practical ethics:
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Practical Ethics:. A Tool for the Ombudsman? Sarah Trafton, JD Finger Lakes Health Systems Agency Rochester, NY. Presentation Outline. Why ethics? Ethical principles generally Ethical issues in long-term care Applying tools of ethics. Why Ethics?. Murky situations - PowerPoint PPT PresentationTRANSCRIPT
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Practical Ethics:
A Tool for the Ombudsman?
Sarah Trafton, JDFinger Lakes Health Systems AgencyRochester, NY
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Presentation Outline
Why ethics? Ethical principles generally Ethical issues in long-term care Applying tools of ethics
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Why Ethics?
Murky situations Conflicting interests Ombudsman role: person who
investigates complaints and mediates fair settlements, especially between aggrieved parties such as consumers and an institution
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What is “Ethics”?
“That branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.”
“ethics” Dictionary.com. Dictionary.com Unabridged (v 1.1). Random House, Inc. http://dictionary.reference.com/browse/ethics (accessed: October 16, 2007).
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“Ethics”, continued…
“That branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions”
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Key Elements of Ethics
Values related to human conduct, with respect to: Rightness and wrongness of actions Goodness and badness of motives
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Values
Values are deeply held beliefs about what is good, right, and appropriate.
Values are deep-seated and remain constant over time.
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“Ethical Dilemma”
A situation that will often involve an apparent conflict between moral imperatives, in which to obey one would result in transgressing another
A moral imperative is a principle originating inside a person's mind that compels that person to act.
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Ethical Principles Generally
Beneficence Nonmaleficence: Least harm Respect for autonomy Justice
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Mr. & Mrs. W______
Shared room in locked behavioral unit
No family Mr. W has dementia, wanders. Mrs. W? Language; socialization Well-intentioned social worker
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Beneficence
Do what is good Strive to achieve the greatest amount
of good (utility)
Mr. & Mrs. W
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Nonmaleficence
Don’t intentionally inflict harm In situations where neither choice is
ideal, choose that which is the least harmful and harms the fewest people
Mr. & Mrs. W
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Respect for Autonomy
People should be allowed to ‘reign over themselves’ and to make the decisions that apply to their lives; control over their lives as much as possible
Paternalism (e.g. professionals)
Mr. & Mrs. W
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Justice
Fair, equitable and appropriate treatment in light of what is due or owed a person
Distributive justice: fair, equitable and appropriate distribution in society determined by justified norms: taxation; donated organs
Mr. & Mrs. W
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Ethical Issues in Long-term Care
Living options Independence vs. safety Capacity to make decisions Managing finances Patient/family/care provider
interactions Others?
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Applying the Tools of Ethics
Assumption: All must be legal Step One: Analyze the Consequences
Who will be helped? Who will be hurt? What kinds of harms and benefits are
possible? How will this look both in the short-term
and in the long-term?
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Applying the Tools of Ethics
Step 2: Analyze the Actions How do they measure up against moral
principles Do any “cross the line” from simple
decency to an important ethical principle? If principles or the rights of different
involved people conflict, is one principle more important than another?
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Applying the Tools of Ethics
Step 3: Make a Decision Take both Step 1 and Step 2 into account
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Examples from Real World
Ken H. Refuses to pay his
Medicaid spend-down to NH
NH court action No personal
allowance
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Examples from the Real World
Mr. A, 81,stroke 2 years ago; NH rehab., now ready to go home
Wife, 55, visited seldom, “rebuilt her life”, unwilling to take Mr. A. home
Mr. A demands to go home
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Examples from the Real World
Ms. L, 47, unmarried, lived alone In NH after hospitalization for MS, in
wheelchair, wants to go home Olmstead decision Ms. L’s is MS unstable
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Examples from the Real World
The changing long-term care world: Policy (e.g Point of Entry) Case law (e.g. Olmstead) Personal and societal values (e.g. Baby
Boomers) Others?
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Examples from the Real World
Your turn?
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Take away message:
Think: Beneficence/Nonmaleficence/Autonomy/Justice
Analyze the consequences Analyze the actions Make a decision