Table Of ContentSPRINGER BRIEFS IN ETHICS
Jeff rey P. Spike
Rebecca Lunstroth
A Casebook in
Interprofessional
Ethics
A Succinct
Introduction to
Ethics for the Health
Professions
123
SpringerBriefs in Ethics
More information about this series at http://www.springer.com/series/10184
Jeffrey P. Spike Rebecca Lunstroth
(cid:129)
A Casebook
in Interprofessional Ethics
A Succinct Introduction to Ethics
for the Health Professions
123
Jeffrey P. Spike Rebecca Lunstroth
McGovern Center McGovern Center
TheUniversity of TexasHealth Science TheUniversity of TexasHealth Science
Centerat Houston, UTHealth Centerat Houston, UTHealth
Houston, TX Houston, TX
USA USA
ISSN 2211-8101 ISSN 2211-811X (electronic)
SpringerBriefs inEthics
ISBN978-3-319-23768-8 ISBN978-3-319-23769-5 (eBook)
DOI 10.1007/978-3-319-23769-5
LibraryofCongressControlNumber:2015959909
©TheAuthor(s)2016
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To my wife Elizabeth Spike, and to the lights
of my life: Alexander Hume, Perry Spinoza,
and Sophia Russell Spike, my three teenage
children who are rapidly becoming unique
and wonderful individuals.
Acknowledgments
It is important to acknowledge that this book is the result of a group project. In
2009, the President of The University of Texas Health Science Center-Houston
gave financial support to faculty from all six professional schools to develop and
enhance the ethics curriculum, the Campus-wide Ethics Program (or CWEP). The
first three years were spent identifyingcore ethics topicsessential tobe introduced
toallstudents,regardlessofprofessionalschool.TheresultwasabookentitledThe
Brewsters,whichisrequiredreadingforfirst-yearstudentsineverydegreeprogram
at all six of our schools: Medicine, Nursing, Public Health, Dentistry, Biomedical
Sciences,andInformatics.(IfyouwanttoknowmoreaboutTheBrewsters,youcan
gototheWebsiteMeetTheBrewsters.com.)AfterthattheCWEPturnedtoworking
on the newest challenge in ethics, interprofessional ethics. The cases in this book
represent the work of the CWEP from 2012 to 2014.
I must particularly acknowledge the work of my colleagues in the McGovern
Center for Humanities and Ethics at UT-Houston. First, our administrative assis-
tants, Angela Polczynski, who helped arrange rooms, keep records, and maintain
thegroup’spaceovertheyearsofmonthlymeetings,andAlmaRosaswhohelped
keeptrack ofmany revisions ofthemanuscript,andsecond, Rebecca Lunstroth, J.
D., the Assistant Director of the McGovern Center, and the co-director of the
medical school and the school of biomedical science’s ethics and professionalism
courses. Rebecca took on the task of final editing of the cases in Chap. 6 of the
book, making improvements to all of them. I also must acknowledge the support
and encouragement of this project by the Director of the McGovern Center, Tom
Cole.
One member of the Campus-wide faculty, Stephen Linder from the School of
PublicHealth,providedsomeconceptualorganizationtothegroupprocessthatwas
especiallyhelpfultothegroup.Hiscontributionsledtohiswritingthefirstdraftof
chapter two, “Framing Interprofessional Ethics Cases.” He deserves special
acknowledgment as a co-author of that chapter.
vii
viii Acknowledgments
I also thank The Hastings Center for hosting me during the process offinishing
the first five chapters of the book, and to my wife Elizabeth Spike, my research
assistant Jennifer Bulcock, and Laura Haupt at The Hastings Center who read and
helped edit those five chapters.
Contents
1 A Very Brief History of Health Care Ethics: Four Decades
from the Golden Age of Bioethics to the Dawn
of Interprofessional Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Suggestions for Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Framing Interprofessional Ethics Cases. . . . . . . . . . . . . . . . . . . . . 11
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Interprofessionalism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Different Levels of Ethical Issues in the Cases . . . . . . . . . . . . . . . . . 14
A Framework to Help Formulate Ethical Judgments. . . . . . . . . . . . . . 14
Suggestions for Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3 Using Ethical Theories as a Tool for Understanding Cases. . . . . . . 19
Introduction: What Ethics Is, What Ethics Isn’t,
and When It All Began . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Ethical Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
The Two Modern Philosophical Theories of Ethics . . . . . . . . . . . . . . 22
Four Less Rigorous ‘Alternative’ Ethical Theories. . . . . . . . . . . . . . . 24
4 Using Principles as a Tool for Understanding Ethics Cases . . . . . . 31
The Original Four Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Four Additional Mid-Level Principles for Professionalism
(and Professional Integrity). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Four Principles for Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5 Instructional Materials for Students and Teachers. . . . . . . . . . . . . 45
Instructional Materials for Students: A Case Analysis Method
to Write Short-Answer ‘Free-Response’ Questions (FRQs),
Essays, and Papers with Valid Ethical Arguments and Sound
Conclusions (Including a Grading Matrix for Teachers
and Students) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
ix
x Contents
Instructional Materials for Ethics Facilitators:
Can Ethics Be Taught?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
An Excursion in Socratic Pedagogy . . . . . . . . . . . . . . . . . . . . . 48
6 Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Outline of Cases by Professions Involved. . . . . . . . . . . . . . . . . . . . . 54
Case 1: The Limitations of Electronic Health Records
(EHRs), Decision-Support, and Financial Conflicts of Interest. . . . . . . 55
Relevant Professions: Health Informatics, Medicine, Nursing. . . . 55
Case 2: Preserving Privacy and Confidentiality with Electronic
Health Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Relevant Professions: Health Informatics, Medicine, Nursing,
Clinical Psychology, Social Work . . . . . . . . . . . . . . . . . . . . . . 56
Case 3: Privacy in the Age of Patient-Driven Websites. . . . . . . . . . . . 57
Relevant Professions: Health Informatics, Medicine,
Biomedical Sciences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Case 4: Workplace Wellness Programs and Health Disparities. . . . . . . 58
Relevant Professions: Medicine, Nursing, Public Health . . . . . . . 58
Case 5: Conducting Human Subject Research Abroad:
Whose Standards? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Relevant Professions: Biomedical Science, Translational Science,
Medicine, Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Case 6: Authorship and Clinical Equipoise . . . . . . . . . . . . . . . . . . . . 60
Relevant Professions: Medicine and Biomedical Science. . . . . . . 60
Case 7: When Professional Identity Conflicts with Research . . . . . . . . 61
Relevant Professions: Medicine, Biomedical Sciences
and Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Case 8: When Experimental Therapies Need to Be Tested . . . . . . . . . 62
Relevant Professions: Medicine, Biomedical Science . . . . . . . . . 62
Case 9: When Practice Guidelines Conflict
with Professional Authority. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Relevant Professions: Health Informatics, Medicine . . . . . . . . . . 63
Case 10: Whistleblowing in a Small Town . . . . . . . . . . . . . . . . . . . . 64
Relevant Professions: Nursing, Medicine, Dentistry,
Dental Hygiene, Dental Assistant. . . . . . . . . . . . . . . . . . . . . . . 64
Case 11: Managing Patient’s Health Information from the Internet. . . . 66
Relevant Professions: Medicine, Nursing, Social Work,
Dentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Case 12: Sandy’s Case. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Relevant Professions: Clinical Social Work, Nursing,
Medicine, Health Informatics. . . . . . . . . . . . . . . . . . . . . . . . . . 67
Case 13: Disasters: Who Gets Priority? . . . . . . . . . . . . . . . . . . . . . . 68
Relevant Professions: Public Health, Medicine, Nursing . . . . . . . 68
Case 14: Planning During a Pandemic: Does Social Worth Count? . . . 69
Relevant Professions: Public Health, Medicine, Nursing . . . . . . . 69
