Bioethics

The study of moral issues in the fields of medical treatment and research.

Law and Ethics

Law is the MINIMUM standard professionals must meet

100% of time No choice in compliance

Ethics is the MAXIMUM standard

There is a choice in compliance Professional accepts the consequences for noncompliance Situational decision-making applies

Morality and Ethics

Morality is the guidelines established by a people to preserve the fabric of their society.
The goal of morality is to protect the values it cherishes

Ethics is a systematic reflection on and analysis of morality adopted for a specific group by those in the group. Health professionals need to be able to analyze the basis of their decisions and determine if the choices come from law, morality, or ethics.

Metaethical Approaches:

Metaethical is a global way of determining ethical issues.. At one end of the spectrum is Absolutism
Clear, unchanging reasons are always present conservative

At the other end of the spectrum is Relativism

Situational, any position can be defended as right as another position liberal

Normative Ethics

Another way of considering ethics is Normative Ethics, which deals with concrete ethical questions. Can the question differentiate types of acts by morally right or wrong? Normative ethics may allow different types of actions by determining which are necessary to maintain harmonious functioning of society. (Different ways to handle the taking of a life: murder, manslaughter, war necessity.) Two positions in Normative Ethics Utilitarianism or Teleological - the end justifies the means Deontological - the means justifies the end

summary

DEONTOLOGY Duty driven Means count Main proponent: Kant

TELEOLOGY Goal Driven Ends count Main proponent: Mill

Virtue Ethics

A third way of looking at ethics is Virtue Ethics. Concerned more with being (character) than doing (acts) Character traits are ascribed as virtuous A mean between two opposing vices - Aristotle Integrity of a persons character is the description of being ethical

Virtue Ethics
Cardinal

Virtues of Integrity are traditionally listed as:

Prudence Courage Temperance (fortitude) Justice Patience Truthfulness

Virtue is an attribute of PT expertise

According to the studies on expertise by Hack, Sheppard, Jensen, and Gwyer.

Each of us has a DUTY as a professional to

Respect Autonomy Assure Nonmaleficence (do no harm) Attempt Beneficence (do good) Keep Fidelity (promise-keeping) Assume Veracity (truth) Provide Justice (distribute benefits) Give Reparations Express Gratitude

Respect Autonomy
Patient

has a right to decide

Refuse treatment Negotiate terms of treatment Select provider of choice Select option

Nonmaleficence to Beneficence
Nonmaleficence
1.

Do no harm 2. Prevent harm 3. Remove harm when it is being inflicted 4. Bring about positive good Beneficence Do good

Fidelity

Faithfulness to the patients reasonable expectations

Respect Competence Follow the statements you have ascribed to as a member of a profession - Code of Ethics Follow policies and procedures of the facility Honor agreements between you and the patient

Veracity
Duty

to tell the truth

Evaluation Practice Billing Community relationships Professional relationships

Justice
Distributive

Justice

Comparative treatment of individuals in allotment of benefits and burdens

Compensatory

Justice

Compensation for wrongs that have been done

Procedural

Justice

Following the rules impartially What is fair treatment

Rights
Patients

Bill of Rights Bioethical Rights

Right to Life Right to Autonomy (self-determination) Right to Health Care

Issues in Bioethics

Research Ethics
Informed

consent Participation without the option of standard treatment Tuskegee Study 1932-1972
Withheld diagnostic information and effective treatment to assure ongoing participation IRB review of all federally funded health research

Defining Death
Absence

of pulse or signs of breathing Ventilator assisted, heart-lung machines Brain death Normally not a dilemma for PTs

Reproductive Medicine
Reproductive
Infertility In

control

vitro fertilization Abortion Fetal Tissue transplants may affect neurological patients Prenatal diagnostic techniques

Economic Issues
Scarcity

of high tech resources Cost controls for procedures Fundraisers to pay for medical procedures tug at heartstrings because it is personal, but as a health policy issue what is paid for can be critical to affordability.

Society versus the Individual

These

areas are the most common faced by rehabilitation personnel in bioethics :

Religious preference Personal preference Right to Die Refusal of Treatment Assisted Suicide

Issues in the News Today

Human

Genome Project

Genetic mapping Cloning

Abandonment
Managed

Care

Rehabilitation Ethical Issues

These

issues have been identified as the major situations causing ethical dilemmas in rehab:
Patient selection Resource allocation Ethics of team care Ethical issues in goal setting

Patient selection and resource allocation

Not

all patients referred to rehab will benefit Resources must be allocated to those who will benefit None selection for rehab may require other interventions

Teamwork
Conflict

between team members Various intervention and ethical philosophies Need to agree on approach

Goal Setting
Conflict

between patient, family, professionals, society Patient input needs consideration

So what?
Why

should we care? Is ethics really a part of our practice?

The

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