Ethics_of_Health care presentation HS4812.pdf

This presentation explores Immanuel Kant’s categorical imperative and its practical application to a real-world ethical dilemma. Kant’s deontological ethics emphasizes moral duties and the principle that actions must be guided by universal moral laws. The categorical imperative is central to Kant’s ethical theory and consists of three key formulations: the Formula of Universal Law, the Formula of Humanity, and the Formula of Autonomy. Each formulation provides a different perspective for evaluating whether an action is morally permissible.

The presentation begins by explaining these three formulations in detail, highlighting how they work together to establish moral duties. It then applies these principles to a real-world scenario, analyzing whether the action can be universally willed, respects human dignity, and aligns with rational self-governance. Through this analysis, the presentation demonstrates how Kantian ethics provides a systematic framework for making ethical decisions.

The chosen scenario involves a common ethical dilemma where competing obligations test the consistency and universality of moral rules. This presentation aims to show how Kant’s categorical imperative remains relevant in contemporary moral decision-making, offering clear guidelines for evaluating right and wrong. By connecting philosophical theory to practical cases, it emphasizes the ongoing importance of ethical reasoning in modern society.

1. Ethics of Healthcare
Prepared by: Irwin I. Cornelio,
RN, DPE

2. Course Description: The course deals with the
application of Ethico-moral concepts and principles affecting
care of the individuals, families, population group and
community. It involves discussion of issues and concerns in
varied health care situations. The learners are expected to
apply sound ethical decision-making in varied health scenarios.
Course Credit: Theory; 3 units (54 hours)

3. According to M. Scott Peck, (in the Road less
travelled) Our view of reality is like a map with
which to negotiate the terrain of life. If the map
is true and accurate we will generally know
where we are, and if we have decided on
where we want to go, we will generally know
how to get there. If the map is false and
inaccurate, we generally get lost.

4. Entering a healthcare profession
Allied Health Science: A group of healthcare professions that provide a range of
diagnostic, technical, therapeutic and support services in connection with health care.
Professions such as physician, nurses, dentist and pharmacist.
Medical laboratory technology.
Radiography.
Operation theatre technology.
Optometry.
Nutrition and dietetics.
Physiotherapy.
Occupational therapy.
Speech-language pathology.
Music Therapist
Athletic Trainers
There are many occupations that one may choose, but few will find their choices as
rewarding, engaging, exciting, meaningful, frustrating and overwhelming as those who
are involved in the practice of health care. Health care practice combines science and
technology with patient care and offers careers that never stop growing, challenging
and providing opportunities for development.

5. Characteristics of a Profession
Competence in a specialized body of knowledge.
The provision of a particular service to society.
Standards of education and practice.
Self-regulation –An acknowledgement of specific duties and responsibilities
towards patients, colleagues and society.

6. Republic Act No. 877, also known as the
Philippine Nursing Law, establishes the
Board of Examiners for Nurses and regulates
the practice of nursing in the Philippines,
including the requirements for examination
and registration, the refusal, revocation, and
suspension of certificates, and the
prohibition of nursing practice without a
valid certificate.
Republic Act 4226 –
Hospital Licensure
Act requires all
hospital professionals
to be licensed
before it can
operate

7. Legal Practice Act
Scope of professional practice.
Requirements and qualifications for licensure or
certification.
Exemptions to basic requirements.
Grounds for administrative actions.
Penalties and sanctions for unauthorized
practice.
HC professional groups
generally operate
under a legal practice
act that outlines the
activities the providers
perform in the delivery
of patient care and
develop a code of
ethics to assist in self-
regulation.

8. Professional Etiquette
Health care practice as a community -All practitioners are responsible for
its continued upkeep.
Health care team –As a member of the professional group, we take an
obligation to be a peer to others.
Professional code of ethics –A guide to self-regulation.
Good practice and good manners.
Involves issues such as the need to avoid talking badly about another
practioner.
Maintain appropriate relationships at the worksite.
Stay within the role boundaries of our specialty.

9. Scenario:
Barbara is a special procedure nurse at a medium sized hospital. She enjoys
her position as it allows her to spend additional time with the patients who
have come in for cardiac stress test. In fact, she enjoys almost all aspects of
her job with the exception of dealing with Dr. Jones, who is invariably late for
procedure appointments. Barbara understands that physicians have full
schedules and often must take additional time with some patients which
makes them late for all other appointments that day. However, in this case it
is not a professional issue that is causing the problem but rather a personal
one. It is widely known among the staff that he is having an affair with a
nurse from the critical care unit and spends time talking with the nurse while
on the job. Barbara does not care who Dr. Jones is having an affair with and
feels it is not her business to judge. However, she resents being bought into
the matter, as the doctor has directed her to tell his waiting patients that he
is being held up in an emergency.

10. QUESTION:
Is Nurse Barbara making a big deal over a small
matter?
Does she have a duty to cover for her
colleague?
How would you address this issue?
What best serves the patients?

11. Health Care Ethics
Designed to promote order and maintain civility.
Deals with rights and welfare of other people.
Master skills of professional courtesy and decorum.
When practitioners fail to maintain an appropriate standard of legal or ethical conduct, the
consequence can be career ending.
Values
Ethics (Joseph Fletcher) -critical reflections and rational analysis about morality. Study of
how we make judgment in regard to right and wrong.
Morals –sense of knowing what is right from wrong.
Those who disagree with our personal views are often seen not only as being wrong but evil.
The value of your opinion is directly related to your command of the facts and the quality of
reasoning and rationales you provide for your opinions.
Specialist who know something is wrong but cannot articulate their reason or the method
by which they derived their beliefs are at real disadvantage.
Abundance of value questions.

12. To acknowledge that individuals can have diferentopinions on ethical issues is not the same as saying
that all opinions are equal and have the same worth and credibility. In healthcare there are decisions
that must not be made. There are actions that must not be tolerated. Below are questions that health
care practitioners may encounter and need to draw from our knowledge and understanding of clinical
ethics, law and health care etiquette.
1.1. When, if ever, is it permissible to take a gift or gratuity from a patient?
2.2. When is it legitimate and perhaps mandatory to break a patient’s confidence?
3.3. Is it permissible to lie to a client if it is for his or her own good?
4.4. What should I do if I make a medication error that no one else knows about but it appears
harmless to my patient?
5.5. What obligations do I have to a colleague and fellow practitioner when I suspect that the
colleague I am working with is abusing alcohol or appears chemically imparedwhile on duty?
6.6. What if I come upon a practice that is legal but appears to me personally to be unethical?
7.7. When, if ever permissible to take a gift, payment or benefit from a company outside my hospital
that I refer patients to?
8.8. What if I come upon a situation where what I want to do seems ethical but is illegal?
9.9. I am writing a paper for publication on the subject of hypothermia. I find an amazing reference
from the medical experiments conducted in the Nazi concentration camps. Is the information
gained in the experiments tainted beyond use?
10.10. I begin to have feelings for a patient, can I ethicalydate him or her?

13. A young man enters a pilot training and needs to take a leave of absence owing to mental
health issues, which he describes as “burnout.” Following therapy he is allowed to return to his
studies and completes the course. After graduation he applies for a position with a small
regional airline, fully disclosing his previous problems. He completes the application and
health examinations and is found to be fit for service and employed. He again begins to
suffer from depression and suicidal thoughts and seeks professional outpatient care.
Although as a pilot he is required by professional duty to self-report any health condition to his
employer that would restrict his ability to perform his duties, he fails to do so. As a result, the
unthinkable occurs and crashes his plane, killing himself, the crew and all the passengers.
The health care providers in this case knew that the young pilot was having difficulties that
would preclude him from flying a plane and therefore had given him a note providing him a
medical release from duty that day. However, given the level of professionalism of his duties
and the need for personal privacy and medical confidentiality, the established process
called for self-reporting, which the pilot did not do.
1. Given the nature of his work and his condition, should the health care providers have
reported his condition to his employers and not depended on him performing his professional
duty of self-reporting?
2. Would you be willing to generalize your decision to other positions such as bus drivers and
train engineers?

14. The Foundations of Law
In his writings, the Greek philosopher Plato proposed an ideal state ruled by
a wise philosopher king. In this state, disputes between individuals would
be settled by the philosopher king applying unwritten laws guided by
reason. Even in his own time, Plato came to understand that this was an
unworkable ideal and agreed to a process where disputes were settled by
authorities using written laws. These laws were to be applied without
regard to the circumstances of the individuals involved. It is from this
neutral application of law that we take the tradition of a “rule of law and
not of men”. Accordingly, each man is to be judged equally under the
law.

15. Sources of Law
Common Law -Which emanates
from judicial decisions
Statutory Law –Which arises from
legislative bodies.
Administrative Law –Which flows
from the rules and regulations of
administrative agencies.

16. VALUE DEVELOPMENT
Hierarchy of Needs by Abraham Maslow
According to Maslow –as each need is satisfied, the needs of the next
level become the dominant motivators for our actions.
Predict your next actions.
There are times, however, when individuals appear to move from needs-
based motivation to attending to an inner subjective set of feelings,
attitudes, beliefs and opinions that make up their personal world view or
value system. When faced with a dilemma, seem to ask themselves not
what we would do but rather what we should do. What you “ought to do”.
There is an unbridgeable gap between fact and value.
Assignment -Hume’s Law

17. Common Decision Shaping Values
Independence -Freedom from constraint
Autonomy –Self-determination
Privacy/confidentiality –Fear of invasion
Self-esteem –Need to value oneself
Well being –Freedom from pain and suffering
Security –Control of fear and anxiety
Sense of belonging –Group identification
Sexual and spiritual support –Fulfillment
Freedom from disability –Physical and mental capacity
Accomplishment -Personal Fulfillment

18. Scenario:
Consider how an athletic patient, who places a high value on personal
independence, self-determination, personal privacy and freedom from
disability might react to a spinal injury that left the patient paralyzed and in
need of his bodily functions being cared for by others. Loss of good life and
no life might be preferable. The same injury to an individual with a different
set of values -that this life is a mere test for rewards given in the after life
might lead that person to cling to life with great tenacity never considering
death as a viable option.

19. Lawrence Kohlberg formulated a theory asserting that individuals progress
through six distinct stages of moral reasoning from infancy to adulthood.
He grouped these stages into three broad categories of moral reasoning,
pre-conventional, conventional, and post-conventional.Each level is
associated with increasingly complex stages of moral development.
Kohlberg suggested that people move through these stages in a fixed
order and that moral understanding is linked tocognitive development.

20. Kohlberg’s Stage Theory of Moral reasoning
PRECONVENTIONAL MORALITY
Preconventionalmorality is the first level of moral development, lasting until
approximately age 7. During this level, children accept the authority (and moral
code) of others.
Preconventionalmorality is when people follow rules because they don’t want
to get in trouble or they want to get a reward. This level of morality is mostly
based on what authority figures like parents or teachers tell you to do rather
than what you think is right or wrong.
Authority is outside the individual, and children often make moral decisions
based on the physical consequences of actions.
For example, if an action leads to punishment, it must be bad; if it leads to a
reward, it must be good.
So, people at this level don’t have their own personal sense of right and wrong
yet. They think that something is good if they get rewarded for it and bad if they
get punished for it.
For example, if you get candy for behaving, you think you were good, but if you
get a scolding for misbehaving, you think you were bad.
At the preconventionallevel, children don’t have a personal code of morality.
Instead, moral decisions are shaped by the standards of adults and the
consequences of following or breaking their rules.

21. Stage 1. Obedience and Punishment Orientation. The child/individual is good to
avoid being punished. If a person is punished, they must have done wrong.
Stage 2. Individualism and Exchange. At this stage, children recognize that
there is not just one right view handed down by the authorities. Different
individuals have different viewpoints.
Level 2 –Conventional Morality
Conventional morality is the adolescent phase of moral development focused
on societal norms and external expectations to discern right from wrong, often
grounded in tradition, cultural practices, or established codes of conduct.
We internalize the moral standards of valued adult role models at the
conventional level (most adolescents and adults).
Authority is internalized but not questioned, and reasoning is based on the
group’s norms to which the person belongs.
A social system that stresses the responsibilities of relationships and social order is
seen as desirable and must influence our view of right and wrong.
So, people who follow conventional morality believe that it’s important to follow
society’s rules and expectations to maintain order and prevent problems.
For example, refusing to cheat on a test is a part of conventional morality
because cheating can harm the academic system and create societal
problems.

22. Stage 3. Good Interpersonal Relationships. The child/individual is good to be seen as being
a good person by others. Therefore, answers relate to the approval of others.
Stage 4. Law and Order Morality. The child/individual becomes aware of the wider rules of
society, so judgments concern obeying the rules to uphold the law and avoid guilt.
Level 3 –PostconventionalMorality
Postconventionalmorality is the third level of moral development and is characterized by
an individual’s understanding of universal ethical principles.
Postconventionalmorality is when people decide based on what they think is right rather
than just following the rules of society. This means that people at this level of morality have
their own ethical principles and values and don’t just do what society tells them to do.
At this level, people think about what is fair, what is just, and what values are important.
What is considered morally acceptable in any given situation is determined by what is the
response most in keeping with these principles.
They also think about how their choices might affect others and try to make good
decisions for everyone, not just themselves.
Values are abstract and ill-defined but might include: the preservation of life at all costs
and the importance of human dignity. Individual judgment is based on self-chosen
principles, and moral reasoning is based on individual rights and justice.
According to Kohlberg, this level of moral reasoning is as far as most people get.
Only 10-15% are capable of abstract thinking necessary for stage 5 or 6 (post-conventional
morality). That is to say, most people take their moral views from those around them, and
only a minority think through ethical principles for themselves.

23. Stage 5. Social Contract and Individual Rights. The child/individual
becomes aware that while rules/laws might exist for the good of the
greatest number, there are times when they will work against the interest of
particular individuals.
The issues are not always clear-cut. For example, in Heinz’s dilemma, the
protection of life is more important than breaking the law against stealing.
Stage 6. Universal Principles. People at this stage have developed their
own set of moral guidelines, which may or may not fit the law. The
principles apply to everyone. E.g., human rights, justice, and equality.
The person will be prepared to act to defend these principles even if it
means going against the rest of society in the process and having to pay
the consequences of disapproval and or imprisonment.
Kohlberg doubted few people had reached this stage.

24. Problems with Kohlberg’s Methods
1. The dilemmas are artificial (i.e., they lack ecological validity)
Most dilemmas are unfamiliar to most people (Rosen, 1980). For example, it
is all very well in the Heinz dilemma, asking subjects whether Heinz should
steal the drug to save his wife.
However, Kohlberg’s subjects were aged between 10 and 16. They have
never been married, and never been placed in a situation remotely like the
one in the story.
How should they know whether Heinz should steal the drug?
2. The sample is biased
Kohlberg’s (1969) theory suggested males more frequently progress beyond
stage four in moral development, implying females lacked moral reasoning
skills.

25. His research assistant, Carol Gilligan, disputed this, who argued that
women’s moral reasoning differed, not deficient.
She criticized Kohlberg’s theory for focusing solely on upper-class white
males, arguing women value interpersonal connections. For instance,
women often oppose theft in the Heinz dilemma due to potential
repercussions, such as separation from his wife if Heinz is imprisoned.
Gilligan (1982) conducted new studies interviewing both men and women,
finding women more often emphasized care, relationships and context
rather than abstract rules. Gilligan argued that Kohlberg’s theory
overlooked this relational “different voice” in morality.
According to Gilligan (1977), because Kohlberg’s theory was based on an
all-male sample, the stages reflect a male definition of morality (it’s
androcentric).
Men’s morality is based on abstract principles of law and justice, while
women’s is based on principles of compassion and care.
Further, the gender bias issue raised by Gilligan is a reminder of the
significant gender debate still present in psychology, which, when ignored,
can greatly impact the results obtained through psychological research.

26. 3. The dilemmas are hypothetical (i.e., they are not real)
Kohlberg’s approach to studying moral reasoning relied heavily on his semi-structured
moral judgment interview. Participants were presented with hypothetical moral
dilemmas, and their justifications were analyzed to determine their stage of moral
reasoning.
Some critiques of Kohlberg’s method are that it lacks ecological validity, removes
reasoning from real-life contexts, and defines morality narrowly in terms of justice
reasoning.
Psychologists concur with Kohlberg’s moral development theory, yet emphasize the
difference between moral reasoning and behavior.
What we claim we’d do in a hypothetical situation often differs from our actions when
faced with the actual circumstance. In essence, our actions might not align with our
proclaimed values.
In a real situation, what course of action a person takes will have real consequences –
and sometimes very unpleasant ones for themselves. Would subjects reason in the
same way if they were placed in a real situation? We don’t know.
The fact that Kohlberg’s theory is heavily dependent on an individual’s response to an
artificial dilemma questions thevalidityof the results obtained through this research.
People may respond very differently to real-life situations that they find themselves in
than they do to an artificial dilemma presented to them in the comfort of a research
environment.

27. DEONTOLOGY
Deontology is an ethical theory that emphasizes the importance of rules,
duties and obligations in determining what is morally right.
The term Deontology comes from the Greek words “deon” meaning duty
and logos meaning study.
Immanuel Kant is the most prominent deontologist. His ethical theory is
based on the idea that the morality of an action depends on whether it
conforms to a rule of duty.
Central to Kant’s deontology is the concept of the categorical imperative,
a universal moral law that applies to all rational beings and is independent
of personal desires.

28. KEY CONCEPTS OF DEONTOLOGY
Duty and obligation: Actions are morally obligatory if they adhere to certain duties,
regardless of the consequences.
Moral absolutism: Deontologist often hold that certain actions are always right or
wrong, no matter the outcome.
Intention vs. consequence: The morality of an action is judged by the intention
behind it, not by its consequences.
STRENGTHS OF DEONTOLOGY
Consistency: Deontology provides a consistent framework for making moral
decisions.
Respect for individuals: It emphasizes the intrinsic worth of individuals and their rights,
making it strong in arguments for human rights.
CRITICISMS
Rigidity: Critics argue that deontology can be too rigid, as it doesn’t allow for
exceptions in extraordinary situations.
Conflict of Duties: Deontologist may struggle with situations where duties conflict,
such as telling the truth versus protecting someone from harm.

29. Telling the Truth:
You are a nurse, and a patient asks you if their condition is terminal.
According to Kant, you have a duty to be honest even though the truth may cause
distress. The duty to tell the truth is paramount.
Keeping promises:
You should keep your promise as breaking it would be morally wrong, regardless of
how much you want to attend the event.
Duty to Save Lives
You are a firefighter and arrive at a burning building where two people are trapped in
different rooms. You only have time to save one.
A strict deontologist might say that, you have a duty to save lives, but deontology
doesn’t always provide a clear answer for how to choose between two equally
important duties. However, some deontologists argue that you should act accdgto
a pre-existing rule, such as save the most people possible.
LYING TO PROTECT SOMEONE:
A murderer comes to your door looking for a person you are hiding. If you tell the
truth, the person will likely to be killed.
In Deontology, you must tell the truth, regardless of the consequences.

30. Respecting Autonomy:
A patient refuses a life-saving treatment because of their religious beliefs.
You know that without the treatment, they will likely die.
Respecting the patient’s autonomy is a key duty in deontology. Therefore,
you should respect the patient’s decision, even though it may lead to their
death.
Following the Law
You are driving and come to a stop sign at an empty intersection late at
night. There is no traffic and it would be safe to go through the intersection
without stopping.
You should stop at the stop sign because its your duty to obey the law
regardless of the situation or outcome.
Whistleblowing
You work for a company that is secretly dumping toxic waste into a river.
Reporting this could cost your job but it is your duty to prevent harm.

31. ON DUTY AND MORALITY: Duty is the necessity to act out of reverence for the law:
Moral actions are of sense of duty, not because of their consequences.
In law, a man is guilty when he violates the rights of others. In ethics, he is guilty of doing
so. This quote illustrates the importance on intention and moral thinking not just outward
actions.
ON HUMAN DIGNITY AND AUTONOMY: So act that you use humanity, whether in your
own person or in the person of any other, always at the same time as an end, never
merely as a means. Never be used as mere tools for another’s purpose, they must be
respected as individuals with their own inherent worth.
Two things fill the mind with ever increasing wonder and awe; the starry heavens above
me and the moral law within me. Reflects deep reverence for both natural world and
the moral order, which he saw as universal and intrinsic to human reason.
ON FREEDOM AND RATIONALITY: Enlightenment is a man’s emergence from his self
imposed immaturity. Immaturity is the inability to use one’s understanding without
guidance from another.

32. Nothing in the world –indeed, nothing even beyond the world can possibly be
conceived which could be called good without qualification except a good will.
Underscores on the purity of one’s intentions as the foundation of moral goodness.
ON ETHICS AND LAW. Morality is not properly the doctrine of how we may make
ourselves happy, but how we may make ourselves worthy of happiness. Kant
distinguishes between happiness and moral worth suggesting that ethical behavior is
about deserving happiness rather than achieving it.
Live your life as though your every act were to become a universal law.
Live your life: Kant is addressing the way we conduct ourselves in everyday situations
–our decisions, actions, and intentions.
As though your every act: This means considering each decision or actin take, no
matter how small or significant.
Were to become a universal Law: Imagine that the way you choose to act could be
made into a law that everyone else would follow in similar situations. In other words,
your action sets a standard or rule that others would be bound to follow universally.
Kant is suggesting that before we act, we should ask ourselves, “Would it be
acceptable if everyone in the world acted in the same way in this situation”?
Lying: Suppose you are considering telling a lie to get out of a difficult situation.
According to this principle, you should ask yourself whether it would be acceptable if
everyone lied in similar situations. If everyone lied, trust would be impossible and
communication would break down. Therefore, lying cannot be a universal law. It is
morally wrong to lie.

33. That morality is not about the consequences of an action but about whether the
action itself can be justified as a universal moral law. The idea is to act in a way that
respects the moral law as something that should apply to everyone equally,
emphasizing consistency, fairness, and the intrinsic value of ethical principles.
In essence, Kant’s quote is a call for ethical consistency and integrity, urging people
to act according to principles that they believe should be applicable to everyone,
thereby ensuring that their actions are morally sound.
Morality is not properly the doctrine of how we may make ourselves happy but how
we may make ourselves worth of happiness.
Kant is stating that the purpose of morality is not to teach us how to achieve
happiness or pleasure. Unlike utilitarianism that focus on maximizing happiness or
well-being. Kant argues that morality should not be concerned with the pursuit of
personal satisfaction or pleasure.
Kant believes that morality is about making ourselves deserving of happiness
through our actions and character. This means living in a way that aligns with moral
principles, fulfilling our duties, and acting out of a sense of duty rather than for
personal gain.

34. Kant is emphasizing that the true value of morality lies not in what it can provide in terms of
personal happiness, but in how it shapes us as moral beings. He is suggesting that happiness
alone is not enough, what is crucial is whether we have acted in a way that merits
happiness.
For Kant, an action has moral worth if it is done out of respect for moral duty not because it
leads to personal happiness or satisfaction. A person who acts morally deserves happiness
because they have acted rightly, regardless of whether those actions bring them pleasure.
Happiness is a state of well-being or contentment, but Kant argues that to be truly worthy of
happiness, one must act according to moral principles. In other words, happiness should be
a result of being morally good, not the goal that drives moral action.
Helping other: Imagine you help someone in need. If you do it solely because it makes you
happy or because you expect some reward, your action, while still beneficial, lacks moral
worth in Kant’s view. However, if you help because you recognize it as your moral duty to
assist others, then you are acting in a way that makes you worthy of happiness.
Kant’s philosophy suggests that we should prioritize moral principles over our personal desires
for happiness. By doing so, we align ourselves with what is morally right, and through this, we
become deserving of happiness. It’s a call to focus on being morally good rather than
simply seeking happiness, as true happiness, according to Kant comes from living a life that is
morally upright.
In essence, morality is striving to be good and acting out of duty, not about seeking pleasure
or happiness as the end goal. When we live morally, we become worthy of happiness we
might experience.