Duty
The responsibility to do good
Paternalism
The practice of overriding or restricting an individual's autonomy for their perceived best interest, often by authority figures.
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p.20
Paternalism

Duty

The responsibility to do good

p.16
Paternalism

Paternalism

The practice of overriding or restricting an individual's autonomy for their perceived best interest, often by authority figures.

p.18
Autonomy and Ethical Reasoning

Conflict of Interest

A situation in which a person or organization is involved in multiple interests, financial or otherwise, and serving one interest could involve working against another.

p.20
Ethical Perspectives: Justice and Health

Consequentialism

The ethical principle of deciding what’s right based on the outcome

p.1
Autonomy and Ethical Reasoning

Why is autonomy good?

Autonomy is good because it has instrumental value which promotes best interests, intrinsic value of free will which is essential for human flourishing, and it promotes patient respect. Autonomy promotes a person’s subjective best interests, which may not align with best medical interests. Autonomy does not equal handing over all the decision making to the patient. To make an autonomous decision, one must understand information, form values, and make decisions based on said info and values.

p.10
Ethical Perspectives: Justice and Health

Autonomy

The ability of an individual to value their life, which gives them value.

p.16
Autonomy and Ethical Reasoning

Best Interest

In the context of children's autonomy, it involves ensuring their current well-being and development into autonomous adults, including promoting physical/emotional care, education, socialization, and the development of autonomy.

p.1
Autonomy and Ethical Reasoning

Autonomy

Capacity to self-govern and to decide about one’s own mind or body without external interference

p.8
Homelessness

Homelessness

The state of having no home or permanent place of residence, often resulting in poor health, social exclusion, and increased risk of various health issues.

p.10
Ethical Perspectives: Justice and Health

Justice

Equal treatment of equals, holding the notion that all humans should be equally valued.

p.16
Autonomy and Ethical Reasoning

Autonomy

The ability of an individual to make their own decisions and act on them, free from undue influence or coercion.

p.18
Autonomy and Ethical Reasoning

Best Interest

The value that constitutes what is best for an individual, which is subjective and not solely based on factual information.

p.16
Approaches to Ethical Reasoning

Child Liberationist Approach

The perspective that children should have the same rights as autonomous adults, and that adults also struggle with decision-making and understanding consequences.

p.15
Autonomy and Ethical Reasoning

Coproduction

Co-production approaches work with stakeholders using their experiences to identify their healthcare priorities and address healthcare inequalities.

p.18
Autonomy and Ethical Reasoning

Parental Autonomy

The general right of parents to make choices on behalf of their children, but with the consideration of whether they have a right to decide or a responsibility to do what is best for their child.

p.20
Autonomy and Ethical Reasoning

Autonomy

Promotes a person’s freedom and choice

p.20
Mental Capacity and Ethical Perspectives

Phronesis

A type of wisdom that cannot be communicated or taught, but can be found, lived, and used to do wonders

p.15
Mental Capacity and Ethical Perspectives

Mental Capacity 2005

Decisions made on behalf of a person lacking mental capacity must be made in the individual’s best interests. Issues in identifying best interests include difficulty in articulation and expression of needs, the need for health professionals to have time and training to hear and understand needs, and how to provide individualized care within an institutional setting.

p.12
Autonomy and Ethical Reasoning

Best Interests

The combination of emotional, physical, and autonomy interests, as well as family wishes, beliefs, and previously held wishes prior to mental disability, that determine what is in the patient's best interest.

p.21
Autonomy and Ethical Reasoning

Moral Identity

The sense of self in relation to moral values and principles, and the integration of these values into one's identity and actions.

p.3
Autonomy and Ethical Reasoning

Information Deficit

The lack of necessary information, which may lead to misunderstanding or uncertainty in decision-making.

p.21
Autonomy and Ethical Reasoning

Motivations for Moral Action

Factors that drive individuals to act in accordance with moral values and principles, such as self-interest, rule-based reasoning, moral resources, and moral identity.

p.8
Homelessness

Logistical Difficulty in Accessing Healthcare

Challenges faced by homeless individuals in reaching healthcare facilities due to various barriers such as transportation, lack of resources, and complex administrative processes.

p.9
Diversity in Healthcare

Resources available

Organizations and tools such as Faculty, StreetLink, Street Support, and 'My right to Healthcare Cards' that provide support and access to healthcare for homeless individuals.

p.11
Autonomy and Ethical Reasoning

Moral Rights

Moral rights imply that there is a duty by the state and society to ensure these rights are protected.

p.11
Ethical Perspectives: Justice and Health

Justice

Justice equals equal rights plus equal respect, which means maximizing capacity for autonomous decisions for everyone as well as acting in their welfare and their best interests.

p.17
Autonomy and Ethical Reasoning

Respect for autonomy

The consideration and acknowledgment of an individual's right to make their own decisions, especially in the context of healthcare and medical treatment.

p.5
Abortion and Termination of Pregnancy Based on Disability

ABORTION AND TERMINATION OF PREGNANCY BASED ON DISABILITY

Abortion is a criminal offence unless: a) Pregnancy > 24 weeks, risks to physical/mental health of woman/children in her family are greater if the pregnancy continued; b) Any stage of pregnancy necessary to prevent grave/permanent injury to mother, continuing pregnancy would be a greater risk to mom's life than termination; Great risk of physical/mental handicap. Downs syndrome accounts for 20% of the abortions performed on the basis of 'serious handicap'. When you terminate a life based on disability, are you saying that their lives are less valuable, reinforcing the prejudices against those with disabilities.

p.4
Approaches to Ethical Reasoning

Duties

Certain actions are right and wrong, and one needs to follow the rules irrespective of consequences.

p.4
Approaches to Ethical Reasoning

Consequences

An action is ethically right or wrong based on the consequences of the action and the net benefit.

p.7
Diversity in Healthcare

Homelessness reduction Act 2017

Legislation that enhances the responsibilities of local authorities to evaluate, prevent, and alleviate homelessness, including the requirement for public bodies to refer homeless individuals to housing or homeless services.

p.15
Ethical Perspectives: Justice and Health

Ethical Perspectives Children and Virtues

Virtue: morally desirable character trait e.g. honesty, compassion. Relationship between autonomy and best interest in children. Value of autonomy has both instrumental (promotes best interests) and intrinsic (essential aspect of individuals flourishing as humans) values. Autonomous choice involves understanding relevant info, forming values, and making decisions based on values of info provided. Not everyone can make autonomous choices, such as infants. Young children might be able to make autonomous decisions about simple activities, but not complex choices.

p.1
Autonomy and Ethical Reasoning

Relational accounts of autonomy

External social structures such as community and interpersonal relationships can encourage or undermine autonomous decision making. For example, why we need feminism.

p.13
Ethical Perspectives: Justice and Health

Equity

The concept that some people have greater needs to achieve the same outcomes, and aims to provide resources or support based on individual needs. However, it may not suffice to address structural barriers.

p.12
Ethical Perspectives: Justice and Health

Health Inequalities

Health inequalities represent a lack of justice, as they indicate unequal treatment and value for individuals. Amartya Sen argues that justice requires ensuring equal capability to flourish in life for all individuals, including access to food, shelter, and decent healthcare.

p.2
Autonomy and Ethical Reasoning

Autonomy

Autonomy refers to the right of an individual to make their own decisions without external influence or coercion, allowing for authentic decision-making.

p.9
Autonomy and Ethical Reasoning

GP Access

The ability for individuals to register with a general practitioner (GP) even without a fixed address.

p.3
Refusal vs Request

Collusion

The act of withholding information from the patient based on the assumption that they do not want to know, which may lead to mistrust.

p.19
Autonomy and Ethical Reasoning

Autonomy

The right of individuals to make their own decisions and act on them, free from coercion or undue influence from others.

p.22
Autonomy and Ethical Reasoning

Beneficence

This principle focuses on the obligation to act in the best interest of the patient, aiming to maximize their well-being.

p.22
Autonomy and Ethical Reasoning

Non-maleficence

This principle dictates that healthcare professionals should do no harm to the patient. It raises questions about the potential risks and harms associated with the proposed treatment.

p.17
Autonomy and Ethical Reasoning

Best interest

The course of action or decision that is most advantageous for the overall well-being and welfare of an individual, especially in the case of children who lack autonomy.

p.19
Autonomy and Ethical Reasoning

Autonomy and Best Interest Conflict

The potential conflicts that may arise between respecting an individual's autonomy and acting in their best interest, particularly in healthcare decision-making.

p.7
Autonomy and Ethical Reasoning

Capacity assumption and autonomy override

The act of assuming that individuals with disabilities lack decision-making capacity, leading to the infringement of their autonomy.

p.7
Homelessness

Homeless link

An organization that provides an informed estimate of the number of people sleeping rough, funded by the department for levelling up, housing, and communities.

p.20
Approaches to Ethical Reasoning

Virtue Ethics

An ethical framework based on intrinsic traits that lead to moral excellence, such as wisdom, empathy, integrity, justice, kindness, compassion, and honesty

p.12
Autonomy and Ethical Reasoning

Autonomous Choice

The ability to understand information and form values, which is not necessarily impeded by mental disability. The capability to make an autonomous choice depends on the decision being made.

p.20
Diversity in Healthcare

Vulnerable Patients

Discussing the principles of involving vulnerable people in research and treatment (non-therapeutic)

p.13
Diversity in Healthcare

Epistemic injustice

The privilege of certain groups in having their knowledge seen as more credible or worthy, while knowledge from minority backgrounds is less likely to be considered credible. This can lead to disparities in healthcare and outcomes.

p.11
Autonomy and Ethical Reasoning

Rights

Rights can be thought of as moral entitlements.

p.11
Autonomy and Ethical Reasoning

Negative rights

Negative rights refer to what someone cannot do to you, such as killing or stealing from you.

p.2
Clinical Conscience

Reasons for Patient Silence

Patients may remain silent due to a power imbalance between doctors and patients, feeling pressured to agree with the doctor, or being unwell and vulnerable.

p.4
Clinical Conscience

Conscience

Can come about as emotional distress or “moral injury” about clinical actions.

p.4
Autonomy and Ethical Reasoning

Autonomy

The patient’s autonomy should not be limited, and another clinician should be asked to perform the treatment if the doctor opts out under certain circumstances.

p.2
Paternalism

Paternalism

Paternalism is the overriding or undermining of a patient's autonomy based on the healthcare professional's view of the patient's best interests, which may involve presenting only one side of the argument, withholding information, coercion, or lying.

p.22
Autonomy and Ethical Reasoning

Parental Rights vs. Child Welfare

This ethical dilemma involves balancing parental autonomy and decision-making authority with the obligation to protect the welfare of the child. Enya’s mother’s wishes, Enya’s autonomy, and the potential impact on Zeno’s well-being all play a role in this consideration.

p.4
Approaches to Ethical Reasoning

Moral rights

A special form of moral claim that individuals deserve, protecting vulnerable individuals or those who lack power/advocacy.

p.7
Diversity in Healthcare

Over-reliance on emergency healthcare services

Dependence on urgent medical care due to obstacles and social stigma in accessing regular healthcare services.

p.21
Autonomy and Ethical Reasoning

Moral Values

The fundamental beliefs and principles that guide a person's behavior and decision-making in ethical situations.

p.12
Autonomy and Ethical Reasoning

Dworkin and Advance Decisions

According to Ronald Dworkin, autonomous individuals have an understanding of how their lives should unfold and end. Respect for previously stated wishes is important when the patient had autonomy, even if the patient loses autonomy (aka Advance decisions).

p.9
Homelessness

Rough sleepers

Individuals who sleep in public places or outdoors, rather than in a permanent home or shelter.

p.9
Diversity in Healthcare

Trauma informed practices

Approach that involves understanding, recognizing, and responding to the effects of all types of trauma.

p.2
Autonomy and Ethical Reasoning

Respecting Autonomy

Respecting autonomy leads to better advice, decision making, mutual understanding, trust, and adherence to the plan.

p.11
Autonomy and Ethical Reasoning

Positive rights

Positive rights refer to what others must provide for you, such as education and healthcare.

p.22
Autonomy and Ethical Reasoning

Autonomy

This principle emphasizes the right of individuals to make decisions about their own lives, especially in matters concerning their health.

p.5
Autonomy and Ethical Reasoning

Virtue Ethics

The right course of action is the action that a 'virtuous individual' would take. A virtue is a character trait a human needs to flourish and live well. The best life of a human is one which consists of exercise of virtues.

p.5
Autonomy and Ethical Reasoning

Moral Permissibility

Just because something is morally permissible does not mean that the action is inherently good. For example, abortion is permissible morally but that doesn't mean it is a morally good action or that the foetus has no moral value or the mother has no obligation to the foetus.

p.19
Clinical Conscience

Clinical Conscience

The ethical responsibility of healthcare professionals to act in accordance with their moral and professional values while providing care to patients.

p.22
Autonomy and Ethical Reasoning

Sibling Obligations

The question of whether Zeno, as Enya’s half-brother, has a moral duty to help her by donating bone marrow raises issues related to familial obligations and the limits of individual autonomy.

p.7
Diversity in Healthcare

Devaluation and stigmatization in language for disabilities

The use of language that diminishes the worth of individuals with disabilities and contributes to negative societal perceptions.

p.7
Homelessness

2018 Rough Sleeping Strategy

A governmental initiative that allocates support to areas with the highest numbers of rough sleepers, aiming to address the issue of rough sleeping.

p.8
Homelessness

Social Exclusion

The process through which individuals or groups are marginalized or isolated from social, economic, and political opportunities and resources.

p.20
Diversity in Healthcare

Effective Communication

Describing and demonstrating principles of effective communication with patients of all backgrounds and adaptations to maximize inclusion

p.13
Diversity in Healthcare

Oximeter readings

Oximeter readings can overestimate oxygen levels in patients with darker skin pigmentation, leading to measurement errors and potential disparities in healthcare outcomes.

p.3
Autonomy and Ethical Reasoning

Autonomy

The right of the patient to make their own decisions about their healthcare, including the ability to request information.

p.8
Homelessness

Population Health Approach

An approach that recognizes the interconnectedness of health issues and social determinants, emphasizing the need for comprehensive support beyond traditional healthcare services.

p.3
Refusal vs Request

Refusal vs Request

The distinction between a competent patient's right to refuse any necessary treatment and the limitations on their ability to request certain treatments.

p.3
Clinical Conscience

Clinical Conscience

The inner sense of right and wrong about one's own clinical actions, shaped by personal core values, beliefs, and experiences.

p.19
Refusal vs Request

Refusal vs Request

The distinction between a patient's refusal of treatment and a patient's request for a specific treatment, which has ethical implications for healthcare professionals.

p.4
Approaches to Ethical Reasoning

Moral conflict

The 'conscience' grounds to opt out should be based on a moral conflict (such as abortion) not a discriminatory one (such as race, sex, religion).

p.17
Clinical Conscience

Blood product support

Medical treatment involving the use of blood or blood components to support a patient's health, often necessary in cases of severe illness or injury.

p.7
Diversity in Healthcare

Health inequalities and poorer health outcomes in homeless population

Disparities in health status and healthcare access experienced by individuals who are homeless, resulting in inferior health results.

p.1
Autonomy and Ethical Reasoning

Requirements for making an autonomous decision

To make an autonomous decision, one must understand information, form values, and make decisions based on said info and values. Doctors need to give patients time, information well explained, no judgement, and no pressure so that patients feel comfortable expressing what they really want.

p.8
Homelessness

Morbidity

The state of being diseased or unhealthy within a population, often used to describe the prevalence of illness or disease.

p.21
Autonomy and Ethical Reasoning

Kohlberg’s Stages of Moral Identity

A theory that describes the development of moral reasoning and ethical behavior in individuals, progressing through stages of moral development from childhood to adulthood.

p.2
Clinical Conscience

Trust in Doctors

Patients trust their doctors to make the right decisions, but they still want to understand the proposed treatment and reasons behind it. Truthful communication builds trust and comfort with doctors making decisions.

p.9
Autonomy and Ethical Reasoning

The 5 principles to improve health among rough sleepers

Guidelines including engaging with rough sleepers, supporting the workforce, prioritizing relationships, tailoring local responses, and utilizing commissioning power.

p.17
Autonomy and Ethical Reasoning

Basic/developmental interests

The fundamental needs and requirements for a person's growth and development, such as health, education, and safety.

p.2
Autonomy and Ethical Reasoning

Restricting Autonomy

Autonomy is only restricted in situations where individuals can be harmful to others, warranting 'sufficient harm' to restrict autonomy.

p.22
Autonomy and Ethical Reasoning

Justice

This principle relates to fairness and equity in the distribution of resources and treatment. It raises questions about the allocation of resources for Enya’s care, as well as the potential impact on her family and her half-brother, Zeno.

p.17
Clinical Conscience

Autologous bone marrow transplant

A medical procedure in which a person's own stem cells are collected and then given back to them after intensive treatment.

p.17
Mental Capacity and Ethical Perspectives

Committed suicide

The act of intentionally ending one's own life, often due to extreme emotional or psychological distress.

p.7
Homelessness

Homelessness

The condition of lacking suitable and secure accommodation, which includes both rough sleepers and individuals without stable housing.

p.21
Autonomy and Ethical Reasoning

Resilience

The ability to recover from setbacks, adapt to change, and maintain a positive attitude and behavior in the face of challenges.

p.3
Paternalism

Best Medical Interests

Decisions made by doctors based on medical considerations, which may not always align with the overall best interests of the patient.

p.3
Clinical Conscience

Uncertainty

The state of not being able to predict life expectancy or treatment outcomes, leading to challenges in decision-making.

p.8
Homelessness

Stigma in Healthcare

Negative attitudes and discrimination experienced by homeless individuals from healthcare workers, often stemming from past negative experiences and lack of understanding.

p.17
Autonomy and Ethical Reasoning

Autonomous choice

The ability for an individual to make decisions for themselves based on their own values and beliefs.

p.2
Clinical Conscience

Encouraging Patient Communication

To encourage patients to speak freely, healthcare professionals should give space and time to speak, reflect on unconscious bias, and offer an ally or advocate such as an interpreter, chaperone, nurse, relative, or second opinions.

p.19
Paternalism

Paternalism

The practice of overriding a person's actions or decisions for their own good, even if it goes against their wishes or autonomy.

p.17
Autonomy and Ethical Reasoning

Bad decisions

Choices or actions that may have negative consequences for an individual's well-being or future, especially in the context of reaching autonomous adulthood.

p.19
Approaches to Ethical Reasoning

Approaches to Ethical Reasoning

The various methods and principles used to analyze and make ethical decisions in healthcare, such as utilitarianism, deontology, and virtue ethics.

p.7
Diversity in Healthcare

Barriers in accessing healthcare

Obstacles or challenges that prevent individuals from obtaining necessary medical care.

p.7
Homelessness

Rough sleeping

The act of sleeping, about to bed down, or actually bedded down in the open air, as well as in buildings or other non-habitable places.

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