.

Jeannie-Mae Durfee, Clinical Nurse Leader, Univ. of Mass. – DartmouthJeannie-Mae Durfee, Clinical Nurse Leader, Univ. of Mass. – Dartmouth

Lori Dewald, Professor, American Public UniversityLori Dewald, Professor, American Public University

Kent Bullis, ACHA Board LiaisonKent Bullis, ACHA Board Liaison

Bob Ward, ACHA Staff Liaison Bob Ward, ACHA Staff Liaison

ObjectivesObjectives

Describe ACHA Ethical Principles and Describe ACHA Ethical Principles and Guidelines 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

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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..

ACHA GuidelinesACHA Guidelines

General Statement of Ethical PrinciplesGeneral Statement of Ethical Principlesand Guidelinesand Guidelines

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 The moral commitments of a profession that: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 Publishers Kidder, R. M. (2005). Moral courage. New York: HarperCollins Publishers

Corey, G., Corey M.S., and Callanan, P. (2007). Issues and ethics in the Corey, G., Corey M.S., and Callanan, P. (2007). Issues and ethics in the helping professions. Pacific grove, CA: Brooks/Cole. helping professions. Pacific grove, CA: Brooks/Cole.

Callanan, P. (2004). The cheating culture. New York: Harcourt Callanan, P. (2004). The cheating culture. New York: Harcourt

Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors and the collision of two cultures. child, her American doctors and the collision of two cultures.

Kidder, T. (2003). Mountains beyond mountains: The quest of Dr. Paul Kidder, T. (2003). Mountains beyond mountains: The quest of Dr. Paul Farmer. 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.

Elliott, C. (2010) White Coat, Black Hat: Adventures on the Dark Side of Elliott, C. (2010) White Coat, Black Hat: Adventures on the Dark Side of Medicine.Medicine.

How can ethics be used in real life How can ethics be used in 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?