Ethics Glossary

A living will, a durable power of attorney for health care, and other written or oral sources that express a patient’s health care preferences, goals, and values. 

The beautiful dimension of an experience, relevant to medicine/surgery in the artful dimension of patient care. 

Regard for or prioritizing the interests of others as equal to or more primary than one’s own interests. 

The resolution of a conflict between opposing parties facilitated by persons chosen by the opposing parties. 

An assault is the threat of an intentional act designed to harm the victim that causes reasonable fear of harm.  Battery is the actualizing of the intent to harm the non-consenting victim. 

Latin root meaning is ‘self-rule’ or ‘self-law’.  ‘Autonomy’ is often used interchangeably with ‘self-determination’.  Associated with ‘emancipated’ to differentiate a sub-set of minors from the default that parents are minors’ surrogate decision-makers.  To be autonomous is to be sufficiently free to reach one’s own conclusions about what ought to be done.  An autonomous person is sufficiently free from controlling interferences and from limitations (e.g., access to information) to exercise responsible decision-making and to be responsible for outcomes.  Patients with decisional capacity have the right to participate in decisions about the life-sustaining treatments they receive, especially by clearly conveying to the care team their goals of care and their values. They have the right to be informed of their diagnosis and their prognosis, to be involved in their care planning and treatment, and to request or refuse treatment.  They have the right to refuse or to discontinue any treatment even if doing so will cause injury or hasten death.  However, as per CMS Standard 482.13(b)(2), pp. 66-67, “this right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate”.  They do not have the right to expect/demand any treatment. 

The treating physician is under no ethical or legal obligation to offer, implement, or continue medically inappropriate (i.e., futile or non-beneficial) treatment, including life-sustaining treatments and CPR.  Every intervention is a ‘trial of treatment’.  Patients should not be encumbered with treatments that cannot be reasonably expected to achieve meaningful goals of care (such as return to pre-injury/illness status, discharge from the hospital to home, discharge to non-acute care).  Should a patient’s life-sustaining management become futile in this sense, the treating or consulting physician — following a previously established ‘Protocol for Futile (Non-beneficial) Care Determination’ — may enter appropriate orders restricting or withdrawing life-sustaining treatments.  At all times, pain relief and comfort measures should be provided.   

Performing actions that (are intended to) bring about good/valued effects for the recipients of the actions.  

Decisions that are made based on a surrogate’s and/or a physician’s judgment about what is best for the patient under the present circumstances or what a hypothetical ‘reasonable patient’ would choose/value under the present circumstances. 

Literally, ‘life ethics’.  Bioethics encompasses ethical complications arising throughout the healthcare field. 

Latin root meaning is ‘in good faith’.  Open, honest, sincere, trustworthy participation in human encounters. 

With ‘brain death’, death is determined based on clear evidence that specific neurological criteria have been met, demonstrating that the patient has lost all brain function (including involuntary brain activity that sustains life). ‘Brain death’ is not interchangeable with or the same as ‘persistent vegetative state’ or ‘coma’. 

By analogy, when a device (e.g., a light bulb or a match) has no capacity left to generate energy.  Burned-out healthcare professionals have lost or exhausted their capacity to care, leaving them with little/no empathy to integrate into the ethical dimension of patient care or for optimizing stated organizational values. 

A cardiopulmonary arrest is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.  Patients in cardiopulmonary arrest do not have enough circulation to maintain blood flow to the brain.  Irreversible brain damage and death will usually occur within a few minutes of the onset of cardiopulmonary arrest. 

A set of defined protocols/techniques designed to restore circulation and respiration in the event of acute cardiopulmonary arrest.  The defined protocols/techniques include closed-chest compression, intubation with assisted ventilation, electroconversion of arrhythmias, and the use of cardiotonic and vasopressive drugs.  CPR is an indicated intervention to reverse the effects of cardiopulmonary arrest.  CPR is indicated or continued when a clinical judgment is made that the defined protocols/techniques are unlikely to do so. 

Guidance and accountability for decision-making established by judicial decisions.  Civil law is the portion of law that does not deal with crimes. 

‘Casuistry’ is seeking insight for resolving conflict/s in a present case by considering a past case similar in social/political context, in clinical details, and in conflict/s.  The strength/value of considering the past case increases with the degree of similarity to the present case. 

An action that is ‘categorical’ has no conditions/qualifications and is required regardless of the circumstances or anticipated outcomes.  A ‘categorical’ action is unethical if the action cannot be universalized.  Consequences are not taken into consideration in reflection on the ethical justification of a ‘categorical’ action. 

That which produces a result whether or not the result is intended. 

Privileges and freedoms granted to and protected for members of a community (in the US, by the Constitution or by various state or federal statutes). 

A client is an individual who participates in decisions about what is to be done, gives consent for procedures, and assumes financial responsibility for services rendered.  A patient is an individual for whom care is delivered and upon whom procedures are done.  With conscious adults who have decisional capacity, the same individual is both client and patient.  In pediatrics, the child is the patient and his/her parents are the clients. 

The exercise of reason(ing) in making decisions or solving problems. 

The patient receives only therapeutic treatments that are intended/expected to optimize the patient’s comfort.  In the event of cardiopulmonary arrest, cardiopulmonary resuscitative measures or endotracheal intubation and mechanical ventilation are not initiated. 

A counterpoint to assuming individuals are best understood when differentiated or separated from their respective social networks, arguing instead that individuals are and consider themselves to be molded/shaped by their communities.  Compatible with ‘narrative ethics’.  Offers a more balanced/nuanced approach to self-determination.  Raises questions about how best to conduct informed consent.  Injury and illness may break down patients’ communitarian self-understanding.   

Demonstrating mercy, pity, or empathy for the pain, suffering, or harmful experience of others.  Compassion is the opposite of cruelty.  Compassionate persons neither enjoy nor are indifferent to the pain and suffering they cause or the pain and suffering caused by others. 

The legal recognition of a person’s ability to make decisions for himself/herself. 

The obligation not to reveal information that another has disclosed.  Confidentiality focuses on who controls access to or disseminates shared information.  Confidentiality is a healthcare professional’s promise not to reveal information from/about a patient without consent.  Ethical challenges occur when there is compelling reason to expect that protecting patient confidentiality will result in harm to or infringements on the rights of other persons. 

Latin meaning is ‘to strike together’ or ‘to hit’.  A conflict of interests may involve personal as well as professional commitments.  Several competing interests are present in most encounters.  Hidden interests may be more significant than acknowledged interests.  Transparency is especially important when the search for mutually acceptable shared decisions among conflicting interests fails.   

Request to be removed from participation in a situation in order not to violate a categorical (i.e., ‘always’ or ‘never’) value or commitment.  If accepted, the responsibilities of the conscientious objector would be shifted to other participants.  For this reason, ‘opting out’ should only be requested when participation would threaten one’s existential integrity so deeply that patients and care team members would be at risk. 

A voluntary act by which one person agrees to allow someone else to do something to/for them.  Consent should be in writing and should include an explanation of the reasons, risks, and benefits for the procedure/s being performed. 

A promissory agreement between two or more persons that creates, modifies, or ends a relationship.  An enforceable agreement that creates legal rights. 

The responsibility to strive for the greatest benefits deriving from the least cost expended. 

A patient’s ability (1) to receive information regarding the risks, benefits, and alternatives of a specific treatment, (2) to understand and process this information, (3) to deliberate, and (4) to make, communicate, and explain choices.  Decisional capacity is determined by a physician, whereas competency is a legal determination rendered by a judge.  An individual’s decisional capacity can fluctuate and can depend on the complexity of the decision being made. 

Decisions based on applying the most applicable rule, duty, code, policy, or law rather than by considering the consequences of an action. Teleological decisions focus on consequences.  Deontological decisions focus on accountability to norms that are reasoned deductions or religious commands considered applicable to all.  As an example, Kant appealed to a ‘categorical imperative’ to always act in a way that can be generalized into a universal law or to always treat others never simply as a means but always at the same time as an end. 

Descriptive ethics documents the values, practices, processes, and norms in a given cultural, social, professional, or institutional setting.  Descriptive ethics is to be distinguished from normative ethics which concentrates on the determination of what ought to be done all things considered. 

All cases have an ethical dimension.  Some cases are complicated by breakdowns in the ethical dimension.  Some breakdowns in the ethical dimension reduce to mutually exclusive and/or equally undesirable choices (i.e., a dilemma). 

In the event of cardiopulmonary arrest, cardiopulmonary resuscitative measures or endotracheal intubation and mechanical ventilation are not initiated. 

An ethical justification in situations when the desire to benefit a patient is complicated by concern that the beneficial intervention may also cause troubling unintended and unacceptable outcomes or side-effects. 

An individual under the age of eighteen years who is married who is the parent or guardian of a minor child or who has been declared emancipated by a court. 

Decisions and actions based on subjective responses to a situation more/rather than on objective reflective reasoning on a situation. 

To see into the stressful experience of and to align sacrificially with another person.  Note — an empathetic person can be perceived as uncaring and also can be too deeply affected emotionally to benefit the suffering person.    

One whose reasoning is based on experience and sense observation, who is scientific, who is evidence-based. 

Latin meaning is ‘to come up against’.  To encounter is to come upon another person face to face, often unexpectedly.  To encounter is to meet another person suddenly, often violently.  Each day is a series of encounters – turning hallway corners, crossing lanes, reaching for an object, getting in line, looking up from a table, chasing a prize, competing for a position.  Encounters make concrete and visible the set of values and the sense of purpose out of which we decide what ought to be done.   

Similar interests are accorded similar value or importance regardless of whose interests they are.  All individuals have equal value or worth in themselves.  Prejudice views and treats individuals as unequal. 

Compelling uncertainty whether the standard of care treatment or the research treatment is the most likely to benefit the patient. A research protocol ends when the data demonstrate conclusively the superiority of one treatment over the other treatment. 

‘Ethics’ is the determination of what ought to be done, all things considered.  ‘Ethics’ examines how well we respect those we encounter.  ‘Ethics’ is the systematic study of how we ought to act toward ourselves and others.  

Latin meaning is ‘a good death’ or ‘to die well’.  Direct/intentional action taken to end a patient’s life.  Euthanasia is passive when the action is to withhold or withdraw life-sustaining technologies.  Euthanasia is voluntary when the action to end a patient’s life is taken at the request of a patient with decisional capacity.  Euthanasia is non-voluntary when the patient has made no such request.  Euthanasia is involuntary when the action to end a patient’s life is taken against the patient’s wishes, values, or goals.  Medically assisted dying refers to cases in which patients with decisional capacity request that their physicians prepare them and provide the means for them to follow through on their decision to control/manage the time and manner of their death. 

Draws attention to ways gender shapes ethical reasoning/discourse, resulting in unexamined biases and unnoticed oversights.   

An ancient Roman legal concept that denotes the transfer of a right from one person to another person with the recipient’s obligation to return the right either at some future time or on the fulfillment of some condition.  The fiduciary holds this right as a trustee with the responsibility to exercise the right on another person’s behalf.  In surgery, ‘fiduciary obligation’ refers to the trust patients place in their physicians to act in their best interests.  The vulnerability acknowledged by the trusting patient creates a fiduciary obligation for the physician who accepts responsibility for the patient’s care.   

Treatment provided to a patient with a life-threatening illness that will do no more than prolong the dying process. Physiologic futility is the utter impossibility that the patient’s condition can be improved by continuing or increasing restorative interventions (i.e., ‘only prolonging the dying process’).  Value-based futility (or quality of life futility) is the recognition that continuing or increasing restorative interventions conflicts with the patient’s preferences, values, and goals of care. 

Comic remarks in the midst of grim, hopeless, and/or baffling circumstances, often defended as a necessary and effective means to relieve the stress of those caught up in such circumstances. 

Having to do with the quality of life that results from the care a patient receives.  The goals of care are restorative when achieving a desired quality of life is feasible.  The goals of care focus on managing the dying process when achieving a desired quality of life is not feasible.  

Any wrong or damage done to another (either to the person, to rights, or to property). 

Dispositions and behavior distinguished by compassion, sympathy, or consideration for other human beings. 

A humanist reveres present/temporal experience, celebrates excellence, remains true to where scientific inquiry and critical reasoning lead, is not centered by or dependent on a religion, has confidence in humanity’s potential for a tolerant and respectful community, seeks reasonable decisions/solutions, champions human (and all sentient) rights.   

The legal concept that, under certain circumstances, the courts may assign a person to stand in the place of parents and possess the parents’ legal rights, duties, and responsibilities toward a child. 

When no procedure is performed until the patient (a) has been determined to have the capacity to give or refuse consent; (b) has been informed of the nature of the procedure, risks, alternatives, and the prognosis if the procedure is not done;  and (c) has given  free and willing consent to having the procedure done.  Informed consent allows healthcare professionals to conduct tests, procedures, and/or experimentation on patients with their understanding and agreement. 

New (including revisions on previously established) interventions intended to improve patient outcome and/or institutional efficiency.  Innovation should be conducted and assessed as research. 

Latin meaning is ‘intact’.  Imagine the responsibility engineers have to ensure that bridges and buildings have structural integrity (e.g., anticipating the fatigue or fracture of materials, the initiation/growth of cracks in the materials, the limits for handling unexpected or overloading stress).  By analogy, integrity – whether individual, team, or organization – has to do with remaining centered, integrated, sound when stressed by powerful centrifugal force/s. 

The view that ‘good’, ‘right’, and ‘duty’ (i.e., ‘ethics’) are immediately or self-evidently grasped or perceived. 

A just society is one in which all members begin life with hope, live life together with mutual respect, and end life with dignity. 

 ‘Justice’ draws attention to the interests/values of everyone with a stake in the outcome of an action.  ‘Distributive justice’ envisions all limited resources distributed equally unless an unequal distribution is to the advantage of those most vulnerable or disadvantaged with a stake in the outcome of the distribution. 

Treatment that keeps a patient alive but does not itself cure or restore the patient.  Treatments are considered life-sustaining when the patient will die imminently due to the underlying illness or injury if life-sustaining treatments are withheld or withdrawn. 

Professional misconduct, improper discharge of professional duties, or failure to meet the standard of care resulting in harm to a patient. 

The customs, traditions, and values upon which humans act, by which humans live together in community. 

Careless action contrary to that of a respectful person. 

Treatment that, in the best professional judgment of the treating physician(s), would not have a reasonable chance of benefitting the patient.  Physicians are not ethically obligated to deliver care that is non-beneficial. 

‘Maleficence’ has to do with actions that (are intended to) bring about harmful effects for the recipients of the actions.  ‘Non-maleficence’ (i.e., ‘do no harm’) prompts one to act in ways that avoid harm or injury.  In patient care, prioritizing this caution results in the least pain or suffering possible from efforts to achieve a beneficial outcome. 

Responsibilities established by law, custom, tradition, or agreement.  An obligation is something one is required to do and for which one is held accountable. 

Having to do with the ethical justification of systemic decisions and the values reflected in such decisions at the division, department, and/or institutional levels.   

Pain refers to measurable bodily discomfort of varying degrees of intensity from infections, diseases, wounds, injuries, traumas.  Suffering refers to cognitive/psychological discomfort of varying degrees of intensity such as depression, anxiety, uncertainty, guilt, shame, grief, sadness, fear, anger, terror, alienation, loneliness. 

Symptom control is a responsibility in every patient case.  Hospice is the last phase of this responsibility.  When the decision is made to forego life-sustaining treatments, comfort measures should be continued.  It may become necessary to provide treatments (including narcotics) with the sole purpose of alleviating symptoms and suffering, even at the risk of accelerating or contributing to death.  When the decision is made to forego life-sustaining treatments, the emotional, physical, and spiritual care of the patient should continue.  Withholding or withdrawing life-sustaining treatments in no way implies withholding or withdrawing care for the patient.  Maintaining the patient’s dignity is paramount. 

A relationship in which one person acts toward an emancipated person with decisional capacity as would a parent with a young child. 

An earlier decision or action considered to be an example or to have authority for an identical or similar situation arising subsequent to the precedent.  Casuistic decision-making depends on such precedents for navigating challenging present situations. 

Latin meaning is ‘at first sight’.  Obligations and values brought into a situation should be applied unless unanticipated circumstances or factors necessitate overriding these defaults. 

The use of general principles (e.g., the codes of ethics adopted by various medical/surgical specialties) as landmarks to guide ethical reasoning in specific situations.  The most widely referenced general principles are non-maleficence, beneficence, autonomy, and justice. 

’Professionalism’ addresses the degree to which we meet the fiduciary responsibilities we accept toward patients and toward the public.  Being ‘professional’ requires mastery of the prerequisite knowledge base and behavior consistent with relevant codes of ethics.  A professional agrees to meet a public/community need and has received certification from a self-regulating body of peers, thus confirming public/community expectations of training and skill to meet the specified need. 

A measure of the value of an individual’s life situation from the individual’s point of view. This assessment is distinguished from the value of the individual’s life situation as assessed by others or by society at large. 

Judgments reflect situation-specific circumstances and vary in accordance with each individual’s dispositions. 

To respect is to see again or afresh, to look back wanting to see more clearly.  The same root verb (L., specere) is evident in words such as speculate, inspect, spectacles, and speculum.  To respect someone is to be attentive, subjective, freeing, reciprocal, gentle, engaged, holistic, patient, modest, trusting, graceful, reconciling, humanizing.  But physicians must be scientific, objective, detached.  Therein lies the ethical complexity of patient encounters.   

Specific legal, moral, and/or social freedoms/privileges that limit others in their conduct toward the holder of these freedoms/privileges. 

The range of services a medical/surgical practice or a hospital is certified, credentialed, staffed, and resourced to deliver.  Ethically justified treatment plans reflect and are consistent with the organization’s scope of services. 

The treating physician makes sure the patient (or surrogate) has the appropriate information and support required to assist in making medically reasonable decisions and recommendations (including but not limited to life-sustaining treatments).  The patient (or surrogate) thoughtfully considers and conveys to the treating physician the goals that are hoped to be achieved from the patient’s medical care.  These goals may need to be periodically re-evaluated as the patient’s medical condition and prognosis change. 

If X is allowed, Y will inevitably follow, and Y is ethically unacceptable. Therefore, X is not allowed. 

An agreement – whether implicit or explicit – among members of a society to work together in achieving societal interests.  Doing so requires members of a society to limit/sacrifice some of their individual benefits.  The scope of the acknowledged society may vary in size and ethnic plurality. 

‘Spirituality’ has to do with the basis upon which patients’ lives have integrity and balance.  Being religious is a subset of (but not equivalent to) being spiritual.  Patients reveal their spiritual identity when they share their core ideas and life values and when they explain how they sustain these core ideas and values.  Attending to patients’ spiritual well-being has to do with minimizing the spiritual disturbance they are experiencing due to being in a hospital and/or due to injury/illness in order to maximize their ability to make decisions about their care.  It is crucial that patients have (or recover) sufficient balance and focus to communicate well (which requires listening carefully, thinking courageously, and speaking clearly) as they participate in decision-making about their care.  Patients who are spiritually distressed complicate the decision-making process and the management of their care.  They may have lost confidence, motivation, hope.  They may appear despondent or panicky.  They may deny the reality of their situation.  Some spiritually distressed patients are despairing, immobilized, depressed, apathetic, fatalistic.  Their spiritual distress may surpass in urgency their injury or disease.   

Those acts performed or omitted that competent peers would have performed or omitted. 

A decision based on what a surrogate has reason to think under the present circumstances would have been the patient’s choice, based on knowledge of the patient’s preferences, goals, and values. 

A person with decisional capacity who makes decisions on behalf of a patient who does not have decisional capacity.  If a patient lacks decisional capacity, an appropriate surrogate (usually but not necessarily a close family member) should assist in the decision-making (1) ideally/preferably by representing the patient’s known values and goals or (2) if such are not known, then by promoting the patient’s best interests. 

Ethical justification of a decision or action has to do with the intended consequences resulting from the action. 

When research participants enroll in protocols with the expectation – perhaps informed and willful, perhaps misinformed by a referring physician or by a research recruiter – that they will receive treatment expected to be beneficial to them. 

‘Trust’ is counter-intuitive, involves risk, is needed to complete most tasks, requires courage.  To trust is to risk one’s safety and outcomes – whether personal and/or for others — by depending on another’s honesty, competency, consistency, and reliability.  

Communication based on accurate, relevant, and comprehensive information sufficient for the recipient to make factual and trustworthy decisions even if the deliverer of the information disagrees with or disapproves of the decisions. 

An action that is ‘consequentialist’ finds ethical justification in the likelihood of desirable or undesirable outcomes.  The focus is on the consequences that follow from specific actions rather than on the action itself.  Egoists find ethical justification in the value of the consequences for themselves.  Altruists find ethical justification in the value of the consequences for others.  Utilitarians find ethical justification in the value of the consequences for the greatest number (including but not limited to the decision-maker).  For ‘act utilitarians’, ethically justified actions produce the greatest good for the greatest number in a specific/given situation.  For ‘rule utilitarians’, a person ought to act in a way that if generally followed would produce the greatest balance of good consequences over bad consequences. 

Any object, circumstance, or idea that is considered desirable or worthwhile.  When something is considered valuable because it brings about (or helps to bring about) some future state of affairs that itself is judged to be desirable, then it is said to have instrumental or extrinsic value.  When something is judged to be desirable in and of itself (independent of its consequences), it is said to have intrinsic value. 

The decision maker’s character is considered to be the origin and guide for the determination about what ought to be done in a given situation.  Primacy is given to the dispositions, motives, intentions, experience, and maturity of the decision maker more than to the results of the decision maker’s action (as in consequentialist ethics) or to shared principles/obligations of ethics (as in deontologic ethics). 

Patients whose demographic characteristics or circumstances expose them to neglect, misunderstanding, prejudice, exploitation, coercion. 

Foregoing life-sustaining treatment includes both withdrawing and withholding of any life-sustaining treatment (including, but not limited to, mechanical ventilation, bi-level positive airway pressure, vasopressors, oxygen, dialysis, antibiotics, blood transfusions, artificial hydration and nutrition).  The same rationale and justification should be applied to withholding and to withdrawing of life-sustaining treatments. Decisions to forego life-sustaining treatments should be based on medical indications in relation to feasible goals of care and should be consistent with the patient’s advance medical directives and/or other documented expressions of the patient’s values and goals (or lacking such guidance, consistent with the best interests of the patient).