Use the readings to evaluate the philosophical and theoretical underpinnings of ethical decision-making and compare and contrast two differing essential features or core principles of medical and behavioral ethical codes.
In a study of primary care physicians Rolfsen determined that ethical issues arise in a whopping 33% of visits (2010). As if to emphasize the point Rosenbaum agonizes regarding societal expectations that place PCPs into ethical dilemmas (2011). As Joseph Des Jardins succinctly explains we need ethics to systematically analyze and answer questions such as How should I live? and What should I do? (2011).
Ethical dilemmas in healthcare warrant a deliberate and systematic examination of ethical components including ethical gaps and inadequacies ethical standards ethical philosophies ethical perspectives ethical processes and ethical approaches and decision-making (Runyan Robinson & Gould 2013; Botes 2000a; Botes 2000b; ODonnell 2013; Lawrence & Curlin 2009)
Freeman and McDonnell introduce two philosophical approaches to ethical decision-making utilitarianism and deontology (2001). Quite simply utilitarianism measures actions based on the value of the consequences and deontology measures actions based on the intention Freeman & McDonnel 2001; ODonnell 2013; Lajeunesse & Lussier 2010).
Botes introduces two ethical perspectives (2000a) ethics of justice and ethics of care. Ethics of justice is based on concrete impartial rules and ethics of care is grounded in empathy and context (Botes 2000a; ODonnell 2013). Both perspectives are inadequate in and of themselves; they should both be considered during ethical discourse (Botes 2000b).
One of the Joint Principles of the PCMH is grounded in patient-centered care (Braddock Snyder Neubauer & Fischer 2012) and traditional principles of codes of ethics resonate with patient-centeredness: justice beneficence nonmaleficence and respect for patient autonomy (Braddock Snyder Neubauer & Fischer 2012; ODonnell 2013; Sokon McFadzean Dickson & Whitaker 2011).
Philosophical approaches (utilitarianism and deontology) perspectives (ethics of justice and ethics of care) and principles of professional codes of ethics are considered in ethical discourse. Incorporated are patient rights and perspective (Barry & Edgman-Levitan 2012) as well as provider telos the virtues of the professional (Botes 200b; ODonnell 2013).
Barry M. & Edgman-Levitan S.(2012). Shared decision makingThe pinnacle of patient-centered care. The New England Journal of Medicine (366)9 780-781. Retrieved from https://www.nejm.org.ezproxy1.lib.asu.edu/doi/pdf/10.1056/NEJMp1109283
Botes A. (2000a). A comparison between the ethics of justice and the ethics of care. Journal of Advanced Nursing 32(5) 1071-1075. doi: 10.1046/j.1365-2648.2000.01576.x
Botes A. (2000b). An integrated approach to ethical decision-making in the health team. Journal of Advanced Nursing 32(5) 1076-1082. doi: 10.1046/j.1365-2648.2000.01577.x
Braddock C. Snyder L. Neubauer R. L. & Fischer G. S (2012). The patient-centered medical home: An ethical analysis of principles and practice. Journal of Internal Medicine (28)1 141-146. doi: 10.1007/s11606-012-2170-x
Freeman J. & McDonnell K. (2001). Ethical theory and medical ethics. Tough decisions: Cases in medical ethics (pp. 185-211). New York NY: Oxford. Retrieved from https://myasucourses.asu.edu/
Lawrence R. & Curlin F. (2009). Physicians beliefs about conscience in medicine: A national survey. Academic Medicine 84(9) 1276-1282.doi: 10.1097/ACM.0b013e3181b18dc5
ODonnell R. (2013). Modified by L. Manson 2013. IBC 660: Healthcare legal ethical and professional issues: Theories of ethics. [PowerPoint] retrieved from https://myasucourses.asu.edu/
Richard C. Lajeunesse Y. & Lussier M. (2010). Therapeutic privilege: Between the ethics of lying and the practice of truth. Journal of Medical Ethics 36 353-357. doi: 10.1136/jme.2009.033340
Rolfsen M.L. (2010). Ethics in the primary care office. Journal of Louisiana State Medical Society 162 26-32. Retrieved from https://myasucourses.asu.edu/
Rosenbaum J. R. (2011). Daily dilemmas. Annals of Internal Medicine 155(12) 855-856. doi 10.7326/0003-4819-155-12-201112200-00011
Runyan C. Robinson P. & Gould D.A. (2013). Ethical issues facing providers in collaborative primary care settings. Families Systems and Health (31)1 1-8. doi: 10.1037/a0031895
Sokol D. McFadzean W. Dickson W. & Whitaker I. (2011). Ethical dilemmas in the acute setting: A framework for clinicians. BMJ. doi: 10.1136/bmj.d5528
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