Live SessionModule 1
HCM515
Health Law and Ethics
Instructor Name
Module 1 Learning Outcomes
1. Determine
ethical
principles
applicable
in
healthcare
situations.
2. Compare ethical principles in
healthcare.
3. Analyze
the
efect
ethical
principles
in
administrators’
decision-making processes.
HCM515: Health Law and Ethics
The Context of Global Health Ethics
Throughout the world, fnancial and healthcare resources are not distributed equally.
Depending on where you live, you can have a drastcally diferent life, as well as shorter
life-span compared to someone living somewhere else. Generally, lower- and middleincome countries tend to have shorter life spans and worse health conditons. Even
within countries themselves there are those who have less educaton, unequal access to
healthcare resources, and die of preventable deaths. In a highly globalized world, where
one can easily travel between locatons, certain health conditons can easily spread
across borders, as well. Healthcare providers and policymakers are interested in these
diferences and resolving these disparites, especially as our communites are becoming
more interconnected. Ethics serves as a lens to help us understand the relatonships
between groups and resources and understand who benefts and who bears the
burdens. By utlizing this self-refecton, it is hoped that we can avoid harms and help
those in need (Pinto & Upshur, 2013).
Healthcare Ethical Principles
• Discuss the principles along with the conficts :
• Autonomy: deals with the ability of an individual to make decisions for themselves. To do this an
individual must have full disclosure of their conditon, treatment and other relevant informaton.
• Nonmalefcence: in healthcare is the ideal that providers should not harm their patent or, in some
instances, infict the least amount of harm.
• Benefcence: is the obligaton to do good. So for a healthcare professional, when there is a medical
choice, it must be the one that most benefts the patent. This could help a provider choose between
treatments.
• Justce is the principle that deals with what is right and fair. For example, if there is a vaccine available
for a partcular disease, then providing it to everyone would be right. But what if there is a shortage of
the vaccine? How should it then be distributed?
• Veracity deals with telling the truth, and comes into play in situatons like informed consent. A provider
must be honest in a diagnosis, even if it is something a patent might not want to hear.
• Fidelity is the principle to be loyal – honor commitments, keep promises, and maintain trust. It is
important that providers respect this principle; patents need to trust them so that they feel confdent
disclosing their private medical informaton.
• Confdentality and privacy deal with keeping a patentts medical informaton private except when
necessary for treatment, operaton or payment purposes. Thus, a nurse shouldntt gossip about a
patentts conditon.
HCM515: Health Law and Ethics
Ethics and Global Health
• Resource Disparites and Power Relatonships
• Ethical Concepts and Reasoning
• Ethical Theory
• As wetve discussed, there are signifcant disparites in health throughout the world.
The sad truth is that some beneft from the imbalance of power and equity while
many others sufer. In healthcare this sufering can be seen through the burden of
disease and poor health outcomes experienced by more vulnerable populatons. The
unequal distributon of resources to these populatons is obvious, and is a violaton
of the justce principle.
• While ethics can difer between cultures, all cultures have a concept of right and
wrong. Ethics is separate from legal responsibilites in that it deals with internal
values and obligatons. Thus, there isntt always a formal authority that regulates
these ideals (Pinto & Upshur, 2013). We will discuss a litle later the professional
bodies that set forth ethical dutes and standards. Itts important to note that there is
a diference between the ethical principles we discussed in the last slide with those
of applied ethics. Ethical theories provide a comprehensive, consistent and
defensible normatve account of moral actvity.
HCM515 Health Law and Ethics
Predominant ethical theories
Deontological – these theories focus on the moral worth of actons – that some are intrinsically
right and others are intrinsically wrong. It does not focus on the consequences of individual
actons– in other words it does not think the end justfy the means. A common example can be
seen in research involving human partcipants. You can apply this theory to state that the rights
of the subjects is more important than the scientfc value of the research.
Consequentalist – these theories look at whether an acton is right and wrong in terms of the
consequences of the acton. Utlitarianism, one type of consequentalism, states that the “right”
actons are those lead to the greater good.
Virtue based – this theory focuses the qualites and characteristcs of human agents. These
include humility, caring and wisdom atributes.
Relatvism – holds that standards determining right and wrong are community-based. Thus, if I
moved to a culture that had diferent ideals, I should be held accountable to those ideals and not
those of my former community. Pinto & Upshur, 2013).
Non-cognitvist- this theory says ethical values are unimportant and are merely a statement of
preference and emotons.
HCM515: Health Law and Ethics
Applied Ethics
•Distnguishing what is moral
•Through frameworks
•Ethical reasoning and argumentaton
There is much variaton in how we make sense of what is moral or
ethical, which can make it tough to determine what is right and
wrong.
One way is through a framework approach. In applied ethics, it is
understood that certain theories have atractve ideals in some
circumstances but might not work for every situaton. Frameworks
are ways to simplify ethical reasoning. It is a good idea to understand
how you personally evaluate what is right or wrong, because in
healthcare you ofen must make quick choices. Utlizing a framework
to make these decisions can save tme and also ensure you are staying
true to yourself.
A systematc reasoning approach allows you to assess the morally
relevant facts of a situaton.
HCM515: Health Law and Ethics
A Suggested Framework to Ethical
Reasoning
• What are the morally relevant facts in the case?
• How are they morally relevant?
• What are my underlying values?
• Prioritze the ethical issues in the partcular situaton.
• What are most important?
• What values did you identfy previously that impact your
decisions?
• Have your views changed at all since this analysis?
• What does the community think about your views?
• How does your role in your organizaton impact your views?
• At what level (personal, community, health system, global, etc. )
arising?
(Pinto & Upshur, 2013)
HCM515: Health Law and Ethics
Pinto and Upshur (2013), suggest this ethical framework
for determining whether a situaton is ethical, and how to
proceed given certain informaton. Itts true that your
decisions will difer depending on the relevant facts of a
partcular situaton. However, it is important to understand
what controls your basis for right and wrong.
This is important because how you act in your
professional life might difer from how you act in your
personal life. Having a plan in place can help you more
efectvely navigate difcult situatons and make tough
decisions.
Course Code and Title
Concepts of Justice
discussed justce in passing earlier but now letts take a closer look. Justce is
fundamental in healthcare because it looks at what is fair and just. Distributve
justce deals with how resources are alloted when there isntt enough to go
around. There are many diferent views on how to distribute scare resources:
• Egalitarianism is the view that everyone is owed the same level of benefts.
• Welfare is the view that the welfare of people is the most important ideal, and
that maximizing what is best for everyone is essental and of utmost importance.
• Desert-based theories state that benefts and burdens should be distributed
based on both the actons of individuals and the societes that create the
benefts. They consider the idea of whether someone is deserving of a partcular
treatment (whether positve or negatve).
• Libertarianism is the view that the distributon of benefts and burdens should
be based on how the free market deals with these situatons.
• Thus, as you can see there are even diferent notons of what is “just” (Pinto &
Upshur, 2013).
HCM515: Health Law and Ethics
Saudi Vision 2030 – New Models of
Care Program
HCM515: Health Law and Ethics
As part of the Saudi Health Sector Transformaton Strategy and Vision 2030, the New
Models of Care Program looks at the patent in an holistc manner—it considers the
physical, mental and social aspects of a patent. In providing care through this model
it is important that the ethical principles we discussed on the previous slide are at
play. These principles work hand-in-hand with this model, as patents who trust their
providers and are given truthful and complete informaton are able to make
autonomous decisions about their health care. Conficts of ethics can arise for a
provider when a patent decides on a course of treatment that the provider might
deem less benefcial then another. Thus, a provider must balance their need to be
paternalistc with the autonomy of their patent.
The program includes six prioritzed systems of care: Keep Well, Safe Birth, Planned
Care, Urgent Care, Chronic Conditons, and Last Phase. The program will deliver 42
interventons across the six systems of care. “The 42 initatves will include defned
patent pathways and key performance indicators (KPIs) including measurement of:
safety and quality process metrics, clinical and patent reported outcomes, and
fnancial performance. These New Models of Care KPIs will be incorporated into the
KPIs for the Essental Benefts Package (EPB) …to ensure that they are monitored and
maintained when achieved “ (MOH, n.d, pg. 17).
Course Code and Title
The following are just some of the interventons:
• Keep Well: community-based wellness programs; healthy food
promoton; school wellness programs
• Planned care: one-stop clinics; pathway optmizaton; length of stay
reducton initatves
• Safe birth: preconcepton care; maternity care; postnatal care; well
baby clinics
• Urgent care: urgent care clinics; populaton-based critcal care
centers
• Chronic conditons: chronic disease screening; case coordinaton;
contnuing care services
• Last phase: patent and family support; hospice care services
(MOH, n.d., pp. 36-37)
Course Code and Title
Health Sector Transformation Strategy – Risk Management
As with any major initatvee the Health Sector Transformaton Strategy faces certain
challenges and risks. The MOH (n.d.) notes that any strategy must be able to
address the following key tests:
1. Adequately address identfed challenges;
2. Achieve defned goals;
3. Enable policies and related initatves that are SMART (specifc, measurable,
achievable, realistc and tmely); and
4. It must be coherent, and the elements comprising the strategy must be in
alignment with one another. (MOH, n.d, 29).
The MOH identfes three broad categories of risk:
• Design risks – faws in the design
• Implementaton risks – good design and weak implementaton
• Operatonal risks – good design, sound implementaton, but operatonal
performance is impacted by antcipated or unantcipated operatonal risks (MOH, n.d,
29).
As you look at this, how might ethical principles come into play when designing such a
program?
HCM515: Health Law and Ethics
The role of the World Health Organization (WHO)
• How does WHO ensure something is ethical and principled?
• How are WHO ethics carried out and monitored?
• WHO major priorites for:
oUniversal health coverage
oHealth emergencies
oHealth and well-being
• As you know the World Health Organizaton (WHO) is a natonal body that advises
countries on certain behavior and actons. The area of ethical behavior in healthcare
is one in which the WHO advises countries. The entty provides awareness and
educaton on how organizatons and providers should act. The WHO has its own
agency of Compliance, Risk Management and Ethics (CRE) that internally and
externally acts to ensure the framework of WHOts ethical principles are being
followed. Through declaratons the WHO issues ideas and procedures for natons.
Natons can then sign on to these declaratons in agreement to uphold these ideals
(WHO, n.d-a). Through this contract, the WHO will then provide support for these
actons. The basic premise of the WHO is that all individuals deserve the right to care.
This is guided by the justce principle of fairness as well as the benefcence principle
(WHO,
n.d.-b)
HCM515: Health Law and Ethics
Saudi Code of Ethics for Healthcare
Practitioners
Healthcare
practtoner
ethics
Duty towards
patents
Dutes
towards
colleagues
Duty towards
community
Duty to
oneself
HCM515: Health Law and Ethics
The code of ethics for healthcare practtoners outlines various responsibilites that
are required to maintain their licensure in the country but also upholds the premise
of the ethical principles we have discussed. These include:
• Practoners should remain true and faithful, honest, humble, and respectul. They
should also value self-accountability and do not indulge in socially reprehensible
actvites.
• Practtoners should respect the patent by being empathetc, discreet, fair and
gentle. Their consent should be valued, confdentality maintained and they should
be reassured that they will be taken care of.
• Practtoners should conduct themselves as role models, recognize the community
and environment are important parts of health, practce with knowledge and
humility, be responsible with resources, improve knowledge and contribute to the
advancement of the feld. This also including supportng other practoners and
receiving feedback and respectng colleagues.
• Practtoners should conduct themselves well, manage their physical and mental
health, honor religious commitments, further their knowledge and never take
unreasonable risks. (Saudi Commission for Health Specialtes, 2014).
Course Code and Title
Reflecting on ethical health priority
• The short video, “Ethical Reasoning in Health Priority-Setng: Animated
Presentatons of Recurring Dilemmas,” raised a queston of priorites of testng
for hypertension in a poor versus a comfortable neighborhood. How would you
answer that queston?
Because healthcare deals with a limited number of resources and tough decisions
about healthcare, ethical dilemmas occur on a daily basis.
Healthcare
professionals and administrators must understand the ethical decision-making
process and where their personal values and those of their organizaton align.
Examine how students felt about the video and then discuss the various principles
that are in play in this situaton such as justce (the right of being fair) and the
belief that even poor individuals deserve the right to healthcare. Doing what is
best for even the most vulnerable populatons is seen through the principle of
benefcence (BioéthiqueOnline, 2015). The strength of a UHC system like that
found in Saudi Arabia is that everyone will have access to these resources;
however, not everyone utlizes these resources. This is why promoton of
healthcare resources is so important, so that even the most vulnerable
populatons understand these resources are available to them
HCM515: Health Law and Ethics
The four ethical principles: should we prioritize autonomy?
Given the 4 ethics principles listed below, should Autonomy be a priority? If not, which
principle (even if not one of the listed 4) should be a priority? Why
• Autonomy
• Benefcence
• Veracity
• Justce
Wetve discussed the ethical principles and their basic purpose; however, there are tmes
when ethical principles might confict. For example, consider a case in which a patent
has stage four cancer and might need to seek chemotherapy. What if the patent does
not want to know that his medical conditon is dire? What should a physician do if the
patent tells him not to tell him about his medical conditon, and to let his family decide
on the treatment plan? How would the physician decide whether one principle is more
important than another? [Here, engage the students in determining their ethical
decision-making process. Be sure to guide them to inquire how their organizatonts
policies and procedures tell them to proceed in this situaton].
(University of Derby Online Learning, 2015)
HCM515: Health Law and Ethics
Module 1 Assignment Requirements
• Discussion Board
o The role of ethical principles on healthcare
o Key concepts
This week we have a discussion board that pertains to the ethical
principles of healthcare. Wetve looked at many of these and have seen
their applicaton in healthcare. As you think about these ethical
principles and post to the discussion board, see if you can apply them to
a work situaton youtve encountered. For example, was there ever a
situaton in which you overhead providers discussing a patentts medical
informaton so loudly that others in the waitng area could hear? If so,
wouldntt this be a violaton of confdentality as well as fdelity in the
healthcare profession? Another situaton you might have encountered
at work or even as a patent is long waitng tmes to see a provider.
What health principle do you think this might violate?
Questions
Take advantage of this
opportunity to seek further
clarifcation.
HCM515: Health Law and Ethics
Next Live Session
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•
HCM515: Health Law and Ethics
References
• BioéthiqueOnline. (2015, April 16). Ethical reasoning in health priority-setng: Animated
presentatons of recurring dilemmas [Video fle]. Retrieved from
htps://youtu.be/tTilvOyAA5k
• Ministry of Health (MOH). (n.d.). Health sector transformaton strategy. Retrieved from
htps://www.moh.gov.sa/en/Ministry/vro/Documents/Healthcare-TransformatonStrategy.pdf
• Pinto, A. D., & Upshur, R. E. (Eds.). (2013). An introducton to global health ethics. New
York, NY: Routledge. ISBN-13: 978-0-415-68183-4
• Saudi Commission for Health Specialtes (2014). Code of ethics for healthcare
practtoners. Retrieved from
htps://www.iau.edu.sa/sites/default/fles/resources/5039864724.pdf
• University of Derby Online Learning. (2015, July 10). The four ethical principles: Should we
prioritse autonomy? [Video fle]. Retrieved from htps://youtu.be/fy2NUALX4Bg
• World Health Organizaton. (n.d.-a). Global health ethics. Retrieved from
who.int/ethics/en/
• World Health Organizaton. (n.d.-b). WHO brochure. Retrieved from
htps://www.who.int/about/what-we-do/who-brochure
HCM515: Health Law and Ethics
This concludes our live
session.
Thank you for your atendance!
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