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Question

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.

Response

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; O’Donnell, 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; O’Donnell, 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; O’Donnell, 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; O’Donnell, 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; O’Donnell, 2013).

References

Barry, M. & Edgman-Levitan, S.(2012). Shared decision making–The 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

O’Donnell, 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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