A Reasonable Person in Healthcare

Question

 Description

explain the "reasonable person standard," and describe how it applies to the health care setting.

Lesson #1

“Science brings society to the next level; ethics keeps us there.” -Dr. Hal Simeroth

As a healthcare professional, you will be faced with making difficult ethical decisions.

As Dr. Simeroth suggests in the quotation above, our science is moving quickly, but to

decide if these discoveries are social advancements is something that individual health

care professionals much do. In making these decisions there are a number of issues to

consider. Some have to do with the nature of ethics and morals themselves. These are

decisions such as, “What is an ethical code?” and “What is the source of moral

authority?” These questions ask us to reflect upon how and why we believe what we do

so we can better assess whether the decisions we make are personal or individual

ones, or whether they can fairly be applied to others in our community. These decisions

fall into the area of meta-ethics. “Meta” is a prefix that means beyond. Therefore,

“metaethics” means looking beyond the ethical to ask questions about the nature of

morality itself. Metaethical questions are deep questions that explore the very

foundations of ethics and the realm of moral values. The essential questions we have

for class each week are like this type of question.

In addition to metaethical issues, we will also ask questions of applied ethics. Applied

ethics asks us to look at the specific application of particular and often controversial

ethical questions such as how we approach pain management in the end of life, the use

of IVF, and the enactment of the Safe Haven Law all of which we will consider in our

course. We must also be aware of our own perspective in decision making and ask

whether our decisions would make sense to someone who’s cultural or social

background was significantly different than our own. Applied ethical questions can be

likened to the topical questions in our course which drive our discussions.

The Internet Encyclopedia of Philosophy has a good way of looking at the difference

between the two. Metaethics is a branch of analytic philosophy that explore the status,

foundations, and scope of moral values, properties, and words. Whereas the fields of

applied ethics and normative theory focus on what is moral, metaethics focuses on what

morality itself is (Mathaetics, n.d.).

Within the study of ethics, there are many branches. We are interested in our class in

the study of medical ethics including questions of autonomy, dignity, identity,

personhood, and the fair distribution of scarce social goods. The core principles of

medical ethics are known as beneficence and nonmaleficence. The standards of

beneficence state that health care practitioners should perform acts to help people stay

healthy or recover from an illness. The first duty of a healthcare professional is to

support the patient’s health above anything else. Beneficence is the moral term,

however, there are legal aspects to medical ethics as well. From a legal perspective,

we may speak of a fiduciary relationship. A fiduciary duty is the highest form of

PHIL222 – Week 1 Lecture 2

responsibility and includes duties of loyalty, confidentiality, good faith, prudence,

disclosure and care. The person who has the fiduciary duty is called the fiduciary and in

this case, would be the health care provider. The person who is owed the fiduciary duty

is called the beneficiary and for our purposes is the patient.

In addition to beneficence, there is also the duty on nonmaleficence. Whereas

beneficence charges us to always perform acts to help patients, nonmaleficence is the

standard of “do no harm.” The Hippocratic Oath, formulated by the Greek philosopher

and physician Hippocrates, is often associated with nonmaleficence. Although

physicians no longer take the Hippocratic oath the spirit of “do no harm” is still alive and

well in the modernized versions that govern health care professionals. An interesting

exercise is to look into the different versions of the Hippocratic Oath and consider the

extent to which health care professionals duties have (or have not) changed throughout

history.

Philosophically there is an important difference between the demand to “do no harm,”

and the demand to “heal.” One is a passive command that orders the healer to refrain

from an action that would harm a patient. The other is an active command that order

the healer to take action to help. Perhaps one of the places this distinction becomes

very clear is in the question of Physician Assisted Suicide which we will consider later in

the course. Many feel that a patient should be allowed to “die with dignity” but that may

conflict with the “do no harm principle.” Some medical professionals allow withholding

care, some believe treatment should be aimed at healing until death occurs, and others

believe that it is permissible to assist a dying patient in passing. The conflict among

these views is a disagreement about the principles of beneficence and nonmaleficence.

PHIL222 – Week 1 Lecture 3

One of the reasons ethical decisions are difficult to make is because you will struggle

with determining who is affected by your decision. Does your decision benefit you, your

patient, or the greatest number of people? You will be studying two ethical theories,

Utilitarianism and Deontology, which will give you some ethical tools to help you make

these decisions. We will consider these theories in greater detail in the next weeks, but

as a starting point, Utilitarianism is a consequentialist theory that seeks to determine

which action will produce the greatest good for the greatest number of people. It is

called consequentialist because the utilitarians believe that the morality of an action

could be located in its consequences or outcome. Deontology, by contrast, is

considered a deontological theory. That means that it is a rule based theory that looks

for the morality of the action in the rule or precedent set by an action.

What are ethics?

Sometimes, ethics are defined simply as moral philosophy. But, that definition does not

help when we are faced with an ethical dilemma. A good definition of ethics is values

that are used to determine moral conduct or beliefs.

In this course, we will be studying the concepts that make up that definition of ethics.

These concepts include values, morals and belief. We will look at these separately.

Values

A person’s values can be difficult to identify because they are different for everyone. To

understand the concept of values you can ask the question “does it matter” and “if so,

how much?” Determine how much the decision you have made is worth to you. Not

everyone will place the same amount of value on the same things. Ultimately, our

values reinforce our considerations, guide our behavior and give purpose to our lives.

Values influence our identity and direct our actions. Most of our decisions in life are

made fairly easily; however, there are times when we are confronted with new and

difficult dilemmas that demand a good framework in order to find an answer. In this

course we will be examining concepts we can use to understand and direct us to the

right answers.

Morals

The concept of morals addresses the question, “what is right and what is wrong?” We

learn about morals at a very young age, usually from our parents, friends or others who

have the job of raising us. We also obtain our moral values from other environmental

factors which contribute to our moral values. Some of these environmental factors that

help shape our values are culture, ethnicity, class structure and a person’s social

standing (Gibson, 2014).

Beliefs

Beliefs are interesting because sometimes we cannot explain them, even though we are

given guidelines for how to make good decisions. There may be situations where we

cannot explain why we believe something is right or wrong and know that we should

base our decisions on facts and evidence when determining if something is true or false

(Stanford, 2014). Using just our beliefs means we are basing our decisions on emotion

PHIL222 – Week 1 Lecture 4

and feelings instead of tangible proof. Beliefs are often associated with religion where

we are taught to “believe” things are true and real—without concrete scientific evidence.

Conflict and Dilemmas

Many times these words are used interchangeably; however they have very different

meanings. Conflicts create dilemmas. Dilemmas do not create conflicts. For example, a

physician who is asked to treat a family member has a conflict. For this doctor, the

conflict is between caring for his family member and worrying how this could interfere

with his medical judgment. In other words, conflicts create the problem and dilemmas

are what occur after the problem has been created. (Gibson, 2014).

Key Terms

Ethics

Morals

Beneficence

Non maleficence

Fiduciary

Hippocratic oath

Utilitarianism

Deontology

Metaethics

Applied Ethics

Lesson #1 Completed! 

Thank you! You have completed this lesson.

PHIL222 – Week 1 Lecture 5

References

File: HippocraticOath.jpg. (2018, June 5). Wikimedia Commons, the free media

repository.

Retrievedfrom https://commons.wikimedia.org/w/index.php?title=File:Hipp

ocraticOath.jpg&oldid=304653059.

Gibson, K. (2014). An introduction to ethics. Boston, MA: Pearson Education.

Metaethics. (n.d.). Retrieved from http://www.iep.utm.edu/metaethi/

Stanford, C. (2014). Ethics for health professionals. Burlington, MA: Jones & Bartlett

(including quote)