Category: Definitions

When we think about justice, we are focused on the distribution of benefits and burdens of social cooperation and we seek to ensure that no particular group is consistently made worse off by the ways social and political structures function. In focusing on distribution of risk, we look to see which individuals or groups have a greater likelihood of being harmed given their position.  For example, individuals who live in closer proximity to sources of pollution are at greater risk of respiratory disease, and individuals who work in health care settings are at a greater risk of exposure to pathogens. Considerations of reciprocity are especially relevant to discussion of distribution of risk; we are less concerned about individuals taking on risk when they are compensated or rewarded for doing so.  For example, the salaries of health care providers might be seen as one way of offsetting risk. Organizations can also express a commitment to reciprocity by taking steps to minimize exposure to...

Moral distress is experienced when an individual believes they know the right way to act but feels that they are being prevented from acting in accordance with their convictions due to internal or external factors. Common constraints include resource limitations, perceived or actual lack of power or influence, or a lack of confidence in one’s ability or judgement. Moral distress often manifests in burnout, cynicism, and symptoms such as headaches, gastrointestinal distress, anxiety, frustration, and depression.  It is correlated with higher numbers of sick days, greater staff turnover, and individuals leaving their professions. It is a cost, both human and fiscal, that results from the way the health care system is structured, and both individuals and organizations are bearing these costs. The phenomenon of moral distress was first identified and has been most extensively studied in the nursing population, but has been identified in health care professionals of many stripes....

Consistency is the value of treating similar situations similarly, and it lies at the heart of the commitment to justice. In ethics consultation we especially value consistency in part because it demonstrates that the recommendations are not arbitrary but are coherent with reasoning applied and presumably endorsed in other relevantly similar situations. In ethics consultation we are especially concerned with consistency of values and principles applied or with the consistency of interpretation of a particular value, even as facts in particular cases might result in different outcomes. We see the same commitment to consistency in the legal tradition of following precedents....

Stewardship is the obligation to manage resources, and particularly public resources, in a responsible and effective manner, with attention to the wide-reaching consequences of decisions and the full range of individuals affected by the decision....

Integrity is the characteristic of acting in accordance with values even when there are compelling reasons not to do so based on expediency, for example, or potential for gain. Integrity is strongly connected with trust, in that the individual or organization can be trusted to act solely or primarily based on a particular set of values or principles and cannot be corrupted.  Integrity is often recognized as a central value for organizations. Transparency and accountability are often seen as hallmarks of integrity, in that if an individual or organization is acting from core principles they have nothing to hide....

Paternalism is contrasted with respect for autonomy and is the process of deciding for one individual based on someone else’s assessment of that individual’s best interests.  It is what appropriately characterizes decision making for infants and young children, but is seen as less appropriate as an individual’s capacity for making decisions develops. In health care, there is an extensive history of health care providers (primarily but not exclusively physicians) deciding on behalf of others, reflected in the cliche “doctor knows best”....

The purpose of ethics consultation is to provide support to patients, families, health care teams, and others who are working through ethically challenging situations.   Some common misconceptions about ethics consultation include: that the ethics consultants know the “right” answer; that the ethics consultants are there to judge; that the ethics consultants only get involved when something unethical has happened; and that the ethics consultants can “convince” others to do something. At the outset of consultations ethics consultants often explicitly establish what the purpose and focus of the discussion is, in an attempt to manage expectations and dispel misconceptions....

Transparency is a commitment to publicizing an organization's actions and decisions as well as the reasoning behind them.  It is especially important in demonstrating accountability on the part of organizations that receive public funding. The public reporting of certain information (such as salaries above $100,000) is mandated by law, and access to information legislation is likewise intended to support transparency . Transparency in health care often regards organizational resource allocation as well as how decisions are made about funding (or not) various programs, services, drugs, and devices....

Depending on the jurisdiction, advance directives are also known as living wills, power of attorney for health care, personal directives, and health care proxies. Advance directives are one reflection of the strong commitment to the principle of respect for autonomy in many Western cultures.  They provide a means of communicating how decision making for an individual should be approached at the time when that person is unable to make decisions themselves. These documents can guide decision making in various ways; by indicating another individual who should make decisions on behalf of the directive’s author (a substitute decision maker), by laying out the values and principles that should be reflected in decisions, or by giving specific instructions for particular scenarios. In most jurisdictions, there is guidance regarding the bases upon which decisions for others should be made.  The primary source of guidance is an individual’s explicitly stated wishes. Should there be no previously expressed wishes relevant to the situation the individual is in, substitute...

Accountability is a value emphasizing the obligation to report or account for individual or organizational decisions and their rationale.  It is seen as especially important when public funds are at stake in decisions. It is a means of ensuring that resources are being used for their intended purpose and is closely linked with transparency and integrity....