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Ethics 101
Case Study: Sam, the Patient
• An 85 year-old retired school teacher.
• C/O decreased vision in both eyes.
• Exam = 20/80 best corrected in right eye
20/60 best corrected in left eye
• Biomicroscopy = 3+ nuclear sclerotic cataracts
• Dr. E explains the risks and benefits to Sam of
having surgery to improve his vision.
Case Study: Sam, the Patient
• Dr. also explains an alternative option to
surgery that is part of a clinical trial.
• Dr. E is the PI in this trial. If this innovative
technique proves effective, it may
revolutionize cataract treatment. Dr. E could
become famous and benefit financially.
• Sam asks Dr. E to do whatever he thinks is
best - after all, he’s the expert.
1) What are the Ethical Issues
in Sam’s Case ?
2) How should the ophthalmologist respond when
Sam asks him to make the decision?
3) Should the ophthalmologist use therapeutic
privilege and make the decision for Sam?
4) Is there a conflict of interest for Dr. E to offer
Sam the option of participating in his study?
Overall Ethical Principle
Sanctity of Life
Respect for Life
4 Core Ethics Principles
 Autonomy
 Beneficence
 Non-maleficence
 Justice
Respect for Autonomy
Derives from patient’s right to:
Self-determination
Privacy
Imposes responsibility on physician:
Veracity - Telling the truth
Informed consent
Beneficence
Derives from fiduciary relationship to:
Do Good
Act to Help
Imposes responsibility on physician:
Fidelity
Advocacy
Non-maleficence
Derives from general rule of human
conduct that applies to everyone to:
Do No Harm to Others
Act to Prevent Harm to Others
Imposes responsibility on physician to:
Analyze the Burdens vs. Benefits of Tx
Maintain Patient’s Confidentiality
Justice
Derives from general rule of human
conduct to treat others fairly:
Like cases are treated alike - fairness.
Imposes unclear responsibilities on
physicians - society has not sorted this out!
How well are resources allocated?
What is futility?
“People have the right to justice
in the distribution of health resources
as opposed to a right to any and all
specific care/treatments
whether or not they need them
and/or are likely to benefit from them.
. . . Citizens must acknowledge their
responsibility to themselves
to maintain their health
to the best to their abilities.”
-
Leah Curtin, RN
Principle Approach
• Analyzes problems, identifies
values
• Does not always provide a good
mechanism to resolve conflicts
• Helpful to combine with concepts
in Ethics of Care
The Ethic of Care
 Focuses on patient’s relationships
 Recognizes the importance of
feelings & emotions
 Moral responsibility derived from
clinician’s relationship to patient
 Need to understand the context
The Meaning of Caring
Doing for
Being responsive to
Valuing
Extending compassion,
mercy & kindness
The Meaning of Caring
Enhancing human dignity
Connecting with another
Being touched
Helping another find
meaning
Empowering
Platinum Rule
“Do Unto Others As They Would
Like To Have Done Unto Them.”
• Cultural Diversity
• Quality of Life
Sir William Osler, MD
“It’s much more important to know
what sort of patient
has the disease
than what sort of disease
the patient has.”
- Porter (1997) The Greatest Gift To
Mankind
Comparison
Principle-based Ethics vs. Ethic of Care
 Rights & Duties
Responsibility from the
relationship
 Reason & Objectivity
Emotions enhance reason
 Detachment enhances
fairness
Engagement enhances
understanding &
fairness
 Focused on individual
 Focused on family

Ethics

How people relate to each other Ancient Greeks  1960’s movements & beyond
Trying to decide the “right” thing to do.
Requires
 deliberation about facts and context
 reflective analysis of beliefs & values
 actions to solve moral problems
Ethical Dilemmas 
 When legitimate ethical reasons support more
than one alternative
 When moral obligations exist on both sides
 When disagreements about the right thing to
do exist among patient, family, health care
team, institution, and/or 3rd party payers
Why an Ethics Committee?
• Each institution has a responsibility to assure
ethical treatment is provided to patients
• Professionals trained and experienced in ethics
may provide insight and assistance to those
faced with ethical dilemmas
• A multidisciplinary committee provides
protection against idiosyncratic perspectives
The Role of the
Ethics Committee
 Provide consultation
 Educate staff, patients/families,
& public
Recommend organizational
policy
Ethics Committee Goals
• To assure ethical health care
• To improve the quality of
health care
• To improve health care
outcomes
Ethics Consultation Approach
Advisory*
 Collecting pertinent facts.
 Making sure everyone’s voice is heard.
 Examining benefits & burdens of options.
 Attempting to build a consensus.
 Honoring the physician’s right to
conscientious objection.
* NOT Authoritarian
Ethical Process
• Identifying ethical issues & conflicts
• Analyzing underlying values and
sources of disagreement
• Resolving, if possible, ethical dilemmas
in clinical cases
The Ethics Committee
Does NOT Respond to:
 Clinical Inquires or Questions re: Clinical Care

Director of Clinical Quality Management
 Possible Physician Impairment
 Chair, Physician Impairment Committee
 Billing Issues and Business Conflicts of Interest
 Director of the Compliance Program
Have an Ethical Issue ?
Call: