Human Service Ethics

Morality and ethics: what are they and why do they matter? All you need to know about ethics approaches and theories Means, ends, principles and virtues six step process of ethical decision making for you to follow Surviving professional life ethically Ethical dimensions of the professional -patient relationship Special challenges: "difficult patients" and patients in suicidal crisis This is a time of great change in our understanding of health, illness, and health care systems.

Medical researchers, practitioners, and administrators must realize that these changes are taking place and look to current, valid research for some answers to the questions which come with increasingly complicated technology and better medications. Since knowledge is the basis for effective decision making, one goal for any medical leader should be to attain as much knowledge as possible.

Ethics has been defined as "rules of conduct recognized in respect of a particular class of human actions." Certainly, a health care administrator should possess a strong sense of what is right and what isn't and have the courage to make sure that everyone in the health care organization understands the difference. Four principles which health care practitioners must consider when faced with a dilemma are A) autonomy, B) beneficency, C) nonmalficence, and 4) justice.

Autonomy is the independence to determine one's own direction, conditioned only by the need to respect others' individual liberties. Beneficence is the righteous philosophy of doing good, while nonmalficence adds the condition that no harm should be done.

Justice, the quality which creates the most controversy, may be defined as fair, just, equitable, and unbiased decision making.1 Morality and ethics: what are they and why do they matter? Case studies become much more than words on a page when health care professionals see these names as people, who hurt, are afraid, and look to you, a medical professional for comfort. The actions the medical practitioner take next will help define their moral values. As Dr.

Purtilo states on page 7, "The goal of morality is to protect a high quality of life for an individual or for a community as a whole." When one enters training to become a health care professional, the next stop should be to prepare themselves to deal with three types of morality: their own, their society's, and that of society as a whole. These are pretty heavy topics for young people of 18 or 20 to ponder, but ponder them they must.

If knowledge is the foundation of trust, morality must be its supporters. All medical professionals will encounter situations which should cause them to "search their souls" for the best answers. The case studies which Dr. Purtilo presents throughout this book are actually a means to play the "what if" game. "What if it were my father/husband/brother/son? What would I do?" Dr. Purtilo closes this first chapter by saying that the formation of our morality and values is an on-going process.

Each case will present slightly different variables and questions, therefore each day will be a type of check-up of our values and morality. All you need to know about ethics approaches and theories Technologic advances are challenging the way health care is delivered and, more than ever, health practitioners as well as administrators are constantly confronted with ethical dilemmas. The DNR - do not resuscitate - order is one of the more challenging edicts to health care professionals today.

The medical professional may have grown to know the patient and family well; the patient may be a terminally ill child or an older person who resembles your grandmother. The desire to save lives has been ingrained in all health professionals from the beginning of their training and perhaps ever longer. A DNR order is one which the patient's family has chosen to be the right course of action. Dr.

Purtilo makes mention of different types of ethics which suit several situations with the goal of giving health practitioners a choice or merely a moment to think before life and decisions must be made: metaethics occur when one attempts to discover the nature and meaning of ethical reasons we propose for making judgments about morality. A thorough understanding of metaethics requires that one should become more familiar with your own beliefs - religious, philosophical, and how you decide what is right and what is wrong.

Self-awareness will lead to knowledge and confidence in making difficult decisions. A normative ethics ask concrete questions related to morality. Within the framework of normative ethics, a person may explore what types of actions are morally right or wrong, what are the actions or ideas which are morally praiseworthy? Answering these types of questions about your own thoughts and beliefs will help you be better prepared to answer the difficult questions which will surely come from a patient, a patient's loved ones, another healthcare practitioner, or even from yourself.

Basically, normative ethics involve what makes up a person's value structure, what he/she will stand for, and what he/she will not tolerate. Normative ethics are the stuff with which a conscience is filled. A the ethics of care - hopefully, the concept of "care" has not been lost in this age of increased technology and alternative medical choices. A health care provider must keep the patient and family foremost in his mind whenever a decision is made about the patient's well-being.

Care is the touchstone of medicine and should always be. Budgets, egos, and expectations from other professionals should never overcome care in the decision-making process. Means, ends, principles and virtues Duties and rights will help you to have the conceptual tools for recognizing and working to resolve problems that arise in your everyday practice. The development of moral character will help you be ready for the hard times when no answers seem forthcoming or when you are confronted that is not easy to face" (Purtilo, p. 63-64).

Being prepared to face the "hard times" in medicine will make one a better healthcare provider. In an article entitled, "Ethical decision making at the end of a life" Deborah Kaplan tells the story of Mrs. C., a 52-year-old woman with metastatic ovarian cancer who is hospitalized with bowel obstruction and pain. She has undergone all the suggested and conventional therapies for her cancer, but now any further intervention is not indicated due to the invasive nature of her cancer in the abdomen. Mrs. C.

does not have an official advance directive, but has expressed her desire to be kept pain free even if this requires her to be sedated at the end of her life. She was started on I.V. morphine which provided good pain relief, but caused her to go into a coma. Mrs.

C.'s family has requested that her morphine dosage be lowered so that she can be alert and interactive and have also asked that she have TPN (total parenteral nutrition) so she won't "starve to death." The moral and ethical question here is: whose orders should be followed, the patient's or the family's? "These are the decisions which face health care practitioners nearly every day. Having a solid foundation in ethics and a firm grasp on your own moral beliefs will be of help when facing situations such as this.

Please notice that I said "help" not "the right answer," because every patient, every family, and every illness in different in at least one respect. A six step process of ethical decision making for you to follow Dr. Purtilo had outlined an excellent set of questions for the health care practitioner and/or administrator to ask: Get the story straight: Gather relevant information.

In other words, "just the facts, ma'm" Your data gathering should cover: A) clinical indications, B) Perference of the patient, C) Quality of life, and D) Contextual Factors. Identify the type of ethical problem: A caring health care provider should try to find out the patient's ethical distress, his/her ethical dilemma, and if there is a locus of authority problem. Use ethics theories or approaches to analyze the problem. Explore practical alternatives. Complete the action. Evaluate the process and the outcome.

Section two: ethical dimensions of professional roles There are several ethical situations which may arise during the time one is a student. Knowing what you believe, how strongly you believe it, your status as a student, and what your moral convictions are will serve you well when you face an ethical question as a student. Surviving professional life ethically In this situation, the necessity for taking care of yourself is of utmost importance.

A moral and ethical health care practitioner will consider the fact hat he/she needs to: A) strengthen one's own self-awareness, B) reflect on past experiences, C) commit to living according to one's own personal values system, D) be vigilant in maintaining personal integrity, and E) develop strategies for fulfilling responsibilities to yourself. Ethical dimensions of the professional -patient relationship study conducted at Harvard Medical School identified the five components of quality end-of-life care as described by the patients themselves.

They are in order of priority: 1) receiving sufficient pain and symptom management, 2) avoiding inappropriate prolongation of dying, 3) achieving a sense of control, 4) relieving burdens and, 5) strengthening relationships with loved ones. Just 25% of Americans die at home surrounded by their family and friends, despite research showing that 70% say that they would prefer to die at home. To prevent the misuse of painkillers, 35 states in the U.S.A. have laws or policies that make it difficult for doctors to prescribe such medications to dying patients.

Many Americans get aggressive end-of-life care in a hospital and not at home. A study showed that 28% of North Americans ages 65 and over were admitted to an intensive care unit during the last six months of life. Most hospitals in the U.S. still don't have end-of-life programs that automatically deliver services to dying patients, such as dedicated help of a social worker or Minister trained to work with the dying and their loved ones.

Despite the growing need for end-of-life care, many doctors and nurses don't receive formal training in this field. Just 39% of the physicians caring for dying patients had been trained in issues that often come up as death approaches. One example of training: how to arrange for social services. It is sad to see how little attention is paid to care at the end of life," said Jim Towey, a former hospice worker who is now the director of the White House Office of Faith-Based and Community Initiatives.

He says He hopes these facts will start a discussion on how the United States can improve the care of dying patients. The most important recommendation is that families should talk about end-of-life issues - before a medical crisis occurs. Special challenges: "difficult patients" and patients in suicidal crisis Even the most conscientious health care provider is human and may sometimes be angered or even provoked by the things that some patients say or do.

Having taken an oath to "first do no harm" some strategies to be used keep a positive attitude with difficult patients are: Keep in mind that many of the most difficult patients come from a world most of us have never seen. Growing up in poverty, with child abuse, or no one to look after you properly does not exactly give a person an outline of the proper way to behave in public.

Some patients present themselves at an emergency room or hospital with conditions which may actually make other people nauseated. Festering, disfiguring tumors, horrifying burns, or sometimes just pure filth, may cause you to want to pull away. Keep in mind that the patient is probably very aware of their problems and is watching you closely to see.