Terms in this set (86)
Study of nature of beauty
Right and wrong in human conduct
With the moral principles that govern behaviour.
Study of reasoning
Study of the nature of being
Understanding the nature of knowledge. Study of what distinguishes belief from opinion.
DD Palmer's views on chiropractic philosophy
Universal intelligent matter called the 'innate' that is rooted firmly in the chiropractic religion.
Co-eternal with all-creative force.
Body should be kept in condition of TONE
Disease is due to unusual
amount of tension above or below that of tone.
Is expressed through the nervous system
Ian Coulters definition of philosophy
As such it has no subject matter of its own; it consists, instead, of
critical reflections on other subjects, that is, of philosophizing
about other subjects.
Ian Coulters view of chiropracic philosophy
Chiropractic philosophy is a misnomer.
Philosophy as an activity and not
some body of doctrine.
What chiropractors call chiropractic philosophy resembles doctrine or dogma.
Purpose of philosophical activity is clarification of thought.
Rene Descartes and first philosophy
- Known for substance dualism (relationship between mind and body)
- Cognito ergo sum (I think therefore I am). that he himself existed.
- Sceptical procedure- methodlogical (to isolate contraindications in the position of those who claim that they know things)
- Cartesian dualism (matter that we see everyday and matter that is made from belief).
Descartes and 2 sources of knowledge
- The sense (reliable for close objects but obscure and distant objects are unreliable and not error proof)
-Intellect (truths of mathematics must be certain e.g 2+2=4)
Knowledge of facts
Weakest knowledge, but without this we cannot have procedural or personal knowledge.
Knowledge of how to do something, such as riding a bike; expressed in behaviors rather than in words.
- Cognitive dissonance (learning from a bad experience)
- Cognitive resonance (learning from positive experience)
Homeostasis and how the body repairs itself
Religious connotations for the chiropractic profession
'When we describe scientific knowledge we are in fact describing those theories that thus far in history have survived attempts at falsification.'
Which philosopher argued the following - in human action there are categorical imperatives, or moral obligations which are binding in all circumstances?
The skill or craftmanship
The knowledge required for practice
Prudence or practical wisdom
Much of scientific proof is based on?
Which of the following terms best describes the tendency to search for, interpret and remember information in a way that confirms preconceptions?
Which of the following cases established duty of care within English Tort law?
Donoghue vs Stevenson (1932)
The Caldicott principles are primarily concerned with which one of the following?
Protecting patient information
If the premises are true, then the conclusions must be true.
Is valid if the conclusions follow the premises
Deductive arguments which are logically incorrect, or invalid, are described as being 'fallacious'.
Consider the following argument: All Ys are Zs, X is a Y, Therefore X is a Z. Which one the following is true of this argument?
The argument contains 2 premises
This argument is valid (deductive argument is valid)
From the information provided it is not possible to know whether this argument is sound
This argument contains 1 conclusion
This is NOT an inductive argument
Sound deductive argument
Only if the argument is valid AND the premises are true.
Described as being sound
If the premise is true, then the conclusion is probably, but not necessarily true.
The conclusion contains information not present in the premise.
It is an assumption to produce an argument
The observer reasons a hypothetical explanation from an observed circumstance.
Infer a reason for something we observe.
For instance, we observe that the patient appears better and was adjusted yesterday. We can infer (abduce) that the adjustment was responsible for the patient feeling better.
Abduction may lead to the wrong conclusions.
Half the sample of A are B, therefore half of A are B.
Which is true of this argument?
This argument is based on a single premise
This argument involves generalisation
If the premise is true then the conclusion is probably, but not definitely true
The conclusion contains information not present in the premise
This IS an inductive argument
Deductive argument if the conclusions follow the premises
Incorrect deductive arguments
How does abduction differ from deduction and induction?
Deduction and induction shows it might be true.
Deduction contains the conclusion int he premises, whereas induction does not
Deduction is what we used for logical means of the world
Tendency to search for, interpret and remember information in a way that confirms preconceptions.
How is confirmation bias relevant to beliefs about chiropractic?
Believe our experience only
Dismissive of other approaches
Doctored centred care due to confirming your bias, instead of focussing on what is best for your patient.
Advertising standards authority
Regulatory body for Advertisement across all media
B3 of the code states to use only legal and verifiable information when publicising yourself as a chiropractor
GCC guidance on advertising
•Not put pressure on the patient to accept your advice, acknowledging their views and decisions (A1).
•Ensure every chiro has contractual basis, properly qualified and registered (B2).
•Substantiate any claims you make at the time they are made.
•Advertisement involves situations where chiropractors provide information for media reports or articles. When considering services you offer, must only be services that you are qualified to offer.
•Use language that patients can understand and avoid ambiguous statement.
•Costs of services made clear.
Intellectual and practical activity concerned with systematic study of the natural world. It involves observation and experimentation. Science is concerned with a search for knowledge, or truth.
Limitations of science
•Not everything is open to scientific testing. E.g the innate/ universal intelligence
•Proof based on induction. Inductive arguments do not prove things beyond doubt. (if the premises are true, then the conclusion is probably true, but not necessarily true).
•Scientific investigations based on induction does not prove things and the scientific theories are never conclusively verified
What is the relationship between science and induction?
Scientific proof based on induction
Inductive arguments do not prove things beyond doubt
Scientific investigation based on induction does not prove things and the scientific theories developed are never conclusively verified, no matter how many tests they have survived.
What is the 'problem of induction' described by Karl Popper?
Popper argued that when we describe scientific knowledge we are in fact describing those theories that thus far in history have survived attempts at falsification (disproving)
What is uniformitarianism, also called the principle of uniformity of nature?
The principle that states that geologic processes that occur today are similar to those that have occurred in the past
Problem of induction, as described by Karl Popper?
The problem of induction may also be formulated as the question of the validity or the truth or universal statements which are based on experience, such as the hypotheses and theoretical systems of the
2 main types of ethical theories
Focus on moral rules or principles.
'Moral absolutism', certain actions must be considered absolutely right or wrong, irrespective of context or consequences.
Action is right if fits in with predefined duty.
Focus on consequences of action.
Action considered right if associated with positive consequences.
Instead of focusing on a predefined set of moral rules, consequentialists take account of the likely outcomes of actions and consider the context in which actions are being performed.
What is utilitarianism?
Is an example of a consequentialist moral theory. Utilitarians argue that actions are right if they promote the welfare and happiness of the majority, if they provide the greatest good for the greatest number.
Help others and act in the interests of others
Altruism is associated with professionalism. Altruism is in contrast with egoism, the ethical theory that treats self-interest as the appropriate foundation for morality.
What are 2 types of deontology
Kantianism/ Kant's moral theory - there are categorical imperatives/ moral obligations which are binding in all circumstances (e.g not lying)
Divine command theory - An action is right if God has decreed that it is right
2 types of consequentialism
Utilitarianism - An action is right if bring benefits for the majority (e.g greatest happiness of the greatest number)
Ethical egoism - Self interest is the foundation of morality
What did Kant state about ethics?
Kant's moral theory offers another example of deontological ethics.
Kant discussed the idea of the 'categorical imperative'. He argued that in human action there are categorical imperatives, or moral obligations which are binding in all circumstances, for example not lying.
Occupation by which a person earns a living
Occupations in which a professed knowledge of some subject, field, or science is applied.
Describe a person who is engaged in a paid occupation rather than a hobby, but also refers to a person who is part of a profession.
Professionalism refers to the competencies and skills expected of professionals, as well as the expected standards of ethical behaviour.
What are the six domains of professionalism described by Hilton and Southgate (2007)?
•Respect for patient
•Responsibility- commitment to excellence/life long learning
Reflective judgement model by King/
Kitchener in Hilton and Southgate, stages 1-3
Stage 1 - Knowledge is absolute and pre-determined. Inability to differentiate between theory and evidence.
Stage 2 - True reality can be certain but not known by everyone.
Stage 3 - Authorities may not always have the truth
Reflective judgement model by King/
Kitchener in Hilton and Southgate, stages 4-5
QUASI REFLECTIVE THINKING
Stage 4 - belief that one cannot know with certainty. Justification of problem solving is seen as an obstruction.
Stage 5 - knowledge depends on perspectives
Reflective judgement model by King/
Kitchener in Hilton and Southgate, stages 6-7
Stage 6 - Knowing is a thinking action. Knowledge is uncertain and must be understood in context and evidence
Stage 7 - Interpretation of evidence and opinion. Knowledge based opinion (epistemology!)
What is stage 1 of Kohlberg's moral development in Hilton and Southgates paper?
Pre conventional (elementary)
Obedience and punishment
Behave to socially accepted norms due to authority figure
What is stage 2 of Kohlberg's moral development in Hilton and Southgates paper?
Pre conventional (elementary)
Individualism, instrumentalism and exchange
Right behaviour means acting in one's own best interest
What is stage 3 of Kohlberg's moral development in Hilton and Southgates paper?
An attitude that seeks to do what will gain the approval of others
What is stage 4 of Kohlberg's moral development in Hilton and Southgates paper?
Law and order
Abiding the law and responding to obligations of duty
What is stage 5 of Kohlberg's moral development in Hilton and Southgates paper?
Post conventional (not reached by majority)
Genuine interest in the welfare of others
What is stage 6 of Kohlberg's moral development in Hilton and Southgates paper?
Post conventional (not reached by majority)
Respect for the universal principle and demands for individual conscience
What are the 3 essential characteristics incooperated in professionalism, according to Hilton and Southgate?
• expert knowledge,
• (fiduciary) trusting the responsibility to place the needs of the patient ahead of the physician's self-interest.
Donoghue v Stevenson (1932)
Tort of negligence when duty of care is breached.
Mrs Donoghue sued Mr Stevenson due to snail in ginger beer
His duty to provide a system which would not allow snails to get into his ginger-beer bottles, and his duty to provide an efficient system of inspection of the bottles before the ginger-beer was filled into them.
How is Donoghue v Stvenson's case relevant to us as chiros?
As chiropractors we profess to have special knowledge and skills which others in society do not have.
We offer our skills for the benefit of the public for which we receive social and monetary rewards, but society expects high standards in return.
Our duty of care for patients extends beyond the general duty of care that all members of society have for each other.
What is English 'tort law' and how does it differ from 'criminal law'?
Tort law is the area of law that protects people from bad acts of others. When a person commits a tort, they violate civil law. If a person is damaged by someone else's wrongful act, they can bring a claim for compensation against the person who commits the tort. The purpose of tort law is to ensure that wrongdoers pay for the damage that they cause instead of the victims.
Bolam v Friern Hospital Management Committee (1957)
Bolam principle: The professional will not be in breach of their duty of care if they acted in a manner that was accepted as proper by a responsible body of other medical professionals.
•A doctor who had not given a mentally-ill patient muscle-relaxant drugs or restrained them in electro-convulsive therapy.
•The patient suffered injuries during the procedure and sued claiming the doctor was negligent for not restraining them or giving them the drug.
•The High Court held that the doctor had not breached his duty to the patient and was not guilty.
Bolitho v. City and Hackney Health Authority (1997)
A child was brought to a hospital suffering from breathing abnormalities. The doctor summoned to deal with the matter never received the summons due to a low battery on her bleep. The child died as a result. The child's mother sued for negligence, arguing that the child should have been seen and intubated.
Bolitho test- the defence could not be considered reasonable if the body of doctors or supporting witnesses were not capable of logical analysis.
Montgomery v. Lanarkshire Health Board (2015)
•Woman who was of small stature and diabetic during her pregnancy. The doctor did not inform her 9-10% risk of shoulder dystocia, where the baby's shoulders are unable to pass through the pelvis among diabetic women as she viewed the problem being very slight and a caesarean section was not in the women's interest.
•The baby suffered from severe disabilities after birth due to shoulder dystocia. The claimant sought damages from the health board for negligence on the part of the doctor for failing to advise her on the risk of shoulder dystocia.
What is 'clinical negligence'?
A healthcare professional failed in their duty to take care of you, and you experienced a damage or loss as a result of that failure.
Damage or loss can include both physical and psychiatric injury, as well as financial loss.
What is the legal basis for duty of care?
Legal obligation to perform interventions to improve health, maintaining health and preventing ill health. Addressing health needs.
Values based practice
Values are one's judgement of what is important in life.
Values-based practice aims to support balanced decision making between clinicians and patients within a framework of shared values appropriate to the situation in question.
The basis for balanced decision making in values-based practice is mutual respect for differences in values.
What values do chiropractors embrace? Are these unique to chiropractic?
Use of adjustment
Core values of the UCA
- Innate intelligence drives and preserves life
- NS has a central role
- Interference to innate (subluxation) diminished healing capacity
- Art of chiro is removal of NS interference by adjustment
- Empowering freedom of choice
Valid informed consent must...
Informed about potential benefits, risks and alternatives. ( Montgomery v. Lanarkshire Health Board (2015))
Make the choice voluntarily and not be pressurised or coerced.
Ability of a patient to understand, remember and consider information provided to them.
Power of attorney
A legal document that allows someone to make decisions for you, or act on your behalf, if you're no longer able to or if you no longer want to make your own decisions. Need an enduring power of attorney (EDA enduring power of attorney)- document and power must be present.
What age can a person give consent?
At the age of 16 and upwards. Guillick principle - not about age, should be about capacity (13 and older is applicable). If 14-year-old wants to be treated but if the mother does not? Bring it up with the GCC. If younger, must see who has custody.
A patient's husband asks to see his wife's chiropractic clinical records. As a chiropractor can you let him see the record?
No, as it breaches the confidentiality records. Must keep info about the patients confidential and avoid improper disclosure of their personal information. Only disclose personal information without patient consent if required by law.
What are the duties of chiropractors in relation to informed consent?
- Share with the patient accurate, relevant and clear information to enable the patient to make informed decisions about their health needs and relevant care options.
- Obtain and record consent from a patient prior to starting their care and for the plan of care.
- Check with the patient that they continue to give their consent to assessments and care.
- Ensure the consent of a patient is voluntary and not under any form of pressure or undue influence.
- Seek parental consent first if a child is to be seen without someone else being present, unless the child is legally competent to make their own decisions.
- Always obtain a patient's consent if it becomes necessary for the purposes of examination and treatment during care, for you to adjust and/or remove items of the patient's clothing.
How must chiropractors maintain and protect patient information?
- Keep information about patients confidential and avoid improper disclosure of their personal information.
- Only disclose personal information without patient consent if required by law.
- Ensure your patient records are kept up-to-date, legible, attributable and truly representative of your interaction with each patient.
- Ensure the safe storage of patient records so that they remain in good condition and are kept secure. Storage should be for at least a period relevant to the age of the patient as prescribed by law. (8 years storage) (Caldicott guardian)
- Make proper arrangements if you close down your practice or move clinics and have appropriate arrangements in place in the event of your death.
- Make sure that patient records remain your responsibility, even where a patient has moved, unless you have contractually transferred this responsibility to another healthcare professional or organisation.
- Give patients access to their personal health records as required by law.
What are the 7 Caldicott principles (created in 2000, except 1)?
1. Justify the purpose for using confidential information
2. Don't use personal confidential data unless absolutely necessary
3. Use the minimum necessary personal confidential data
4. Access to personal confidential data should be on a strict need to know basis
5. Everyone with access should be aware of their responsibilities
6. Comply with the law
7. The duty to share info can be as important as the duty to protect patient cofidentiality
Which is the last Caldicott principle that was added and what was it?
Principle 7 - The duty to share information can be as important as the duty to protect patient confidentiality
Added in April 2013
4 factors of systematic knowledge basis of tehnical rationality on Hilton and Southgates paper
4 factors of professional's knowledge in Hilton and Southgates paper?
Propositional knowledge (facts and concepts)
Process knowledge (applying)
Personal knowledge (experiences)
Know- how knowledge (intimate)