health ethics – justice, autonomy, veracity, and fidelity

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justice
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an assessment of how goods and harms are distributed; how equal or fair are the patterns of benefit or harm
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compare ethics (justice) to beneficence and nonmaleficence
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producing as much good and preventing as many harms as possible vs being concerned with how the goods and harms are distributed (equity or fairness of the patterns of benefits and harms)
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instances in which justice may directly conflict with other ethical principles ( fidelity, patient values)
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in the case of a malingerer – who is the needier patient, obligation to pharmaceutical manufactures – the cost of production vs the cost for saving the patient , treating a patient vs treating the caregiver- what would do the most good? ; who should pay for ED meds – do they cure or prevent a disease?
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malingerer
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a patient that takes up the pharmacists time; implies secondary gain (Getting benefits, time off from work,etc) ; the dr or pharmacist will not take them seriously
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Hippocratic ethics (justice)
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this may simply involve the pharmacist and their patient so the pharmacist may not worry about the cost to society but medicare/medicaid and the actual pharmacy may not allow this
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autonomy
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In ethics terms: self-rule free from interference by others and/or limitations that prevent “meaningful choice” ; Usually indicates that someone has free will to make decisions and they are able to act upon them if they choose
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autonomy vs beneficence
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Beneficence: Actions that are done for the benefit of others (specifically, the patient) vs. Autonomy: Actions done according to the patients’ choice or decision. Patients are free to choose and informed of options ( ex. hiding side effects from the patient bc not sure the patient would make the right choice to choose treatment if she knew the side effects)
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internal constraints that may limit autonomy
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cognitive- Dementia, memory loss, mental illness; physical- Handicap, trauma, stroke
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external constraints that may limit autonomy
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environment of decision -Prison, long-term care, mental health facility; finances; family/friend influence
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potential violations of autonomy
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hiding side effects, giving blood to someone who’s religious beliefs goes against it, making someone take their meds and they are cognitively able to understand what it means if they dont, prison clinical trials, etc
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paternalism
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limiting autonomy to produce good for the patient (ex. If person is unable to make decisions for self and making wrong decision may cause harm to others ) ; may be seen in hippocratic pharmacists who strives for good outcomes
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therapeutic nihilism
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assumption that patient won’t understand options so only given a couple ; ex. If person is unable to make decisions for self and making wrong decision may cause harm to others
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capacity assessment
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Is the patient able to understand… Current medical problem Proposed treatment for problem Alternative to proposed treatment Option of refusing treatment Potential consequences of accepting or refusing treatment
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tools that may help a patient maintain autonomy while staying safe
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Pill minders, timers, calendars; involving family members/ caregivers, social workers in med management
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veracity
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honest disclosure
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traditional ethics approach on veracity
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it’s wrong to lie to people; lying indicates a lack of respect for people; lies that produce good results are still wrong
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condition of doubt about the facts of a situation + veracity
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the provider isn’t sure of the information he or she is disclosing to the patient so should the patient be told of the information
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lying in order to benefit + veracity
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protecting the patient or others; Patient may be injured physically or psychologically if truth is told ;can the problem be avoided by referring the patient to the physician for disclosure? ;
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special cases of truth telling + veracity
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patients that don’t want to be told the truth and family members who don’t want the patient to be told
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right to access medical records + veracity
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the patient is allowed to his or her medical records
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hippocratic oath + veracity ( does it require doctors to deal honestly with patients)
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no; if it saves the patient agony then it is okay for lie to the patient
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APhA code of ethics + veracity
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truthfulness is part of the essential characteristics of a pharmacist …..”to tell the truth and act with conviction of conscience.”
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utilitarian ethics + veracity
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Evaluates the benefits and harms to all parties; Assesses the acceptability of a lie based on total consequences
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respect for persons view + veracity
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it’s wrong to lie; Shift in acceptance by MDs of patients’ rights to be told the truth
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autonomy vs veracity
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the patient can’t be completely autonomous if he or she does not know all the facts about the situation
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fidelity
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The principle that obliges one to be faithful to commitments, especially in keeping promises and protection of confidentiality; duties associated with this are the function of the nature of the relationships and expectations brought to them
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two types of relationships that are associated with fidelity
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covenantal ( unspoken bond) and contractual (agreement)
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examples of covenantal relationships
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parents to children; pharmacist relationship with patients (mutual obligations); scheduling appointments ; providing payment for services;
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examples of contractual relationships
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lawyers and clients,work contract, etc
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promises to a colleague + fidelity
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does the obligation to the patient outweigh the obligation to the colleague
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limits to promises of confidentiality
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Certain situations may require pharmacist to break confidentiality with patient (not supported under hippocratic oath and vague interpretation under APhA code of ethics; safety concerns, legal requirements
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Acceptable to break confidentiality if it…
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Benefits the patient Benefits others, society Benefits/required by third parties (legal system)
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Tarasoff Act
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duty to protect any potential targets/victims if homicidal intent is verbalized, despite confidentiality of patient-provider discussions.

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