Download Ethics as a Contributor to a Culture of Quality

Spectrum Health
Ethics & Quality
NAHQ Annual Educational Conference
September 17-20, 2006
Jason E. Gillikin, CPHQ
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Agenda
 Introductory comments
 A bit about ethics
 Challenges for application
 Basic principles of ethical theory
 Strategies for linking ethics & quality
 Open discussion
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Introductory Comments
 About your presenter
 About Spectrum Health
 State of the industry –
 Moral philosophy
 Healthcare quality
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A Bit about Ethics
 What “ethics” is NOT:
 Compliance
 Teamwork
 Psychology
 Social work
 Trendy “leadership” fad
 Manipulation tool
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A Bit About Ethics
 “Ethics” – moral philosophy – is a
branch of value theory that addresses
the methods by which value-laden
decisions are made among several
possible outcomes
 Principles of conduct (process) versus
principles of value (outcome)
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Challenges for Application
 State of academic moral philosophy
 Low degree of public knowledge about
the essentials of moral theory
 Belief that anyone can speak with
authority about ethical issues
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Initial Concepts
 Metaethics
 What is the source of ethics?
 How do we know what is ethical?
 How rigidly do ethical rules/norms apply?
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Initial Concepts
 Evaluation criteria for moral theories
 Consistency (usefulness)
 Determinacy (usefulness)
 Livability (usefulness)
 Publicity (usefulness)
 Coherence (correctness)
 External support (correctness)
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Initial Concepts
 Absolutism (principles & processes)
 Agency
 Autonomy – does it matter?
 Determinism/free will
 Externalism (moral beliefs don’t
moviate moral actions) v. internalism
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Initial Concepts
 Fact-value fallacy
 Heroism
 Instrumental value
 Moral facts; quasirealism
 Perfection of duty
 Projectivism
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Ten Major Systems
 Egoism
 “I have moral obligations only to myself.”
 Varieties, e.g., superenlightened egoism
 One of the few truly self-consistent theories
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Ten Major Systems
 Relativism
 “All of morality depends on the local culture.”
 Denies universal truths
 Usually not considered a true theory, but rather
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an objection to theory – but, often considered to
be sufficient in itself by the uninformed
As such, acts like egoism with a social aspect
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Ten Major Systems
 Teleology (consequentialism)
 “The moral content of an action depends on its
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consequence.”
Varieties, e.g., utilitarianisms
Usually have a few set maxims (e.g., “minimize
pain and maximize happiness”) as guiding
principles
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Ten Major Systems
 Deontology (nonconsequentialism)
 “Although consequences matter, some acts are
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right or wrong independent of the outcome.”
Varieties, e.g., duty-based and rule-based
ethics
The concepts of duty, honor and obligation form
strong aspects of deontological moral analysis
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Ten Major Systems
 Virtue Theories
 “Being moral means being virtuous.”
 Good character is essential and can be
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habituated into existence
In Aristotle’s view, virtues are the mean
between vices (e.g., bravery is the virtuous
mean between fearfulness and rashfulness)
Emphasis on character, not process/outcome
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Ten Major Systems
 Care Ethics
 “Morality consists in fostering relationships
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among people, and in responding to the
perceived needs of others.”
Foil to the justice-based perspectives of
utilitarianism and Kantian duty ethics
Strongly represented in medicine, pastoral care
and social work
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Ten Major Systems
 Natural Law
 “Morality consists in honoring the purposes and
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systems effected by nature.”
Strong current in Catholic moral theology
Can, in some ways, admit to social Darwinism
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Ten Major Systems
 Divine Command
 “God’s will determines what is subject to moral
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praise or blame.”
Permits a high degree of absolute thinking
Internally self-consistent
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Ten Major Systems
 Social Contract/Rights Theories
 “Man as a social animal has obligations to the
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broader society that cannot be ignored.”
Often not considered its own theory but rather a
subset of deontology or rule utilitarianism
Expands traditional rule/duty systems by making
society as a whole a primary moral agent –
communitarianism – with emphasis on “rights”
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Ten Major Systems
 “Null Theory”
 “Ethics? Nonsense.”
 Denial that ethics is possible or meaningful
 Often rooted in technical philosophy (e.g.,
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philosophy of language)
Interesting implications for the analysis of
sociopathic behavior
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Terri Schiavo: Case Study
 Should hydration be withheld?
 Each theoretical system will provide a
different answer, and a different
justification for that answer
 Then … what’s the right answer?
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Why Link Ethics & Quality?
 Whether they know it or not, people
tend to adopt value systems that are
consistent with the basic moral
theories
 Leveraging the motivating power of an
ethical paradigm can improve a
“culture of quality”
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Strategies
 Include all levels of staff in the
decision-making aspects of the quality
program, since people’s ethical
response shifts as they grow in
involvement or familiarity
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Strategies
 Communication – official and
especially unofficial – should include
the core concerns of the major
theories (e.g., process, outcomes,
duty) as justification points
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Strategies
 HOWEVER, do not presume to tell
staff what their moral imperatives are
– the locus of ethical decision-making
is the self, not a health-care system;
lecturing breeds cynacism
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Strategies
 Respect that staff members will have
a variety of perspectives that are
worthy of toleration
 Remember that advancing one
particular theoretical approach may
alienate some staff members and
make resolving dilemmas harder
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Resources
 Blackburn, Simon. “Being Good.”
Oxford, 2001
 Ellin, Joseph. “Morality and the
Meaning of Life.” Harcourt, 1995.
 Furrow, Dwight. “Ethics: Key
Concepts.” Continuum, 2005.
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Resources
 Scruton, Roger. “Modern Philosophy.”
Penguin, 1994.
 Timmons, Mark. “Conduct &
Character.” Wadsworth, 1999.
 Veatch, Robert. “The Basics of
Bioethics.” Prentice Hall, 2003.
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Conversation
 Questions?
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Comments?
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