health-care-ethics-critical-issues-for-the-21st-century-fourthnbsped-9781284124927-1284124924_compress.pdf

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.

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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 …