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Transcript
Spectrum Health Ethics & Quality NAHQ Annual Educational Conference September 17-20, 2006 Jason E. Gillikin, CPHQ 1 Agenda Introductory comments A bit about ethics Challenges for application Basic principles of ethical theory Strategies for linking ethics & quality Open discussion 2 Spectrum Health Introductory Comments About your presenter About Spectrum Health State of the industry – Moral philosophy Healthcare quality 3 Spectrum Health A Bit about Ethics What “ethics” is NOT: Compliance Teamwork Psychology Social work Trendy “leadership” fad Manipulation tool 4 Spectrum Health 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) 5 Spectrum Health 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 6 Spectrum Health Initial Concepts Metaethics What is the source of ethics? How do we know what is ethical? How rigidly do ethical rules/norms apply? 7 Spectrum Health Initial Concepts Evaluation criteria for moral theories Consistency (usefulness) Determinacy (usefulness) Livability (usefulness) Publicity (usefulness) Coherence (correctness) External support (correctness) 8 Spectrum Health Initial Concepts Absolutism (principles & processes) Agency Autonomy – does it matter? Determinism/free will Externalism (moral beliefs don’t moviate moral actions) v. internalism 9 Spectrum Health Initial Concepts Fact-value fallacy Heroism Instrumental value Moral facts; quasirealism Perfection of duty Projectivism 10 Spectrum Health Ten Major Systems Egoism “I have moral obligations only to myself.” Varieties, e.g., superenlightened egoism One of the few truly self-consistent theories 11 Spectrum Health Ten Major Systems Relativism “All of morality depends on the local culture.” Denies universal truths Usually not considered a true theory, but rather 12 an objection to theory – but, often considered to be sufficient in itself by the uninformed As such, acts like egoism with a social aspect Spectrum Health Ten Major Systems Teleology (consequentialism) “The moral content of an action depends on its 13 consequence.” Varieties, e.g., utilitarianisms Usually have a few set maxims (e.g., “minimize pain and maximize happiness”) as guiding principles Spectrum Health Ten Major Systems Deontology (nonconsequentialism) “Although consequences matter, some acts are 14 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 Spectrum Health Ten Major Systems Virtue Theories “Being moral means being virtuous.” Good character is essential and can be 15 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 Spectrum Health Ten Major Systems Care Ethics “Morality consists in fostering relationships 16 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 Spectrum Health Ten Major Systems Natural Law “Morality consists in honoring the purposes and 17 systems effected by nature.” Strong current in Catholic moral theology Can, in some ways, admit to social Darwinism Spectrum Health Ten Major Systems Divine Command “God’s will determines what is subject to moral 18 praise or blame.” Permits a high degree of absolute thinking Internally self-consistent Spectrum Health Ten Major Systems Social Contract/Rights Theories “Man as a social animal has obligations to the 19 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” Spectrum Health Ten Major Systems “Null Theory” “Ethics? Nonsense.” Denial that ethics is possible or meaningful Often rooted in technical philosophy (e.g., 20 philosophy of language) Interesting implications for the analysis of sociopathic behavior Spectrum Health 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? 21 Spectrum Health 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” 22 Spectrum Health 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 23 Spectrum Health Strategies Communication – official and especially unofficial – should include the core concerns of the major theories (e.g., process, outcomes, duty) as justification points 24 Spectrum Health 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 25 Spectrum Health 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 26 Spectrum Health Resources Blackburn, Simon. “Being Good.” Oxford, 2001 Ellin, Joseph. “Morality and the Meaning of Life.” Harcourt, 1995. Furrow, Dwight. “Ethics: Key Concepts.” Continuum, 2005. 27 Spectrum Health Resources Scruton, Roger. “Modern Philosophy.” Penguin, 1994. Timmons, Mark. “Conduct & Character.” Wadsworth, 1999. Veatch, Robert. “The Basics of Bioethics.” Prentice Hall, 2003. 28 Spectrum Health Conversation Questions? 29 Comments? Spectrum Health Spectru m Health