Chat with us, powered by LiveChat Florida National University PHI1635 Biomedical Ethics: Assignment Week 4 Discussion Ex | Max paper
  



Florida National University



PHI1635 Biomedical Ethics: Assignment Week 4

Discussion Exercise: Chapter 7 and 8


Objective:
The students will complete a Virtual Classroom Discussion Exercise that will Extend your knowledge beyond the core required materials for this class, Engage in collaborative learning with other students to improve the quality of the learning experience for all students and Apply the higher cognitive skills associated with critical thinking to your academic and professional work.


ASSIGNMENT GUIDELINES (10%):

Students will judgmentally amount the readings from Chapter assign on your textbook. This assignment is prearranged to help you to learning in all disciplines because it helps student’s process information rather than simply receive it.
You need to read the PowerPoint Presentation assigned for week 4 and develop a 2-3 page paper replicating your appreciative and competence to apply the readings to your ethics knowledge. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page.

EACH PAPER SHOULD INCLUDE THE FOLLOWING:

1.
Introduction (25%)
Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words that will apply to the case study presented.

2.
Discussion Challenge (65%)

Health care in the 21st century is governed by a confusing array of rules, regulations, laws and ethical standards. Issues that involve confidentiality, informed consent and patient relationships can appear out of nowhere, even when health care workers have the best of intentions. What’s legal today might not be considered ethical, and there is the ever-present threat of being sued for negligence and malpractice. There are unresolved issues around doctor assisted dying that have yet to be worked out, while medical procedures considered ethical for adults might not be seen as ethical for minors.

Here are the top five ethical issues that health care managers of today and tomorrow will be facing in the course of delivering responsible and compassionate patient care.

a. Patient Confidentiality

b. Patient Relationships

c. Malpractice and Negligence

d. Informed Consent

e. Issues Related To Physician Assisted Suicide (PAD).

STUDENT CHALLENGE:

1. Describe, mention and define the five ethical issues that health care managers of today and explain your point of view relate with the ethical implication.

2. Designate and discussion how this five issues where affected by the COVID-19 pandemic?


ASSIGNMENT DUE DATE:

The assignment is to be electronically posted in the Assignments Link on Blackboard no later than noon on Sunday, November 21, 2021.


ASSIGNMENT RUBRICS

Assignments Guidelines

1 Points

10%

Introduction

2.5 Points

25%

Your Discussion Challenge

6.5 Points

65%

Total

10 points

100%



ASSIGNMENT GRADING SYSTEM

A

90% – 100%

B+

85% – 89%

B

80% – 84%

C+

75% – 79%

C

70% – 74%

D

60% – 69%

F

50% – 59% Or less.

Dr. Gisela Llamas

HEALTH
CARE
ETHICS

Critical Issues for the 21st Century

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

FOURTH EDITION

World Headquarters
Jones & Bartlett Learning
5 Wall Street
Burlington, MA 01803
978-443-5000
[email protected]
www.jblearning.com

Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett
Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.

Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional
associations, and other qualified organizations. For details and specific discount information, contact the special sales
department at Jones & Bartlett Learning via the above contact information or send an email to [email protected]

Copyright © 2019 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical,
including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright
owner.

The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett
Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or
otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not
be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Health
Care Ethics: Critical Issues for the 21st Century, Fourth Edition is an independent publication and has not been authorized, sponsored, or
otherwise approved by the owners of the trademarks or service marks referenced in this product.

There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities
represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios
featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only.

This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the
understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert
assistance is required, the service of a competent professional person should be sought.

Production Credits
VP, Product Management: David D. Cella
Director of Product Management: Michael Brown
Product Specialist: Danielle Bessette
Production Manager: Carolyn Rogers Pershouse
Vendor Manager: Molly Hogue
Senior Marketing Manager: Sophie Fleck Teague
Manufacturing and Inventory Control Supervisor: Amy Bacus
Composition: codeMantra U.S. LLC

Project Management: codeMantra U.S. LLC
Cover Design: Kristin E. Parker
Rights & Media Specialist: Robert Boder
Media Development Editor: Shannon Sheehan
Cover Image: © nixki/Shutterstock; © Dutourdumonde

Photography/Shutterstock. 
Printing and Binding: Edwards Brothers Malloy
Cover Printing: Edwards Brothers Malloy

Library of Congress Cataloging-in-Publication Data
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
LC record available at https://lccn.loc.gov/2017043204

6048

Printed in the United States of America

22 21 20 19 18 10 9 8 7 6 5 4 3 2 1

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

iv

© 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

Theories of Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Reflective Equilibrium as a
Decision-Making Model . . . . . . . . . . . . . . . . . . . . . . .53

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .55

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

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

The Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Donors and the Cultural Ethos . . . . . . . . . . . . . . . . . . .81

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .83

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

v 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

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Why an Ethics Committee? . . . . . . . . . . . . . . . . . . . . 108

The Function and Roles of Ethics Committees . . 108

Ethics Committee Membership . . . . . . . . . . . . . . . . 111

The Healthcare Ethics Committee’s
Background and Education . . . . . . . . . . . . . . . . . . 113

Institutional Commitment . . . . . . . . . . . . . . . . . . . . . 114

Challenges for Healthcare Ethics Committees . . 115

Update from a Practitioner’s View . . . . . . . . . . . . . . 116

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 119

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Chapter 7 Ethics in the Management of
Health Information
Systems . . . . . . . . . . . . . . . . . . . 123

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Operational Definitions . . . . . . . . . . . . . . . . . . . . . . . . 123

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

Recent Innovations Involving Technology
and Their Ethics Concerns . . . . . . . . . . . . . . . . . . . 141

HIT and the Medical Group Practice . . . . . . . . . . . . 147

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Questions for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

Chapter 9 Ethics and Safe Patient
Handling and Mobility . . . . . . 153

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Extent of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . 153

Problem-Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

Ethics Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

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

This Thing Called Spirituality . . . . . . . . . . . . . . . . . . . 164

Is There a Place for Spirituality in the
Healthcare Workplace? . . . . . . . . . . . . . . . . . . . . . . 168

Spirituality in the Business of Health Care . . . . . . 172

Integration of Spirituality into Healthcare
Workplaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

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

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Healthcare Reform in the United States . . . . . . . . 183

Health System Reform in the 20th Century . . . . . 184

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

Ethics Considerations Underlying
Healthcare Reform . . . . . . . . . . . . . . . . . . . . . . . . . . 190

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 191

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

PART IV Critical Issues for
Society’s Health 195

Chapter 12 Health Inequalities and
Health Inequities . . . . . . . . . 197

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

What Are Health Inequalities? . . . . . . . . . . . . . . . . . . 198

Why Are Some Health Inequalities also
Health Inequities? . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

How Can We Measure Health Inequalities? . . . . . 203

What Is the Best Way to Reduce or
Eliminate Health Inequalities? . . . . . . . . . . . . . . . 206

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 208

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Chapter 13 The Ethics of Epidemics . . . . 211
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

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 217

Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

Chapter 14 Ethics of Disasters:
Planning and Response . . . . 221

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

Disasters in U .S . History . . . . . . . . . . . . . . . . . . . . . . . . 222

Disaster Planning and Response
by the Federal Government . . . . . . . . . . . . . . . . . 223

Disaster Preparedness and Response for
Healthcare Institutions . . . . . . . . . . . . . . . . . . . . . . 226

Professional Readiness for Disasters . . . . . . . . . . . . 228

Individual Response to Disasters . . . . . . . . . . . . . . . 228

Update from a Practitioner’s Point of View . . . . . . 230

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 235

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Chapter 15 Domestic Violence:
Changing Theory,
Changing Practice . . . . . . . . . 239

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

vii

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

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 247

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248

Chapter 16 Looking Toward
the Future . . . . . . . . . . . . . . . 261

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261

New Considerations in Ethics Theory . . . . . . . . . . . 261

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 275

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

Glossary � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 279

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

Contents

viii

© 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

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

ix

© f11photo/Shutterstock

About the Editors
Eileen E. Morrison is a professor in the School
of Health Administration at Texas State Univer-
sity, San Marcos, Texas, USA. Her educational
background includes a doctorate from Vander-
bilt University, Nashville, Tennessee, USA, and a
master of public health degree from the Univer-
sity of Tennessee, Knoxville, Tennessee, USA. In
addition, she holds an associate degree in logo-
therapy 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 back-
ground 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 edu-
cation unit (CEU) workshops for nurses on
ethics issues. Her publications are in the areas
of health policy, vulnerable populations, and
ethics.

x

© f11photo/Shutterstock

Preface
The history of health care is filled with change. For example, providers and sys-tems 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 fund-
ing, programs, and regulations are linked to

this legislation, the healthcare system will con-
tinue 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 pre-
vious editions. Therefore, the Greek temple
image remains its organizational framework as
a model for addressing ethics issues in health
care (see …

Chapter Seven

1

Operational Definitions

Health information is data related to medical history.

Health information records include history, lab results, diagnostic information, and notes.

It creates data sets that are used for individuals and populations.

Operational Definitions

Health information management (H IM) includes obtaining, using, and protecting both digital and traditional patient information.

Professionals in each IM manage patient records.

They also are part of quality measurement including accreditation.

Operational Definitions

Health information technology (HIT) assists the exchange of health information through electronic systems.

HIT is used extensively in health care.

Privacy and security are important. HIT issues.

Operational Definitions

WHO defines the functions of HIT as data generation, compilation, analysis, synthesis, and communication.

Introduction

Health care is making progress in addressing DV.

Guidelines for treatment now exist.

Initiatives include awareness, guidelines, and strategies for response.

The ACA requires screening and counseling.

Introduction

Practitioners need to increase their awareness of diagnoses concerning DV.

They also must confront their own feelings and beliefs about domestic violence and its victims.

Ethical Dilemmas

Protection of privacy is a major ethical dilemma in HIM.

Access to medical records must balance privacy and equity.

Violation of privacy personal gain is a serious concern for health care.

Ethical Dilemmas

Conspiracy to commit PHI fraud for personal gain is both a legal and ethical issue.

These crimes harm individuals, organizations, and taxpayers.

Ethical Dilemmas

Failures to communicate about computers and their appropriate, use exists across generations.

Computers enable people to assume a different personality.

Computers also let people disregard their ethics foundations.

Ethical Dilemmas

Ethics professional societies encourage the development and use of codes of ethics.

However, those without a moral compass forget about ethics in their eat actions.

Individuals make decisions about their conduct in the cyber community.

Ethical Dilemmas

Examples of theft can also relate to the ethics and the Internet.

Ransomware is a type of computer software (malware) that infects computers, servers, and systems.

Ransomware makes files unreadable.

Ethical Dilemmas

Cyber attackers use extortion to receive a ransom for returning access to information.

Computer should not be in an environment for criminal attack.

Protection of information systems requires action including making it difficult for hackers to have access.

Smart Phone Networks

Smart phones collect and store large amounts of personal data.

From an ethics view, users agreed to this collection of data through apps.

The U.S. government does not vet health applications.

Many issues exist for the protection of privacy and health apps.

Ethics Decision-Making Models

The “3 rules of thumb” model is a foundation for decision-making.

Weber suggests that individual rights should be a priority.

The next consideration should be the good of the community and its interests.

Ethics Decision-Making Models

The Weber model than considers the good of the organization and its interests.

Lastly, individual good, and interests should be considered.

The Weber model helps to establish priorities in ethics decision-making.

Ethics Decision-Making Models

The “grandmother test” is also useful as a guide. Can you tell your grandmother about your decision?

Would she approve of this decision?

Decision-making models need to be part of education and healthcare organization ethics resources.

In Summary…

19

Chapter Eight

Technological Advances in Health Care: Blessing or Ethics Nightmare?

1

2

Medical and Health Information Technology

Medical technology involves products, equipment, and processes that help to make diagnoses.

Health information technology (HIT) includes computer hardware, software, and databases that assist the providers in giving quality care.

3

Medical and Health Information Technology

HIT can include the electronic medical record (EHR).

It can also include support systems like physician order entry (CPOE) and clinical decision-support systems (CDSS).

4

Ethics Obligations

The healthcare field is becoming more dependent on technology.

Innovation in technology requires due diligence.

Patient safety and effectiveness are being considered.

Attention needs to be paid to overall benefits.

5

Ethical Issues in Research

Technology research allows for a disassociation between the researcher and the research.

The lack of focus on the bigger picture can cause ethics violations that have major impact.

History demonstrates this issue.

6

Unethical Medical Research

Evaluation of research studies needs to consider the right to autonomy.

Autonomy is demonstrated by informed consent.

Informed consent includes competence, voluntariness, disclosure, and authorization.

7

Research Studies and Ethics

Tuskegee Syphilis Study (1932-1972)

This study failed to meet the criteria for true informed consent.

There was manipulation of subjects by researchers.

The researchers took advantage of a disadvantaged population, but they thought they were being ethical.

8

Research Studies and Ethics

The Willowbrook Study (1963-1966)

This study used children who had various mental disabilities for testing the progression of hepatitis virus.

The researchers assumed that these subjects were competent.

Researchers in this study took advantage of a vulnerable population.

9

Research Studies and Ethics

Researchers can become so absorbed in the study that they fail to see the ethical implications.

Susan Reverby uncovered another example of this issue in the USPHS funded syphilis study in Guatemala.

Findings like this call for an ethics review and a third-party evaluation of research studies.

10

Recent Innovations

There are many innovations that involve technology that pose ethics concerns.

One example is synthetic biology.

Researchers can create non-genetic raw materials to substitute for genetic material.

11

Recent Innovations

Synthetic biology shows both promise and concern.

Ethics questions include concerns about usage and controls.

The Presidential Commission for the Study of Bioethical Issues was formed to study ethics principles as they relate to this field.

12

Ethics Principles

Public beneficence looks at gains or losses for the public populations affected by the new research.

Responsible stewardship asks researchers to consider those who cannot represent themselves in future studies and in the use of products of the studies.

13

Ethics Principles

Freedom of intellectual efforts balances total freedom for study with stopping research. It asks for ongoing accountability.

Justice and fairness asks researchers to not subject individual, groups, or communities to risks in an unfair manner.

14

Computer –Assisted Robotic Surgery

This area combines the use of computer imagery and robotic equipment to assist in surgical interventions.

It includes stereotatic radiosurgery, computer-aided maxillofacial surgery, and robotic-assisted visceral surgery.

15

Computer –Assisted Robotic Surgery

Ethics issues include the lack of resources for all facilities to have this level of technology, thereby affecting population beneficence.

In addition, the costs of the investment must be recovered and that cost is passed on to the patient.

Only patients with funds can benefit.

16

Magnetic Resonance Imaging

MRI now have increased field strength (signals).

MRI strengths may reach 7-9.4T; resulting in enhanced image quality.

Ethical issues arise with the increase in costs versus the overall increased patient benefit.

17

17

Magnetic Resonance Imaging

Marketing makes an investment in higher “T” for MRI machines.

Deontology is often used as an argument for purchasing the higher “T” machines.

However, the higher “T” machine can also generate lower “T” images.

18

Magnetic Resonance Imaging

Consideration is being given for reimbursement for MRIs by signal strength.

This action can increase ethics temptation to upcode.

There is also a temptation to order more 1.5T images on 3T machines.

19

IBM Watson an Cognitive Health Care

IBM Watson is a supercomputer that can change healthcare decision making.

There are ethics concerns including the replacement of physicians.

Autonomy issues need to be considered.

20

HIT and Medical Group Practice

HIT is expanding rapidly and there is a rush toward implementation.

The HITECH is an attempt to ensure adoption of the EHR.

Meaningful use is required including proof of application and certification.

21

HIT and Medical Group Practice

An ethical concern about beneficence can be found when looking at the need for speedy implementation of the EHR.

The quality of care for patients should be of concern regardless of the form of documentation. There is a moral obligation to act in their benefit.

22

HIT and Medical Group Practice

Providers may choose to opt-out of the incentive program for EHR adoption.

This decision may be based on excessive capital expense, costs of training, and other concerns.

Patient quality concerns are issues with this decision (nonmaleficence).

23

IT and Privacy

The benefits of the EHR can also be liabilities.

Patients are concerned that their medical records are not confidential.

HIPPA violations have occurred.

Security continues to be an issue in protecting patient information.

24

IT and Privacy

Ethics issues include the protection of confidentiality.

In addition, training needs to be ongoing.

Organizations have a fiduciary obligation to protect security.

25

Keeping Up with Regulations

Medical group practices also have increasing and changing funding issues and regulations.

There is a need to stay current with MACRA and other reimbursement changes.

Autonomy of medical providers and nonmaleficience are ethics issues.

26

In Summary…

27

27

error: Content is protected !!