The words, theories and discussions that occur around ethics can be confusing. Definitions are included here for selected words and in some cases are linked to more detailed information.
Agent: means an adult who has the authority to make health care treatment decisions for another person, referred to as the principal, pursuant to a health care power of attorney (Arizona Revised Statutes (ARS) 36-3201)
Artificially administered means providing food or fluid through a medically invasive procedure.(ARS 36-3201)
Bioethics: Bioethics is the branch of applied (practical) ethics that studies the philosophical, social, and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being, though it sometimes addresses ethical questions relating to the nonhuman biological environment. Medical and nursing ethics are sometimes thought of more in terms of professional ethics but still fall under the general scope of bioethics which may address such things as: 1. medical procedures, technology and engineering; 2. end-of-life decisions; 3. genetic research and engineering; 4. impact of financing and delivery of health care; 5. Patient rights to information, consent and confidentiality; 6. Disparities in health status and care; 7. Reproductive choices and treatments….
Comfort care means treatment given in an attempt to protect and enhance the quality of life without artificially prolonging that life.(ARS 36-3201)
Ethics: As the term is commonly used, ethics is a set of rules, principles or standards of “right” conduct-what we ought to do in the face of moral choices we encounter in our lives. Whether we refer to medical ethics, professional ethics, organizational ethics or personal ethics, we apply these standards to help us make decisions according to our values as expressed in various aspects of social life. The field of ethics is a subset of philosophy that examine the genesis, justification and validity of the moral norms (customary behavior) that govern our conduct in society. Stated simply, ethics is the systematic study of the moral domain.
Health care directive means a document drafted in substantial compliance with this chapter (ARS 36-32), including a mental health care power of attorney, to deal with a person’s future health care decisions.(ARS 36-3201)
Health care power of attorney means a written designation of an agent to make health care decisions that meets the requirements of section 36-3221 and that comes into effect and is durable as provided in section 36-3223, subsection A. (ARS 36-3201)
Hospice Care: Hospice is a concept of care that involves health professionals and volunteers who provide medical, psychological, and spiritual support to terminally ill patients and their loved ones. Hospice stresses quality of life—peace, comfort, and dignity.
Living will means a statement written either by a person who has not written a health care power of attorney or by the principal as an attachment to a health care power of attorney and intended to guide or control the health care treatment decisions that can be made on that person’s behalf.(ARS 36-3201)
Mental health care power of attorney means a written designation of an agency to make mental health care decisions that meets the requirements of section 36-3281.(ARS 36-3201)
Moral distress is the psychological disequilibrium that occurs when a person believes he or she knows the right course of action to take, but cannot carry out that action because of some obstacle, such as institutional constraints or lack of power.
Moral Principles.A set of four major principles are usually used to explore differences that occur around ethical decision making. Often, a conflict becomes evident when tension between two of these principles is identified. These four principles are widely used to analyze or “frame” the discussion of values or common morality expected when working with a patient/family or clinical staff. The priciples offer a context for considering recommendations for resolving the differences.
Principle # 1Patient Autonomy is based on respect for the individual and the right of the individual to make decisions for themselves. It requires consideration of the patient’s informed wishes as the guide for decision making in clinical care. The patient’s capacity to make those decisions, their mental competence, whether a surrogate has been appointed to make decisions for them when they cannot, and informed consent are all important considerations that influence respect for the patient’s autonomy.
Principle # 2Beneficence, or do the right thing to foster the interests and happiness of the person(s) involved and of society at large
Principle # 3Non-Maleficence, or do no harm, avoid harm. This involves weighing the benefits of a choice veses the burdens created by a choice (or among several choices) being considered. Patients may have different values than their family members and even the clinical staff providing care. The situation may also be so uncertain that it is not clear what benefits or burdens might result from a particular choice. Any of these situations can create tension and conflicts and it is often in such situations where a request for an ethics consult can be helpful.
Principle # 4 Justice suggests everyone involved act fairly and equitably when attempting to distribute benefits, burdens and costs and that the resolutions to disputes be reached through a fair and open process.
Palliative Care: Palliative care seeks to relieve (pain, suffering) without curing since in many cases a disease or condition may not be curable. Palliative can be offered at any point in a serious or life-threatening illness and it often occurs while treatment is still being done.
Principal means a person who is the subject of a health care power of attorney.(ARS 36-3201)
Surrogate means a person authorized to make health care decisions for a patient by a power of attorney, a court order or the provisions of section 36-3231.(ARS 36-3201)