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Contents
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp xiii-xvi
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Foreword
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 08 April 2015, pp vii-xi
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Summary
‘My Hippocratic oath tells me to cut a gangrenous appendix out of the human body. The Jews are the gangrenous appendix of mankind. That’s why I cut them out.’ So explained one of the doctors working in a Nazi death camp during World War II. He thought the procedures he carried out at Auschwitz were justifiable on medical grounds. Killing Jews, Gypsies, Catholics, the mentally and physically disabled, homosexuals and other vulnerable people by various methods - including starvation, lethal injection or poisoning with carbon monoxide - furthered Hitler’s aim of cleansing the gene pool and ensuring the Aryan race’s dominion over all other races (Cook, 2014, citing Lifton, 2000: 232).
Unfortunately, the Allied Powers do not escape culpability for the misuse of science and medicine. In recent years, reports have emerged of unethical medical experiments conducted by the Americans in Guatemala after World War II. Dr John Cutler, who eventually rose to be US Assistant Surgeon-General, led this project and was associated with a parallel one in Tuskegee, Alabama. To study the course of sexually transmitted diseases and the effect of penicillin, the US Public Health Service deliberately infected soldiers, prostitutes, prisoners and mental patients with syphilis without their knowledge or consent.
List of contributors
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Book:
- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp xvii-xviii
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Frontmatter
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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5 - Empathy and care
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 70-84
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Summary
Empathy for the patient is a key attribute that is much prized in the healthcare professional. It is much harder, however, to specify what empathy is. It is to be distinguished from sympathy and compassion, as well as sentimentality. This chapter will explore the nature of empathy, drawing on the work of Edith Stein (1989). Care is central to healthcare but, in view of the discussion on empathy presented, this chapter will take a look at the ethics of care. The ethics of care argues for the importance of contextualising the relationships between caregivers and care-receivers.
The great advances in medical technology and the discovery of new, powerful drugs in recent times have led to a belief that almost all diseases and health problems can be treated efficaciously. We are told that the frontiers of what is medically possible are continually being pushed back, and that medical advances in areas such as nanotechnology and stem cell research promise to be able to treat currently incurable diseases. These advances are truly exciting, but healthcare is much more than the treatment of bodies that have succumbed to disease, or suffer from some disability. It is a truism to say that healthcare professionals do not treat bodies, but persons. Human beings who are suffering from health problems need much more than simply attention paid to their physical needs; they also need comfort and reassurance. Furthermore, it is also recognised that they need to have their psychological and spiritual needs met. In the healthcare setting, these needs are recognised through the provision of counselling and chaplaincy services. This, however, does not mean that the individual healthcare professional – such as a doctor or nurse – is relieved of a responsibility to treat patients as people by an assumption that the comforting and reassurance are the jobs of other members of the healthcare team.
Dedication
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp v-vi
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7 - Rationality in utilitarian thought
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 102-119
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Summary
Utilitarian thought in the Western world could be said to originate with Jeremy Bentham, an eighteenth-century philosopher and social reformer. Bentham introduced the principle of acting for the greatest good for the greatest number, which is at the heart of utilitarianism. Also known as consequentialism, utilitarianism has various forms, such as act and rule utilitarianism and preference utilitarianism. In its modern form, utilitarianism proposes that an action will be morally good if the good outcomes of the action outweigh the bad. This is irrespective of the nature of the action itself, so achieving the desired consequences is at the heart of judging the moral nature of the action. Its appeal is due to the conception of weighing up courses of action and deciding to pursue the one that results in the greatest benefits to all. However, it has its weaknesses, and these will also be considered in this chapter.
There is something appealingly intuitive about consequentialism and its offshoot, utilitarianism. Our daily lives are filled with choices, and unless we are prepared to simply act at random, in order to make the best choice we need to be able to evaluate them all. While in some cases there may be little to distinguish between choices, we normally try to choose the option that affords us most satisfaction. We choose a new car, a new phone or a new job by first working out a set of criteria that will help us to make up our minds and then by applying these to the available choices. For example, in buying a car we might compare different models on engine size, fuel economy, reliability and other relevant factors. In the end, our deliberations lead us to buy the particular car that best satisfies the set of criteria we have chosen. It would be odd if we chose a car we did not like or that we knew had major faults, such as bad brakes or poor steering. Our deliberation is directed towards weighing up our options in terms of good or optimal consequences.
Foundations of Healthcare Ethics
- Theory to Practice
- Jãnis T. Ozoliņš, Joanne Grainger
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- 21 June 2018
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In order to provide the highest level of care to patients and clients, health professionals need a sound knowledge and understanding of healthcare ethics. Foundations of Healthcare Ethics: Theory to Practice focuses on the philosophical concepts underpinning contemporary ethical discourse for health professionals, and arms both students and professionals with the knowledge to tackle situations of moral uncertainty in clinical practice. Specially written to provide an in-depth study into the theoretical foundations of healthcare ethics, it covers a range of normative ethical theories, from virtue ethics to utilitarianism, while also investigating their application to contemporary issues in health care and society. It provides opportunities for self-directed learning, and presents questions and case studies to facilitate engagement and discussion. Foundations of Healthcare Ethics provides both students and professionals with an understanding of the philosophy governing healthcare ethics in order to help provide a better level of care to patients and clients.
6 - Healthcare and virtue
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 85-101
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Summary
Virtue ethics is one of the major normative ethical theories, and has a very long history, having its origins, among other places, in the eudemonic ethics of Aristotle. Virtue ethics begins by considering the question of what is meant by the good for human beings and answers that it is to live a life of moral virtue. For Aristotle (1976), four cardinal moral virtues were required: courage, temperance, justice and prudence. Added to these in the Christian era are the theological virtues of faith, hope and charity, which also make a distinctive contribution to ethical decision-making in the healthcare context.
Character and virtue
The beginnings of virtue ethics can be found in reflecting on the kind of healthcare practitioner by whom we would like to be treated. If we are facing delicate brain surgery to alleviate a particular condition, we would want a good brain surgeon, not a poor one. Similarly, when we are later returned to the ward after a successful operation, we would want to be looked after by a competent nurse, rather than one who is incapable of performing their duties. This is true in every area of life. No one wants their MRI scans interpreted by an incompetent physician or to be represented by an inept lawyer. The slow lane at the checkout at the supermarket, where the checkout operator is bumbling and unskilled, is also to be avoided. In all these cases – as in every situation where we rely on the skills and competencies of others – we want those providing various services not simply to have some minimal competence, but to carry out their roles or activities well.
2 - Ethical theories
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 14-32
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Summary
This chapter begins with the question ‘What is ethics?’ It is not just a list of prohibitions, but rather a reflection on what we consider to be good or bad. It involves an evaluative and disciplined study of what we regard as morally good and what we see as morally bad. This is required if we are to decide how to act. Moral judgements, it will be shown in this chapter, are not simply based on what we think, but on ethical theories. There are two kinds of ethical theories: meta-ethical theories and normative ethical theories. The former are about the kinds of ways in which we can think about the nature of ethical principles and judgements, such as whether they are conventional or universal. Normative ethical theories provide a framework of moral principles that can help us decide whether or not an action is morally right.
Introduction: What is ethics?
Ethics, as it is commonly understood, is connected with various bans against wrong-doing – particularly in business or in the professions. In people’s private lives, it is seen as demanding that, as far as possible, the actions someone chooses to perform have minimal effect on others around them – in some sense, that what people do is morally right. According to such a view, ethics is a means of regulating human behaviour, and so acts as a constraint on human action. This is, in fact, a very simplistic understanding of ethics. Ethics is not about any of the following:
prohibitions concerned with sex
ideal systems, such as codes of behaviour, which are all very noble in theory, but no good in practice
something intelligible only in the context of religion, or
personal likes and dislikes.
In other words, it is neither relative to a particular time, culture or place, nor is it merely the expression of subjective wants and desires (Singer, 2011).
14 - Autonomy and consent
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 228-245
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Summary
One the most vexed questions in healthcare involves patient autonomy, and the extent to which patients are able to make decisions about their healthcare. It may not always be the case that patients will be able to understand the information that they have been given and decide what advice regarding their treatment they should follow. The question of autonomy and the extent to which patients are able to give informed consent to the treatment being recommended to them becomes more difficult as their health deteriorates. These issues will be explored in this chapter.
The idea that patients need to be asked to consent to the medical and healthcare treatment that is being proposed to them is reasonably modern. After all, the healthcare practitioner is the professional, the person with the expertise to decide what treatments are needed by the patient in order to return to health. If a patient needs an operation to remove a tumour, they are expected to accept the surgeon’s advice and have the operation. The Hippocratic Oath states nothing about asking patients for their informed consent before the physician prescribes medication or performs surgery. Despite this, it has generally become accepted that, because patients are autonomous, self-determining human persons, they need to be fully informed of the treatment options available to them, and to decide, having assessed the available information and taken appropriate advice, what treatments they will undertake. This is the recognition that a pathway to health will involve the active participation of patients – that is, it is not simply a matter of patients passively receiving treatment. The whole person needs to be involved in recovery to full health.
Index
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 278-283
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8 - Natural law and the sanctity of human life
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 120-137
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Summary
The concept of natural law has a venerable past in the Western world, having its beginnings in ancient Greece. For example, in the Theban plays, Sophocles illustrates how human actions have to conform to the laws governing human beings that have been ordained by the gods. Natural law theory holds that an understanding of human nature reveals that there are basic human goods, which all human beings need in order to flourish and be fulfilled. Although there are differing views about what is to be included in the list of basic human goods, the broadest list includes life, work and play, beauty, truth, friendship, self-integration, peace of conscience, marriage and religion. Natural law holds that these goods are incommensurable, and one cannot be preferred over another – although some goods may be dominant in particular lives. Crucially, whether some goods dominate or not, we need to share in all the goods to some extent. This leads to some potential problems in terms of ethical decision-making.
The idea of a law
The idea of the natural law is very broad, and not only encompasses views about natural science and the laws governing natural phenomena, but also extends across a number of disciplines, such as law, politics, theology and, of course, ethics. In some respects, all of these areas in the natural law tradition intersect with one another, and arguably the natural law that lies at the base of all of these disciplines is the same natural law. It is claimed that it is the natural law that justifies our intuitions about what is morally right. It is morally right to do our best to heal our patients, for example, because one of the basic human goods is life and health. It is one we all need to lead flourishing lives. We shall provide a brief account of what we might understand by a natural law or law of nature, and then outline how the idea can be applied to develop a normative ethical theory with universal application.
9 - Obligations, duties and rights
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 138-154
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Summary
In the last decade, there has been a resurgence of utilising a Kantian theoretical approach in healthcare ethical reasoning. Kant (1909, 1991, 1997) argues that morality does not depend on how one feels about a particular action, but rather on whether one approaches the action with a good will. Kant believes that the moral life is based purely and simply on duty or obligation, and not on a utilitarian calculation of the best consequences or on a natural law respect for the basic human goods. So Kant holds a deontological view of ethics – an ethics of duty or obligation. Kant says that the most important thing is to will to do what is rational to do, and what reason commands. He says that the principle according to which we should act is to do what we would want to be a universal law – that is, we would want everyone to act in the same way. In healthcare ethics, this means that duties and rights are taken into account in our ethical decision-making.
Kant’s deontological approach to ethics
Kant’s main discussion of ethics can be found in Groundwork for the Metaphysics of Morals (1997), The Critique of Practical Reason (1909) and The Metaphysics of Morals ((1991). The first of these is generally taken to encapsulate Kant’s novel contribution to the discussion of ethics. Throughout his work on ethics, Kant takes a contrary view to those who claim that we can determine what is morally good by an appeal to the good, which he claims we cannot know, as well as those – such as virtue ethicists – who claim that the end of ethical behaviour is happiness. The latter, he thinks, cannot adequately be established. Kant provides us with a view of ethics that he believes is based on reason, the distinguishing mark of a human being. He distrusts emotion, holding that doing what is good is an imperative of reason: the recognition of doing what is right and the will to do this, irrespective of how one feels about what one has to do.
3 - Ethical principlism
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- By Jānis (John) T. Ozoliņš, Australian Catholic University
- Jãnis T. Ozoliņš, Australian Catholic University, North Sydney, Joanne Grainger, Australian Catholic University, North Sydney
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- Foundations of Healthcare Ethics
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- 21 June 2018
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- 08 April 2015, pp 33-50
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Ethical principlism is a popular ethical theory in healthcare ethics. It is based around four principles: beneficence, non-maleficence, autonomy and justice. Some codes of ethics, which try to provide guidance in healthcare, make use of these principles. This chapter will first explore what each of these principles involves, consider some examples of the principles in action and look at some of the difficulties and limitations of principlism. Principlism is at its best when the four principles work together to provide a framework for moral action, and at its worst when principles come into conflict. For example, showing respect for patient autonomy may not always lead to treatment that would be in a patient’s best interests, and so could conflict with the principle of beneficence.
It is no surprise that when we discuss standards of moral conduct or seek guidance in moral decision-making that we appeal to moral principles that help us make decisions about how we should act. Different normative moral theories have different starting points, so we can arrive at different views about what is good and what is morally right. Different theories, starting from different principles, result in different moral rules. This suggests that where there are challenging moral issues in the healthcare area, there will be considerable difficulty in finding agreement about what course of action is morally appropriate. Ethical principlism is a possible way forward: it proposes that, despite differences among ethical theories, there is a common core morality, and invites us to consider our moral decision-making within a framework of four moral principles. That is, it is claimed that whatever our starting point in moral theory might be – whether it is utilitarianism, virtue ethics, deontology or natural law – if we begin from the framework of ethical principlism, then the more likely we are to reach an agreed decision on a moral question. The appeal of ethical principlism is that it will help us to make justifiable moral decisions rather than establish what is objectively morally right. Principlism assumes that because there will be an overlap among the various moral rules enunciated by different normative theories which yield a common core morality, there will be acceptance of the four principles that form the framework within which moral questions are considered.