HEALTH
CARE
ETHICS
Critical Issues for the 21st Century
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 Emerita, Center for Health Policy and Ethics
Creighton University
Omaha, Nebraska
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Library of Congress Cataloging-in-Publication Data
Names: Morrison, Eileen E., editor. | Furlong, Elizabeth, editor.
Title: Health care ethics: critical issues for the 21st century / edited by
Eileen Morrison, Beth Furlong.
Other titles: Health care ethics (Morrison)
Description: Fourth edition. | Burlington, Massachusetts: Jones & Bartlett Learning, [2019] |
Includes bibliographical references and index.
Identifiers: LCCN 2017043204 | ISBN 9781284124910 (pbk.: alk. paper)
Subjects: | MESH: Bioethical Issues | Delivery of Health Care—ethics | Ethics, Clinical
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Writing is always a collaboration. While writers have
unique ways of seeing the world, they are influenced
by their experiences, research, and education.
Therefore, I dedicate this edition of Health Care
Ethics: Critical Issues for the 21st Century to all
those who contributed to chapters in this work
and those who supported me through its creation.
First, there is my immediate family, Grant, Kate,
Emery Aidan, and Morrigan Leigh, who listened and
encouraged. There are also colleagues, relatives,
and friends who provided feedback and a lift of
spirit when I needed it. Finally, there is my publisher,
Michael Brown; my coeditor, Beth Furlong; and my
Jones & Bartlett Learning editor, Danielle Bessette.
They each added much to the quality and integrity of
this work.
–Eileen E. Morrison
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 ethics education of others
with this book is possible because of the collegiality
and support of my coeditor, Dr. Eileen Morrison. It has
been a professional pleasure to work with her.
–Beth Furlong
iv
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Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
PART I Foundations in Theory 1
Chapter 1 Theory of Healthcare
Ethics . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ethics and Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ethical Relativism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ethics Theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Ethics Theories and Their Value to
Healthcare Professionals . . . . . . . . . . . . . . . . . . . . . . .30
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .31
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Chapter 2 Principles of Healthcare
Ethics . . . . . . . . . . . . . . . . . . . . . . 41
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Nonmaleficence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Beneficence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Autonomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Theories of Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Reflective Equilibrium as a
Decision-Making Model . . . . . . . . . . . . . . . . . . . . . . .53
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .55
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
PART II Critical Issues for
Individuals 57
Chapter 3 The Moral Status of Gametes
and Embryos: Storage and
Surrogacy . . . . . . . . . . . . . . . . . . 59
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
The Moral Community . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Making Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Surrogacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .69
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Chapter 4 The Ethical Challenges of
the New Reproductive
Technologies . . . . . . . . . . . . . . . 71
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Two Inadequate Approaches to Evaluating
Alternative Reproductive Technology . . . . . . . . . .72
A Basis for Developing an Ethical Position . . . . . . . .73
A Proposed Ethical Standard . . . . . . . . . . . . . . . . . . . . .75
The Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Donors and the Cultural Ethos . . . . . . . . . . . . . . . . . . .81
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . . .83
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
v Contents
Chapter 5 Ethics and Aging in America . . 87
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
The Growing Population Needing Care . . . . . . . . . .88
Issues of Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Forces for Improving Access . . . . . . . . . . . . . . . . . . . . .94
What Are the Prospects for Improved Access? . . . .96
Update from a Practitioner’s View . . . . . . . . . . . . . . . .98
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 100
Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
PART III Critical Issues for
Healthcare Organizations 105
Chapter 6 Healthcare Ethics
Committees: Roles,
Memberships, Structure,
and Difficulties . . . . . . . . . . . . 107
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Why an Ethics Committee? . . . . . . . . . . . . . . . . . . . . 108
The Function and Roles of Ethics Committees . . 108
Ethics Committee Membership . . . . . . . . . . . . . . . . 111
The Healthcare Ethics Committee’s
Background and Education . . . . . . . . . . . . . . . . . . 113
Institutional Commitment . . . . . . . . . . . . . . . . . . . . . 114
Challenges for Healthcare Ethics Committees . . 115
Update from a Practitioner’s View . . . . . . . . . . . . . . 116
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 119
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Chapter 7 Ethics in the Management of
Health Information
Systems . . . . . . . . . . . . . . . . . . . 123
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Operational Definitions . . . . . . . . . . . . . . . . . . . . . . . . 123
Ethical Dilemmas Involving
Data on HISs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Smartphone Network of Healthcare
Awareness—Good Idea
or Violation of Privacy? . . . . . . . . . . . . . . . . . . . . . . 130
Is Health Care a Right or a Benefit? What Data
Protection Should Be Provided to PHI? . . . . . . . 131
Ethical Decision-Making
Models for the Management of HIM . . . . . . . . . 131
Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 133
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Chapter 8 Technological Advances in
Health Care: Blessing or
Ethics Nightmare? . . . . . . . . . . 137
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Medical and HIT Defined . . . . . . . . . . . . . . . . . . . . . . . 138
The Ethical Obligation . . . . . . . . . . . . . . . . . . . . . . . . . 138
Science and Technology Innovations
and Ethics Concerns . . . . . . . . . . . . . . . . . . . . . . . . 139
Recent Innovations Involving Technology
and Their Ethics Concerns . . . . . . . . . . . . . . . . . . . 141
HIT and the Medical Group Practice . . . . . . . . . . . . 147
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Questions for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Chapter 9 Ethics and Safe Patient
Handling and Mobility . . . . . . 153
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Extent of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . 153
Problem-Solving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Ethics Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 157
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Chapter 10 Spirituality and Healthcare
Organizations . . . . . . . . . . . . 161
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
vi Contents
Evidence-Based Practice: The Answer and
the Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
This Thing Called Spirituality . . . . . . . . . . . . . . . . . . . 164
Is There a Place for Spirituality in the
Healthcare Workplace? . . . . . . . . . . . . . . . . . . . . . . 168
Spirituality in the Business of Health Care . . . . . . 172
Integration of Spirituality into Healthcare
Workplaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Ethics Theories and Spirituality . . . . . . . . . . . . . . . . . 176
Ethics Principles and Spirituality . . . . . . . . . . . . . . . . 177
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Questions for Review . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Chapter 11 A New Era of Health Care:
The Ethics of Healthcare
Reform . . . . . . . . . . . . . . . . . . 183
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Healthcare Reform in the United States . . . . . . . . 183
Health System Reform in the 20th Century . . . . . 184
Key Provisions of the Healthcare Reform
Legislation of 2010 (ACA) . . . . . . . . . . . . . . . . . . . . 187
How Well Have the Reforms Met the
Expectations of a Just Healthcare System? . . . 189
Ethics Considerations Underlying
Healthcare Reform . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 191
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
PART IV Critical Issues for
Society’s Health 195
Chapter 12 Health Inequalities and
Health Inequities . . . . . . . . . 197
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
What Are Health Inequalities? . . . . . . . . . . . . . . . . . . 198
Why Are Some Health Inequalities also
Health Inequities? . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
How Can We Measure Health Inequalities? . . . . . 203
What Is the Best Way to Reduce or
Eliminate Health Inequalities? . . . . . . . . . . . . . . . 206
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 208
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Chapter 13 The Ethics of Epidemics . . . . 211
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Epidemics, Ethics, and Public Health . . . . . . . . . . . 211
Modern Epidemics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Determination of the Decision-Making
Responsibility: Individual Autonomy
Versus Paternalism . . . . . . . . . . . . . . . . . . . . . . . . . . 216
International Perspectives and the
Bioethics Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 217
Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Chapter 14 Ethics of Disasters:
Planning and Response . . . . 221
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Disasters in U .S . History . . . . . . . . . . . . . . . . . . . . . . . . 222
Disaster Planning and Response
by the Federal Government . . . . . . . . . . . . . . . . . 223
Disaster Preparedness and Response for
Healthcare Institutions . . . . . . . . . . . . . . . . . . . . . . 226
Professional Readiness for Disasters . . . . . . . . . . . . 228
Individual Response to Disasters . . . . . . . . . . . . . . . 228
Update from a Practitioner’s Point of View . . . . . . 230
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 235
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Chapter 15 Domestic Violence:
Changing Theory,
Changing Practice . . . . . . . . . 239
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
vii
Personal and Social Barriers . . . . . . . . . . . . . . . . . . . . 240
Systemic Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Impact of Theory on Clinical Practice . . . . . . . . . . . 241
Structural Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Implications for Training and
Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 247
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Chapter 16 Looking Toward
the Future . . . . . . . . . . . . . . . 261
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
New Considerations in Ethics Theory . . . . . . . . . . . 261
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Questions for Discussion . . . . . . . . . . . . . . . . . . . . . . . 275
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Glossary � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 279
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Contents
viii
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Contributors
Omolola Adepoju, PhD, MPH
Assistant Professor
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
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
Kimberly A . Contreraz, BSN, MSN, FNP, ACHPN
Director of Palliative Care
St. Vincent Anderson Regional Hospital
Anderson, IN
Dexter R . Freeman, DSW, LCSW
Director
Master of Social Work Program
Army Medical Department Center & School
Army-Fayetteville State University
Houston, TX
Janet Gardner-Ray, EdD
CEO
Country Home Healthcare, Inc.
Charlottesville, IN
Glenn C . Graber
Professor Emeritus
Department of Philosophy
The University of Tennessee
Knoxville, TN
Nicholas King, PhD
Assistant Professor
Biomedical Ethics Unit
McGill University Faculty of Medicine
Montreal, QC, Canada
Scott Kruse, MBA, MSIT, MHA, PhD, FACHE, CPHIMS,
CSSGB, Security+, MCSE
Assistant Professor and Graduate Programs
Director
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Christian Lieneck, PhD, FACMPE, FACHE, FAHM
Associate Professor
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Richard L . O’Brien, MD
University Professor Emeritus
Creighton University
Omaha, NB
Robert W . Sandstrom, PT, PhD
Professor and Faculty Associate
School of Pharmacy and Health Professions
Creighton University
Omaha, NB
Jim Summers, PhD
Professor Emeritus
School of Health Administration
College of Health Professions
Texas State University
San Marcos, TX
Carole Warshaw, MD
Director
National Center on Domestic Violence,
Trauma & Mental Health
Chicago, IL
Michael P . West, EdD, FACHE
Executive Director
University of Texas Arlington-Fort Worth
Campus
Fort Worth, TX
ix
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About the Editors
Eileen E. Morrison is a professor in the School
of Health Administration at Texas State Univer-
sity, San Marcos, Texas, USA. Her educational
background includes a doctorate from Vander-
bilt University, Nashville, Tennessee, USA, and a
master of public health degree from the Univer-
sity of Tennessee, Knoxville, Tennessee, USA. In
addition, she holds an associate degree in logo-
therapy and a clinical degree in dental hygiene.
Dr. Morrison has taught graduate and
undergraduate courses in ethics and provided
workshops to professionals, including those in
medicine, nursing, clinical laboratory services,
health information, and dentistry. She has also
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 (3rd
ed.), published by Jones & Bartlett Learning,
and a children’s book called The Adventures of
Emery the Candy Man.
Beth Furlong is an associate professor emerita
and adjunct faculty in the Center for Health
Policy and Ethics at Creighton University,
Omaha, Nebraska, USA. Her academic back-
ground includes a diploma, BSN, and MS in
nursing, an MA and PhD in political science,
and a JD. Dr. Furlong has taught graduate
ethics courses and provided continuing edu-
cation unit (CEU) workshops for nurses on
ethics issues. Her publications are in the areas
of health policy, vulnerable populations, and
ethics.
x
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Preface
The history of health care is filled with change. For example, providers and sys-tems have embraced changes that lead to
cures for disease, new ways to care for patients,
regulation, and funding. However, during the
creation of this fourth edition of Health Care
Ethics: Critical Issues for the 21st Century, the
healthcare system has been in change overload.
It must address changes from technology, the
emphasis on patient-centered care, and fiscal
challenges. It is also trying to address the truly
unknown. For example, legislators continue to
consider the appeal of the Patient Protection
and Affordable Care Act of 2010, while others
are debating its repair. Since healthcare fund-
ing, programs, and regulations are linked to
this legislation, the healthcare system will con-
tinue to engage in multilayers of contingency
planning for survival and service.
Readers will also notice changes in this
edition as its authors consider the implications
of change with respect to their content areas.
However, the fourth edition still reflects the
organizational model that was used in pre-
vious editions. Therefore, the Greek temple
image remains its organizational framework as
a model for addressing ethics issues in health
care (see …
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