Category: Definitions

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....

Complementary and alternative therapies are a range of treatments and approaches that are currently viewed as being outside the purview of conventional or allopathic health care providers.  Complementary therapies are those that are provided alongside conventional approaches while alternative therapies are provided instead of conventional therapies. In dealing with complementary and alternative therapies in conventional health care organizations, discussions tend to focus on risk, likelihood of benefit, likelihood of harm, and evidence.  There has been a history of bias against complementary and alternative therapies, which can make it challenging to be attentive to the ways in which the evidence supporting some conventional therapies and approaches is in some cases less robust than we would like. The use of complementary and alternative therapies often signals a context where values diversity will be especially relevant to discussions of the ethical issues....

An all hazards response plan provides a consistent approach to a range of emergency situations, including terrorism, disease outbreak, natural disaster, and mass casualty situations.   Key values, principles, and approaches are identified and then applied as appropriate to the situation....

Ethically relevant differences are aspects of context or facts of the matter that shift the values that we think to be applicable to deciding a course of action.  These are essential in determining whether or not justice has been achieved in that particular situation. For example, there could be two patients who are clinically very similar, but one lacks capacity and the other does not.  The difference in decision making capacity between the two means that respect for autonomy will be less important in both the content and form of decision making for the patient who lacks capacity, such that a best interests standard is much more likely to be applied (and we see this reflected in guidelines around decision making with infants and children). Other ethically relevant differences might be resource constraints; decisions made about care during times of crisis (higher demand) or shortages (reduced supply) are not expected to be the same as those made during times when it is...

The allocation of health care resources is possibly the most significant ethical challenge in health care, although it is not often perceived as such by the general public.  Decisions about allocation of resources provide significant insight into how an organization translates its values->organizational values into practice; it is not a stretch to claim that the most significant ethical document an organization produces is its budget and business plan. Resource allocation in health care is a zero sum game in a meaningful way; decisions that generate benefit for one group preclude generating benefit for another group, raising concerns about justice in these allocations. In health care we are concerned not just about the use of funds but also the allocation of space, equipment, and health care provider time.  Resource allocation decisions are deeply ethical in that they significantly determine how individuals are treated (or not) by the health care system....

Privacy is the right that individual have to protect and control the access that others have to information about themselves. Privacy is a strong right but is not absolute; individual privacy can be breached when another individual’s significant interests are at stake....