Terminology

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Advance directive (proxy):  A general term used to describe oral or written instructions given by an individual to guide care regarding specific and general health care desires should that individual become incapacitated and unable to make these wishes known. There are two types of advance directives: a living will or a durable power of attorney for health care (DPAHA).

Applied Ethics:  Moral inquiry directed to making actual choices in moral conflicts; drawing upon ethical theory, moral principles, and methods of choice to reach or to scrutinize moral judgments; supplementing the abstract structures of normative ethics by the systematic study of concrete moral choice (Hastings Center).

Assent:  To agree to something especially after thoughtful consideration; implies an act involving the understanding or judgment and applies to propositions or opinions: CONSENT involves the will or feelings and indicates compliance with what is requested or desired (Merriam-Webster). In ethical terms, agreement by an individual not competent to give legally valid informed consent i.e., a child or cognitively impaired person, to participate in research.

Assisted suicide: The act or an instance of intentionally and willfully requesting and receiving assistance taking one’s own life, generally by a physician, especially by someone determined of sound mind and mature years

Autonomy:  Liberty to follow one's will (OED). From the Greek "autos" and "nomos," meaning self rule. Respect for persons (President's Commission for the Study of Ethical Problems in Medicine). Duty to abstain from controlling influence (Beauchamp and Childress). Autonomy of the will is the supreme and sole principle of ethics (Kant). Autonomy as (1) free action, (2) authenticity, (3) effective deliberation, and (4) moral reflection (Miller). Self-determination involving the formation, revision over time, and pursuit of a person's own particular plan of life (Rawls).

Beneficence:  Doing good, the manifestation of benevolence or kindly feeling, active kindness (OED). Duty to help others further their important and legitimate interests (Beauchamp and Childress). Includes, in order of priority, the duties not to inflict evil or harm, to prevent evil or harm, to remove evil, and to do or promote good (Frankena). An "imperfect" duty, meaning that one ought to do good but that one has some choice about when to do so (Kant).

Best interest(s):  A legal standard used by courts in making decisions for children, often about custody and parental visitation; also used by ethicists as well as the courts in making choices for children about health care. The legal standard lists many factors that should be taken into account in determining a child’s best interest—such as age and developmental level, the child’s physical, emotional and educational needs, continuity with culture, religion and creed, and so forth. The best interest standard asks the surrogate decision-maker to choose the course of action that optimizes the patient’s interests according to what most reasonable persons would choose. Critiques of the best interest standard include concerns that it is inherently subjective, not realistic (“best” can often not be achieved), not consistently applied, and not necessarily ethical since the interests of others often create constraints on the best interest of one.

Casuistry:  The application of general rules and principles to questions of ethics or morals in order to resolve them.

Categorical Imperative:  From Immanuel Kant, the command of the moral law, given by pure reason, and universally binding on every rational will expressed in the following formulations: (1) Act only on that maxim through which you can at the same time will that it should become a universal law; (2) Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end.

Common Good: The collection of goods that, having been produced by the broadest and most inclusive form of social cooperation, belong to a society as a whole, as opposed to belonging to individuals, and which benefits every individual directly or indirectly.

Competence:  According to law, sufficient mental ability to understand the nature and consequences of one's actions and to make a rational decision (AHA). Determining whether a patient has sufficient decision making capacity to make choices about health care treatment is based on (1) the abilities of the patient, (2) the requirements of the task at hand, (3) and the consequences to the patient that are likely to flow from the decision. The individual must have sufficiently stable and developed personal values and goals, an ability to communicate and understand information adequately, and an ability to reason and deliberate sufficiently well about the choices (President's Commission).

Confidentiality:  The principle that, as a promise inherent in one's professional role, knowledge obtained about a patient will not be revealed to others except when it will benefit the patient or in instances of overriding social good (e.g. the reporting of communicable disease). The ANA Code for Nurses states that: "The nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature." The World Medical Association (Geneva, 1949) declaration states that: "A doctor owes to his patient absolute secrecy on all which has been confided to him or which he knows because of the confidence entrusted to him."

Conflict of Interest:  A failure to avoid a conflict of interest may therefore be wrong even when one is not influenced by secondary interests at all. When professionals do not take reasonable precautions to avoid situations of conflict or do not observe rules regulating such conflicts, they have acted unethically.

Conscientious Objection (“CO”):  Refusal to offer, accept or participate in a treatment plan or other action on grounds that it would violate one’s conscience. For an objection to be “conscientious” implies that it is based on deeply held moral or religious convictions, rather than on mere preferences or practical considerations (e.g., convenience, risk management). In the context of health care, protections for conscience can help patients, families and clinicians preserve their moral integrity and religious commitments; however, claims of CO by health care providers or surrogate decision-makers can conflict with other important rights and protections, such as a patient’s access to medically beneficial care.

Deontology:  From the Greek "deon," meaning binding duty. Deontological theories of ethics are based on binding duties which have moral validity independent of their consequences. In deontological ethics, right is defined independent from the good to be produced.

Descriptive Ethics:  Study of the moral behavior and beliefs of individuals or groups, without moral judgment or prescription, often conducted by anthropologists, sociologists, and historians rather than philosophers.

Dilemma (Ethical):  Situation marked by conflict between ethical beliefs, duties, principles, or theories, and involving choice between alternatives which are or appear to be equally morally unacceptable. For the moral agent, an ethical dilemma represents a refractory moral conflict characterized by unyielding elements, grave harms, moral crisis, and tragic choice, the resolution of which may require fundamental changes in one's attitudes and actions.

Durable Power of Attorney:  A written statement appointing another as a proxy agent, conferring authority to perform certain acts on the principal's behalf, which endures or remains valid after the principal becomes incompetent. The federal Patient Self-Determination Act required the states to direct health care institutions to make available information to patients about the opportunity to appoint a durable power of attorney for health care or a health care proxy agent.

Duty:  An act understood to be ethically required. A "Prima Facie Duty" is always to be acted upon unless it conflicts on a particular occasion with an equal or stronger duty. An "Actual Duty" is determined by an examination of the respective weights of competing prima facie duties.

Emancipated Minor:  A patient under the age of eighteen years who, by statute, is deemed able to make medical decisions, either because of the minor's "adult" lifestyle (married, widowed or divorced; having given birth; a member of the armed forces; living separate and apart from parents and financially independent) or because of the specific disease or condition being treated (drug dependency, a sexually transmitted disease, pregnancy). Unless there is a danger to life or limb, all interventions remain confidential from the minor's parent or guardian.

Ethics:  The department of study concerned with the principles of human duty (OED). The study of rational processes for determining the most morally desirable course of action in the face of conflicting value choices (AHA).

Ethics Committee:  A multidisciplinary group of persons within a health care institution who meet regularly for the purpose of education, policy development and/or case review related to ethical aspects of patient care and professional behavior.

Ethics Consultation:  A service provided by an individual consultant, team, or committee to address the ethical issues involved in a specific clinical case. Its central purpose is to improve the process and outcomes of patient care by helping to identify, analyze, and resolve ethical problems. (Fletcher JC, Siegler M. What are the goals of ethics consultation? A consensus statement. J Clin Ethics. 1996; 7:122-26.).

Euthanasia:  The act or practice of killing somebody who has an incurable illness or injury, or of assisting that person to die. Euthanasia is illegal in most countries.

Fidelity: The duty to be faithful to one's commitments; also referred to as the principle of promise-keeping, including implicit as well as explicit promises.

Futility:  Lack of usefulness or effectiveness.

Informed Consent: A process for active and shared decision making between practitioner and patient that involves adequate disclosure (informed) and the element of choice (consent) (AHA).

Justice:  The formal, minimal principle of justice holds that like cases should be treated alike. Theories of distributive justice deal with the proper distribution of benefits and burdens (retributive justice deals with punishment). Justice may be held to consist, wholly or primarily, in the treatment of persons (1) as equals, or according to (2) need, (3) ability, (4) merit, (5) effort, (5)social contribution, (6) legal entitlement, or (7) common good or utility. Rawls' theory of justice as fairness holds that each person have maximum liberty consistent with similar liberty for all permitting only those inequalities which work to the greatest advantage of the representative least advantaged person.

Law:  A set of rules that tend to build on themselves, established to maintain social order by setting and regulating a minimum standard of behavior.

Living Will:  A written document by which an individual can indicate - while still alive and mentally competent - their preferences regarding end-of-life care. Most living wills contain advance refusals of long-term ventilatory support and other life-sustaining interventions if the patient is terminally ill.

Mature Minor:  A patient under the age of eighteen (usually 16 or 17 years old) who is deemed able to provide informed consent and whose parents are un-involved in the specific clinical decision. Maturity as a basis for intervention is generally applied in cases of clear and high benefit and low risk of harm, e.g., the initiation of psychotherapy for teen expressing symptoms of depression as opposed to a minor's potential consent for neurosurgery. As with emancipation, there is a presumption of confidentiality absent a danger to the minor's life or limb.

Metaethics:  Inquiry into the presuppositions of normative ethics through examination of the meaning of moral terms, the rules of reasoning, and the methods of knowing the truth or falsity of moral beliefs.

Morality:  A social institution with a history and a code of learnable rules. It exists before we are instructed in its relevant rules and, thus has a trans-individual status as a body of guidelines for action. It defines when actions ought or ought not to occur because of the considerable impact these actions can be expected to have on the interests of other people.

Morals:  From the Latin for custom and manners; habits of life in regard to right and wrong conduct (OED). Morality can be defined as traditions of belief about right and wrong human conduct (Beauchamp and Walters).

Non-maleficence:  The duty not to harm others; the first step on the way to the duty of beneficence, and prima facie more binding (W.D. Ross).

Normative Ethics:  The formulation or study of moral statements, principles, or theories about right and wrong acts, virtues and vices in moral character worthy of praise or blame, and the justice or injustice of institutions and societies.

Obligation:  Something that must be done because of legal or moral duty
Paternalism: Treating a person in the way that parents treat their children. The limitation of a person's liberty of action or liberty of information justified by reasons referring exclusively to the welfare or needs of the person whose liberty is limited (Beauchamp and Walters). The interference with a person's liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests, or values of the person being coerced.

Principle of Double Effect:  Contains four criteria, all of which must be met in order to morally justify an act which has both a good and an evil effect: (1) the act itself must be good or at least morally neutral, (2) the agent must intend only the good effect and not the evil effect (the evil effect may be foreseen but not intended, allowed but not sought), (3) the evil effect cannot be the means of achieving the good effect, (4) there must be a proportionately favorable balance of good over evil.

Reparation:  The duty to make amends for a previous wrongful act.

Right:  A valid moral or legal claim that an individual can assert against someone else. Some of the most cherished rights are conferred and protected by constitutions, statutes and other forms of law. "Legal Right" is as constant or changing as the society's code of law. "Moral Right" exists prior to and independent of legal or institutional rules. It often serves to indicate something everybody ought to have (as in the UN Declaration of Human Rights). Rights may be described in various ways such as "natural," "fundamental," "positive," or "negative."

Substituted Judgment:  A legal standard, frequently used by ethicists, health care proxies and others making medical decisions for incompetent patients who were previously competent, holding that the choice should be made in accordance with the incompetent patient's prior wishes, values and preferences.

Teleology:  From the Greek "telos" meaning end or final cause. Theories of ethics in which the ultimate criterion of duty or obligation is the non-moral value produced. Teleologists have sought different ends or non-moral values such as pleasure, knowledge, self-realization, perfection, power, etc.

Utilitarianism:  A teleological theory of ethics that the ultimate end to be sought is the greatest general good. The right act is one which will bring about the greatest balance of good consequences (or the least possible balance of bad consequences) in the world as a whole.

Veracity:  From the Latin "veracitas," meaning true; in ethics, the principle of truth telling.

Virtue:  A character trait and an internal disposition, habitually to seek moral perfection, to live one's life in accord with the moral law, and to attain a balance between noble intention and just action (Pellegrino).

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