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i

Health Care Ethics CRITIC AL ISSUES FOR THE 21ST CENTURY

Third Edition

Edited by

Eileen E. Morrison, EdD, MPH, LPC, CHES Professor, School of Health Administration Texas State University—San Marcos San Marcos, Texas

Beth Furlong, PhD, JD, RN Associate Professor, Center for Health Policy and Ethics Creighton University Omaha, Nebraska

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Library of Congress Cataloguing-in-Publication Data Health care ethics : critical issues for the 21st century / [edited by] Eileen E. Morrison and Beth Furlong. —3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4496-5737-6 (pbk.) ISBN 1-4496-5737-0 (pbk.) I. Morrison, Eileen E. II. Furlong, Elizabeth. [DNLM: 1. Bioethical Issues. 2. Delivery of Health Care--ethics. 3. Ethics, Clinical. WB 60] 174.2—dc23 2012039134 6048 Printed in the United States of America 17 16 15 14 13 10 9 8 7 6 5 4 3 2 1

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iii

Dedication

EILEEN E. MORRISON

The third edition of Health Care Ethics: Critical Issues for the 21st Century is dedicated to all those who contributed their time and talent to update existing chapters or develop new ones. They shared their insights on topics that will help to balance ethics and healthcare practice in the 21st century. On a personal level, I would like to dedicate the third edition of this text to those who have provided both inspiration and advice. First, there is my family: Grant, Kate, Emery Aidan, and Morrigan Leigh, who listened, loved, and encouraged. There are also my colleagues, relatives, and friends—you each know how much you have meant to me during this process. Finally, there is my publisher, Michael Brown; my coeditor, Beth Furlong; and my Jones & Bartlett Learning editors, Chloe Falivene and Rebekah Linga, whose knowledge, guidance, and patience added so much to the quality and integrity of this work.

BETH FURLONG

Mentors facilitate one’s journey. My gratitude goes to Dr. Amy Haddad and colleagues at Creighton University’s Center for Health Policy and Ethics. I value the ever-present support of my husband, Robert Ramaley. Furthering the ethical education of others with this book is possible because of the collegiality and support of coeditor, Eileen Morrison. It has been a professional pleasure to work with her.

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v

Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

PART I—FOUNDATIONS IN THEORY . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1 Theory of Healthcare Ethics . . . . . . . . . . . . . . . . . . . . . . . . 3 Jim Summers

Chapter 2 Principles of Healthcare Ethics. . . . . . . . . . . . . . . . . . . . . 47 Jim Summers

PART II—CRITICAL ISSUES FOR INDIVIDUALS . . . . . . . . . . . . . . . . 65

Chapter 3 The Moral Status of Gametes and Embryos: Storage and Surrogacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Glenn C. Graber

Chapter 4 The Ethical Challenges of the New Reproductive Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Sidney Callahan

Chapter 5 Abortion: The Unexplored Middle Ground . . . . . . . . . . . 97 Carol Petrozella

Chapter 6 Proposals for Human Cloning: A Review and Ethical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Kevin T. FitzGerald

Chapter 7 Competency: What It Is, What It Is Not, and Why It Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Byron Chell

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vi CONTENTS

Chapter 8 Older People and Issues of Access to Long-Term Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Janet Gardner-Ray

Chapter 9 Assisted Living and Ethics . . . . . . . . . . . . . . . . . . . . . . . . 159 Rosalee C. Yeaworth

Chapter 10 Ethical Issues in the Use of Fluids and Nutrition: When Can They Be Withdrawn? . . . . . . . . . . . . . . . . . . . 171 T. Patrick Hill

Chapter 11 Death, Medicine, and the Moral Significance of Family Decision Making. . . . . . . . . . . . . . . . . . . . . . . . 185 James Lindemann Nelson

Chapter 12 Ethical Issues Concerning Physician-Assisted Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Barbara Supanich

PART III— CRITICAL ISSUES FOR HEALTHCARE ORGANIZATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Chapter 13 Healthcare Institutional Ethics: Broader Than Clinical Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Carrie S. Zoubul

Chapter 14 Hospital Ethics Committees: Roles, Memberships, Structure, and Difficulties . . . . . . . . . . . . . . . . . . . . . . . . 227 Michael P. West and Eileen E. Morrison

Chapter 15 Bioethical Dilemmas in Emergency Medicine and Prehospital Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Kenneth V. Iserson

Chapter 16 Technological Advances in Health Care: Blessing or Ethics Nightmare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Cristian H. Lieneck

Chapter 17 Spirituality and Healthcare Organizations . . . . . . . . . 277 Dexter R. Freeman and Eileen E. Morrison

PART IV—CRITICAL ISSUES FOR SOCIETY’S HEALTH. . . . . . . . . 299

Chapter 18 Health Inequalities and Health Inequities . . . . . . . . . . 301 Nicholas B. King

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Contents vii

Chapter 19 Is Rationing of Health Care Ethically Defensible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Chris Hackler

Chapter 20 Domestic Violence: Changing Theory, Changing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 Carole Warshaw

Chapter 21 Ethics of Disaster Planning and Response . . . . . . . . . . 345 Eileen E. Morrison and Karen J. Bawel-Brinkley

Chapter 22 A New Era of Health Care: The Ethics of Healthcare Reform . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Richard L. O’Brien

Chapter 23 Healthcare Reform: What About Those Left Behind?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375 Beth Furlong

Chapter 24 Looking Toward the Future . . . . . . . . . . . . . . . . . . . . . . . 391 Beth Furlong and Eileen E. Morrison

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

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ix

Contributors

Karen J. Bawel-Brinkley, RN, PhD

Professor School of Nursing San Jose State University San Jose, CA

Sidney Callahan, PhD Distinguished Scholar The Hastings Center Garrison, NY

Byron Chell, JD Eugene, OR

Kevin T. FitzGerald, SJ, PhD Dr. David Lauler Chair in Catholic

Healthcare Ethics Associate Professor Center for Clinical Bioethics Georgetown University Medical

Center Washington, DC

Dexter R. Freeman, PhD Director Master of Social Work Program Army Medical Department Center

and School Army-Fayetteville State University Houston, TX

Janet Gardner-Ray, EdD CEO Country Home Healthcare, Inc. Charlottesville, IN

Glenn C. Graber, PhD Professor Emeritus Department of Philosophy The University of Tennessee,

Knoxville Knoxville, TN

Chris Hackler, PhD Professor of Medical Humanities Division of Medical Humanities College of Medicine University of Arkansas for Medical

Sciences Little Rock, AR

T. Patrick Hill, PhD Senior Policy Fellow Edward J. Bloustein School of

Planning and Public Policy Rutgers, The State University of New

Jersey New Brunswick, NJ

Kenneth V. Iserson, MD, MBA Professor Emeritus of Emergency

Medicine The University of Arizona Tucson, AZ

Nicholas B. King Assistant Professor Biomedical Ethics Unit McGill University Faculty of

Medicine Montreal, QC, Canada

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x CONTRIBUTORS

Cristian H. Lieneck, PhD, FACMPE, FACHE, FAHM

Assistant Professor Texas State University—San Marcos San Marcos, TX

James Lindemann Nelson, PhD Professor of Philosophy Michigan State University East Lansing, MI

Richard L. O’Brien, MD Professor Emeritus Center for Health Policy & Ethics Creighton University Omaha, NE

Carol Petrozella, BSN, MSN, MSED, EdD

Professor Miami Dade College Adjunct Clinical Professor Nova Southeastern University Miami, FL

Jim Summers, PhD Professor Emeritus School of Health Administration College of Health Professions Texas State University—San Marcos San Marcos, TX

Barbara Supanich, RSM, MD Medical Director

Palliative Care Holy Cross Hospital Silver Spring, MD

Carole Warshaw, MD Director National Center on Domestic

Violence, Trauma & Mental Health Chicago, IL

Michael P. West, EdD, FACHE Executive Director and Fellow University of Texas at Arlington—

Fort Worth American College of Healthcare

Executives Chicago, IL

Rosalee C. Yeaworth, RN, PhD, FAAN

Professor Emeritus and Dean Emeritus

Medical Center and College of Nursing

University of Nebraska Omaha, NE

Carrie S. Zoubul, JD Borchard Fellow Center for Health, Science, and

Public Policy Brooklyn Law School New York, NY

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xi

About the Authors

Eileen E. Morrison, EdH, MPH, LPC, CHES is a professor in the School of Health Administration at Texas State University—San Marcos. Her academic background includes a doctorate from Vanderbilt University and a Master of Public Health from the University of Tennessee. In addition, she holds the credential of Associate in Logotherapy from Viktor Frankl Institute of Logotherapy and a clinical degree in dental hygiene.

Dr. Morrison has taught graduate and undergraduate ethics courses and provided professional workshops on ethics to physicians, nurses, clinical laboratory professionals, dental professionals, and counselors. She has authored articles and chapters on ethics for a variety of publications. In addition, she is the author of Ethics in Health Administration: A Practical Approach for Decision Makers, Second Edition, published by Jones and Bartlett Publishers.

Beth Furlong, PhD, JD, RN is an associate professor in the Center for Health Policy and Ethics at Creighton University in Omaha, Nebraska. Her academic background includes a bachelor’s degree and master’s degree in nursing, a master’s degree and doctorate degree in political science, and a law degree (JD).

Dr. Furlong has taught graduate ethics courses and led continuing education unit workshops for nurses on ethical issues. Her publications are in the areas of health policy, vulnerable populations, and ethics.

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xiii

Preface

The writing of the third edition of Health Care Ethics: Critical Issues for the 21st Century occurred during a time of great change for the healthcare system. In fact, health care is facing its greatest changes since the advent of Medicare and Medicaid. In light of this fact, chapters are included that address healthcare reform and its ethical issues. In addition, authors have contributed new chapters to emphasize the impact of technology and new options in long-term care. Existing chapters were updated; some chapters underwent major revisions to connect better to the challenges faced by health professionals in the post-reform era.

The third edition keeps the organizational model of previous editions to assist students in building their knowledge base of ethics and ability to relate ethics to patient issues across the lifespan. It also provides organizational issues, as well as examples of ethical issues germane to society. In homage to those who greatly influenced ethical thought, the model of a Greek temple organizes the chapters in this new edition (see Figure FM–1). The foundation of the temple is ethical theory and principles. Students need this foundation so they can analyze future issues in their practices based on theory and principles and not just on opinion.

The three main pillars of the model illustrate the foundation for the other sections of the text: individual, organizational, and societal issues. An introduction to each section sets the stage for the issues presented in the chapters that follow. Authors with extensive experience in healthcare practice and in ethics contributed their insights in these chapters. At the end of each chapter, discussion questions provide the opportunity for thoughtful analysis and application of the issues raised in the chapter. In addition, a new feature,

Ethical Issues

Theoretical Foundations

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“Food for Thought,” gives the student the ability to apply what he or she has learned to healthcare situations. These mini-cases can also lead to lively class discussions.

The authors of this new edition of Health Care Ethics: Critical Issues for the 21st Century are experts in their fields, but they are not clairvoyant. Therefore, they cannot predict what will happen in the next 5–10 years, as the Patient Protection and Affordable Care Act becomes the norm for health care. However, one can always apply the principles and theories of ethics to whatever new situation arises. We hope that students will continue to ask themselves, “Is this the best ethical decision to make?” and “How do I know that this is the best decision?” as they progress through their careers. Patients and the community rely on the answers.

xiv PREFACE

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PART I

Foundations in Theory

With the advent of the Patient Protection and Affordable Care Act (PPACA), a new era of health care has begun. The changes and proposed changes associ- ated with this law increase the complexity of both patient care and the larger healthcare system. Because of this law, health care will receive even more scrutiny and must provide high-quality, patient-centered, research-based care with fewer or different types of resources. The community will continue to expect a high level of ethics from practitioners and healthcare organizations. In short, you are supposed to “know your stuff” at both a practice and an orga- nizational level if you want to be considered a professional in health care.

To be fully prepared, you need to know your ethics. In today’s complex healthcare setting, ethics is not just about doing the right thing, like your Mom taught you. The new healthcare era brings issues that often are exceedingly complex and far from black and white. In addition, society and the health professions themselves often have stringent expectations regarding ethics. In light of these challenges, it seems logical that one must have a solid foundation in the theory and principles of ethics in order to make appropriate professional decisions. The first part of this new edition of Health Care Ethics: Critical Issues for the 21st Century contains two chapters that provide this foundation.