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Ethics and the Interprofessional Health Care Team

Week 6
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Lecture Overview
Ethical Dilemmas in Healthcare and Interprofessional Teams Professional Codes of Ethics

Ethical Framework and Decision Making

Learning Objectives
1. Identify the distinction between moral and ethical dilemmas 2. Understand ethical reasoning and ethics frameworks as they relate to teams 3. Apply ethical reasoning skills to scenarios

Morals vs. Ethics


A criminal defense lawyer will keep aside his morals when defending a criminal and murderer in court. It does not matter whether he considers the killing of another person to be against a moral code but, according to his ethics, he has to defend the client as strongly as possible.

Source: Difference Between Ethics and Morals | Difference

Between | Ethics vs Morals http://www.differencebetween.net/science/nature/differencebetween-ethics-and-morals-2/#ixzz1m4qj1BOc

Real-Life Stories
A nurse who is married to a police officer is asked to provide care to a gun-shot patient who is under guard and has been charged with the murder of a cop

The colleague of a lab technician, a fellow technician who performs phlebotomy, reveals she is HIV positive
A health care professional who is a devout practitioner of a faith that condemns abortion is asked to care for a patient undergoing an abortion A drug seeking patient has lost a prescription for narcotics and is seeking a replacement and is in obvious pain
What morals might be in conflict with ethical codes? How might individuals vs. teams react in these scenarios?

Morals vs. Ethics


Morals are values-based and are influenced by culture, religion, family, peers, society, philosophy Ethics are codified and describe a societal view of appropriate behaviours

Ethics
Ethics is, simply put, the study of what is good and bad, right and wrong, and of moral duty and obligation. It also includes the values and principles of conduct governing an individual or a group.

In health care ethical issues are usually conceptualized as standards of practice linked to the dyadic responsibilities of individual providers toward their patients and each other as professionals (Clark, Cott & Drinka, 2007, p. 591)

Ethical Principles in Practice


Beneficence promoting well-being Non-maleficence do no harm Respect for autonomy supporting patient choice Justice distribution of risks and benefits Veracity truthfullness Substitute judgement standard someone else deciding based on knowledge of the will of the patient Best interest standard deciding for a patient when they cannot decide for themselves
(Beauchamp and Childress, 1994, 2001)

Morals & Ethics in the Media


Karen Ann Quinlan (1975) Robert Latimer (1994) Dr. Jack Kevorkian Sue Rodriguez (1994) Shafia family (2012) Obama Health reform law and contraception (2012)

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Moral & Ethical Dilemmas


The crucial features of a moral dilemma are these:
the agent is required to do each of two (or more) actions; the agent can do each of the actions; but the agent cannot do both (or all) of the actions.

The agent thus seems condemned to moral failure; no matter what she does, she will do something wrong (or fail to do something that she ought to do)* When two or more ethical values apply to a situation, but these values support diverging courses of action, an ethical conflict or dilemma exists. (CNO, 2009)
*Source: http://plato.stanford.edu/entries/moral-dilemmas/#ConMorDil

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Moral & Ethical Conflicts


Health professionals and families who believe that human life should not be deliberately shortened and that unpreventable pain should not be tolerated face a conflict in deciding whether to withdraw life support from a dying patient*.

A nurse has explained to his client the benefits of taking medication and firmly believes that the medication is in the clients best interest. The client understands Normans explanation, but refuses to take the medication. The client states that the side effects of the medication cancel out any benefits. (CNO, 2009)
*Source: http://plato.stanford.edu/entries/moral-dilemmas/#ConMorDil

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Practice #1
In your group, discuss the case Keeping Tabs on Mom Identify the practical considerations and ethical principles (slide 8) that are relevant to this case.

Bruce, C. (2011). Keeping tabs on mom: The ethics of motion sensor based monitoring of the elderly. Retrieved from http://www.scu.edu/ethics/practicing/focusareas/medical/sensor-basedmonitoring.html For more case studies, visit: Markkula Centre for Applied Ethics, Santa Clara University, http://www.scu.edu/ethics/practicing/focusareas/medical/

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Relevance of Ethics in Health Care Organizations


Disclosure policies Consent policies Do Not Resuscitate orders Conflict of interest guidelines Substitute decision makers Living wills Interprofessional Team Work

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Relevance of Ethics in Health Care Organizations


Disclosure policies Consent policies Do Not Resuscitate orders Conflict of interest guidelines Substitute decision makers Living wills Interprofessional Team Work (our focus)

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Why Do Ethics in Interprofessional Teams Matter?


Collaboration across healthcare professions and within varied care settings is increasing

Unique moral & ethic dilemmas are arising from collaborative team work
New questions have to be asked and answered as expanded teamwork practice grows

Lessons from the Bacteria: How Good Culture Trumps Bad Leadership (podcast)
http://www.globalethics.org/lessonsbacteria.php

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(6 min) Institute for Global Ethics (www.globalethics.org)

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Ethical Principles in Teams


Reasonableness Responsibility Respect Trust Justice Honesty Integrity Think about your group norms and team contracts any similarities?
From Morality and the Professional Life: Values at Work by Cynthia Brincat and Victoria Wilk (as cited by Frey, 2012)

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Ethical Framework
A framework aids in thinking about & understanding the ethical dimensions of interprofessional teamwork Clark, Cott and Drinka propose three elements:

1.
2.

principles that suggest general guidelines for behaviour,


structures (both formal and informal) that encompass established forms of knowledge and patterns of behaviour within an organization for individual and collective practices related to teamwork, and processes that are factors related to the procedural aspects of ethical practice, focusing less on what is important than on how things are done in the health care setting.

3.

(2007, p. 593)

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Ethical framework (cont.)


Ethical dimensions can be analyzed at three different levels:
the individual, the team, and the organization
(Clark, Cott & Drinka, 2007, p. 593)

See Table 1 in Week 6 folder for full framework

Ethical Framework - Principles


Individual
i.

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Team
the responsibility of each member for promoting and protecting the team as a distinct structure, and

Organization
i. respect the unique relationship between the team and the patient as a part of the team approach to providing care,

ii.

To develop knowledge i. of oneself and competency in ones own discipline as the basis for mutual respect among the professions on the team, ii. To understand the norms and practice standards of the other professions on the team, and

the shared accountability of each member for the teams decisions and outcomes.

ii.

understand the basic principles of teamwork, and


provide sufficient resources for the team to be able to accomplish its work and fulfill its mission.

iii.

iii.

To master the basic knowledge and skills required for effective teamwork.

(Clark, Cott & Drinka, 2007, p. 594)

Ethical Framework - Structures


Individual
i.

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Team
Integrate professional knowledge with other team members Develop integrated patient problem definitions and a structure for assessment and care planning

Organization
i. Provide sufficient resource foundation for team Establish evaluative structures for assessment of teams work

ii.

Develop standards i. of professional practice for personal relationships with other team members ii. Acquire insights into basis for practice of other professions on team

ii.

iii. Establish a personal structure for iii. Promote and teaching new protect team as members about distinct structure ones profession and roleCott on team (Clark, & Drinka, 2007, p. 594)

Ethical Framework - Processes


Individual
i. Practise active awareness of respectful communication with other team members Discuss controversies and problems with others

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Team
i. Develop ethic of open communication and dialogue Arrive on time for team meetings

Organization
i. Support team development and function Appoint facilitator to address communication and ethics issues and mediate team conflicts

ii.

ii.

ii.

iii. Get to know and assimilate new members into teamwork processes

iii. Develop and implement integrated patient care plans

(Clark, Cott & Drinka, 2007, p. 594)

Ethical Decision-Making Framework: ISSUES

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Post an example of a alternate ethical framework to your Group Work Discussion forum

Source: Hamilton Health Sciences Centre Ethics Framework

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Practice 2: Integrating A New Team Member


Apply the framework proposed by Clark et al. (see separate handout in Week 6 folder) to illustrate how the various components can be used in a real-life situation. Reflect on the differences between ethical situations impacting teams and those discussed earlier.

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Related Readings
Community Ethics Toolkit : http://www.jointcentreforbioethics.ca/partners/doc uments/cen_toolkit2008.pdf Meadus, J. & Wahl, J. (2008) Transfer from hospital to long-term care: reframing the ethical debate from the patients Perspective. Retreived from www.acelaw.ca Meadus, J. (2010). First available bed policies & discharge to a long-term care home from hospital. Retrieved from www.acelaw.ca

Meadus, J. (2009). The role of community care access centres in admission to long term care from Hospital. Retrieved from www.acelaw.ca

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For next class


No class February 21 reading week Week 8 (February 28) will be Organizational Change: Collaborating in Times of Change Review Assigned readings from reading list

Enjoy your break!

References
Beauchamp, T. L., & Childress. J. F. (2001). Principles of Biomedical Ethics (5th ed.). New York, NY: Oxford University Press. Bruce, C. (2011). Keeping tabs on mom: The ethics of motion sensor based monitoring of the elderly. Retrieved from http://www.scu.edu/ethics/practicing/focusareas/medical/sensorbased-monitoring.html Clairmont, S. (2011, November 1). Forced apart after nearly 70 years. The Hamilton Spectator. Retrieved February 12, 2012 from http://www.thespec.com/news/local/article/617797-forced-apart-after-nearly-70-years Clark, P., Cott, C., & Drinka, T. (2007). Theory and practice in interprofessional ethics: A framework for understanding ethical issues in health care teams. Journal of Interprofessional Care, 21(6): 591 603. Retrieved from http://www.cihc.ca:8180/library/bitstream/10296/382/1/ClarkEtAl_InterprofessionalEthics_Dec 2007.pdf College of Nurses of Ontario (2009). Ethics. Retrieved from http://www.cno.org/Global/docs/prac/41034_Ethics.pdf Frey, W. (2012). New Ethics of Teamwork (presentation). In Ethics of Team Work (on-line course module). Retrieved February 12, 2012 from http://cnx.org/content/m13760/latest/?collection=col10491/1.9 Hamilton Health Science Centre. (2010). Ethics framework. Retrieved from http://hamiltonhealthsciences.ca/workfiles/CLINICAL_ETHICS/HHSEthicsFramework.pdf McConnell, T. (2010). Moral Dilemmas. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy (Summer 2010 ed.). Retrieved from http://plato.stanford.edu/archives/sum2010/entries/moral-dilemmas

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