* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Practical Ethics
Consequentialism wikipedia , lookup
Moral relativism wikipedia , lookup
Informed consent wikipedia , lookup
Morality and religion wikipedia , lookup
Virtue ethics wikipedia , lookup
Ethical intuitionism wikipedia , lookup
J. Baird Callicott wikipedia , lookup
Kantian ethics wikipedia , lookup
Ethics of technology wikipedia , lookup
Sexual ethics wikipedia , lookup
Declaration of Helsinki wikipedia , lookup
Secular morality wikipedia , lookup
Alasdair MacIntyre wikipedia , lookup
Marketing ethics wikipedia , lookup
Aristotelian ethics wikipedia , lookup
Accounting ethics wikipedia , lookup
Thomas Hill Green wikipedia , lookup
Compliance and ethics program wikipedia , lookup
Organizational technoethics wikipedia , lookup
Arthur Schafer wikipedia , lookup
Ethics of artificial intelligence wikipedia , lookup
Clare Palmer wikipedia , lookup
Business ethics wikipedia , lookup
Practical Ethics Stuart Sprague, PhD Practical Ethics Some see this as an oxymoron Ethical realists think ethics stands above practice • Ethics is fixed and unchanging, regardless of practice • Changing ethics in light of practice smacks of cultural relativism Other post-modern views allow for ethics which rises out of practice Solidarity Idea from Richard Rorty, and others, that moral progress is possible • Changes in moral standards over time reflect common human experiences of pain, humiliation, pity and benevolence • Reason can give “ideals,” but practice shows us an equilibrium between principles and practice. Practice of Resuscitation Devised in modern medicine as a response to body systems arrest or failure Seen as something anyone can learn Has a common sense appeal that it should be given to everyone who experiences cardiac or pulmonary arrest-”Why would you not do it?” Unlike other medical procedures, it becomes a default assumption. Must write order not to do it. Autonomy Highly valued principle since the Enlightenment One of four basic principles of medical ethics Key element of physician-patient relationship Essential component of informed consent Autonomy Not an absolute Two persons in dyad, each of whom has autonomy • Professionalism demands subjection to the interests of the patient • AMA Code of Ethics says no physician is required to give treatment simply because it is requested Resuscitation II Common assumption that CPR is always beneficial challenged in era of debilitating chronic illness Requests for CPR may not be based on fully autonomous choice • Full autonomy requires full knowledge • Substituted judgment of surrogate adds a layer of separation from full autonomy Recent AMA action Opinion 2.035 (AMA Code of Ethics) “Physicians are not ethically obligated to deliver care that, in their best professional judgment, will not have a reasonable chance of benefiting their patients. Patients should not be given treatments simply because they demand them.” Annual Meeting 2011 saw request to CEJA “for practical ethical guidance to help them refuse inappropriate requests while maintaining positive relationships with patients.” Back to Practical Ethics Physicians commonly refuse patient requests for inappropriate treatments: narcotics ,antibiotics, cesarean sections et al. What are reasons for acceding to requests for inappropriate CPR? • Fear of legal repercussions • “This is different; it’s life or death.” Would solidarity of action create new guidelines from which to operate? Potential Problems Could be seen as effort only to save money. It would require a new perspective on CPR in the mind of the public. • It is a major medical intervention requiring skill and judgment rather than something anybody can do and everybody ought to have. • Guidelines needed will vary among patients. It would require true solidarity among a variety of institutions and perspectives. Buy in from the top is crucial. Advantages Patients would be spared suffering from invasive therapy of little or no value. Staff would experience less moral distress. Valuable resources could be devoted to other, more urgent needs. (e.g. shortages of epinephrine, etc.) Strategies Work with ethics committees to raise discussion of a new approach. Work with policy making entities to develop new policies. Do in-service with staff Develop role plays to practice the language of a new approach. Join SC-CSI