L5 - Ethics and Law

Question 1

What is ethics?

Answer 1

Ethics is about ‘how we should live’. It
concerns our sense that there are some
things that are ‘right’ and others that are
‘wrong’.
These ideas are ‘universal’: they are part
of being ‘human’.

Question 2

How should we live?

Answer 2

Our sense of what is ‘right’ and ‘wrong’
reflects our values: those things we regard as
important
These values come from multiple diff places, eg. family, culture, society,

Question 3

Where do ethical problems come from?

Answer 3

1. somebody neglects important values
2. we encounter a situation that is new
3. there is a conflict in values
   - can try to resolve these problems by talking about our differences. communication is key!!

Question 4

Describe healthcare ethics in NZ

Answer 4

• The ‘Cartwright Inquiry’ was
  the first public scrutiny of
  medical practice, research, and
  institutions in NZ.
• Led to the establishment of the
  Health and Disability
  Commission, and the
  development of the ‘Code of
  Health and Disability Services
  Consumers’ Rights’.

Question 5

Ethics vs. law

Answer 5

• Ethics and law are related, but they are not the same.
  – The law should reflect our ethics (but will not
  necessarily).
  – It is not possible to ‘legislate’ for everything
  – Ethics is grounded (ultimately) in individual conscience
  – Laws establish authorities and powers that may administer punitive measures when a person does wrong, irrespective of their individual conscience
  – Ethical views can change, as can laws

Question 6

what are some key ethical concepts?

Answer 6

• Beneficence (helping the patient)
• Non-maleficence (not harming the patient)
• Autonomy (patient’s right to decide)
  – Proxy decision making
• Respect
• Professional integrity
• Distributive justice
• Patient dignity
• Informed consent
• Competence
• Trust
• Confidentiality
• Sanctity of life
• Dignity
• Social accountability

Question 7

describe the ethical concept of respect

Answer 7

• This is ‘Right 1’ in the Code of Patients’ Rights
• Respect is, arguably, foundational to ethics
• It involves recognizing a person as valuable,
  and their perspective as worthy of
  consideration

Question 8

describe the ethical concept of beneficence

Answer 8

• Protecting and promoting well-being
  (achieving some ‘benefit’ to the patient
  through your actions).
• Common difficulties:
  – Therapeutic uncertainties
  – What counts as a benefit?
  – Who should benefit?
  – Balancing risks and harms

Question 9

describe the ethical concept of non-maleficence

Answer 9

• The duty not to inflict harm on others.
  (often related to an extract from the
  Hippocratic Oath: Primum non nocere =
  first do no harm)
• Many healthcare interventions involve
  harming the patient. In good practice
  these harms must be considered
  alongside possible benefits
• It can be very difficult to weigh
  short(er)-term harms against long
  terms benefits

Question 10

describe the ethical concept of autonomy

Answer 10

• Autonomy describes the ability of persons to make their own
  decisions, or to determine the course of their lives. Etymologically,
  it refers to the ability to ‘self-legislate’, i.e. to be the ‘ruler’ of one’s
  own life (‘auto’ = self; ‘nomos’=law).
• Relates to:
  – Respect for the person
  – Treatment decisions
  – Honesty (avoiding deception)
  – Informed consent
  – Confidentiality
  – Data protection
• Normally, respect for autonomy means allowing (and perhaps helping) people to
  exercise this ability. In healthcare, it underpins the patient’s right to consent to or refuse treatments that are offered.
  While it is generally agreed that practitioners should respect autonomy in some way,
  the concept brings up a number of theoretical and practical questions.
• ‘Respect for autonomy’ is often contrasted with the attitude of ‘paternalism’. To be
  ‘paternalistic’ is to make decisions for other people because you believe you know
  what is best for them (or at least that you know better than they do). It is, in other
  words, to take the position of ‘the father’.

Question 11

describe the ethical concept of justice

Answer 11

• Concerns the effects of social and political structures on
  health, and the distribution of health and healthcare services
  across society
• Key questions:
• who is responsible for addressing ill-health and its effects?
• How should healthcare services be funded?
• Which areas should receive services?
• Which services should be provided?
• Who should receive the services that are made available?
• Should healthcare training schools – and graduates of those schools
  – be socially accountable?