Doing Health Ethics

Ethical reasoning explains what actions are right or wrong, why we should strive to be good persons as a way of contributing to a good society, and how we might choose the action likely to have the best consequences. These three ways of reasoning are familiar to us, because we all think like this as we make ethical decisions. But in ethics textbooks that emphasize principles, these distinctions are often ignored. The three ways of reasoning I describe in the previous paragraph may be distinguished with the words rules, goals, and outcomes. Ethical arguments about what actions are right or wrong are usually resolved by rules. In contrast, when we want to improve the way we (and others) interact with one another, we try to motivate ourselves (and others) by setting goals. Generally, we also try to predict what action will most likely have the best outcomes. Doing health ethics is a conversation that includes those who are sick as well as specialists, patients and physicians, nurses and family members, students and community members who may sit on a hospital ethics committee, young and elderly. In this ethical approach feelings as well as reasons matter, communicating clearly and listening carefully are given high priority, and having respect and empathy for all those involved are important goals for everyone. In doing ethics we are not only concerned with thinking clearly about ethical issues, but also in acting ethically. Concerning health care, this includes attending to the ethical concerns of patients and their family members, with openness to their cultural and religious expectations, in a manner both respectful and engaging. Chapter 1 distinguishes reasoning from rationalizing and clarifies several of the most important words used in ethics. Chapter 2 examines the assumptions we are making about our ability to know and act, and gives reasons for why we can find value in nature. Chapter 3 argues for replacing the “medical model” of reasoning about health care with a “person-first” approach. Chapters 4 and 5 concern ethical rules involving duties and rights in health care. Chapters 6 and 7 examine goals affirmed in an “ethics of care” or within “natural law” reasoning. Chapter 8 explores various forms of consequential reasoning. Chapter 9 addresses ethical decisions concerning the use of genetic tests. Chapter 10 considers how scarce health care resources should be allocated. Chapter 11 discusses how the Affordable Care Act will affect the funding and costs for health care. Chapter 12 looks at several health care problems for which preventive care health care is effective. Chapter 13 reviews ethical arguments having to do with contraception, abortion, and substance abuse by pregnant women. Chapter 14 assesses choices about providing or withholding treatment in neonatal care. Chapter 15 considers end of life ethical decision-making. I hope when you have finished the book, you will feel more confident in evaluating ethical arguments about health care and will be committed to a person-first approach to health care.