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6/12/2019
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Ethics in Healthcare: “What is it you do again?"
Jacob Dahlke, MSB, HEC-C Ethics Director
Office of Healthcare Ethics Nebraska Medicine
(no conflicts to disclose)
1. Introduce fundamental ethical principles as they relate to medical decision making.
2. Apply principles to situations involving medical decisions.
3. Discuss tools for considering the role of clinicians in such decisions.
objectives
zugzwang
The only thing that makes life possible is permanent, intolerable uncertainty:
not knowing what comes next.~ Ursula K. Le Guin
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A lifeboat scenario …
CaptainYouLisa (7 y.o.)Lisa’s momAlex (a stowaway)Dr. AlvarezMr. Zhou (84 y.o.)
values
What is important to
me?(intrinsic )
morals*
What is right and wrong?(extrinsic )
*external systems of morality, not specifically one’s conscience
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ethics
How do I decide what to do?(normative)
bioethics
How do I use certain ethical principles to
make medical decisions?
Why ethics?values clarification, integration
analysis of issues or problem‐solvingconflicts or disagreements about patient care
answer questions or provide supportclarify documentation, policy, legal issue
analysis of issues or problem‐solvingpatient review
A thing is not necessarily true because a man dies for it.
~ Oscar Wilde
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What ethics?Treatment decision makingSubstitute decision making
Beginning of lifeend of life
Post‐death, post‐mortemProfessionalism, research
Organizational ethics, policy, resource allocation
Zen pretty much comes down to three things: everything changes, everything is connected, pay attention.
~ Jane Hirshfield
Who ethics?Ethics
Committees
Ethics Consultation
Service
Accept criticism only from those who are willing to help.
~ Amit Sood
Ethics toolsFour Principles:
1. autonomy2. justice
3. beneficence4. non‐maleficence
Do all the good you can, by all the means you can, In all the ways you can, In all the places you can, At all the times you can, To all the people you can, As long as ever you can.
~ John Wesley
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Ethics toolsFour Quadrants:
1. medical indications2. patient preferences
3. quality of life4. contextual features
Perhaps the truth depends on a walk around a lake.~ Wallace Stevens
Ethics tools Decision Making Standards:1. patient/informed consent
2. advance directives3. surrogates
People pay for what they do, and still more for what the have allowed themselves to become. And they pay for it very simply; by the lives they lead.
~ James Baldwin
How do I …?HealthcareRNAPPMD/DOPharmDsocial workallied health
AcademiaPhDMA/MS (bioethics) BS (education)
health care law public policypublic health
Before feeling guilty it is good to remember that luck and constraints are not in your control.
~ Amit Sood
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jacob dahlke, msb, hec‐c402.552.3647
You can’t repeat things because each time is different. The universe has changed. Everything has changed. ~ Jerry Garcia
All background photos from Death to the Stock Photo. www.deathtothestockphoto.com
