Description
InstructionsApply one or more ethical principles in answering the question related to this scenario:You are the Chair of the Ethics Committee at the hospital where you work. An inpatient makes a request of his care team that makes them uncomfortable, and they contact you for advice. You convene the Ethics Committee to discuss the situation and must provide the care team guidance on short notice. Here is the patient’s situation and request.The patient is an 87-year old insulin dependent diabetic. He was admitted for altered mental status related to uncontrolled blood sugar levels. Once stable, he reports that he wishes to stop taking insulin to control his blood sugar, and declines the nutritional advice of his dietitian. His physician tells the patient that these actions will prematurely end his life. The patient has no terminal condition(s) and is of sound mind. Some members of the care team describe this patient’s decision as suicidal and refuse to care for him. What tactic will you use to guide the discussion with the Ethics Committee? Will you take a vote? If so, will you require a unanimous decision or something else? What advice will you give the care team? Will you permit the patient to stay in your hospital as his condition changes from his refusal to use insulin? Identify the ethical theory(ies) and/or principle(s) you would apply.
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HEALTH
CARE
ETHICS
Critical Issues for the 21st Century
FOURTH EDITION
Edited by
Eileen E. Morrison, EdD, MPH, LPC, CHES
Professor, School of Health Administration
Texas State University, San Marcos
San Marcos, Texas
Beth Furlong, PhD, JD, RN
Associate Professor Emerita, Center for Health Policy and Ethics
Creighton University
Omaha, Nebraska
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Names: Morrison, Eileen E., editor. | Furlong, Elizabeth, editor.
Title: Health care ethics: critical issues for the 21st century / edited by
Eileen Morrison, Beth Furlong.
Other titles: Health care ethics (Morrison)
Description: Fourth edition. | Burlington, Massachusetts: Jones & Bartlett Learning, [2019] |
Includes bibliographical references and index.
Identifiers: LCCN 2017043204 | ISBN 9781284124910 (pbk.: alk. paper)
Subjects: | MESH: Bioethical Issues | Delivery of Health Care—ethics | Ethics, Clinical
Classification: LCC R724 | NLM WB 60 | DDC 174.2—dc23
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Printed in the United States of America
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Writing is always a collaboration. While writers have
unique ways of seeing the world, they are influenced
by their experiences, research, and education.
Therefore, I dedicate this edition of Health Care
Ethics: Critical Issues for the 21st Century to all
those who contributed to chapters in this work
and those who supported me through its creation.
First, there is my immediate family, Grant, Kate,
Emery Aidan, and Morrigan Leigh, who listened and
encouraged. There are also colleagues, relatives,
and friends who provided feedback and a lift of
spirit when I needed it. Finally, there is my publisher,
Michael Brown; my coeditor, Beth Furlong; and my
Jones & Bartlett Learning editor, Danielle Bessette.
They each added much to the quality and integrity of
this work.
–Eileen E. Morrison
Mentors facilitate one’s journey. My gratitude goes
to Dr. Amy Haddad and colleagues at Creighton
University’s Center for Health Policy and Ethics. I value
the ever-present support of my husband, Robert
Ramaley. Furthering the ethics education of others
with this book is possible because of the collegiality
and support of my coeditor, Dr. Eileen Morrison. It has
been a professional pleasure to work with her.
–Beth Furlong
© f11photo/Shutterstock
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
About the Editors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
PART I Foundations in Theory
1
Chapter 1 Theory of Healthcare
Ethics. . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ethics and Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ethical Relativism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ethics Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Ethics Theories and Their Value to
Healthcare Professionals. . . . . . . . . . . . . . . . . . . . . . . 30
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . . 31
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 2 Principles of Healthcare
Ethics. . . . . . . . . . . . . . . . . . . . . . 41
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Nonmaleficence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Beneficence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Autonomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
PART II Critical Issues for
Individuals
57
Chapter 3 The Moral Status of Gametes
and Embryos: Storage and
Surrogacy. . . . . . . . . . . . . . . . . . 59
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
The Moral Community. . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Making Decisions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Surrogacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Storage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . . 69
Additional Readings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Chapter 4 The Ethical Challenges of
the New Reproductive
Technologies . . . . . . . . . . . . . . . 71
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Two Inadequate Approaches to Evaluating
Alternative Reproductive Technology. . . . . . . . . .72
A Basis for Developing an Ethical Position. . . . . . . . 73
A Proposed Ethical Standard. . . . . . . . . . . . . . . . . . . . . 75
Theories of Justice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The Family. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Reflective Equilibrium as a
Decision-Making Model. . . . . . . . . . . . . . . . . . . . . . . 53
Donors and the Cultural Ethos. . . . . . . . . . . . . . . . . . . 81
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . . 83
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . . 55
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
iv
Contents
Chapter 5 Ethics and Aging in America . . 87
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
The Growing Population Needing Care . . . . . . . . . . 88
Issues of Access. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Forces for Improving Access. . . . . . . . . . . . . . . . . . . . . 94
What Are the Prospects for Improved Access?. . . . 96
Update from a Practitioner’s View. . . . . . . . . . . . . . . . 98
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 100
Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
PART III Critical Issues for
Healthcare Organizations 105
Chapter 6 Healthcare Ethics
Committees: Roles,
Memberships, Structure,
and Difficulties . . . . . . . . . . . . 107
v
Ethical Dilemmas Involving
Data on HISs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Smartphone Network of Healthcare
Awareness—Good Idea
or Violation of Privacy?. . . . . . . . . . . . . . . . . . . . . . . 130
Is Health Care a Right or a Benefit? What Data
Protection Should Be Provided to PHI?. . . . . . . 131
Ethical Decision-Making
Models for the Management of HIM. . . . . . . . . . 131
Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 133
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Chapter 8 Technological Advances in
Health Care: Blessing or
Ethics Nightmare?. . . . . . . . . . 137
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Medical and HIT Defined. . . . . . . . . . . . . . . . . . . . . . . . 138
The Ethical Obligation. . . . . . . . . . . . . . . . . . . . . . . . . . 138
Science and Technology Innovations
and Ethics Concerns . . . . . . . . . . . . . . . . . . . . . . . . . 139
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Recent Innovations Involving Technology
and Their Ethics Concerns. . . . . . . . . . . . . . . . . . . . 141
Why an Ethics Committee? . . . . . . . . . . . . . . . . . . . . . 108
HIT and the Medical Group Practice. . . . . . . . . . . . . 147
The Function and Roles of Ethics Committees. . . 108
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Ethics Committee Membership. . . . . . . . . . . . . . . . . 111
Questions for Review. . . . . . . . . . . . . . . . . . . . . . . . . . . 150
The Healthcare Ethics Committee’s
Background and Education. . . . . . . . . . . . . . . . . . 113
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Institutional Commitment. . . . . . . . . . . . . . . . . . . . . . 114
Challenges for Healthcare Ethics Committees. . . 115
Chapter 9 Ethics and Safe Patient
Handling and Mobility. . . . . . 153
Update from a Practitioner’s View. . . . . . . . . . . . . . . 116
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Extent of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 119
Problem-Solving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Ethics Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Chapter 7 Ethics in the Management of
Health Information
Systems. . . . . . . . . . . . . . . . . . . 123
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Operational Definitions. . . . . . . . . . . . . . . . . . . . . . . . . 123
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 157
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Chapter 10 Spirituality and Healthcare
Organizations . . . . . . . . . . . . 161
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
vi
Contents
Evidence-Based Practice: The Answer and
the Challenge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
What Is the Best Way to Reduce or
Eliminate Health Inequalities?. . . . . . . . . . . . . . . . 206
This Thing Called Spirituality. . . . . . . . . . . . . . . . . . . . 164
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Is There a Place for Spirituality in the
Healthcare Workplace?. . . . . . . . . . . . . . . . . . . . . . . 168
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Spirituality in the Business of Health Care. . . . . . . 172
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Integration of Spirituality into Healthcare
Workplaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Chapter 13 The Ethics of Epidemics . . . . 211
Ethics Theories and Spirituality. . . . . . . . . . . . . . . . . . 176
Ethics Principles and Spirituality. . . . . . . . . . . . . . . . . 177
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Questions for Review. . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Chapter 11 A New Era of Health Care:
The Ethics of Healthcare
Reform . . . . . . . . . . . . . . . . . . 183
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 208
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Epidemics, Ethics, and Public Health. . . . . . . . . . . . 211
Modern Epidemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Determination of the Decision-Making
Responsibility: Individual Autonomy
Versus Paternalism. . . . . . . . . . . . . . . . . . . . . . . . . . . 216
International Perspectives and the
Bioethics Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 217
Healthcare Reform in the United States. . . . . . . . . 183
Acknowledgment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Health System Reform in the 20th Century. . . . . . 184
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Key Provisions of the Healthcare Reform
Legislation of 2010 (ACA). . . . . . . . . . . . . . . . . . . . . 187
How Well Have the Reforms Met the
Expectations of a Just Healthcare System?. . . . 189
Chapter 14 Ethics of Disasters:
Planning and Response. . . . 221
Ethics Considerations Underlying
Healthcare Reform. . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Disaster Planning and Response
by the Federal Government. . . . . . . . . . . . . . . . . . 223
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 191
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
PART IV Critical Issues for
Society’s Health
Disasters in U.S. History. . . . . . . . . . . . . . . . . . . . . . . . . 222
Disaster Preparedness and Response for
Healthcare Institutions. . . . . . . . . . . . . . . . . . . . . . . 226
Professional Readiness for Disasters. . . . . . . . . . . . . 228
Individual Response to Disasters. . . . . . . . . . . . . . . . 228
195
Update from a Practitioner’s Point of View. . . . . . . 230
Chapter 12 Health Inequalities and
Health Inequities . . . . . . . . . 197
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 235
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Why Are Some Health Inequalities also
Health Inequities?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Chapter 15 Domestic Violence:
Changing Theory,
Changing Practice. . . . . . . . . 239
How Can We Measure Health Inequalities?. . . . . . 203
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
What Are Health Inequalities?. . . . . . . . . . . . . . . . . . . 198
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Contents
Personal and Social Barriers. . . . . . . . . . . . . . . . . . . . . 240
Systemic Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Impact of Theory on Clinical Practice. . . . . . . . . . . . 241
Structural Constraints. . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Implications for Training and
Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
vii
Chapter 16 Looking Toward
the Future . . . . . . . . . . . . . . . 261
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
New Considerations in Ethics Theory. . . . . . . . . . . . 261
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 275
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Questions for Discussion. . . . . . . . . . . . . . . . . . . . . . . . 247
Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Glossary ������������������������������������������������������������������� 279
Index�����������������������������������������������������������������������������287
© f11photo/Shutterstock
Contributors
Omolola Adepoju, PhD, MPH
Assistant Professor
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Karen J. Bawel-Brinkley, RN, PhD
Professor
School of Nursing
San Jose State University
San Jose, CA
Sidney Callahan, PhD
Distinguished Scholar
The Hastings Center
Garrison, NY
Kimberly A. Contreraz, BSN, MSN, FNP, ACHPN
Director of Palliative Care
St. Vincent Anderson Regional Hospital
Anderson, IN
Dexter R. Freeman, DSW, LCSW
Director
Master of Social Work Program
Army Medical Department Center & School
Army-Fayetteville State University
Houston, TX
Janet Gardner-Ray, EdD
CEO
Country Home Healthcare, Inc.
Charlottesville, IN
Glenn C. Graber
Professor Emeritus
Department of Philosophy
The University of Tennessee
Knoxville, TN
Nicholas King, PhD
Assistant Professor
Biomedical Ethics Unit
McGill University Faculty of Medicine
Montreal, QC, Canada
viii
Scott Kruse, MBA, MSIT, MHA, PhD, FACHE, CPHIMS,
CSSGB, Security+, MCSE
Assistant Professor and Graduate Programs
Director
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Christian Lieneck, PhD, FACMPE, FACHE, FAHM
Associate Professor
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Richard L. O’Brien, MD
University Professor Emeritus
Creighton University
Omaha, NB
Robert W. Sandstrom, PT, PhD
Professor and Faculty Associate
School of Pharmacy and Health Professions
Creighton University
Omaha, NB
Jim Summers, PhD
Professor Emeritus
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Carole Warshaw, MD
Director
National Center on Domestic Violence,
Trauma & Mental Health
Chicago, IL
Michael P. West, EdD, FACHE
Executive Director
University of Texas Arlington-Fort Worth
Campus
Fort Worth, TX
© f11photo/Shutterstock
About the Editors
Eileen E. Morrison is a professor in the School
of Health Administration at Texas State University, San Marcos, Texas, USA. Her educational
background includes a doctorate from Vanderbilt University, Nashville, Tennessee, USA, and a
master of public health degree from the University of Tennessee, Knoxville, Tennessee, USA. In
addition, she holds an associate degree in logotherapy and a clinical degree in dental hygiene.
Dr. Morrison has taught graduate and
undergraduate courses in ethics and provided
workshops to professionals, including those in
medicine, nursing, clinical laboratory services,
health information, and dentistry. She has also
authored articles and chapters on ethics for
a variety of publications. In addition, she is
the author of Ethics in Health Administration:
A Practical Approach for Decision Makers (3rd
ed.), published by Jones & Bartlett Learning,
and a children’s book called The Adventures of
Emery the Candy Man.
Beth Furlong is an associate professor emerita
and adjunct faculty in the Center for Health
Policy and Ethics at Creighton University,
Omaha, Nebraska, USA. Her academic background includes a diploma, BSN, and MS in
nursing, an MA and PhD in political science,
and a JD. Dr. Furlong has taught graduate
ethics courses and provided continuing education unit (CEU) workshops for nurses on
ethics issues. Her publications are in the areas
of health policy, vulnerable populations, and
ethics.
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© f11photo/Shutterstock
Preface
T
he history of health care is filled with
change. For example, providers and systems have embraced changes that lead to
cures for disease, new ways to care for patients,
regulation, and funding. However, during the
creation of this fourth edition of Health Care
Ethics: Critical Issues for the 21st Century, the
healthcare system has been in change overload.
It must address changes from technology, the
emphasis on patient-centered care, and fiscal
challenges. It is also trying to address the truly
unknown. For example, legislators continue to
consider the appeal of the Patient Protection
and Affordable Care Act of 2010, while others
are debating its repair. Since healthcare funding, programs, and regulations are linked to
this legislation, the healthcare system will continue to engage in multilayers of contingency
planning for survival and service.
Readers will also notice changes in this
edition as its authors consider the implications
of change with respect to their content areas.
However, the fourth edition still reflects the
organizational model that was used in previous editions. Therefore, the Greek temple
image remains its organizational framework as
a model for addressing ethics issues in health
care (see Figure FM.1).
Like all buildings, this temple needs a
firm foundation and ethics theory and principles serve this purpose. It also makes sense if
one is going to be able to analyze the ethical
Ethical Issues
Organizations
Individuals
Theoretical Foundations
FIGURE FM.1 Healthcare Ethics Organizational Model.
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Society
Preface
implications of an issue. An appropriate analogy would be that a surgeon cannot be successful unless he or she understands human
anatomy. Likewise, a student who wishes to
analyze the ethics of a particular issue in health
care must have knowledge of theories and principles of ethics. Dr. Summers provides a strong
foundation for applying ethics in the chapters
“Theory of Healthcare Ethics” and “Principles
of Healthcare Ethics” of this edition.
The three main pillars of the temple
model illustrate sections to organize the ethics
issues faced in healthcare situations. Note that
the center pillar represents individuals who are
called patients in the healthcare system. This is
because the healthcare system would not function unless there are patients who need care.
The remaining two pillars represent issues relevant to healthcare organizations and society
and reflect challenges to the future of healthcare organizations and their ability to care for
patients.
Given the current environment in the
healthcare system, the potential for chapters
and their content was extensive. The challenge
for the writers was to select example of topics
that represent ethics challenges for the future
and avoid a non-readable tome. While it was
not possible to address each potential issue,
topics were updated and expanded within
a 16-chapter format. For example, under
the “Critical Issues for Individuals” section,
attention was given to the most vulnerable
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patients. Therefore, there are chapters related
to the moral status of embryos and infants and
reproductive technology. To address patients
at the other end of the life continuum, major
revisions were made to the discussion of aging
patients and the ethics of their care. The other
pillars of healthcare organizations and society
also include major revisions of existing chapters. New chapters that reflect current ethics
issues in today’s environment have also been
added. For example, there are chapters on the
ethics of health information management and
the ethics of epidemics.
Health care is truly in the epoch of change,
but ethics will always matter. Even experts in
ethics and health care cannot predict the future
of health care with absolute certainty. However, this does not mean that ethics should not
be part of making decisions amid a challenging environment. In fact, the ethics of what we
do maybe even more important because health
care is always held to a higher standard, even
when it must meet unknown challenges.
However, Morrison and Furlong are
optimistic that students will continue to ask
themselves, “Is this the best ethical decision to
make?” and “How do I know that this it is the
best?” as they progress through their careers.
Patients, healthcare organizations, and the
community rely on their answers so that health
care can be patient-centered, cost-effective,
and fiscally responsible. What a challenging
combination to face in the epoch of change!
PART I
Foundations in
Theory
hange is not new, but it appears to be the theme of the current era of health
C
care. The Patient Protection and Affordable Care Act (ACA 2010) became a
law in 2010 and created major changes in the health care system. Regardless
of the outcome of its status, healthcare organizations will be expected to
provide patient-centered care that complies with legislation, uses qualified
and compassionate professionals, and is conducted with fiscal responsibility.
In addition, the foundation of health care must also be centered in ethical
policies and action.
To address necessary ethics-based decisions amid an environment of
consistent change, you must have a foundation in ethics theory and principles.
While some think that ethics is just about “doing the right thing,” in an epoch of
change, one must justify decisions. In addition, the professionals employed in
healthcare settings have ethics guidelines and duties encoded in their practices.
Of course, patients expect healthcare providers and facilities to be concerned
about their best interests, which include ethical behavior and practices. How
can you justify your decisions in the practice or administration with an ethics
rationale? The first section of this new edition of Health Care Ethics: Critical Issues
for the 21st Century begins with two chapters that will provide this foundation.
The foundation in ethics theory and principles provided in the chapters
“Theory of Healthcare Ethics” and “Principles of Healthcare Ethics” give you
practical tools for analyzing ethics-related issues. In the chapter “Theory
of Healthcare Ethics,” Dr. Summers presents a well-researched overview of
the theories commonly used in healthcare ethics. He includes a model that
illustrates the position of ethics in philosophy. Following that, he discusses
theories that indirectly relate to healthcare, such as authority-based ethics,
egoism, and ethical relativism. Then, he provides a thorough analysis of
theories that are most commonly applied in healthcare practice. These include
natural law, deontology, utilitarianism, and virtue ethics. In his discussions, he
uses several examples to improve understanding concerning the application
of these theories in professional practice.
In the chapter “Principles of Healthcare Ethics,” Summers continues his
scholarly discussion of ethics by presenting the most commonly used ethics
principles in health care. These principles are nonmaleficence, beneficence,
autonomy, and justice. Because justice is the most complex of the four, he
provides additional definitions of types of justice and includes information
for making decisions about justice in healthcare practice. At the end of the
1
2
Part I Foundations in Theory
chapter, Summers also presents a decision-making model called the reflective equilibrium model. This model
demonstrates the application of ethics theory and principles in the practice of making clinical and business
decisions.
You can apply the information given in these two chapters to your understanding of the remaining
chapters in this edition. You will find that having a solid grounding in theory and principles will allow you to
have greater clarity in making ethics-based decisions in your own area of health care. Certainly, as Summers
suggests, principles and theory should be an important part of your ethical decision-making throughout your
practice of health care.
CHAPTER 1
Theory of Healthcare Ethics
Jim Summers
▸▸ Introduction
I
n this chapter, Dr. Summers provides a scholarly review of the main theories that apply to
the ethics of healthcare situations. Why is knowledge of theory important to busy healthcare
professionals? In this time of great change and challenge within the healthcare system, there is
a need to apply ethics in all types of decision-making. To make this application successfully, one
needs a foundation in ethics, in addition to data and evidence-based management tools, including
those offered by advanced technologies. An understanding of ethics theory gives you the ability
to make and defend ethics-based decisions that support both fiscal responsibilities and patient-
centered care. While these kinds of decisions are difficult, without a foundation in ethics theory,
they might prove impossible. Therefore, this chapter and the one that follows, on the principles of
ethics, will serve as your ethics theory toolbox.
▸▸ Ethics and Health Care
From the earliest days of philosophy in ancient Greece, people have sought to apply reason in
determining the right course of action for a particular situation and in explaining why it is right.
Such discourse is the topic of normative ethics. In the 21st century, issues resulting from technological advances in medicine will provide challenges that will necessitate reasoning about the right
course
