Chapter 12: Ethics and Ethical Principles in

Healthcare
Introduction

When you hear the word “ethics” what do you think? For
most people ethics means that sense of right and wrong
or your moral obligation to others. Both are good answers
to “What is ethics”? But, here’s the problem...WHO
decides what is right and what is wrong? Who
determines what your moral obligation to others is?
Those are extremely important questions to think about.

If you remember back in the critical thinking lesson, we

talked about where your thinking comes from. We stated that your thinking might come
from your parents, your schools/teachers, your neighbors, the tv you watch, the books
you read and, if you are involved in a faith based community, from their philosophy. It
comes from the people you “hang out” with. Well, take all that and now apply it to the
topic of ethics because ethics and critical thinking go hand in hand.

If ethical decisions were easy with a clear sense of right or wrong or moral obligation,
there would not be any ethical dilemmas. Wars have been fought because of different
peoples’ sense of right and wrong and moral obligation. Families have been divided
because of different views of issues. When talking about ethical dilemmas a few of the
more controversial topics are abortion, euthanasia, stem cell research, and cloning.

This is where developing exceptional critical thinking skills is important. You have to
learn to look at things without bias and honestly, that is extremely difficult to do. But
remember, just like in the exercise you did for critical thinking, there are facts that
support and facts that oppose the issue. It is a dilemma because it isn’t just one sided.

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Importance to Student

Just like in the critical thinking assignment, as you get

into college it is time to think about your thinking and
to evaluate your thoughts. This applies to ethical
dilemmas. One of the great things about being a
student at Sinclair is the diversity of our student
population. Because of this, you are exposed to many
different ways of looking at situations. That is what is
going to help you on your journey to discover what
YOU think about different dilemmas not how others have told you to think about them.
It’s okay to be a “flip flopper” if that means you are seriously looking at the information -
the FACTS not the opinions - and working to figure out what is right and wrong and
what your moral obligation is. And the younger you are, the higher the likelihood that
your opinion will change over time. After you get out into the world of healthcare and
get exposed to so many different situations, you WILL start questioning those beliefs.
That is good! You need to examine and question your beliefs based on new
experiences and information.

The other thing you will be exposed to as a student is your profession’s code of
conduct. You are going to take a brief look at this in this class but as you get into your
programs, knowledge of your code of conduct (also known as standards of care and
other names) provides you the direction you need to determine right from wrong when it
comes to the care of your patients and the moral obligation that you have to those
patients.

Importance to Professional

Ethics will guide your work in healthcare. You have the moral obligation to treat all
people the same regardless of race, ethnic group, religion, or ability to pay. You have
the moral obligation to provide care to the highest standard of your profession.

As a healthcare professional, you will be exposed to situations that

go against your belief system. This is where sometimes the only
thing you can do is walk away from your job. Before you take a job,
you need to find out what the mission statement of that company is.
What are their policies and procedures especially when faced with
situations that can be ethically sensitive? If you do not believe in
the mission statement of an employer and cannot abide by their
policies and procedures, you need to find a different place to work.

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Chances are very high you will not make them change their position and their mission
statement so why are you still working there? To illustrate this point, below are two
mission statements from two very different facilities who provide health services. These
were chosen because they are on different ends of a very long spectrum. Could you
work at either of these?
● Mission Statement 1: To empower individuals to make independent, informed
decisions about their sexual and reproductive lives, we provide information and
health care, and promote public policies that make those services available to all.
● Mission Statement 2: We are dedicated to excellence and to providing each
individual the most appropriate care in the most appropriate setting. In the spirit
of Seventh-day Adventist health care ministry, we strive to be innovative and to
convey God's love in a caring environment.
Remember there is no right or wrong in either of these, but you need to know the
mission of the institution where you want to work and if it will be a good fit for you.

If you ever get the opportunity to serve on an ethics committee where you work, jump at
the chance. As part of the committee you will be working with others whose views differ
from yours to develop the policies and procedures that will guide personnel during times
when ethical issues arise. You might even be able to be part of a team that must
address a very specific ethical dilemma that directly impacts a person’s life or death.
You will not leave the committee unchanged. I had the opportunity to serve on such a
committee. A baby was born without a brain but did have a brain stem. He was being
kept alive on a ventilator. The fundamental issue was that with a brain stem the
autonomic systems could function; but the child did not have a brain which would allow
for sight, hearing, tasting, etc. What would you do? Oh, let’s make this just a little more
complicated, the parents had been trying for 20 years to have a child, and this was their
first successful delivery. Ethical situations are not easy.

Bottom line, your positions on ethical situations in healthcare change based on what
you see, what you do, and who you work for. It is a natural part of your development as
a professional.

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Terms

Ethics Terms

● Ethics - the sense of right and wrong or

your moral obligation to others; although
people generally agree on common
moral norms, it is how we interpret them
based on our values and life experiences
that can lead to ethical disagreements.
● Code of ethics - a set of rules or
standards for professional behavior that
outline the expectations of our moral obligation to our profession.
● Standards of care - the basic care that must be provided by an individual within
that healthcare profession. It sets the standard for how other qualified healthcare
professionals will manage a patient’s care given the same or similar
circumstances. In case of a lawsuit it must be proven the professional did not
meet this in regard to the care provided.
● Bioethics - there are a variety of ways to define this but in our complex world it is
looking at the ethical issues that have come about because of advancements we
have made in biological research and how the results of that research applies to
medical policies and procedures. Think of the statement “just because we can,
should we”?
● Clinical ethics - a practical discipline which helps to provide a structured
approach in identifying, analyzing and resolving ethical issues in clinical
medicine.
○ Clinical ethicist - person who offers guidance to patients, their families,
and professional staff on ethical, legal and policy issues and concerns that
stem from dealings between healthcare professionals and patients.
● Medical ethics - the study and application of standards of care within medicine.
● Practical ethics - start with practical
problems and using moral theorizing to
work towards solutions for those problems
in real life. Seeks to bridge the divide
between the theory and the application of
that theory.
● Professional ethics - The personal, moral,
and business rules that govern the behaviors of a profession. All healthcare
professions have these. Can also be called code of conduct.
● Research ethics - involves the planning, conducting and reporting of studies
conducted within a scientific profession. It often needs to include protections for

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 both human and animal subjects. It promotes the aims of the research, the work
between the collaborators and the reporting of the results to the public.

Fundamental Ethical Principles

● Autonomy - also known as self-governance which means having independence
in one's thoughts or actions; being able to make own decisions.
● Beneficence - actions taken that will help to prevent or remove harm and/or
improve the situations of those who are in our care. Remember - first do no
harm.
● Competence - maintaining and improving your skills, knowledge and expertise
as it relates to your profession. This includes making a commitment to lifelong
education and learning.
● Confidentiality - keeping personal information learned about another person
private or secret.
● Honesty - communication and activities that are free from deceit; providing
information that is truthful.
● Human Subjects Protections - in the area of research ethics this is making the
commitment to ensure that subjects that are part of a study are put at minimal
risks and harm and yet still receive maximize benefits. It is important that special
precautions are taken with populations which are more vulnerable. Within a
study it is important to strive to distribute the benefits and burdens of research
fairly.
● Integrity - being straightforward and truthful;
displaying strong moral principles; not believing or
aligning yourself with information that contains false
or misleading statements.
● Justice - behavior or treatment that is equitable to
all involved; allowing for the fair distribution of
scarce resources.
● Morality - living by a code of what is what is right
and just; system of values and principles of conduct.
● Non-maleficence - always acting in ways that do not cause harm to others;
avoiding intentional harm and the risk of harm.
● Objectivity - looking at things based on facts and not allowing your biases to
influence your thoughts. This includes not letting others influence your
professional ideas due to pressure put on you by them. Not being involved in
things that result in conflict of interest.
● Openness - in your professional environment the willingness to share
information, data, ideas, tools, resources and more. This is also seen in
willingness to accept constructive criticism and to listen to new ideas.

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 ● Privacy - allowing a person to be free from being observed by others or allowing
others to keep secret information they do not want to share.
● Professional behavior - complying with the regulations and laws of your
profession while avoiding actions that could lead to a negative effect of your
profession.
● Social Responsibility - striving to promote the good of society while preventing
the effects of harm through dedication to research, education and advocacy.
● Veracity - adherence or conformity to truth or fact; the pursuit of accuracy.

Additional Terms

● Fact - a truth verified through actual experience or confirmed through

observation; proven to be true.
● Opinion - forming a view about something that is not necessarily based on fact
or knowledge; holding a belief that certain facts, ideas are probably true even if
facts are not in evidence.
● Bias - to feel a certain way or prejudice for or against someone or something
without necessarily taking in the facts associated with the person or thing into
account.

Please go to the Learning Activities page for the Law and Ethics in Healthcare lesson to
access the Practice Games to help you prepare for your quiz on these terms.

Photo References:
First Photo:
Ethics by Hcogg001 via CC-BY-SA-2.0

Second Photo:
No restrictions under CC, located at pixabay

Third Photo:
Business ethics.jpg by Madhumathi S V via CC BY-SA 4.0

Fourth Photo:
No restrictions under CC, located at pixabay

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Fifth Photo:
Definition of Integrity by Nick Youngson via CC BY-SA 3.0

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