BME 407 Hospital Planning,

Design & Management

Lesson 4
Bioethics: Codes, Standards, Ethical Issues
Concerning Healthcare
Technology Practices

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Learning Objectives
• Importance of bioethics
oEthics
oBioethics
oClinical/Medical Ethics
oProfessional Ethics
• Development of medical ethics
•Tools and Frameworks to resolve ethical issues in
healthcare

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Ethics

• A set of principles of right conduct.

• Motivation based on ideas of right and

wrong

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Ethics
• A system of moral principles or standards governing
conduct.
• A system of principles by which human actions and
proposals may be judged good or bad, right or wrong;
• A set of rules or a standard governing the conduct of a
particular class of human action or profession;
• Any set of moral principles or values recognized by a
particular religion, belief or philosophy;
• The principles of right conduct of an individual.

(UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4)

 Bioethics
•It is derived from Greek bio (means life) and ethicos
(means moral).
•The science/art that aims at identification, analysis,
and resolution of the ethical issues in almost any
field that is related to human life and health.
• Deals with the ethical and moral implications of new
biological discoveries, medical research and practice.
https://www.youtube.com/watch?v=7Va-PCIDrBg
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Thinking
• Give example of an ethical issue/problem you faced
or witnessed, mentioning the following:
oWhat was the situation?
oWhat was your feeling towards it?
oWhat did you do?
oDo you think you did the best thing? why?
oWhat you think you need to know more to be able
to handle similar situations in the future?
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Morality and Ethics…
• Morality: the beliefs and standards of good and bad, right
and wrong, that people actually do and should follow in a
society, while ethics is defined as the systematic study of
morality.
• Metaethics: tries to clarify the rational standards and
methods for the study of ethics
• Normative ethics: develops ethical principles, rules, and
ideals that spell out standards of good and bad, right and
wrong. It can be divided into: moral theory and applied
ethics.
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Questions answered by Bioethics
o Deciding what we should do (what decisions are
morally right or acceptable);

o Explaining why we should do it (how do we justify

our decision in moral terms); and

o Describing how we should do it (the method or

manner of our response when we act on our
decision). 8
Bioethics education for medical practice is
essential in today’s complex world because:

• Medical policies and patient rights legislation are

ever-changing

• Health care systems function differently than before

• Clinical practice now involves decision-making

about many new issues
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Less Embarrassing Choices…
• I need to pass the exam..cheat or not?
• I need the organs of this dying patient... Let him
die fast?
• I need the money of this Pharma company...
Shall I change the results of my research on their
drug?
Ethics is about making choices...
Usually hard ones!
Levels of Moral Response
• The expressive level (unanalyzed expressions or feeling
that, by themselves, don’t provide reasons or
justification)
• The pre-reflective level (justification via law, religious
tenets, social values, codes of ethics, etc.; accepted
uncritically)
• The reflective level (reasoned ethical argument/defense
based on ethical principles, rules, virtues, values to
which we consciously subscribe; justification provided)
Thomas J and Waluchow W, 1998
The Fact-Value Distinction
• Fact: description of the way the world is; an actual
state of affairs (“is”)

• Value: judgment about the way things should be

(“ought”)

ono “ought” can be deduced from an “is”

Ethical Reasoning
Values and ethical principles
• Value = something a person/community has
identified as important (e.g. autonomy/self-
determination)
• Values by themselves don't tell us what we ought
to do.
• Key values in bioethics have corresponding ethical
principles meant to guide action (e.g. principle of
respect for autonomy)
Clinical/Medical Ethics
• It is that branch of bioethics that is related to the
identification, analysis, and resolution of moral problems
that arise in the healthcare of individual patients.
• The rules or standards governing the conduct of a person
or the members of a profession relating to the study or
practice of medicine.
•The practice of good clinical medicine requires some
working knowledge about ethical issues such as informed
consent, truth-telling, confidentiality, pain relief, and
patient rights. 14
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Questions Answered by Bioethics
• Deciding what we should do (what decisions are morally
right or acceptable);
oExample: should patient A or B have the ICU bed?
• Explaining why we should do it (how do we justify our
decision in moral terms); and
oWhy did we decide to admit A & not B?
• Describing how we should do it (the method or manner of
our response when we act on our decision).
oWhat are we going to do for patient B?
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Ethical Issue or Moral Problem
There is an ethical issue when:
o…we encounter conflicting values, beliefs, goals,
or responsibilities
o…we are concerned that persons or their rights
are not being respected
o…we are concerned about fairness and justice
o…we are unsure what we should do or why we
should do it, morally speaking
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 Health/Medical Ethical Issues
• Abortion • Human
• Euthanasia experimentation
• Suicide • Birth Control
• Death Determination • In vitro fertilizations
• Cloning • Stem cell technology

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Domains of Ethics in Health Care
• Shared decision making with patients
• Ethical practices in end-of-life care
• Patient privacy and confidentiality
• Professionalism in patient care
• Ethical practices in resource allocation
• Ethical practices in management
• Ethical practices in research
• Ethical practices in the everyday workplace 19
What else could it be?
• Miscommunication stands for 70-80% of problems
in healthcare
e.g. Doctors don’t know how to tell medical info
• Management issue
o“when shall I get promoted? All my colleagues
did. This is not ethical!”
• Financial issue
o“I am underpaid for my workload. This is not
ethical!” 20
The Four Boxes Model
Box 1: Medical Indications
• Medical Indications are those facts about the patient's physiological
or psychological condition that indicate which forms of diagnostic,
therapeutic, or educational interventions are appropriate.
• Is the Problem Acute? Chronic? Critical? Reversible? Emergent?
Terminal?
• What Are the Goals of Treatment?
• InWhat Circumstances Are Medical Treatments Not Indicated?
• What Are the Probabilities of Success of Various Treatment
Options?
• How Can This Patient Be Benefited by Medical and Nursing Care,
and How Can Harm Be Avoided?
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Box 2: Preferences of Patients
• The choices that persons make when they are faced with
decisions about their health and medical treatment.
• Ethical issues include 1) respect for the autonomy of the
patient; (2) the legal, clinical, and psychological significance
of patient preferences; (3) informed consent; (4) decisional
capacity; (5) truth telling; (6) cultural and religious beliefs;
(7) refusal of treatment; (8) advance directives; (9)
surrogate decisions; (10) the challenging patient; and (11)
alternative medicine.
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Box 3: Quality of life
• Refers to that degree of satisfaction that people
experience and value about their lives as a whole,
and in its particular aspects, such as physical
health.

• The main ethical principles involved are:

beneficence & autonomy.

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Box 3: Quality of life...cont’d
Relevant ethical questions
• What are the prospects, with or without treatment, for a return to
normal life, and what physical, mental, and social deficits might the
patient experience even if treatment succeeds?
• Are there biases that might prejudice the provider's evaluation of
the patient's quality of life?
• What ethical issues arise concerning improving or enhancing a
patient's quality of life?
• Do quality-of-life assessments raise any questions regarding changes
in treatment plans, such as forgoing life-sustaining treatment?
• What are the plans and rationale to forgo life-sustaining treatment?
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Box 4: Contextual Features
• It addresses the ways in which professional, familial,
religious, financial, legal, and institutional factors
influence clinical decisions
• Involved ethical principles are: beneficence, respect
for autonomy and justice
• Justice refers to those moral and social theories that
attempt to distribute the benefits and burdens of a
social system in a fair and equitable way among all
participants in the system.
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The CASES Approach
• The CASES approach was developed by the National
Center for Ethics in Health Care
• Clarify the facts & requirements
• Assemble the relevant information
• Synthesize the information
• Explain the synthesis
• Support the ethical decision making process
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Clarify the facts & requirements
• Characterize the type of problem
• Obtain information about the case
• Establish the goal from the ethical analysis
(consultation process)
• Formulate the ethics question
oGiven [uncertainty or conflict about values], what
decisions or actions are ethically justifiable? or
oGiven [uncertainty or conflict about values], is it
ethically justifiable to [decision or action]? 28
Assemble the Relevant Information
• Consider the types of information needed
(Medical facts, Patient’s preferences, QOL,
Contextual features)
• Identify the appropriate sources of information
• Gather information systematically from each
source
• Summarize the information and the ethics
question
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Synthesize the Information
• Determine whether a formal meeting is needed

• Engage in ethical analysis

• Identify the ethically appropriate decision maker()

• Facilitate moral deliberation about ethically

justifiable options
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Explain the Synthesis
• Communicate the synthesis to key participant

• Provide additional resources

• Document the consultation in the health record

• Document the consultation in consultation service

records
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Support the Consultation Process

• Follow up with decisions taken

• Evaluate the outcome of the decision

• Adjust the consultation process

• Identify underlying systems issues

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Ethics and Law
• Laws are based on ethical principles.
• Most laws enforce ethical standards.
oConfidentiality of Patient Information
oEthical standard that has become a legal standard
• Sometimes laws are in conflict with a person’s ethical principles.
oAbortion
oYour ethical code may prohibit; law support woman’s right
to choose
• Healthcare workers should act in the best interest of patients and
support legal standards for patient care.
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 Ethics and Law
• As a future healthcare professional, do you think you will ever be
put in a position where your personal ethics are in conflict with the
requirements of your profession?
• If so, how will you manage it?
• As a healthcare professional, will you be able to disengage your
emotions when dealing with ethical conflicts?
• Universal concerns
• Infectious Diseases such as HIV/AIDS
• Unable to separate yourself from their care as a healthcare
provider
• Legally and ethically, they must act professionally when dealing
with all patients. 34
Guiding Principles
• The upcoming slides provide examples of ethical
principles for healthcare workers and the
corresponding laws that were created to support
them.

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Guiding Principles

1) Preserve life 5) Be honest

2) Do good 6) Be discreet
3) Respect autonomy 7) Keep promises
4) Uphold justice 8) Do not harm

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Healthcare Ethics: Euthanasia
• What is it?
o Results in death to alleviate suffering or when
there is no hope for recovery.
• Many healthcare professionals feel euthanasia is
contrary to their professional ethics.
• Regardless of their beliefs, healthcare workers
should follow state laws.
• Oregon only state to legalize
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Healthcare Ethics: Organ Transplants
• Organ donations come at a time of crisis when
somebody dies.

• Healthcare workers should ask about donation.

• Illegal to transplant organs without patient or

family permission.
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Healthcare Ethics: Organ Transplants
Who gets the organ?

• Handout “You be the Judge”

o Mr. N
o Ms. L
o Mr. Z
o Mrs. P

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Healthcare Ethics: Organ Transplants
Who gets the donated organ?
• Criteria
o Likelihood of benefit
o Urgency of need
o Change in quality of life (improved?)
o Duration of benefit

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Codes of Conduct
• Ethical responsibilities include respecting the
cultural, social and ethnic differences of patients and
other healthcare workers.
• “Scope of practice” helps define the code of conduct
for healthcare workers.
• Performing skills outside the scope of practice is
illegal and unethical.
• Ethical codes of conduct are based on moral
standards and society’s expectations. 41
Ethical Dilemmas
• Advances in health care have created ethical
dilemmas for healthcare providers.
• There are no easy answers when addressing ethical
dilemmas.
• The question is – what is the responsibility of
healthcare providers when addressing ethical
dilemmas?

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Ethical Dilemmas
• Should family members be allowed to discontinue
life support?
• Do parents have a religious right to refuse life-saving
blood transfusions for their child?
• Should people be allowed to sell organs for use in
transplant?
• Should human beings be cloned?
• What should be done with fertilized frozen embryos
when the parents no longer want them? 43
Ethics Committee
• Most hospitals have ethics committees that
examine ethical issues related to patient care.
• They can advise patients, families and healthcare
providers.
• A hospital ethics committee might decide the best
action to take for a terminally ill patient on a
respirator.
• An ethics committee might also be asked to pass
judgment on the actions of a healthcare provider.
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Professional Practice
1. Use the approved methods when performing
procedures.
2. Obtain proper authorization before performing
any procedure.
3. Identify the patient.
4. Observe all safety precautions.

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Professional Practice
5. Think before you speak and carefully consider
everything you say.
6. Accept no tips or personal gifts.
7. Immediately tell your supervisor if you make a
mistake.
8. Act professionally in everything you say and do.

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