Final Exam- Week 11, 12, 14 PPTS (main part of test) Flashcards Preview

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Flashcards in Final Exam- Week 11, 12, 14 PPTS (main part of test) Deck (73):
1

What are two interesting facts about Relational Ethics?

Our first and only Canadian ethical theory!

Also a theory created specifically in a nursing context in response to traditional ethical theory.

2

Criticism of Traditional ethical theories?

Here, “traditional ethical theories” means the utilitarian, deontological, and virtue traditions.

Such theories are alleged to:
Deny an “embodied self” (Pollard, 2015, p. 363)
Be universalistic in their approach to ethical issues (ibid.).

Consider that, e.g., to a utilitarian the only ethically significant relation one may bear to another is utility-based. (Ross, 1930)

3

Explain relational ethics .. anything you know and understand. (info from article)

Relational ethics is defined as an action ethic that is
placed within the interpersonal relationship. The action
ethics include engagement, mutual respect, embodiment,
and interdependent environment [11,12]. The relational
ethics is a new approach to ethical practice in health care.
Moreover, relational ethics may be another framework for
nurses and other health professionals in considering how
to help patients and families [13,14]. For example, a study
found that relational ethics help nurses acknowledge the
importance of opening dialogue, considering a diversity of
perspectives, and understanding the need for attention to
environment in order to provide appropriate health care

4

Explain relational ethics (from PPT)

“[RE] puts relationships, rather than principles, virtues, or problems, in the foreground of the analysis” (66)

It begins with the idea that everyone is always and everywhere embedded in a series of overlapping and inter-related relationships

These are based on embodied experience with the world.
Have an ethical content.

“… the project of [RE] is to ‘create an ethics of healthcare that is grounded in our commitments to each other’” (66)

Takes a “phenomenological critical social theory perspective” (Pollard, 2015, p. 362)

Negotiates the requirements of care and responsibility with patients rather than for patients.
E.g. The case of Fred revisited

*note* this article is free online and will probably help with the exam

5

What type of ethical question does relational ethics ask?
how is this different from other ethical theories?

“what relationships and commitments already inform the person that I am, and the persons others around me are, in this particular situation?” (66)

Patients are not static bearers of rights, and nurses not static bearers of duties (see Pollard 2015, p. 364)

Differs:
The main question is not "what type of person should be" or "what should i do" as with other theories

6

What are the central tenants and themes of relational ethics?

Mutual respect: “…inspired by responsibility to the other” (Pollard 2015, 365). Part of any healthy relationship.

Engagement: identifying, from another’s perspective, “the unique needs, talents, and capacities of [one’s] patients” (ibid, p. 366)

Embodied Knowledge: A recognition that knowledge has cognitive, affective, and emotional dimensions (ibid.)

Environment: recognizing the self cannot be detached from the environment (ibid., p. 366-7)

Uncertainty: recognizing the myriad of experiences that result when ethics is not so clear or we are caught in “a storm of values” (ibid. p. 367)

“Uncertainty is a truth that asks for humility rather than power, understanding rather than information, and relationship rather than ideology” (ibid.)

7

What are the arguments against relational ethics? which one is arguably not a weakness?

A relational focus in ethics “does not preclude attention to and reflection upon principles, virtues, problems, or dynamics of power” (67) (i have no idea why he listed this as a criticism-- it doesn't sound like one at all)

“Relational ethics does not furnish us with moral rules or prescriptions for action” (67)
This is arguably a feature rather than a bug, but if we want specific guidance in a situation, you won't get it with this theory. you must start with who you are and then where you are and the relationships and obligations that tie you to it.

8

Who said "Not that you lied to me, but that I no longer believe you, has shaken me"


--Nietzsche Beyond Good and Evil § 183

9

History of truth in ethics- How does truth in health care differ historically from other professions?

Like autonomy, truth-telling was once considered a distant priority in patient interactions in healthcare.

“While it would be unacceptable for lawyers or accountants to deceive their patients, in medicine deception has been widely practiced, if not prescribed” (208)

This was done in the the service of beneficence and non-maleficence — for the patient’s own good.

10

Truth in ethics- What do healthcare professionals think about truth nowadays? Why might this be?

The norms in healthcare have shifted around truthtelling, as they have shifted around autonomy.
“being truthful with patients is less associated with harm than it used to be” (209)
“Today, there is a greater recognition of the therapeutic benefits of information disclosure in general” (209)

“Beneficence – especially as associated with paternalism – has been devalued in proportion to the ascent of patient autonomy as a value” (209).

“The ethical consensus today, although by no means unanimous, is that patients have a right to know the truth, even if disclosure is likely to be harmful” (209)

11

How do we use truth to promote informed decision making? A value of nursing!! This is written into our code of ethics

The following is just a snippet of how truth is written into the COE. There are other ethical principles related to:
maintaining privacy, promoting justice and so forth.

C1. Nurses provide persons in their care with the information they need to make informed and autonomous decisions related to their health and well-being. They also work to ensure that health information is given to those persons in an open, accurate, understandable and transparent manner.

12

Truth in Ethics- What is the difference between a factual truth and truthfulness?

Factual truth: Something that is accurate against the facts.

Factually true statements are assessed for their truth or falsity.

Truthfulness: Not intending to mislead.

Truthful statements are assessed for their misleadingness

13

Can you think of a statement that is factually true but not truthful?

If I was late to school because I wanted to sleep in but said "I hit traffic on the way to school" so i wouldn't be lying but I would be purposely misleading my instructor

Or in health care if you said " you have many treatment options" this could be true, but if you know many of them have poor results and the prognosis of disease is poor, it could mislead the patient into thinking that they have very good odds. This would be diverging from the truth by omission of not giving the complete information.

14

Can you think of a statement that is truthful but factually false?

If I said "spanking your child is the best way to teach them to behave" I may have good intention and not mean to mislead, but it might be false, and not properly based in evidence

If I said "the test is easy!" and i think i am being truthful but you found it very hard

15

How can people depart from the truth?

The distinction between telling the truth and being truthful means there are several ways to depart from the truth.

a lie: saying something we know to be false for the purpose of deceiving another

Using “gestures, false clues, understatement, exaggeration, manipulation, the use of jargon, withholding information, evasion, and silence” to deliberately conceal something from another (216)

Whether and to what extent these are departures from truth is context dependent.

But at the very least it’s clear that factual truth is only part of the truth!

16

Arguments for and against truthfulness related to beneficence and maleficence

Beneficence and non-maleficence
Even if truthful disclosure is harmful, should this outweigh other values?

Is truthful disclosure even harmful? “A blanket assumption that disclosure will prove harmful is dubious at best” (210)

Can the harm of truthfulness in clinical contexts be mitigated by a “thoughtful and sensitive” relational approach to clinical practice?

Beneficence and non-maleficence
What about the benefits of truthfulness?

“Disclosure makes it possible for patients to express their feelings, and this alone may have therapeutic value” (211)

Helps to allay “needless fears and anxiety” (212)

17

what are Arguments for and against truthfulness related to autonomy?

Autonomy.

Having the relevant information “on board” is a condition of informed consent and of effective decision-making for patients.

“[T]ruthfulness also promotes autonomy by helping patients to maintain a sense of control over their lives” (212)

In the limiting case, truthfulness could harm autonomy if the patient does not want to know (213).

18

What are arguments for and against truthfulness that are related to patient- practitioner relationships?

The practitioner-patient relationship

Tends to support “openness and disclosure” (213)

Reciprocity with patients who “are expected to disclose all relevant information fully and frankly” (213)

19

What are arguments for and against in general? Hint- information gap

The knowledge gap: if patients lack the requisite knowledge to assess, understand, and interpret information, perhaps this supports less than full disclosure.

But being unable to understand fully doesn’t preclude being unable to understand at all.

Even if it is impossible to provide complete information to patients, we can still be “open and accurate about what we do know” (214)

Exceptions from these general considerations are possible, but must be justified (214)

20

How should truth be told?

The goal is generally not just to say factually true things…

…It is also to say them honestly, i.e. without the intention to mislead.

This means in the ongoing dialogue with patients one has to get a sense of the specific…

wishes, interests, and capacities

…of each patient that go into what, when, and how to communicate information to that patient.

This is onerous, but it reflects the fact that the truth is not simply factual and telling it can cause varying amounts of good and bad.

21

What are some issues with truthfulness and scope of practice?

Sometimes, the ability of a nurse to be truthful is limited by workplace policy and professional role.

As the text points out (219-20), these rules may not be as defensible as rules that allow the nurse more ability to communicate with patients and families.

“The reality in many practice settings is that disagreement with the physician concerning disclosure may be costly to nurses, both personally and professionally” (220)

This can raise issues of integrity, moral distress, and moral residue.

22

What is privacy?

Certain self-regarding information is private
E.g. the contents of a letter to a friend.

Some ideas:

“the control we have over information about ourselves” (247).

“right to be left alone” (ibid.)

“the claim of individuals, groups, or institutions to determine for themselves when, how, and to what extent information about them is communicated to others” (ibid.)

Can be thought of as a normatively loaded or neutral concept.

23

What are the three dimensions to privacy?

For Gavison (1984), it’s the extent to which we are non-accessible to others in that …

we keep information about us non-accessible.
we keep our physical selves non-accessible.
we keep attention away from ourselves. (248)

Privacy is thus a matter of secrecy, solitude, and anonymity.

Is there anything missing here?
Are each of these aspects of privacy equally valuable

24

Why might some people decide to keep their individual information private? (related to stereotyping and groups)

Groups prone to stereotyping may choose to keep private individual data

The text mentions research on indigenous health problems leading to stereotyping of all indigenous people (248)

25

Privacy is a right (T or F). This provides what type of duty for the nurse?

“Privacy is a right or moral claim of the patient” (249)

This creates a duty on the part of the healthcare provider who acquires knowledge of private information to keep it confidential

26

Patients allow health professionals access to knowledge that is otherwise private or personal... In opening up in these ways, patients become more what?

The patient becomes more vulnerable

27

What is this from? "What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of human beings which on no account one must spread abroad; I will keep to myself, holding such things shameful to be spoken about"

– Hippocratic Oath (245)

28

Who said this? "I … will hold in confidence all personal matters committed to my knowledge in the practice of my calling "

Florence Nightingale

29

Confidentiality and privacy are built into the CNA code of ethics. What are some examples ? (the answer is exact words but you can summarize the points)

Section E of the CNA Code of Ethics for RNs (2008), p. 15-16, deals with privacy and confidentiality.

E1: Nurses respect the right of people to have control over the collection, use, access and disclosure of their personal information.

E2 When nurses are conversing with persons receiving care, they take reasonable measures to prevent confidential information in the conversation from being overheard.

E3 Nurses collect, use and disclose health information on a need-to- know basis with the highest degree of anonymity possible in the circumstances and in accordance with privacy laws
E7. Nurses respect policies that protect and preserve people’s privacy, including security safeguards in information technology.

E10. Nurses intervene if others inappropriately access or disclose personal or health information of persons receiving care

30

Confidentiality has very similar connections to ethical theory as truth did. What beliefs about truth do the following theories hold:
deontological theory
feminist theory
relational ethics theory

Deontological ethics: a respect for privacy and confidentiality is rooted in the idea of never treating another person as a mere means.

Feminist ethics: disclosing confidential information can be an exercise of power over the less powerful patient, as can the mere act of knowing.

Relational ethics: the nurse-patient relationship comes with a commitment to confidentiality on the part of the nurse

31

What is the first philosophical issue related to privacy and confidentiality?

What information is confidential/ private?

32

Confidentiality and ethics- What are some problems related to the first philosophical issue (what information is confidential or private)

Some information is more personal and sensitive than other information. What patient information comes with a duty of confidentiality for the nurse?
All patient information? Or Only some patient information?
Epistemic (relating to knowledge or to the degree of its validation) considerations: a nurse may be wrong about whether revealing private information is ok with the person whose information it is.

More epistemic considerations: people disagree over what is considered private and what is not.

Axiological neutrality: “Happy news” is just as private as “bad news”.

33

What is the axiological neutrality in confidentiality and ethics?

Axiological neutrality: “Happy news” is just as private as “bad news”.

34

What information is confidential (confidentiality / privacy and ethics)?

“As a general rule, therefore, the answer to the question as to whether information is confidential and needs to be treated as such is simply: if nurses become privy to information in the course of their professional duties, the information is confidential” (253)

35

What makes information confidential? (confidentiality/ privacy in ethics)

It is not the content that makes some information confidential to the nurse

It is the situation in which that information was given or gleaned.

Put another way: it’s not what is said, it’s when it is said that makes information confidential in a healthcare context.

Is there any reason to question this approach?

36

What is a breach of confidentiality?

“A breach of confidentiality occurs when information about someone is shared with or made available to others without patient authorization, and when that information is a matter of confidence between nurse and patient.” (251)

37

Breaches of confidentiality may be what? (3 things- IAJ)

May be …

Intentional or inadvertent
Attributed to systematic or individual factors
Justifiable or unjustifiable

38

Can you think of an example of a breach of confidentiality that is: Intentional, and for which the individuals involved are responsible?

A nurse intentionally telling her friend about a patient. A nurse telling a patient's family member about private and personal information she found out while providing care.

39

Can you think of an example of a breach of confidentiality that is: Intentional, and for which systematic factors are responsible?

possible examples: rounds including the multidisciplinary team. Not all staff who partake in rounds are directly involved in care, yet they are privy to information about all the patients during these meetings.

**IT** the hospitals have many electronic health files that any nurse can access and there have been breaches and cases of people abusing this access. a nurse can look this up intentionally, but the privacy restrictions on the electronic files could be to blame, because anyone can access them (although they are tracked, so thats how these people were caught)

40

Can you think of an example of a breach of confidentiality that is: Unintentional, and for which the individual is responsible?

A nurse talking loudly to a patient about their health care issues and another patient overhearing

41

Can you think of an example of a breach of confidentiality that is: Unintentional, and for which systematic factors are responsible?

Set up of the hospital. Many hospitals have shared patient rooms so it is inevitable that patients will learn about the other's medical condition because they are privy to anything going on in the room. We have curtains to maintain privacy but there is no way for the other patient not to hear things, see things on the monitor, etc.

42

When is breaching confidentiality okay?

Sometimes breaches of confidentiality are not wrong, other times they are even positively required.

“The nurse is not morally obligated to maintain confidentiality when the failure to disclose information will place the patient or third parties in significant danger” (255)

Some situations rise to the level where there is an obligation to report based on the magnitude and probability of harm.

Even still in these situations “the patient or substitute decision maker should be informed that the nurse has a duty to report, and in light of this knowledge the patient should be given the opportunity to disclose him/herself” (255).

Exception: when giving the patient the opportunity to disclose themselves could place others at significant risk, including the healthcare professional and/or an abuse victim. E.g. erasing evidence of abuse, etc.

43

Is there a situation in which you should breach confidentiality, but dont give the patient an opportunity to disclose for themselves before reporting?

Exception: when giving the patient the opportunity to disclose information may be expected to place others at significant risk, including the healthcare professional and/or an abuse victim.


In exceptional cases in which it is justifiable or even mandatory to breach confidentiality, this act should be carried out in as respectful and minimally invasive a way as possible. The CNA Code (2002a) notes that in circumstances in which the law requires disclosure without consent, nurses "should attempt to inform individuals about what information will be disclosed, to whom, and for what reason(s)" (Confidentiality, principle 6). In Ontario, practice standards for eth- ics advise that before information is disclosed without consent nurses should consult with the health team and, if appropriate, report the information to the person or persons affected. T

Also- the patient should know which information will be shared ahead of time so they can choose to keep certain details private, or properly understand the role of the nurse in reporting specific information (so that they do not feel this is a breach of trust)

44

If a nurse has a "duty to report" (breach confidentiality) in what way can she/he still protect the patient's rights?

Even still in these situations “the patient or substitute decision maker should be informed that the nurse has a duty to report, and in light of this knowledge the patient should be given the opportunity to disclose him/herself” (255)

45

What are some confidentiality issues related to other health care professionals who work within the same work place?

Historically, information has been shared with other staff members besides those primarily responsible for the care of the patient on a need-to-know basis.

Yet the ‘circle of care’ has expanded to include many besides those primarily responsible for care in a healthcare setting:

Nurses, physicians, chaplains, home-care workers, nutritionists, speech therapists, physiotherapists, lab techs, management, and clerical staff, and volunteers.

There is the potential for disagreement over who needs to know amongst these different staff with different priorities.

46

What are some pros and cons to electronic health records and information? Informationtechnology

A main benefit of the age of IT to healthcare is the increased availability, affordability, and reliability of electronic records and communication.

Yet some see these as bringing new risks with them as well.

These risks are due to the increased interconnectedness of data.
The increasingly indirect way in which data is collected and held

For example, researchers interested in so-called meta-data may have access to clinical records when they have “no direct clinical relationship to the patient” (258)

The IT age brings with it an evolution in the relationship between patient and healthcare institution. Patients trust the system to provide safeguards for information. From a confidentiality point of view, this may be a very significant aspect of patient confidentiality.

At the same time, it can be frustrating to healthcare providers that they have ceded control over information to “the cloud”.

Arguably, “when nurses do find themselves lacking the ability to control information flow on behalf of their patients, [they should] qualify their promises of confidentiality accordingly” (259).

47

IT and ethics- What are some dangers of using electronic records for patients?


In its computerized form, health information is easier and less costly to reproduce, process, and share. The information is thus more useful and valuable for a variety of purposes, many of them not directly related to the provision of care to the patient whose information has been collected. Emerging policy goals such as population health and the prevention of harm to others have also contributed to increased access demands for health information. Efforts to improve the health system and to manage it more effectively are information-intensive. More information is sought in order to promote accountability

48

How are privacy and confidentiality different?

Privacy is a right and confidentiality is a duty

49

What does justice mean? (Latin) I didn't write the other ones because they literally look like the words

is from the latin justitia, meaning equity or righteousness

50

Where are some places we have seen the term Justice before?

In the context of Care Ethics as the name for way in which men and boys tend to reason morally.

As a virtue in Virtue Ethics

51

What are some ideas belonging to: distributive justice or substantive justice.

Just distribution of resources. Getting your fair share.

52

What is procedural justice?

Just treatment. Getting your fair say.

53

RNs are expected to promote justice. Can you think of any principles we are to uphold ? (can just summarize in own words, answer is long)

F1. Nurses do not discriminate on the basis of a person’s race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, gender identity, gender expression, sexual orientation, age, health status, place of origin, lifestyle, mental or physical ability, socio-economic status, or any other attribute

F2. Nurses respect the special history and interests of Indiginous Peoples as articulated in the Truth and Reconciliation Commission of Canada’s (TRC) Calls to Action (2012)

F3. Nurses refrain from judging, labelling, demeaning, stigmatizing and humiliating behaviours toward persons receiving care, other health-care professionals and each other.
F5. Nurses provide care for all persons including those seen as victims and/or abusers and refrain from any form of workplace bullying (CNA, 2016a)

F6. Nurses make fair decisions about the allocation of resources under their control based on the needs of persons receiving care. They advocate for fair treatment and for fair distribution of resources for those in their care.

54

What are the three categories of distributive justice:
Issues of justice may fall into three categories?



Micro-allocation

Meso-allocation

Macro-allocation

We need to know how to properly allocate resources within each one of these levels

55

What is an issue that frontline nurses face everyday with regards to microallocation?

There is a finite amount of healthcare resources (beds, time, equipment, etc.) available at any given time and place.

Front-line nurses and other healthcare staff address justice in the day-to-day at this level.

In healthcare today distributive justice at this level often takes the form of rationing scarce resources.

56

P.Anne Scott (2017) argues decisions on rationing should be made according to an explicit and agreed set of criteria, otherwise: ???

-Risk of unnecessary patient neglect and possible death.
-Risk of eroding a model of good care as the norm for nursing care provision
-Risk of undermining the trust and respect the general public have for nurses and the nursing profession (Scott 2017, 170)

57

What is the question of meso and macro allocation?

The question of meso- and macro-allocation is not “Who should get the resources we do have to ready and available to distribute?” but

“Which resources should we make available, and in what quantity?”

58

What is the difference between meso allocation and macro allocation?

When these are within an existing health care institution or community they’re questions of meso-allocation.
Such questions tend to be faced by management and senior leadership.

When they are at the societal level they’re questions of macro-allocation
People in government and policy-makers tend to face these questions.

59

The text notes three schools of thought on what is a fair distribution of healthcare resources. They are?

Libertarianism
Utilitarianism
Egalitarianism

These three schools of thought about what justice is often (not always) conflict with one another when applied to specific issues.

60

What is Libertarianism?

One of the three schools of thought related to fair distribution of healthcare resources-

“Access to health care is not a right, nor is it regarded as a duty of government to provide for everyone’s health care needs” (298).

Fair share of resources may be influenced by things like personal responsibility for illness or injury and how much of a share of health care resources a patient has purchased (through insurance or taxes).

61

What is Utilitarianism?

One of the three schools of thought related to fair distribution of healthcare resources-

Utilitarianism: justice is defined by maximizing the overall good; injustice is defined by not doing so.

Fair share is defined by what would promote the most good overall for everyone (considered as equals).

62

What is egalitarianism?

One of the three schools of thought related to fair distribution of healthcare resources-

Egalitarianism: justice is defined by equality between individuals; injustice is defined by inequality.

Fairness means “treating like cases alike,” regardless of who will be better off, by how much, or whether they “deserve” their share

63

Who is John Rawls?

Philosopher John Rawls developed an extremely influential form of egalitarianism (school of thought relating to distributive justice) in the late 20th century.
“Justice as fairness” This led to Rawlsian Egalitarianism

64

What does the book say about egalitarianism? (longer explanation)

In matters of justice people with an egalitarian orientation are guided by the main value of equality with respect to meeting needs. This equality can be interpreted in a number of different ways. For example, equality of opportunity is different from equality of outcome. Gorovitz (1988, p. 570) distinguishes four main senses of equality: equality in the amount of money spent on each individual; equality in individual health status; equality in the maximum to which each person is benefited; and equal- ity in the treatment of similar cases. Each sense of equality furnishes a different standard for making resource allocation decisions.
Most egalitarians put special emphasis on how people have unequal needs. They believe that we ought to give according to our means and receive according to our needs. They would be willing to give more than an equal share of resources to those in our society who are sickest because generally those people have greater needs.

65

How do the three schools of thought on justice
(utilitarianism, egalitarianism, and libertarianism) butt heads?

These three theoretical approaches to justice may be complementary with respect to a given allocation decision, but they will often be in conflict. For example, allocating resources on the basis of the ability to pay (libertarianism) is bound to result in an unequal distribution of resources; yet an allocation that best realizes equality (egalitarianism) may not produce the most overall benefit (utilitarianism). Further- more, each theory of justice is closely tied to a related political theory (Rodney et al., 2004). Rawls's comprehensive and very influential Theory of Justice, which overall is egalitarian, mediates the tension be- tween liberty, utility, and equality.

66

What is Rawlsian Egalitarianism? (warning the answer is super long.. you do NOT need to say this much, but it's for reference bc it's so confusing)

John Rawls’ A Theory of Justice is a dense political text centered around the problems that arise with distributive justice, in system in which goods are allocated fairly in a society. In this book, Rawls discusses how equality and freedom are not mutually exclusive, continuing by stating that all citizens must have the same rights in order for justice to truly work. In doing so, he establishes the core principles of justice. Firstly, each person must be extended the same basic freedoms when compared to others. Secondly ,he states that social positions (as well as economic positions) should be available to everyone for a society to truly flourish equally.

To be able to clearly discuss distributive justice, Rawls must first discuss the significance of ethics in society. He begins by bringing up an example about “the veil of ignorance,” where people are placed in an “original position.” They are given the most basic information regarding society and are supposed to continue only based on their morals, without any specific knowledge about their own selves or laws. This causes the “players” to basically abide solely by extremely generalized rules and laws of morality. Rawls says: “Moral conclusions can be reached without abandoning the prudential standpoint of positing, a moral outlook merely by pursuing one’s own prudential reasoning under certain procedural bargaining and knowledge constraints.”

After this “experiment” regarding the veil of ignorance, Rawls concludes that anything that the players would have come up with or agreed on behind the veil, based only on their morality, should be reasonable principles. He is careful to concede that this doesn’t mean that people are all the same. In fact, each person has vastly different goals in life. However, under this moral blanket principle, each person is awarded the same opportunities to develop their skills to follow their dreams or objectives. Rawls argues that instead of an individual competition, society should be a team game, where everyone cooperates to make sure all reach the same reasonable life goal, all on the same level.

This does not mean that people should forgo their own goals and focus solely on others. In fact, it means that citizens should all strive for equal opportunities for all, so that everyone gets an equal slice, regardless of how ambitious or modest their goals may be. And when, in the veil of ignorance, each person strives for the same opportunities, it means that each person will also be equally moral. How a person will choose to use this opportunity is up to the individual.

The veil of ignorance illuminates how society would function if everyone was stripped of privilege and status, subject to the same laws and given the same opportunities. Rawls also posits that this version of justice would obviously not be favored, if implemented in today’s world. If institutions and businesses, who often receive preferential treatment under the law, were suddenly rendered equal, the previous injustices would become clear.

67

What does egalitarianism mean in healthcare?

Equality of access to healthcare resources does not imply sameness of access.

“Egalitarian theory combines the principles of need and equality. According to the theory, government should provide for the basic needs of people, making available the services necessary to meet those needs and ensuring equal terms and conditions to meet that goal.” (302)

Resources are allocated on the basis of need amongst equals.

68

What is restitution?

“According to the principle of restitution, individuals or groups disadvantaged as a consequence of injustice done them in the past deserve preferential consideration.”

e.g. the truth and reconciliation committee of Canada- aborignal rights and closing the gap of health disparities, possibly providing preferential treatment now to make up for injustices in the past (the moral accounting system)

other example (from book)

nurses ask why the principle of retribution is not also being used. They think that if they are putting themselves in the front lines of the fight against the pandemic flu, in the event that they became infected they would want access based on the condition that they had followed their ethical duty to serve during a pandemic.

69

What is one call to action of the truth and reconciliation committee of Canada?

18: We call upon the federal, provincial, territorial, and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result
of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties.

70

Distributive justice at the macro level- How do the american and canadian health care systems differ?

Historically, the U.S. has had a libertarian approach to healthcare funding.
One is free to buy health insurance or not to do so;
healthcare providers are free to charge what they will for services.

Historically, the Canadian system has taken an egalitarian approach to healthcare funding.
Health insurance is heavily or completely subsidized by the State
Healthcare providers charge government-mandated rates

Proponents of healthcare reform in Canada sometimes make libertarian and utilitarian arguments for partial privatization of Canada’s healthcare system (Dirnfield, 1996).

71

How does procedural justice see health care/ resource allocation?

A fair process for making resource allocation decisions in health care is one which is …

Explicit and public: available (at least in principle) for all to see, discuss, and understand

Accountable: the person making the decisions can be held accountable for their decisions.

Representative: made by people who have in mind the interests of those who have a stake in the decision-making process (the public in our system).

These principles emphasize the “right of stakeholders to have a voice or representation in decision-making that concerns them” (306).

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What is embodiment??? (this is related to Relational ethics in nursing)

recognition that the mind/body split is artificial and healing cannot occur unless both are given equal consideration

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what theory said this?

When ... we view ethical action from the perspective of relation- ship, we move away from direct attention to epistemology (tradi- tionally defined in terms of ethical theory and principles), virtues (behaviors such as telling the truth and being compassionate), or problems (such as euthanasia, stem cell research, or disparities of health and illness, wealth and poverty). Rather, we attend to the moral space created by one's relation to oneself and to the other. (p. 486)

relational ethics