Bioethics
Literally, ‘life ethics’. Bioethics encompasses ethical complications arising throughout the healthcare field. 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. 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. Feminist ethics draws attention to ways gender shapes ethical reasoning/discourse, resulting in unexamined biases and unnoticed oversights. Principlist ethics is 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. Morals are the customs, traditions, and values upon which humans act, by which humans live together in a community.
Burnout
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 to optimize stated organizational values.
Casuistry
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 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.
Categorical Imperative
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.
Communitarian
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.
Conflict of Interest
Latin meaning is ‘to strike together’ or ‘to hit’. A conflict of interest 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.
Conscientious Objection (i.e., opting out)
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.
Deontological
Deontological decisions are based on applying the most applicable rule, duty, code, policy, or law rather than 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.
Dilemma
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).
Double Effect
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.
Empiricist
An empiricist is a person whose reasoning is based on experience and sense observation, who is scientific, who is evidence-based. An intuitionist holds the view that ‘good’, ‘right’, and ‘duty’ (i.e., ‘ethics’) are immediately or self-evidently grasped or perceived.
Encounter
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.
Fiduciary
Obligations are responsibilities established by law, custom, tradition, or agreement. An obligation is something one is required to do and for which one is held accountable. Prima facie obligations and values brought into a situation should be applied unless unanticipated circumstances or factors necessitate overriding these defaults. Fiduciary refers to 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 medicine, 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.
Humanism
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 tolerant and respectful community, seeks reasonable decisions/solutions, champions human (and all sentient) rights.
Integrity
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 a person’s remaining centered, integrated, sound when stressed by powerful centrifugal force/s.
Paternalism
A relationship in which one person acts toward an emancipated person with decisional capacity as would a parent with a young child.
Professionalism
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.
Respect
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.
Slippery Slope
If X is allowed, Y will inevitably follow, and Y is ethically unacceptable. Therefore, X is not allowed.
Trust
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.
Truth-telling
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.
Utilitarian (Consequentialist or teleological)
An action that is utilitarian 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 the way that if generally followed would produce the greatest balance of good consequences over bad consequences. Ethical justification of a decision or action has to do with the intended consequences resulting from the action.
Value
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.
Virtue (Character Ethics)
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).