Optometry Semester 1

OPTOMETRY · SEMESTER 1 Ethics and Professional Conduct in Medical Practice Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic Outline At the end one should be able to:- Code Of Ethics For Medical Profession Ethics and Professional Conduct in Medical Practice NOTE Code Of Ethics For Medical Profession Cont.’ History in brief The principles of ethics are inspirational goals and attributes of the professions. Principles Of Ethics And Code Of Professional Conduct For Medical Practitioners 1. Beneficence (Do Good) It requires that:- One should not worsen any human being’s situation; The practitioner shall:­ Have the duty to give emergency care until he is sure that others are willing to give such care; 2. Non-maleficence (Do No Harm) The practitioner shall:- Strive to have adequate standard equipment and necessary supplies for practice; Not permit oneself or herself to be exploited in a manner which is undesirable to the public or professional interest; 3. Autonomy (Self Determination) The provider shall:- Note that: The client has the right to choose a practitioner, who will attend the 4. Justice (Fairness) Justice is commonly conceptualized as Distributive or Commutative. Distributive Justice Commutative Justice Veracity (Truthfulness) and Fidelity (Faithfulness/ Loyalty) The practitioner shall: ETHICS AND PROFESSIONALISM IN MEDICAL PRACTICE Outline Code of ethics for medical profession Principles of Ethics and Code of Professional Conduct for medical practitioners At the end one should be able to:- Describe the code of ethics for medical profession Describe principles of ethics and Code of Professional Conduct for medical practitioners Code Of Ethics For Medical Profession Definition of code of ethics A statement encompassing the set of rules based on values and the standards of conduct to which practitioners of a profession are expected to conform. A standard of conduct deep-rooted in commitment, confidentiality, and relationships. With regards to medical profession it is meant for medical practitioners Ethics and Professional Conduct in Medical Practice Committed to performance improvement and maintaining integrity, personal accountability and moral obligation to all customers served—clients, employees, employers, physicians, organizations, and the public. Professionals promote the dignity of the profession and are committed to practicing the profession with honesty, integrity, and accountability, respecting all laws and refusing to participate in or conceal any unethical, false, fraudulent, or deceptive activity Code Of Ethics For Medical Profession Cont.’ NOTE The true professionalism in medicine will al ways put in first place the well-being of the patient and the community as principal objective. Code Of Ethics For Medical Profession Cont.’ Code Of Ethics For Medical Profession Cont.’ Altruism: Clinician is obligated to attend to the best interest of patients, rather than self-interest. ƒ Accountability: Clinicians are accountable to their patients, to society on issues of public health, and to their profession. ƒ Excellence: Clinicians are obligated to make a commitment to life-long learning. ƒDuty: Clinicians should be available and responsive when ‘on call,’ accepting a commitment to service within the profession and the community. Code Of Ethics For Medical Profession Cont.’ Honour and integrity: Clinicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession. ƒRespect for others: A Clinician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows. ƒThese values should provide guidance for promoting professional behaviour and for making difficult ethical decisions. History in brief The Principles of Ethics and Code of Professional Conduct, have their roots In Greece', way back in 500 B.C and traceable to the emergence of Hippocrates (460B.C.) and his philosophy in scientific approaches in medicine and principles on moral and ethical requirement of an ideal physician. Code Of Ethics For Medical Profession Cont.’ History in brief The principles, which were then summarized in the form of "Hippocratic oath", were the fundamental governance of the medical and dental professions. Existed throughout history until when they were officially modified by the Geneva Convention in 1948, which then formed the basis for diverse ethical approaches Code Of Ethics For Medical Profession Cont.’ The principles of ethics are inspirational goals and attributes of the professions. They provide guidance and other justification for the professional conduct. Code Of Ethics For Medical Profession Cont.’ Ethics and Professional Conduct in Medical Practice The Principles can overlap each other as well as compete with each other for priority as one principle can justify a given element of the code of professional conduct and may at times, need to be balanced against each other. Otherwise the principles are the profession‘s firm guideposts. Code Of Ethics For Medical Profession Cont..'’ Ethics and Professional Conduct in Medical Practice Notably, ethics attained in the principles closely relate to the law but are not the same I', and often do exceed legal duties. For that matter, in resolving any ethical problem not explicitly covered by the code, both practitioners and clients shall consider the ethical principles, client's need and interests with respect to the applicable law. Code Of Ethics For Medical Profession Cont..’ Principles Of Ethics And Code Of Professional Conduct For Medical Practitioners The Principles of Ethics and Code of Professional Conduct for medical and dental practitioners in Tanzania are therefore epitomized and presented into five cardinal principles Beneficence Non maleficence Autonomy Justice and Veracity and Fidelity 1. Beneficence (Do Good) Beneficence is one of the moral principles of medical practice. The principle of beneficence refers to positive acts that lead to the welfare of others and a client in particular. It implores that a practitioner has to do all he can to promote good, kindness or generosity, and it implies acts of humanity, mercy or charity. It is a moral obligation required from the practitioner to act for the benefit of others. Ethics and Professional Conduct in Medical Practice It holds that one should help others further their important and legitimate interests as those persons understand them, or as one conceives them to be. One is obliged to act to benefit others when one

OPTOMETRY · SEMESTER 1 Professional and Ethical Conduct Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic PROFESSIONAL CONDUCT CORE PRINCIPLES OF PROFESSIONAL CONDUCT ETHICAL CONDUCT PRINCIPLE OF ETHICAL AND PROFESSIONAL CONDUCT VALUE 5.confidentiality IMPORTANCES OF PROFESSIONAL CONDUCT IN OPTOMETRY PROFFESSIONAL AND ETHICAL CONDUCT PROFESSIONAL CONDUCT set of attitude , behaviour , and characteristics deemed desirable in member of profession. shows the relation ship between member and society . CORE PRINCIPLES OF PROFESSIONAL CONDUCT 1.Integrity and honesty 2.competence and deligance 3.accountability and responsibility 4.cofidentiality 5.respect ETHICAL CONDUCT act with integrity ,honestly,fairness and responsibility guide by moral principle to what is right for individuals and society. PRINCIPLE OF ETHICAL AND PROFESSIONAL CONDUCT VALUE 1.honest and intergrity actiong truthfully and ethically even when its difficult. 2.accountability and responsibility take actions,decisions and outcomes to stuation. 3.respect valuing colleageous,client and deverse experiences and treating all with diginity 4.competence derivering high quality work ,maintaining skills and acting within one scope 5.confidentiality protecting sensitive information 6.fairness and impartiality treating people equitably and without bias 7.transparency being open and honest in dealing 8.commitment dedication to professional duties and standards IMPORTANCES OF PROFESSIONAL CONDUCT IN OPTOMETRY 1. buld trust ethical conduct fosters strong trusting patients professional relationship 2.ensures of safety competence and honesty minimize harm and ensure appropriate care and referral 3.upholds reputation maintain public faith inthe otometry professional as whole 4.guides decision provide the frame work for navigating complex ethical dilemmas 5.legal and regulartory complience meet legal recquirements for record keeping,privecy and professional standard ← PREVIOUS TOPICNEXT TOPIC →VIEW MODULE NOTESVIEW SEMESTER NOTESALL OPTOMETRY NOTES Need These Notes as PDF? Request a formatted copy for offline study, printing or revision. GET PDF NOTES ON WHATSAPP

OPTOMETRY · SEMESTER 1 Ethical Professionalism and Informed Consent Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic PRINCIPLE OF ETHICAL PROFESSIONALISM IN INFORMESD CONSENT TYPES OF CONSENTS 4.General Consent: SIGNIFICANT OF INFORMED CONSENT 4.Trust and Communication: The process builds a therapeutic alliance and transparency between patients and healthcare providers. INFORMED CONSET FOR MINORS AND ADOLESCENTS EXCEPTIONS TO CONSENT Ethical Professionalism and Informed Consent PRINCIPLE OF ETHICAL PROFESSIONALISM IN PROMOTING INFORMED CONSENT INFORMESD CONSENT is an ethical and legal process where a patient or research subject voluntarily agrees to a treatment, procedure, or study after understanding all relevant information. ELEMENTS (1) disclosure, (2) understanding, (3) voluntariness, (4) competence, and (5) consent TYPES OF CONSENTS 1.Written Consent (Signed Consent): Required for invasive, complex, or high-risk procedures (e.g., surgery, chemotherapy, anesthesia). It involves a signed document confirming the patient understands the details. 2.Verbal Consent (Oral Consent): Given spoken, for simpler, low-risk procedures or treatments. It is documented in the patient’s medical records. 3.Implied Consent (Action-based): Inferred by a patient's actions rather than words, such as holding out an arm for a blood pressure check or voluntarily entering an examination room. 4.General Consent: Typically obtained upon hospital admission, covering routine, low-risk, or daily care, distinct from specific, informed consent for individual procedures. 5.Electronic/Online Consent: A modern, digital form of written consent, often using digital signatures or clicking to accept, used in both clinical and research settings. SIGNIFICANT OF INFORMED CONSENT 1.Respect for Autonomy: It upholds the patient's right to self-determination, allowing them to make decisions about their own body. 2.Legal Protection: It is a legal obligation to prevent charges of battery (unauthorized touching) or malpractice, documenting that patients were informed. 3.Ethical Obligation: It is rooted in the ethical duty to do no harm and respect patients, ensuring they are not coerced. 4.Trust and Communication: The process builds a therapeutic alliance and transparency between patients and healthcare providers. 5.Patient Empowerment: It ensures patients are actively involved in their care decisions. INFORMED CONSET FOR MINORS AND ADOLESCENTS This is generally requires parental or guardian permission, alongside the child's "assent" (agreement) for research or treatment. This is the State regulations normally require the parents or guardians to give informed consent in place of minors, without considering the developmental changes in childhood and adolescence. EXCEPTIONS TO CONSENT Exceptions to informed consent allow medical treatment or research to proceed without standard, prior patient consent in specific, critical situations Ethical Professionalism and Informed Consent Emergency Situations (Life-Threatening): When immediate, life-saving care is needed (e.g., cardiac arrest, major trauma, stroke) and the patient is unable to consent, and no legal representative is available. Exception from Informed Consent (EFIC) Research: FDA regulations allow research on life-threatening conditions without consent if the patient is incapacitated, a prospect of direct benefit exists, and obtaining consent is not feasible. Therapeutic Privilege: A rarely used, legally contentious exception where a physician believes that disclosing information about risks would pose an immediate, serious psychological threat or harm to the patient. Ethical Professionalism and Informed Consent Patient Waiver: A competent patient may voluntarily decide to waive their right to informed consent, allowing the doctor to proceed with treatment. Incapacitated Patient: If a patient lacks the capacity to make decisions and no legal representative (proxy) is immediately available, treatment can be provided under the principle of implied consent. Minors in Emergencies: Parental or guardian consent is not required in emergency situations where a delay would cause serious, imminent harm to the child. ← PREVIOUS TOPICNEXT TOPIC →VIEW MODULE NOTESVIEW SEMESTER NOTESALL OPTOMETRY NOTES Need These Notes as PDF? Request a formatted copy for offline study, printing or revision. GET PDF NOTES ON WHATSAPP

OPTOMETRY · SEMESTER 1 Medical Ethics: Professional Obligations and Records Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic MEDICAL ETHICS Medical Ethics Medical Ethics: Professional Obligations and Records Medical practice and research as well as changes in society. A new doctor entering the profession of medicine joins a fraternity dedicated to the service of humanity. (He should adhere to these core values and seek guidance whenever in doubt) Ethical Obligation of Doctors to the Patient: No consent is valid if obtained under the following conditions: Medical Records and Reports: POLICE FORM 3 T AND U Medico legal Examination MEDICAL ETHICS 1 MEDICAL ETHICS Medical examinations, For: EmPLOYMENTs. School and college enrollment. The purpose is to determine whether the offered can perform the essential functions of the job. Studies etc To ensure that the employees are in good health To determine whether he or she qualifies for short term or long disability benefits 2 Medical Ethics A civil code of behaviour considered correct by members Of the profession for the good of both the patient and profession. Leads the public at large to expect of the doctor to have not only a high standard of medical ability and skill but also impeccable behaviour 3 Medical Ethics: Professional Obligations and Records The need for patients trust in his doctor is the basis for ethical codes from many centuries ago as manifested in the traditions of all the major civilizations. In recent times, national regional and world association doctors as well as other health care professionals have revised existing codes of ethics and formulated new ones to keep up with advances in medical knowledge, 4 Medical practice and research as well as changes in society. All doctors subscribe to the spirit of caring and confidentiality that regulate the doctor-patient relationship and these values continue to be accepted by all those who practice the art of medicine. 5 A new doctor entering the profession of medicine joins a fraternity dedicated to the service of humanity. He will be expected to subordinate his personal interests to the welfare of his patients, and together with his fellow practitioners seek to raise the standard of health in the community where he practices. 6 Medical Ethics: Professional Obligations and Records He inherits traditions of professional behaviour on which he must base his own conduct, and which he must pass on unfarnished to his successors. There are many core values running through the ethical beliefs of the various communities. Some of these values are extracted here for the guidance of our doctors. 7 Medical Ethics: Professional Obligations and Records The Physician should not recommend nor administer any harmful material and should not render help regardless of the financial ability, ethnic origin or religious belief of the patient. The Physician should protect the patient’s confidentiality and adopt an appropriate manner of communication. He should examine a patient of the opposite sex in the presence of a third person whenever feasible. He should not criticize another Physician in the presence of patients or health personnel. 8 (He should adhere to these core values and seek guidance whenever in doubt) 9 Ethical Obligation of Doctors to the Patient: Consent for Medical Examination good communication between the doctor and patient is essential for consent. Patient’s should be given adequate information in a way they can understand to enable them to make decisions about their medical care. It is a general rule that doctors should examine and treat patients only with consent. 10 No consent is valid if obtained under the following conditions: When there is coercion or threat or force. When the party giving consent is not aware of the full implications of consent. When the patient is incompetent and therefore cannot give a valid consent; then consent should be obtained from the next of kin. 11 Medical Records and Reports: Good Medical Records are an indication of good practice. The doctor is encouraged to record all relevant details of his management of a patient. Accurate, legible, comprehensive and contemporaneous notes are advised. Doctors have obligations relating to the storage, access and use of health information available in the patients records. The patient is entitled to a written report of the care that has been given to him. 12 Medical Ethics: Professional Obligations and Records The doctor is obliged to provide him such a report speedily, without any unreasonable delay. The withholding of information of the care given to the patient is ethical. The doctor can be held responsible for any breaches of confidentiality of medical records. Medical information can be released to a third party only when written consent has been given by or on behalf of the patient. Third parties who frequently seek information from a doctor are employees who request reports on the medical condition of absent or sick employees. 13 POLICE FORM 3 T AND U 14 Medico legal Examination Insurance companies requiring particulars about the history of proposers for life insurance or deceased policy holders, medical bonds and other agencies seeking medical information about individuals associated with it as well as solicitors to consider and assess claims. Medico legal examination for the purpose of workers compensation or other medico legal matters are not of traditional doctor-patient relationship. 15 Medical Ethics: Professional Obligations and Records These examinations frequently requested by third parties often a lawyer, pension scheme or insurance company, rather than the patientthemselves During examination on behalf of third parties, it is not the role of the doctor to jnitiate treatment EXCEPT for immediate emergency treatment or to refer the patient to other doctor If the examining dr believes such treatment or referral is necessary, he or she should make this recommendation to the party who reffered the patient, client, and or to his or her usualtreating dr, and make clear that there is no dr examinee treating relationship established 16 ← PREVIOUS TOPICNEXT TOPIC →VIEW MODULE NOTESVIEW SEMESTER NOTESALL OPTOMETRY NOTES Need These

OPTOMETRY · SEMESTER 1 Ethical dilemmas and ethical issues Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic objectives Definition of Ethical Dilemmas Characteristics of Ethical Dilemmas Common Ethical Dilemmas Dilemmas of Non-maleficence Dilemmas of Autonomy Dilemmas of Justice Dilemmas of Fidelity Dilemmas of Veracity ASS 2 Sources of Ethical Dilemmas Ethical dilemmas and ethical issues Strategies Used to Solve Ethical Dilemmas She notes that six steps proved useful to define those obligations:- After examining one’s obligations, it is usually recommended that four additional steps should be taken: Even after taking the steps described above, solutions may not necessarily be forthcoming when ethical conflicts are present. special situation with implication in medical ethics Prisoners Approaches to Special Situations Based on Medical Ethics Medical Research Torture of Human Being Abortion Disaster and Emergency Situation HIV& AIDS and other Infectious Diseases Medical Examinations Requested by Employer Publicity and Advertisement Diagnosis of Death Health Management Organizations Practitioner Appropriate Presentation and Attire Ethical dilemmas and ethical issues in special situations in medical practice objectives Define the term ethical dilemmas Explain the characteristics of ethical dilemmas Explain common ethical dilemmas Identify source of ethical dilemmas Describe strategies used to solve ethical dilemmas Describe several special situation with implication in medical ethics Definition of Ethical Dilemmas An ethical dilemma is a situation having two or more undesirable alternatives. It can also be defined as a confusing problem that offers a choice between equally unsatisfactory alternatives. An ethical dilemma is a situation that will often involve a conflict that brings questions on which to obey as one would result affecting the other. Ethical dilemma addresses ethical questions of right vs. wrong. Characteristics of Ethical Dilemmas In order for a problem to be an ethical dilemma it must have three characteristics­ The problem cannot be solved using only empirical data (empirical data is information derived from observation/experiences) The problem must be so confusing that deciding what facts and data need to be used in making decision is difficult. The results of the problem must affect more than the immediate situation; and there should be far reaching effects. Common Ethical Dilemmas Dilemmas of Beneficence Involve deciding what is good as opposed to what is harmful. Often occur when a clinician, patients, or family members disagree about what course of action is in the best interest of the patient. Dilemmas of Non-maleficence Involves the avoidance of harm. These issues often involve a clinician’s responsibility to ‘blow the whistle’ if she sees others compromising the patient’s safety. In these situations, a clinician notifies higher authorities on weaknesses in the care they provide by not following established communication channels Dilemmas of Autonomy Involves deciding what course of action maximizes the patient’s right of self-determination. Autonomy issues are related to beneficence issues, especially when individuals other than the patient must determine what is best for the patient The patient has a right to refuse or choose their treatment Dilemmas of Justice Involves issues of fairness and equality, such as dilemmas that involve dividing limited health care resources fairly. Dilemmas of Fidelity Involves issues that involve honouring promises. Refers to situations where individual must navigate conflicting loyalties responsibilities or promises. Dilemmas of Fidelity These may include the extent and limits of a clinician’s role and duties to patient that might conflict with other duties such as duties of the laboratory technician. Balancing loyalty to a patient’s best interests against organizational policies or limited resources. Dilemmas of Veracity Arises when there is conflict between the ethical obligation to tell the truth and other competing duties or considerations such as protecting someone's feelings This is an obligation to be truthful to patients and to cultivate their understanding of relevant consideration. This may involve even delivering bad news to patients and relatives. Dilemmas of Veracity Veracity means adherence to truthfulness and honesty. The dilemma occurs when telling the truth could lead to harm or conflict with other ethical principles ASS 2 With vivid examples discuss different sources of Ethical Dilemmas 4 points Ethical dilemmas arise when individuals face conflicting values or principles, making it difficult to decide on the right course of action. Below are four key sources of ethical dilemmas, each illustrated with vivid examples: 1. Conflict Between Professional Duties and Personal Values Professionals may encounter situations where their personal beliefs clash with their professional responsibilities. Example: A pharmacist who is morally opposed to abortion may struggle with dispensing emergency contraception. While their professional duty is to provide prescribed medications without bias, their personal values might prevent them from doing so, creating an ethical dilemma. 2. Confidentiality vs. Harm Prevention The need to maintain confidentiality can conflict with the ethical obligation to prevent harm. Example: A psychiatrist learns that a patient is planning to harm someone but the patient refuses to inform the intended victim. The psychiatrist faces a dilemma: Option 1: Respect confidentiality and risk harm to another person. Option 2: Break confidentiality to warn the intended victim, violating the patient's trust. 3. Allocation of Scarce Resources Limited resources, such as funding, time, or medical supplies, can force tough decisions about prioritization. Example: In a hospital with only one ventilator left during a pandemic, the medical team must choose between two critically ill patients. One is a young parent with a higher chance of recovery, and the other is an elderly professor with significant contributions to society. The team faces a dilemma in deciding who should receive the ventilator. 4. Autonomy vs. Beneficence Respecting an individual's autonomy can sometimes conflict with acting in their best interest. Example: A diabetic patient refuses insulin despite the risk of severe complications. The healthcare provider must choose between respecting the patient’s decision (autonomy) and administering treatment against their will to save their life (beneficence). Sources of Ethical Dilemmas Problems arise when one or more ethical principles conflict with each other. Patients and clinicians- For example human rights are involved when a patient refuses to commit herself

OPTOMETRY · SEMESTER 1 Ethical Theories and Principles in Medical Practice Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic Learning Objectives – Identify the ethical principles in medical Ethics Virtue Virtue Ethics Bioethics Ethical Principle Values Consequentialism or Utilitarianism Non-Consequentialism or Deontological Ethics Ethical Theories and Principles in Medical Practice Importance of Systematic Study of Ethics to Medicine Types of Ethical Principles The Value of Life Principle Activity: Brainstorm (15 minutes) Possible Answers Example The Principle of Goodness or Rightness Goodness or Rightness Activity: Brainstorm (10 minutes) ‘What are you going to do’? The Principle of Justice and Fairness A health practitioner who adheres to this principle has the opportunity to utilize the available resources adequately – Egalitarian- Resources should be distributed strictly according to the need Activity: Case Study (15 minutes) What do you think about this practice? The Principle of Truth Telling and Honesty (Veracity) It means adequate and right information in order for the patient to make a decision. Activity: Exercise (5 minutes) ALLOW students to share reactions. The Principle of Individual Freedom (Autonomy) An individual has the freedom to make choices about issues that affect him/her. Managing clients without consent will result in non-compliance. Autonomy also values patient’s advance directives. What is your opinion concerning the reaction of that mother? Other Ethical Principles These include the following: Ethical Theories and Principles in Medical Practice Learning Objectives By the end of this session, students are expected to be able to: Define common terms related to ethical theories and principles in medical practice Identify major ethical theories in medical practices Identify the importance of systematic study of ethics to medicine – Identify the ethical principles in medical practice Analyze ethical principles in medical practice Apply ethical principles when managing patients/clients Definition of Terms Ethics The word ethics originated from the Greek word ‘ethos’ meaning customs or character. Ethics is a systematic study of what a persons’ conduct and actions ought to be with regard to himself or herself, other human beings and the environment. It is concerned with judgement about what is right or wrong conduct. Virtue Virtue is defined as moral excellence, goodness and rightness. It is also defined as conformity of one’s life and conduct to moral and ethical principles, uprightness, and rectitude. Virtue Ethics Refers to a virtue of character as a health practitioner rather than rules governing conduct or consequences of any action by a health practitioner. Virtue ethics demands the practitioner to exercise loyalty, devotion and trustworthiness, good temperament, compassion and integrity. Bioethics A system of standards arising from the professional agreement to determine, sanctions, and justify the interaction of biomedical professional and patient. Ethical Principle Is a basic concept by which behaviour can be judged. Ethical Principles help people to make decisions, because they serve as a standard with which to measure actions. Governing rules of conduct, as code of conduct by which life and action can be directed, or as generalization that provide a basis for reasoning. A principle is an established rule of action to be followed in implementing a set of activities. Values Is something of worth or excellence or that which is esteemed, prized, or highly regarded. Values refer to one’s evaluative judgement about what one believes is good or what makes something desirable. Ethical Theories Consequentialism or Utilitarianism This is a moral theory that holds that an action is judged as good or as bad in relation to the consequence, outcome or end result that is derived from it. According to the utilitarianism school of thought, right action is that which has great utility or usefulness. Utilitarianism holds that the only factors that make actions good or bad are the outcomes, or end results, that are derived from them. Non-Consequentialism or Deontological Ethics Deontological theories of ethics are based upon rationalistic view that rightness or wrongness of an act depends upon nature of the act rather than its consequences. The term is taken from the Geek word for duty. Ethical Theories and Principles in Medical Practice For example, a man needs money to feed his family. He knows that he will not be able to repay it but sees that nothing will be lent to him if he does not promise to repay it at a certain time. Deontological ethics advocates against giving wrong promises disregarding the outcome of the wrong promise, hence this man should not give the wrong promise. Importance of Systematic Study of Ethics to Medicine Helps in understanding the origin and process of ethical and moral thinking. Enables health care workers to recognise situations with ethical and moral implications and make coherent and logical ethical decisions based upon recognised ethical principles and theories. Equips medical practitioners with knowledge necessary for making right decisions in issues and situations that have element of ethical or moral uncertainty and dilemma. Types of Ethical Principles There are five types of ethical principles: The value of life principle The principle of goodness or rightness The principle of justice or fairness The principle of truth telling or honesty The principle of individual freedom The Value of Life Principle This principle requires the medical practitioner to value human life and honour the patients’/clients’ wishes regarding quality of life. It demands to recognize life as basic and important, but also life should be recognized as having an end. Yet no life should be ended without strong justification such as in the situation whereby life of a pregnant woman is threatened by the presence of the fetus. Ethical Theories and Principles in Medical Practice In addition, when a medical practitioner becomes negligent, he threatens the life of the patient; when life of a patient is valued, a medical practitioner will not ignore any instruction on patient’s care. This explains why individuals should never be treated as mere means of achieving your objective, but always as a unique individual who will benefit from the results. When medical practitioner takes

OPTOMETRY · SEMESTER 1 Ethical Issues in Special Situations Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic Learning Objectives Ethical Issues in Special Situations – Capital punishment – Disaster & emergency situations. – Diagnosis of death (Brain dead) Approaches to Special Situations Based on Medical Ethics Medical Research Torture of Human Being Abortion Prisoners Disaster and Emergency Situation HIV& AIDS and other Infectious Diseases The practitioner shall: Medical Examinations Requested by Employer Publicity and Advertisement Diagnosis of Death Health Management Organisations Practitioners must have interest of their clients at heart and should not barge to HMO’s pressures. Practitioner Appropriate Presentation and Attire Activity: Case Study What medical ethics do you think these doctors/clinicians have violated? Answers: Ethical Issues in Special Situations Learning Objectives By the end of this session, students are expected to be able to: Describe several special situations with implications in medical ethics Explain approaches in addressing special situations based on medical ethics Ethical Issues in Special Situations In medical practices there are various situations that can be encountered and found to be a dilemma to the performance of medical duties. These working situations include: Medical research Torture to human being – Capital punishment Abortions Prisoners – Disaster & emergency situations. HIV and AIDS and other infectious diseases Medical examination required by employer Publicity and advertisement – Diagnosis of death (Brain dead) Health management organizations Practitioners appearance, presentation and attire Approaches to Special Situations Based on Medical Ethics Health care providers face different issues that require some ethical solutions. The kind of solution is normally determined by nature and situation of the task as follows: Medical Research Familiarity with research methods is essential for competent medical practice and the best way to gain this familiarity is to take part in research projects. The most common method of research for practicing clinicians is clinical trial. Ethical Issues in Special Situations In conducting research, the ethical values of the medical practitioner compassion, competence, autonomy, dignity apply to medical researcher as well as long as the medical practitioner understand and follow the basic rules of research ethics There are several procedures required to make the research legal and this shall be dealt with in Research Module. Torture of Human Being It is the obligation of the practitioner in the service of humanity, to preserve and restore physical and mental health of the client. The practitioner shall: Not participate in any way in the practice of torture of human being or other forms of cruel, inhuman or any form of degrading procedures no matter whether such practice or procedure is ordered after due process of law. Ethical Issues in Special Situations Not provide any premises, instrument, substance or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment, or to diminish the ability of the victim to resist such treatment. Abortion Medically induced abortion is not allowed by the laws of the country. Abortion is not legal in Tanzania; only in some medical conditions where mother’s health is compromised by the presence of the pregnancy. Prisoners The practitioner while attending a client held in prison or detention is urged to provide professional services to the best interest of the health of the prisoner or detainee and the general community of that prisoner. The practitioner shall: Draw to the attention of the responsible authority of an existing or impending unhealthy environment or condition. Take all necessary steps to preserve dignity of the prisoner or detainee. Disaster and Emergency Situation In disastrous and emergency situations like floods, road accidents, earth quakes, and fire outbreak, practitioner shall practice the profession with conscience and dignity, and the health of the clients shall be paramount. The practitioner shall have an obligation during life threatening emergencies to take immediate steps to ensure that necessary treatment is given to the victim without discrimination and undue delay. HIV& AIDS and other Infectious Diseases In the management of HIV and AIDS and other infectious diseases, the practitioner may encounter ethical problems embodied in the special nature of the disease, its fatality, and absence of cure, public stigma and imminent danger to the society. The practitioner shall: Balance the need to observe confidentiality and save human life against deliberate acts likely to infect potential victims. Acquire adequate knowledge and skills on counselling related to the special aspects of HIV&AIDS and other infectious diseases including prevention and transmission. Ethical Issues in Special Situations Ensure that individuals infected with HIV or suffering from AIDS and other infectious diseases are informed on supportive measures available. Ensure that individuals infected with HIV&AIDS or any other chronic disease are afforded opportunity to agree or decline from being research subjects and to the method applied for scientific research, teaching, and taking of photographs, video or film. Medical Examinations Requested by Employer Practitioners shall ensure that an employee is fully aware and consent to medical or dental examination requested by the employer Publicity and Advertisement Sound relationship between a practitioner and colleagues is essential for fostering the esteem and truthfulness of the medical profession. Practitioners shall be aware that matters of general interest are paramount and practitioner shall refrain from adopting methods aimed at advertising a particular person, institution, remedy or technique. Diagnosis of Death A situation may arise whereby the human body is controlled by a brain which is damaged to an uncertain degree and poses ethical dilemma for termination of life. In such a situation a patient shall be considered dead when there is irrevocable establishment of brain stem death. Ethical Issues in Special Situations Death shall be clinically ascertained by not less than two physicians and one of them shall be the doctor in charge of the care and another one should be an experienced and clinically independent of the first. In any case the examination must be done over twenty four hours at eight hourly intervals. Health Management Organisations Health Management Organizations (HMOs) have their

OPTOMETRY · SEMESTER 1 Ethical Dilemmas: Extended Notes Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic Ethical Dilemmas: Extended Notes SESSION CONTENTS COMMON ETHICAL DILEMMAS IDENTIFY SOURCES OF ETHICAL DILEMMAS STRATEGIES USED TO SOLVE ETHICAL DILEMMAS SEVERAL SPECIAL SITUATIONS WITH IMPLICATIONS IN MEDICAL ETHICS Case 1: Case 2: Ethical Dilemmas: Extended Notes ETHICAL DILEMMAS AND ETHICAL ISSUES IN SPECIAL SITUATIONS IN MEDICAL PRACTICE. Learning Objectives By the end of this session, students are expected to be able to: a) Define the term ethical dilemmas b) Explain the characteristic of ethical dilemmas c) Explain common ethical dilemmas d) Identify sources of ethical dilemmas e) Describe strategies used to solve ethical dilemmas f) Describe several special situations with implications in medical ethics SESSION CONTENTS DEFINE THE TERM ETHICAL DILEMMAS An ethical dilemma is a situation that will often involve a conflict confusing problem, offers a choice between equally unsatisfactory alternatives, that brings questions on which to obey as one would result affecting the other. CHARACTERISTICS OF ETHICAL DILEMMAS In order for a problem to be an ethical dilemma it must have three characteristics The problem cannot be solved using only empirical data (empirical data is information derived from observation/experiences) The problem must be so confusing that deciding what facts and data need to be used in making decision is difficult. The results of the problem must affect more than the immediate situation; and there should be far reaching effects. COMMON ETHICAL DILEMMAS Dilemmas of Beneficence Involve deciding what is good as opposed to what is harmful. Often occur when a clinician, patients, or family members disagree about what course of action is in the best interest of the patient. Dilemmas of Non-maleficence Involves the avoidance of harm. These issues often involve a clinician’s responsibility to ‘blow the whistle’ if she sees others compromising the patient’s safety. In these situations, a clinician notifies higher authorities on weaknesses in the care they provide by not following established communication channels. Dilemmas of Autonomy Involves deciding what course of action maximizes the patient’s right of self-determination. Autonomy issues are related to beneficence issues, especially when individuals other than the patient must determine what is best for the patient, even clinician will be affected by the decisions that will be made. Dilemmas of Justice Involves issues of fairness and equality, such as dilemmas that involve dividing limited health care resources fairly. Dilemmas of Fidelity Involves issues that involve honouring promises. These may include the extent and limits of a clinician’s role and duties to patient that might conflict with other duties such as duties of the laboratory technician. Dilemmas of Veracity This is an obligation to be truthful to patients and to cultivate their understanding of relevant consideration. This may involve even delivering bad news to patients and relatives. IDENTIFY SOURCES OF ETHICAL DILEMMAS Sources of Ethical Dilemmas Problems arise when one or more ethical principles conflict with each other. Patients and clinicians- For example human rights are involved when a patient refuses to commit herself in signing consent while the clinician believes it is ethically appropriate to get his/ her permission. The value system, beliefs and culture- For example a patient who belongs to Jehovah’s Witnesses refuses blood transfusion at the time when blood will save the life of that individual. Dilemma may arise from justice and conflicts between clinician and other health care professionals, health care organizations, administrators or patients and family members. Example one: Quick service provided to patients who can pay extra money and leaving patients with low economical status to wait. Example two: Family members may demand the HIV results of a patient and create a difficult situation. Example three: A woman may demand abortion for her school age girl who has been raped by a school teacher. Technology advancement- Knowledge among people is growing and patients may come to the hospital with full information of their expectations including services like DNA, such as when the clinician is asked to conduct tests to confirm if the claimed father is a true father of the child or not. Technological advancement provides challenges when we are required to extend life support services for terminally sick patients and simplifies accessibility to information. STRATEGIES USED TO SOLVE ETHICAL DILEMMAS There are no clear ways of solving the dilemmas. Different strategies and ways need to be applied in solving the dilemma as described below. First the medical practitioner defines her/his obligations, to patients and fellow employees which helped her/his to analyze ethical conflicts. She/he notes that six steps proved useful to define those obligations:- To maximize a patient’s wellbeing. To balance the patient’s need for self determinations and, in the case of a minor, his/her parents’ responsibilities for his or her wellbeing. To support each family member and enhance the family support system. To carry out the hospital’s policies. To protect the other patients’ good. To protect his or her own standards of care. After examining one’s obligations, it is usually recommended that four additional steps should be taken: Collect as much information as possible about the patient and other significant persons in the situation. Describe probable consequences of each of the courses of action being considered, for the patient and the significant others in the situations. Consider who should make the final decision in the matter. Consult other health practitioners, especially those who are prepared by practice, ethical committee and education to contribute meaningfully to solving problems of an ethical nature. Even after taking the steps described above, solutions may not necessarily be forthcoming when ethical conflicts are present. Commitment to ethical standards of practice is an essential part of medical care, as is the commitment to respecting the rights and dignity of the person receiving care. SEVERAL SPECIAL SITUATIONS WITH IMPLICATIONS IN MEDICAL ETHICS In medical practices there are various situations that can be encountered and found to be a dilemma to the performance of medical duties. These working situations include: