HLSC 480: Ethical Decision-Making Models and Frameworks

In this assignment, you will be demonstrating your understanding of the eight-step ethical decision-making process, the ten Universal Values in Ethical Decision-Making, and the eight ethical decision-making models that will structure your critical thinking analyses when applied to the facts of a given scenario.

Thoroughly answer each question, including all subparts, be concise, accurate, and specific, properly cite your source(s) (e.g., “Text, p. X”), and provide responsive and relevant examples when required.

Assignment

1. List fully the 8-step process the text provides for ethical decision-making.

2. List and briefly describe the 10 Universal Values in Ethical Decision-Making used to govern and guide decisions when ethical dilemmas are reviewed to help health care providers apply ethical principles to their actions. Provide a health care example for each.

3. Provide a concise, complete, and accurate description of the Rights Model of ethical decision-making (“The Rights Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What are moral rights? What are Legal rights? What is its 5-step framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

4. What is the philosophy of utilitarianism? Provide a concise, complete, and accurate description of the Utility Model of ethical decision-making (“The Utility Model is an ethical decision-making model that asserts a decision or action is ethical if . . .” ). In other words, under this decision-making model what determines whether an action or proposed action or consequence is ethical or unethical? What is its 6-step process/framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

5. Provide a concise, complete, and accurate description of the Exceptions Model of ethical decision-making (“The Exceptions Model is an ethical decision-making model that asserts a decision or action may be ethical if . . .”). What model is often used before this model and why? What important question does it ask? What is its 5-step process/framework? What are some of its strengths and limitations? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

6. Provide a concise, complete, and accurate description of the Choices Model of ethical decision-making (“The Choices Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What does it focus on (what is expected)? What are “negative moral rights”? Provide a health care example. What are “positive moral rights”? Provide a health care example. Under this model, how should conflicts between moral and legal rights be resolved? What is its 4-step process/framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

7. Provide a concise, complete, and accurate description of the Common Good Model of ethical decision-making (“The Common Good Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What does it focus on (what is expected)? How does it differ from the Utility Model? Provide a health care example that illustrates this difference. What is its 6-step process/framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

8. Provide a concise, complete, and accurate description of the Social Media Model of ethical decision-making (“The Social Media Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What is it also known as? What main question does it ask? What is its 3-step process/framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

9. Provide a concise, complete, and accurate description of the Virtue Model of ethical decision-making (“The Virtue Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What are the 10 virtues of health care professionals? How does it differ from the other ethical-decision-making models addressed in this course? Provide a health care example that illustrates this difference. What is its 5-step process/framework? Why is this model a valuable way to decide whether an action or situation is ethical or unethical?

10. Provide a concise, complete, and accurate description of the Justice Model of ethical decision-making (“The Justice Model is an ethical decision-making model that asserts a decision or action is ethical if . . .”). What is the difference between “justice” and “fairness”? What is the focus of this model (what is expected)? What are some of its strengths and limitations? What is its 5-step process/framework? Why is this model a valid way to decide whether an action or situation is ethical or unethical?

CHAPTER 2:
VALUES AND
PRINCIPLES
CONFRONTING
OUR HEALTH
CARE SYSTEM
VALUES AND PRINCIPLES CONFRONTING
OUR HEALTH CARE SYSTEM
“Only ignorance! Only ignorance!
How can you talk about only ignorance?
Don’t you know that ignorance is the
worst thing in the world, next to
wickedness?—and which does the most
mischief, Heaven only knows. If people
can say, ‘Oh! I did not know, I did not
mean any harm,’ they think it is all right.”
— ANNA SEWELL (1820−1878),
FROM BLACK BEAUTY (1877)
© Paul Fleet/Shutterstock
Lecture Overview
1) Introduction
2) History of Medical Ethics Committees
3) Policy and Treatment Decisions Facing Medical
4)
5)
6)
7)
8)
9)
Ethics Committees
Universal Values in Ethical Decision-Making
Autonomy
Beneficence
Compassion
Equality of Opportunity
Fairness
Lecture Overview, continued
10) Human Dignity
11) Individual Responsibility
12) Justice
13) Non-Malfeasance
14) Truthfulness
15) Universal Principles of Ethics
16) Difference between Legal and Ethical Decisions
17) The Future: Socially Responsible Decisions
Introduction and History of
Medical Ethics Committees
• Medical Ethics Committees (MECs) are the forum where
many ethical dilemmas are reviewed and resolved by
multidisciplinary teams comprised of health care professionals
from medicine, nursing, law, chaplaincy, and social work.
• Medical Ethics Committees often address the difference
between what is legal and what is ethical, and attempt to
reconcile the two when possible.
Policy and Treatment Decisions
Facing Medical Ethics Committees
Dealing with Ethical Dilemmas:
• Laws can be applied for good or can cause evil.
• Ethics, by definition, is directed toward the
common good.
Policy and Treatment Decisions
Facing Medical Ethics Committees
Decisions Confronting Medical Ethics Committees:
• While MECs generally play an advisory role in ethics
consultation for patients and their families, MECs are
increasingly serving as decision-makers for health care
organizations.
• MECs help health care providers develop the decision-
making capacity to determine how ethical principles
should be applied.
Universal Values in Ethical
Decision-Making
• The American Ethic: An Evolving Public Ethic
• Alignment of the American Ethic with Medical
Decision-Making
Ten Guiding Values
Help govern the decision-making process of Medical Ethics
Committees when ethical dilemmas are reviewed:
Autonomy
2) Beneficence
3) Compassion
4) Equality of Opportunity
5) Fairness
6) Human Dignity
7) Individual Responsibility
8) Justice
9) Non-Malfeasance
10) Truthfulness
1)
Autonomy
Principles of Autonomy
• Personal Autonomy: The Right to Self-Determination
• Corporate Autonomy: An Autonomous Economic Person
• Autonomy from Government
Application of the Value of Personal
Autonomy and Self-Determination
• Providing Women Their Human Rights to
Reproductive Care
• Ensuring Access to Essential Health Care
• Managing Medically Futile Care
• Protecting Patients’ Right to Informed Consent
Application of the Value of
Corporate Autonomy
•
Protecting the Wellbeing of Health Care Institutions
•
Regulating the Health Care Industry
Application of the Value of Autonomy
from Government
•
Accepting the New Federalism
•
Safeguarding Federal and State Outlays for
Health Care
•
Providing Access to Essential Health Care
Beneficence
• Principles of Beneficence
• Application of the Value of Beneficence
1) Providing Access to Affordable Health Insurance
2) Affording Access to Essential Health Care
3) Balancing the Benefits and Risks of Medical Treatments
4) Protecting Human Research Subjects
5) Preserving the Lives of Mature Minors
6) Justifying Vaccinations
7) Making Restitution for Gun Injuries
Compassion
• Principles of Compassion
• Application of the Value of Compassion
1)
Administering Health Insurance Benefits
2)
Designing Government Insurance Programs
3)
Authorizing Physician-Assisted Dying
4)
Consenting to Non-Treatment of Chronically Irreversibly
Comatose Children
Equality of Opportunity
• Principles of Equality of Opportunity
• Application of the Value of Equality of Opportunity
1) Assuring Universal Access to Affordable Health Insurance
2) Providing Equitable Access to Reasonable-and-Necessary Care
3) Defining Impairments for Individuals with HIV Infections
4) Implementing Lifestyle Employment Discrimination Practices
5) Providing for Pregnant Employees
6) Managing Charitable Tax Subsidies at Tax-Exempt Hospitals
Fairness
• Principles of Fairness
• Application of the Value of Fairness
1)
Reforming Regulation of Private Health Insurance
2)
Redistributing the Risk of Poor Health
3)
Improving Fairness in Coverage Decisions by Health Insurers
4)
Reorienting Insurance Incentives to Encourage Healthy Lifestyles
5)
Managing Hospital Readmissions
6)
Responding to Selective Non-Treatment and Selective Abortion
7)
Improving the Fairness of Malpractice Compensation
8)
Compensating Participants Injured in Medical Research
9)
Holding the Food Industry Responsible for Unsafe Food Products
Human Dignity
• Principles of Respect for Human Dignity
• Application of the Value of Respect for Human Dignity
1) Honoring Patients’ Consent to Non-Treatment
2) Consenting to Physician-Assisted Dying
3) Providing Incentives for Donation of the Human Body or Its
Body Parts
4) Meeting the Need for Forcible Medication of Prison Inmates
5) Protecting the Human Rights of HIV/AIDS Patients
Individual Responsibility
• Principles of Individual Responsibility and Self-Reliance
• Application of the Value of Individual Responsibility
1)
Adopting Comprehensive Paradigms of Prevention
2)
Choosing Healthy Lifestyles
3)
Considering Personal Responsibility Legislation
4)
Regulating Low-Nutritious Foods
Justice
• Principles of Justice
1)
Competing Interests: Justice and Compassion in
State Medicaid Spending
2)
Intertwined Interests: Justice and Compassion
in Malpractice
Application of the Value of Justice
1) Providing Universal Access to Affordable
Health Insurance
2) Setting Treatment Priorities
3) Redressing Medical Errors
4) Using Alternatives to Litigation: No-Fault
Malpractice Insurance
Non-Malfeasance
• Principles of Non-Malfeasance
• Application of the Value of Non-Malfeasance
1)
Mandating Vaccinations against Infectious Disease
2)
Determining Best Courses of Treatment
3)
Protecting Patient Privacy and Confidentiality
Truthfulness
• Principles of Truthfulness
• Application of the Value of Truthfulness
1)
Preventing Conflicts of Interest
2)
Licensing Physicians, Nurses, and Other Health Care
Professionals
3)
Eliminating the Corporate Practice of Medicine Doctrine
4)
Reporting in Incentive-Payment Systems
5)
Prescribing Off-Label Medications and Other Medical
Products or Services
6)
Advertising Non-Nutritious Foods to Children
Decisions of Medical
Ethics Committees
• The expectation is that decisions by medical ethics
committees will be socially responsible.
• However, there is no commonly accepted definition of
social responsibility applicable to medical ethics
committees.
Conclusion
• Universal Principles of Ethics
• Difference between Legal and Ethical Decisions
• The Future: Socially Responsible Decisions