Ethics Glossary

GLOSSARY

ETHICS MODULES

GLOSSARY Alphabetized Terms Related to Ethics Modules	RESOURCES Related Literature & URLs
Advance Directive---A document that communicates wishes and preferences for care when people are too sick to speak or make decisions for themselves (ex. a living will or durable power of attorney for health care).
AMA Code of Ethics---this code has been in place with frequent revisions since 1847. The last major revision was in 1994. This code expresses values that are commonly held but has no commanding power over physicians.
ANA Code of Ethics---American Nurses Association Code has been under revision for several years. The current code is based on a revision in 1985. Obtain a copy from your school of nursing.
Autonomy---respect for the self-determination of each adult person. This is a very strong principle in American culture.
Beliefs---the word comes from Old English and means "that which is beloved". A belief is whatever is loved or is valued highly by an individual. We all have beliefs that guide our interpretation of reality. We all have beliefs that interpret our life-situation in selected ways.
Beneficence---a key principle of bioethics ethics that demands that professionals act for the good of patients. Knowing what is good for a patient is not always clearly understood, and doing what is good for a patient is not always supported by the health care system.
Benefits---the list of health care services paid for and made available to plan member.
Bioethics---ethics as applied to health care. The term was invented in 1970 by Van Rensselaer Potter, an oncology research scientist with a wide interest in biology and human values.
Character---the habitual dispositions or traits that a person consistently expresses makes up the character. For some theorists, the character of persons is more determinative of how they ought to act than rules or goals.
Critical thinking-humans do a lot of thinking: some is sloppy, unreasonable, and illogical, and some is carefully based on sound reason and logic. Critical thinking is careful, reasonable and logical.
Compassion---a trait or virtue that expresses an ability and willingness to suffer with other persons.
Confidentiality---this virtue is directed toward protecting information about a patient that could be used to harm the patient if known by certain others.
Cost containment---this phrase became the watch word of the 80's as the cost of medical services rose so rapidly that buyers of insurance called for restrain of charges. Efficiency and reduction of profits were the two main strategies to reduce contain costs. Rationing of services was not openly practiced, but there are examples of denying medical service for the purpose of reducing costs.
Cultural expectations---the values that are maintained by a social group. The social group, or moral community, established the rules of expected behavior for all individuals within that social group.
Discernment--Sorting through all the values, issues, concerns, attitudes, and emotions of everyone concerned in order to select which are the most important to consider.
Distributive justice---this is the justice that is concerned with arranging the social order so that everyone appropriately or fairly receives the goods and services available. Other forms of justice are retributive justice in which compensation due is paid, or criminal justice in which crimes are punished.
Ethical analysis- a pattern of systematic reflection through which values are arranged according to importance until the balancing of competing values ends in a decision for some specific action.
Ethical principles---principles are organizing themes in systematic thought. In bioethics four principles have been selected to organize thought and action: (1) autonomy--respect for the decisional capacity of individual persons, (2) non-maleficence--not doing harm to persons, (3) beneficence--doing good for persons, (4) justice--treating persons fairly.
Ethics---the systematic examination of the values held by individuals in community.
Ethic of care---this moral perspective tends to emphasize relationships and roles rather than rules and goals. It often is associated with feminist bioethics.
Fairness---this is an important organizing word in the concept of justice. Fairness has come to mean that each individual in a community will be treated in the way most appropriate for that individual. This does not mean that every one is treated the same, but that everyone is treated appropriately for that individual. Fairness means that everyone is treated as they ought to be treated. This idea is incomplete because what is appropriate for each person remains to be decided.
Fiduciary---the basic meaning is "trust". A fiduciary relationship is a trusting relationship. Acting out a fiduciary role is being trustworthy.
Framework of ethical deliberation---there are several functional methods of doing an ethics analysis of a moral problem and reaching a decision about how to act out a solution to the problem. The essential points are 1. Sort out the facts, 2. Understand the values of the stakeholders, especially that of the patient, 3. Name the moral values to be protected, 4. Imagine the options for solution, 5. Project the outcome of each option, 6. Decide which option protects the most important values.
Fundamental moral encounter--- is the realization of the value of the other person.
Gaming the system---using the loopholes and inadequacies of a system to make the system serve your interests.
Goals theory---goals refers to the good outcomes or consequences of decisions and actions. How good the aim or goal of an action is can be a way of justifying that action.
Hippocratic Oath---an oath taken commonly but not universally by physicians upon graduation from medical school. Many elements of the oath seem out dated but it remains a corner stone in ethics among physicians.
Insurance packages---the agreed upon list of benefits available to a member of a specific insurance plan. The cost of insurance packages varies with the range of benefits.
Integrity---a virtue that coordinates all other virtues. To have integrity is to have organized and controlled all the important traits of your character in such a way that you are expected to act well.
Interests of patients---it is an ethical imperative accepted by all health care professionals to give the highest priority to the "interests of patients". This can create conflict between the professional's self-interest and the professional group's commitment to giving the highest priority to the "interest of patients".
Justice---this bioethics principle is concerned with treating patients fairly in healthcare systems through access to care, quality of care received, and sharing the burden of cost throughout society.
Justice as fairness---[see fairness]---John Rawls is a social philosopher whose theory of justice is based on a concept of fairness that insists on the most vulnerable in society being treated in such a way that they receive a larger share of social goods than those who are less vulnerable. In health care this translates to mean that the societal arrangement that distributes the goods of health care must be such that the most vulnerable receive a larger share to meet their needs. This is not the theory which guides current practice.
Maximizing human flourishing---this goal is a good that supports much of medical intervention because it is aimed at helping the patient live better and possibly longer.
Minimizing human suffering---this goal is a good that supports medical intervention that is aimed at palliation when flourishing is not possible. These two good goals form polar opposites and all of healthcare falls in between the two poles.
Moral community---the social group that maintains the values for its individual members.
Moral distress---moral tension can result in moral distress. When tensions between conflicting values rise and cannot be resolved, persons experience moral distress. The emotional basis for moral distress is anger. Signs of moral distress vary from expressed anger, biting cynicism, silent withdrawal, to depression. Less often moral distress is turned into corrective action.
Moral imagination---the ability to anticipate or project oneself into the middle of a moral dilemma or conflict and understand all the points of view.
Moral tension-the tension can be between two rights, or a clear right and a clear wrong, or between a right and something questionably wrong. The tension can be between two positive values that conflict such as the desire to serve a cause of social justice and the desire to coach your daughter's volley ball team. The tension can be between what you hold as a positive value, such as respecting the dignity of a patient, and a negative value, such as the demand that you violate the dignity of that patient. Often this tension is between what we think is right and what some authority figure, or the "system" thinks is right. Some degree of moral tension is a constant experience of professional life and of ordinary, everyday existence.
Morality---a system of values and the moral rules, goals and virtues that derive from those values.
Morals---the values held by an individual and maintained by the individual's moral community. Morals define what constitutes a good life.
Mutual regard---a reciprocal relationship in which both persons are able and willing to share and understand the perspective of the other. Mutual regard forms the core of a deeply moral relationship.
Nonmalificence---the literal translation is "do not harm". The principle is meant to prevent harming a person through acts of another person. In health care it is often difficult to do medical interventions without harming or risking harm to the patient.
Plan managers---a key element for the implementation of an insurance plan is the manager who controls the activities of persons who carry out the process steps in service functions. A manager controls actions of employees.
Powerful provider---in the social construction of our health care system providers are generally more powerful than patients. Some providers are more powerful than other providers. Powerful providers have the responsibility to use power for the good of the powerless.
Practical reasoning---reasoning that is aimed at solving a problem around values or morals such as how to decide about withdrawing life support, as opposed to technical reasoning that is aimed at solving a factual problem such as the square root of 124.
Preferences---in addition to certain beliefs about our life-situation, each individual holds preferences about what kind of response to the situation is the most fitting response. A preference is a desire for a certain goal or outcome. Preferences are central to morality because preferences reflect what we think of as a good life.
Privacy---the right of patients to not have information about them placed in medical records or shared verbally with others.
Professional code of ethics---professions are powerful social groups who have been assigned the responsibility to use their power for the good of the less powerful. A code of ethics is a formal statement that both claims that responsibility and gives guidance to its accomplishment. A code of ethics guides the responsible action of the professional.
Professional value---all healthcare professional groups have identified a set of expectations for each of their members to meet. These expectations are based on what the professional group has agreed are the most important values, or virtues, to be maintained. Integrity, respect, and compassion are commonly cited as virtues expected of healthcare professionals.
Reciprocity---the give and take of a relationship is reciprocity. Reciprocity in ethics is the mutual regard that persons hold for one another.
Regulatory bodies---all managed care insurance plans, as well as all health care institutions, are under the partial control of regulatory bodies. These may be federal governmental, such as the Health Care Finance Administration, state governmental, such as statutes and regulatory interpretation of statutes, and non-governmental such as National Committee for Quality Assurance, [the managed care equivalent of JACHO]. All managed care plans function within a wide range of standards and restrictions.
Respect---a trait or virtue that expresses an ability and willingness to protect the dignity of others.
Release of information---a process that is similar to informed consent in which the patient agrees to allow some of all of their records to be released to a party other than the provider who holds the safe-keeping of the record.
Roles theory---the roles or traits of character or virtues that make up the personality are the focus of role theory. Role theory is more concerned with what kind of person one is and how such persons tend to act.
Responsibility---to be responsible is to meet the expectations of the moral community to act within certain limits.
Rules theory---synonyms for rules are principles, standards, laws, codes, rights, and commandments. Rules theory maintains that there is a right way to act in the world that ought not to vary with the situation or the goal or the person acting.
Self-interest---this is an ethical term that points toward the human tendency to give the highest priority to satisfying personal goals.
Systematic reflection---an established pattern of deliberation. Ethical analysis is a pattern of systematic reflection.
Value judgment---values are the preferences held by individuals in community and may be praiseworthy or blameworthy, virtues or vices. Value judgment is the process of sorting out which are praiseworthy and which are blameworthy. In addition value judgment is prioritizing which values are more praiseworthy. The highest value ought to be the most important guide to action.
Values---the essential elements that guide action.
Values clarification---this term describes a variety of strategies to raise values from an unconscious or inarticulate status to a conscious level where they can be intentionally used to guide decisions. Clarifying personal values is necessary in order to understand one's morality.
Violating integrity---integrity is the virtue that coordinates all other virtues. To have integrity is to have organized and controlled all the important traits of your character in such a way that you are expected to act well. To violate one's integrity is to lose control over one's character traits which allows some unexpected and undesirable constellation of virtues or vices to express itself in action.
Virtues---Aristotle defined a virtue as "an habitual disposition to act well". A virtue is a character trait that motivates a person to act in patterns that achieve the good.
Vulnerable patient---vulnerable means wounded and unable to defend oneself. Patients have a strong self-perception of vulnerability, but truly vulnerable patients are those who cannot act on their own to protect themselves from threats to their health and dignity. Vulnerable patients are powerless.