Section 1
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Nonconsequentialism
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Date created
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Cards (175)
Section 1
(50 cards)
Nonconsequentialism
Theory where an action is right when it conforms to a duty or rule; also called deontological ethics or Kantian ethics.
How is success measured in the HCP world?
By putting patient 1st (happy patients) The motive of a patients welfare is placed above the profit motive
Value
A principle or concept considered worthwhile.
DH primary focus
- Public good - Role in prevention of dental disease - Promotion of oral health
Oath
- 1st DH oath: written by Apolla - the God of Health & Hygeia - the Goddess of Health. - Formed to help each practitioner in performing the "sacred duty of teaching to the public, particularly children and young people, by precept, lecture and every other available mode of instruction, the value of dental health as a priceless possession.
Ethical theory
A systematic examination of morals involving critical reflection and analysis about what is right and wrong.
Ethics
The inquiry into the nature of morality or moral acts; values by which human beings live in relation to other human beings, nature, a higher power and themselves.
History of Dental Hygiene
The DH profession was created in the early 1900's - Alfred C. Fones & Irene Newman.
Professional Traits for the DH
- Honesy & Integrity - Caring & Compassion - Reliable & Responsible - Mature & Self-Analysis - Loyalty - Interpersonal Communication - Respect for others - Respect for self
Self-Regulation
Higher standards expressed in code of ethics, enforced by professionals and represents an increased level of trust from the public.
Accreditation
System that has been developed to protect the public welfare and provide standards for the evaluation of educational programs and schools. - commission uses a peer review process to ensure that the DH standards are met in each program. - completed every 7 years.
Professionalism
The quality of performing at a high level and conducting oneself with purpose and pride.
Competency
Patient care competencies are standards that must be met by graduates of any educational program accredited by CODA.
Licensure
Designed to enforce practice codes, establish standards, and sanction incompetent practitioners - all for the purpose of protecting the health & safety of the public.
Peer Review
Ethical DH's willing accept the duty of self-regulation, both in judging their colleagues and in submitting to peer review, to ensure quality care for the public.
What do patients seeking healthcare expect?
1. Professional & ethical practitioner 2. That services provided evolve - technical skill, appropriate knowledge, critical judgement & caring.
When did the ADHA adopt and revise the original DH oath?
1979.
Standards
The ADHA established these for clinical DH practice in 1985 to outline the expectations for the practicing dental hygienist.
Professionalism
Rooted in a relationship or contract with society.
Autonomous
Independant & self-determining
Specific duties of DH found in State Practice Act
Only duties or functions allowed in a particular state may be performed even if the person is trained & licensed in another state where the act is more expansive.
Is DH truly self-regulating?
No - controlled by laws/rules that Dentists make.
Morality
That which is right and good; the quality of an action with regard to right and wrong.
What two standards are in the ADHA standards but NOT the Accreditation standards for DH education programs?
Standard 2: Diagnosis Standard 6: Documentation -no D's
Traits
The term professional has evolved to mean a person who demonstrates certain attributes, traits and behaviors that embrace the best qualities of care and service.
What are the 5 stages of competency?
1. Novice 2. Advanced beginner 3. Competency 4. Proficiency 5. Expertise
Characteristics of a true profession
1. Specialized body of knowledge of value to society 2. Intensive academic course of study 3. Standards of practice 4. External recognition by society 5. Code of ethics 6. Organized association 7. Service orientation
Moral reasoning
The formulation of a morally ideal course of action; the process of judging what one ought to do in a specific situation.
Morality
That which is right or good.
Why do we teach ethics?
- Ethics of a professional provide general standards of right and wrong - Guides the behavior of the members of that profession.
The 1st oath written for DH
Apolla & Hygiea - original DH oath
Graduates from an entry-level DH program must be competent in?
1. Providing DH care for the child, ado, adult, senior pt, & special needs. 2. Providing the DH process of care: - Assessment - Planning - Implementation - Evaluation 3. Care for all types of perio diesease 4. Interacting with all types of populations 5. Assessing, planning, implementing & evaluating 6. Providing life support measures 7. Applying ethical, legal & regulatory concepts 8. Identifying self-assessment skills 9. Eval current scientific literature 10. Apply problem solving strategies in the comprehensive care & management of patients
Duties
ONLY duties or functions allowed in a certain state may be performed by a RDH - even if they are licensed in another state to perform that duty.
How is success measured in the Corporate World?
Financial Gain
Utilitarianism
The theory that an action is right when it conforms to a rule of conduct or judgment providing the greatest balance of good or evil; also termed deontology.
When was the scope of practice established by law & where?
Connecticut in 1915 at the urging of Alfred Fones.
Ethics
The inquiry into the nature of morality or moral acts; values by which human beings live in relation to other human beings, nature, a higher power, and/or themselves.
Duty
Action or conduct based on moral or legal obligation. - Ethical DH's willing accept the duty of self-regulation, both in judging their colleagues and in submitting to peer review to ensure quality care for the public.
Moral Development How do we become moral?
- progressive steps or stages 1. age 2. maturation of components of personality 3. increased experience w/ moral development 4. cognitive development MACE
Consequentialism
The theory that the rightness or wrongness of actions is determined by consequences; also called teleology.
Virtue ethics
A theory that focuses on the character traits of an individual rather than on the individual's specific behavior.
Professional Traits
Characteristics desirable in a health care profession.
What are the ADHA standards?
1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation 6. Documentation ADPIED
Legal Requirements for the DH
DH's are subject to the rules and regulations of the jurisdiction in which they practice.
What is caring?
Caring is what the patient seeks - this gives the HCP the greatest opportunity for professional service & satisfaction.
What is CODA?
Commission on Dental Accreditation -grants accreditation to schools.
Ozar's 3 models of professionalism
1. Commercial Model - Commodity - Sales 2. Guild Model - Paternalistic - Decided for the patient 3. Interactive Model - Equals - Pt & HCP work together
Amoral
To be without morals - opposite of morality
Character
The qualities that define a person or group of persons; a person's moral nature.
Services performed by DH
Classified as either - traditional scaling, SPR, patient eduction - expanded functions; LA, restorative
Section 2
(50 cards)
How did Kohlberg study moral development?
Told children many dilemma stories to get responses - known as the *Heinz Dilemma
What did Kant stress?
Kant stressed that ALL human beings are free, worthy of respect and their own choosers of their purposes & actions. - this school of thought has had significant effect on biomedical ethics which has led to pt autonomy.
*What is compared to the "Golden Rule"?
Kant's *categoric imperative is compared with the golden rule which cautions individuals to "do unto others as you would have others do unto you."
Deontology belief
A moral person has the DUTY to tell the truth or never to lie. Not founded on consequences of telling the patient the truth but on belief that absolute duty exists never to lie or the patient is entitled by reason of fundamental right to receive the truth.
What do utilitarians believe?
That consequences should be considered for EVERYONE effected - the greatest good for the greatest number of people.
Implied
Not specifically stated or written but capable of being inferred by actions.
Consequentialism/Utilitarianism
Rightness or wrongness of action is determined & justified by *consequences of the act judged in comparison with other possible acts. - *focus on the consequence of an act - comparative in nature - maximize good consequence & minimize bad
Justice
The principle that deals with fairness & the allocation of what people earn or deserve.
Deontologists answer
By appeal to norms, rights, or obligations: - the rightness or wrongness of lying or killing cannot be explained simply by its consequences. The actions of lying or killing are often wrong in themselves, independently of whether they have good consequences.
Utilitarianism
Sub-category of consequentialism - theory based on consequentialism
What is Kant's theory of Universal Law?
Test of any rule or conduct is whether it can be a duty for all humans to act on.
Virtue Ethics in DH
DH treats hostile & unhappy patient with kindness and caring not because it is his/her duty or to maximize good and reduce harm but because that is being a good professional and good caring person=virtuous person
Prima Facie Duty*
Considering only one single moral principle - the 1st principle to act on over another equally compelling principle - the duty that may be primary.
Perfect vs. Imperfect duties
Perfect duty is something you should do all the time - ex. not to murder, steal, lie. Imperfect duty is something you should do some of the time - ex. giving to charity, helping the homeless.
*Who is credited for establishing one of the most non-consequential/deontological theories?
Immanuel Kant - you KANT base decisions just on consequences :)
Virtue Ethics
An ethical philosophy claiming that morality's primary function is to develop virtuous character: - most of our actions are the product of our "character" - persons of excellent character are moral persons - every person thinks and acts in the best way possible for a given situation - good character = good choices - not focused on duties or rightness/wrongness but focused on what kind of person we ought to be.
Distributive Justice
The just allocation and distribution of resources for the good of society.
Consequentialism vs. Utilitarian outcomes
C: no specific desired outcome U: desired outcome is "good" ex: fluoride in public water - greatest good for the greatest # of people.
What did Paget & Kohlberg both state?*
That moral development is sequential and is dependent on the individuals level of cognitive development.
Autonomy
The principle of self-determination in a person; the right to participate in and decide on a course of action without undue influence; provides the foundation for a right to privacy and the ability to choose.
T/F In a perfect world, the needs & wants of the patient always comes 1st with no conflicts or disputes, however, a patients best interest can be open to question depending on whose perspective.
True - different perspective's including the clinicians, patient, patients family or other HCP.
Veracity
Truth telling - honesty
*What does Deontology emphasize?
DUTIES* - absolute obligation - an act to be done regardless of consequences.
Imperfect Duty
Conditionally binding - obligation to help someone
Ethical Theories
- lay the foundation for ethical decision making. - help us by providing a frame of reference to help the individual make morally appropriate responses to moral dilemmas.
Categorical
Meaning *definite
Imperative
Meaning *essential, a must
Ethical principles guide conduct the of HCP's by:
1. helping identify, clarify & justify moral choices. 2. principles help address the question - what should I do?
Cognitive matter vs. moral development
- differentiating right from wrong = cognitive - incorporating right and wrong into life = overall moral development
Primum Non Nocere*
Latin term meaning "first, do no harm"
*What was Immanuel Kant's theory called?
Categorical Imperative - Imperative = Immanuel (ii)
Who are Paget & Kohlberg?
Developmental psychologists - categorized stages in the moral development of male children.
What was John Stuart's thought?
That moral action is one that maximizes good & minimizes harm.
What is the cognitive development theory?
That people move through *stages of development that allow them to think in new, more complex ways. (CC) Cognitive = Complex thinking
Nonmaleficence*
The principle that states the duty to avoid harming the patient, summarized in the phrase "do no harm"
Perfect Duty
Binding unconditionally - dont kill, dont lie
How do we determine whether lying or killing is morally right or wrong: Consequentialist answer
By appeal to consequences: - the rightness or wrongness of lying or killing must be explained by its consequences; if it has good consequences, then it may be right to lie or kill. On the other hand, if it has bad consequences, then it may be wrong to lie or kill.
What is deontology's approach example related to dental hygiene?
Duty to maintain patient confidentiality. - It is right because respect for patient's autonomy is an overriding duty
What was Kohlberg's theory?
The cognitive process and that *thought guides behavior
Beneficence
The principle of promoting good or well-being.
What is the categorical imperative?
A rule or standard of conduct that is absolutely binding for all human beings under all circumstances in which the rule or standard applies.
Paternalism*
An act or action based on doing good for a patient, in the manner that a father would - but that is done without the patients full knowledge; an approach that limits a patients autonomy.
Formal Education*
A strong relationship exists between education & development of moral judgement.
*What is the fundamental principle for Utilitarianism?
The principle of *utility (usefulness) UU: Utilitarianism = Utility - the morally right action is the one that produces the best overall consequences with regard to the utility or welfare of all the affected parties.
What is an ethical dilemma?
Occurs when 1 or more ethical principles are in conflict. Ex: pt requires premed but tell the DH that he does not wish to take it - pt is expressing autonomy but the DH has taken the oath to do no harm.
*Who is the famous proponent of utilitarianism?
John Stuart Mill - think of the U in Utilitarianism and in Stuart to relate them together :)
3 Classical Views of Ethical Decisions Making
1. Consequentialism or Utilitarianism (CU) 2. Deontology or Nonconsequentialism (DN) 3. Virtue Ethics (VE)
Deontology or Nonconsequentialism
Deon: meaning *duty
Confidentiality
That which is entrusted or held in secret; the precept by which information shared by a patient during the course of receiving health care is kept in confidence by the health care provider.
Informed Consent
The act of providing information to and ensuring the understanding of a patient regarding tx risks, treatment options & the nature of the disease or problem.
Section 3
(50 cards)
*What might provide a suggested mechanism for critical thinking & resolution of ethical dilemmas?
Ethical decision making models
What is the HCP's 1st obligation to the patient?
*Do not harm
What are Normative Principles
Provide a cognitive framework for analyzing moral questions and problems.
What are the 2 aspects involved in ethics?
1. ability to discern right from wrong 2. commitment to act on a decision
What is the main concept of Justice?
*Fairness
Justice
*Providing individuals or groups with what is owed, due, or deserved. - treat all people who have similar needs in a similar manner. - *fairness - *nonconsequentialists: view justice as duty Ex: regardless of age, gender, social status, religion etc - each person should be entitled to the same oral health care options.
Are you mandated to report suspected neglect or abuse?
There are mandated reporters - varies per state.
Moral distress
Frustration from perceived powerlessness when what is happening appears to be wrong and the person is unable to act ethically
Moral weakness
A state in which moral responsibilities and personal inclinations are in conflict
Beneficence*
- doing what *benefits a patient or "doing good" for the patient. - *consequentialist approach - removing existing harm & assist in *prevention of future harm - ex: SRP & POHI
Ethical analysis
The process by which ethical decisions are made using a structured format
*What is the HCP's 1st obligation to the patient?
Do no harm
Moral uncertainty
A state of questioning whether a moral obligation exists and/or the scope of that obligation
What approach does beneficence follow?
*Consequentialism - best possible outcome requires consequence analysis.
*Doing what benefits a patient or "doing good for the patient" is known as?
Beneficence
Can you share a patients history with anyone?
Only under *patient authorization when the patient consents to have their treatment info sent to other HCP.
Moral principle
A mode of choosing that which is universal
What should be done when duties conflict on more than 1 principle?
*Prima Facie Duties - consider only one single moral principle and make that your primary duty. - always do the act that has the greatest of prima facie rightness over prima facie wrongness. Ex: DH suspects child abuse - puts the welfare of the child above parent autonomy, making the child the 1st primary duty.
Impaired professional
An individual who has undergone professional training but who is no longer able to function in a professional capacity because of illness or substance abuse
What is HIPPA?
Health Insurance Portability & Accountability Act
3. Moral deilemmas
Exists when obligations or responsibilities are in conflict
Ethical awareness Categories of moral problems
1. moral weakness 2. moral uncertainty 3. moral dilemma 4. moral distress
Veracity
Being honest & telling the truth - basis of the trust relationship btwn DH & pt - binds the patient & clinician
Nonmaleficence* From the latin term: Primum Non Nocere
- to do no harm to others and to prevent harm. - founding principle of *ALL health professionals. - HCP's 1st obligation to the pt is to *do no harm - emphasized in the Hippocratic Oath
What approach does autonomy follow?
*Deontology aka Nonconsequntialism - based on respect for persons.
Ethical dilemma
A situation in which two or more ethical principles are in conflict
Confidentiality
Critical aspect of trust - requirement for confidentiality is mentioned in all codes of ethics & Hippocratic oath. - pt has a right for privacy concerning all records. - privacy in the way info is gathered, stored & communicated to other HCP = HIPPA.
Normative Principles in healthcare
- nonmaleficence - beneficence - autonomy - justice All help provide direction about what should and should not be done in a specific situation.
What are some exceptions to confidentiality?
1. reported suspected child abuse or neglect 2. reporting STD's
*1. Moral weakness
Moral responsibilities point in one direction and personal inclinations point in another direction. Ex. skipping POHI bc the DH wants to go to lunch early - lacking professional responsibility.
Can anyone make informed decisions?
Nope! Who can't? - children - mentally disabled - language barrier *only exception: pts life is in danger
Nonmaleficence & Dental Implications
- keeping knowledge and skills current - knowing ones own limitations and when to refer
The dental hygienist will be faced with many choices & dilemmas. Some of these choices are simple right & wrong, whereas others may be *ethical dilemmas.
True Ethical dilemma- A situation in which two or more ethical principles are in conflict
What is justice in dentistry?
Distributive justice - policy makers - who gets what and why
Paternalism
Dentist or DH taking on the role of the parent - makes decisions for the pt - *paternalism & autonomy are in conflict
Providing individuals or groups with what is owed, due, or deserved is known as?
*Justice
Moral sensitivity
The process of interpreting a situation from a moral perspective; involves making inferences about thoughts, feelings, and perceptions of others; understanding
Autonomy
Self-determination Self-governing Self-directing *Deciding about your own needs. - you must give the patient all information in order for them to make a decision. - founded in Deontology* - based on respect for persons. - HCP has a *duty to allow pt's to make decisions about actions that will affect their bodies. - the HCP also has the autonomy to not provide certain tx's that conflict with standard of care - ex: extraction of all healthy teeth bc dentures are easier.
2. Moral uncertainty
The question of whether a moral obligation exists and its scope. Ex. dealing with a noncompliant periodontal patient cause raise issues of uncertainty - how far should the DH go to attain a level of health when the patient is unwilling/uninterested in following dental health advice/guidance?
When the HCP has a duty to allow the patient to make decisions about actions that will effect their body - this is known as?
*Autonomy
Informed Consent
- has both ethical & legal obligations - all info must be given to the pt before they make a decision - informed refusal; faith healing
What approach does justice follow?
*Nonconsequentialism - view justice as a duty
What binds the patient and the HCP?
Veracity - basis of trust btwn HCP & patient
What helps guide decision making?
Principles Values Rules
Moral dilemma
Situation in which obligations and responsibilities are in conflict
Can a HCP refuse to perform tx if its considered to not be in the best interest of the patient?
Yes
Ethical awareness
How the DH responds to ethical issues that arise in practice depends on the ethical awareness of the individual (moral sensitivity)
*What does the term Primum Non Nocere mean?
First, do no harm
*When do ethical problems arise for the DH?
When the DH is caught between two competing obligations
*To do no harm to others and to prevent harm is known as?
Nonmaleficence
Section 4
(25 cards)