NSCI 300 Lecture Notes - Lecture 5: Health Professional, Deontological Ethics, James Mill
26 Apr 2019
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NSCI300 Lecture 5 – Intro to Bioethics January 22nd, 2018
Speaker : Carolyn Ells (Biomedical Ethics Unit)
• What kind of ethics do we need ?
o Blend of robust theoretical principles + way to apply them
o Practical theory
• How to use ethics principles/theories
o Guidelines, that orientate us in a direction
o But need to consider them with solid judgment/knowledge of practical realities
• Ethical issues present at all levels
o Global – mostly focuses on inequalities/inequities in access to health, but also
epidemics/pandemics…
o Federal – regulations for research and healthcare
o Provincial – prioritizing, issue of allocation of resources, waiting lists…
o Organizational – institutional guidelines/priorities
o Specific cases – what to do for a particular case/situation/patient
• Ethical issues can arise in a variety of contexts, and they’re not alone
o Can also involve patient care (confidentiality, consent, boundary issues)
o Team/group relations (clash of personal values)
o Leadership and accountability (disclosure of public safety, breach, favoritism, authorship)
o Objection of conscience
o Use of resources (unfair allocation)
▪ Rationing : something is in short supply ; need to use it smartly so it doesn’t run
out // or don’t have enough for everyone who would be eligible. It’s a case of
allocation in scarcity.
▪ Access
▪ Allocation
o Policy
o Institutional relations
• A variety of these things can factor in in a complex situation
• How do you pick out an ethics problem ?
o Some people only think of ethics when something’s bad
o But ethics are present in a lot more situations and decisions
o Ethical flags :
▪ Language : ought, should, right, good, ought not, should not, wrong, bad
▪ Guilt, shame, self-esteem, need to wrestle up a lot of courage to do something
▪ An issue that’s not dealt with well ; unusually complex, stakes are very high,
can’t seem to find a way to resolve it without frustration…
▪ “That goes against our standards of care”
▪ “I’m concerned with who I am as a nurse/doctor”
• What kind of values/responsibilities are at stake ?
o In the healthcare sector, professional values, personal safety, organizational values…
o But can be a lot more at play : religious, social, legal, research…
• Different ways to think about ethical dilemmas
o 1. Ethical Uncertainty
▪ “I don’t know what the right thing to do in this situation is”
▪ “I don’t know what applies here”
▪ “I’ve never been in this situation before”
▪ What are the relevant features of the problem ? What values/principles are
involved ?
▪ Ethics tools can help clarify the issue.
NSCI300 Lecture 5 – Intro to Bioethics January 22nd, 2018
Speaker : Carolyn Ells (Biomedical Ethics Unit)
o 2. Ethical Conflict
▪ 2+ ethical values/principles that seem to be important/relevant take us in two
different directions
▪ Ethics tool can help prioritize
o 3. Ethical Distress
▪ Brought up by a nurse educator
▪ Relevant ethics values are known
• Knowledge of the hospital rules, the law…
• But we still cannot act in the way we ought to to honor that
• Something impedes the decision-maker from taking the right action
▪ It’s not easy to solve
• Key thing to identify distress : the decision-maker is not in a position to
change the thing that’s the barrier to ethical action ; need to act at a
higher level.
▪ Ethics tools can help create policies/institutional change that supports ethical
action
• Roles of Ethical Theories + Ethical Literature
o Pick out problems, understand the nature and what’s at play
o Would be nice if there was only one or two theories about how to understand and
resolve ethical issues – but that’s not the case
o Ethical scholarship help us go deeper, and understand the concepts in play and the
situation more deeply (unpack the concepts)
▪ Eg, treating people with minimal levels of consciousness
▪ Need to understand what consciousness is, a bit more
▪ Need to delve into the experience of people who have this condition
▪ Need to look into medical decision-making for people who are not capable to
participate in the decision processes that affect them. Surrogate decision-
making. What we should prioritize.
o Helps build guides, policies that lay out an ethical process for decision-making. Sort of
build “instruction manuals”, for example in approaches towards justice.
o The scholarly literature allows for some of that
• Ethical theories offer lots of different perspectives
o Principles
▪ Beneficience : seek a positive balance, provide benefits
▪ Non-maleficence : avoid or minimize harm
▪ Respect for autonomy : respect the decision-making capacities of autonomous
persons ; consent, proxy consent. Allow people to make decisions about their
life. Also, should protect and foster protection of those who lack that autonomy,
or have less of it.
• This principle draws attention to something that’s distinct, and valued
among people : we can, to some extent, choose our way in the world,
choose to be a certain way, choose to take certain actions.
▪ Justice : in this context, usually focused on distributed justice (fair distribution of
benefits and burdens across populations). What’s the fair access and allocation
of hospital beds, when we don’t have enough for everybody that has a claim to a
bed ?
• Justice doesn’t just refer to distribution ; there’s also social justice, etc.,
but we’re looking at a healthcare framework here.
Document Summary
It"s a case of allocation in scarcity: access, allocation, policy. In the healthcare sector, professional values, personal safety, organizational values : but can be a lot more at play : religious, social, legal, research , different ways to think about ethical dilemmas, 1. I don"t know what the right thing to do in this situation is . What values/principles are involved : ethics tools can help clarify the issue. Speaker : carolyn ells (biomedical ethics unit: 2. Ethical conflict: 2+ ethical values/principles that seem to be important/relevant take us in two different directions, ethics tool can help prioritize, 3. What we should prioritize: helps build guides, policies that lay out an ethical process for decision-making. Allow people to make decisions about their life. Justice : in this context, usually focused on distributed justice (fair distribution of benefits and burdens across populations).
