Optometry Notes

OPTOMETRY · SEMESTER 1 Ethics, Morality, Culture and Values Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic Learning tasks Definition of terms What is ethics Morality One respects each and every basic goods or value of human existence Why morality in health care Culture Values Ethics, Morality, Culture and Values Virtue is a type of behavior that reflects the person’s moral excellence (e.g. kindness) VIRTUE ETHICS DEONTOLOGICAL ETHICS TELEOLOGICAL ETHICS RELIGIOUS WORLD VIEW Patient Privacy: Confidentiality: Confidentiality in Practice: Why are Privacy and Confidentiality Important? Group work Ethics in Medical radiology and Imaging Learning tasks By the end to the session the students will be able to; Describe ethics, morality, culture and values Definition of terms Duty; That which one is required to perform by law or morality Patient; refers to a person who is sick with or being treated for an illness or injury or an individual receiving medical care What is ethics Ethics; is a code or set of principles by which people seek to live their lives Essentially, ethics has to do with what we perceive to be right or wrong, good or bad Medical ethics involve issues that may rise in treating individuals based on values, facts and logics Ethical decisions are as essential to patient care as clinical and technical ones Ethical decisions are as integral to patient care as clinical and technical ones. Morality Morality; a set way of conducting oneself OR The quality of human acts by which we call them right or wrong, good or evil The standards that enable the people to live cooperatively in the group or society Human action is right when it conforms with norms, rules or law of morality One respects each and every basic goods or value of human existence Among these goods; is human life itself, including health, bodily integrity, friendship, religion etc. Why morality in health care Health is an essential need of a human person Morality guides us to the satisfaction to that need Culture Culture can be defined as the way of life for an entire society including arts, beliefs and practices of population that are passed down from generation and generation Organization culture is in according to the shared values, beliefs, behavior, attitudes, experience built in work place symbols / assumptions, dressing code etc. Culture development is driven by professionals who share similar values and objectives Values Values are a set of principles or standards of behavior; (in form of attitudes, feelings) they are regarded desirable important and held in high esteem by a particular society in which a person lives Personal values represent professional’s conceptions of what it means both to be and to act as a good professional Ethics, Morality, Culture and Values The values are in the form of goals, attitudes interests, feelings, conviction and beliefs embraced by professionals serve to guide their thinking, actions and interactions with patients The professional has an obligation to individuals, to society and the country, to profession, coworkers, workers in other field and to the self Virtue is a type of behavior that reflects the person’s moral excellence (e.g. kindness) OR The moral strength of human being’s will in fulfilling his duty The characters or quality that are considered morally good e.g. honest, kindness, obedience, fairness, good judgement) VIRTUE ETHICS Virtue ethics, focuses on the inherent character of a person rather than on the specific actions he or she performs. Some people see the different aspects of moral character, which we call virtues, (such as honesty, loyalty, kindness) as a suitable foundation for professional ethics. Virtue ethics…. is about developing good character traits and being the kind of person who naturally acts morally DEONTOLOGICAL ETHICS Deontology comes from the Greek Deon, meaning “duty” and logos, meaning “word” This theory holds that we are obliged to do certain things, regardless of the consequences, simply because it is the right thing to do. Deontological theories concentrate on the act being performed. According to deontological theories, certain types of act are intrinsically good or bad, i.e. good or bad in themselves. These acts ought or ought not to be performed, irrespective of the consequences. There are many different ways of deciding what is the “right thing” Deontological ethics…..is focuses on following or fulfilling duties, regardless of the outcomes TELEOLOGICAL ETHICS This word comes from the Greek word telos, meaning “end” and logos meaning “word”. These theories differ completely from deontological ethics. They teach that actions are judged good or bad, right or wrong, on the basis of the consequences they produce. These theories hold that we ought always to act in the way that brings about the best consequences. It doesn’t matter what those acts are; the end justifies the means. All that matters for ethics is making the world a better place. How we achieve that is given secondary importance. Teleological ethics…..based on judges actions based on the results they produce ,aiming for the best possible outcome RELIGIOUS WORLD VIEW Religious world view…..is shaped by faith in a higher power and religious teachings often offering guidance on moral and ethical behavior All religions promote certain moral values and virtues, and try to influence the moral behavior of their particular followers. There are considerable areas of ethical teaching that the worlds religions share in common. However, although they may be similar on a surface levAll religions promote certain moral values and virtues, and try to influence the moral behavior of their particular followers. There are considerable areas of ethical teaching that the worlds religions share in common. However, although they may be similar on a surface level, but when we dig deeper we find the fundamental beliefs and teachings are very different. If we try to claim that they are all true, then these differences become a real problem. el, but when we dig deeper we find the fundamental beliefs and teachings are very different. If we try to claim that

OPTOMETRY · SEMESTER 1 Introduction to Medical Ethics and Professionalism Medical Ethics and Professionalism Read the consent, confidentiality and source corrections alongside these notes. START READING NOTES Contents of This Topic MEDICAL ETHICS AND INTRODUCTION TO MEDICAL Definition of Terms They serve the purpose of governing conduct to ™ Medical Ethics, are general ethics applied Definition of Terms cont'd Definition of Terms cont’d value clarification process Helping clients identifying their values Morals Welfare rights (also called legal rights) thical rights (also called moral rights) are based Optional rights: These are rights that are based on The goals of laws are preserving the species and promoting inition of Terms cont'd ii) Moral obligations — Are those based —_ on moral or ethical Obligations: Ethical obligations Obligation to the sick Obligations to colleagues. Legal obligations Standards of professional practice '® Deal honestly with patients and colleagues and strive to Question Importance of nursing ethics to Assignment MEDICAL ETHICS AND PROFESSIONALISM INTRODUCTION TO MEDICAL ETHICS = Teaching/Learning objectives; By the end of the session, the learner(s) should be able to; / 1. Define the different terms in medical ethics. 2. Explain the importance of studying medical ethics. Definition of Terms Ethics: | specialized area of philosophy whose origins can be traced to ancient Greece. thics are general declarations of what is right or wrong and of what aught to be. hey/are usually presented as systems of value behaviors d beliefs. They serve the purpose of governing conduct to ensure the protection of an individual’s rights. Ethics: usually refers to the practices, beliefs, and standards of behavior of a particular group such as nurses. It also refers to the method of inquiry that assists people to understood the morality of human behavior (study of morality) ™ Medical Ethics, are general ethics applied to the practice of all aspects of health care. Definition of Terms cont'd ode of Ethics: Is a written list of a profession’s values and standards of conduct. It is a framework for decision making by the profession should be oriented toward the day-to-day cisions made by members of the profession. Definition of Terms cont'd \re ideals or concepts that give meaning to the individual’s life. alues are usually derived from societal norms, religion and family orientation. hey serve as the framework for making decisions and ing certain actions in everyday life. hey/are usually not written down. It\is/necessary to undertake a value clarification process Definition of Terms cont’d Value Conflicts: Can force an individual to select a higher priority value over a lower one e.g. a HCP who values both his/her career his/her family may be forced to decide between going o work and staying at home with a sick relative etc. value clarification process Requires that the Health Care Provider (HCP): Identify, assess, valuate Then determines a set of personal values Find out how the priority values are to be ranked. Helping clients identifying their values List alternatives Examine possible consequences of choices Choose freely Feel good about the choice mber: never impose your personal values never offer an opinion Definition of Terms cont'd orals: he fundamental standards of right and wrong that an individual learns and internalizes, usually in the early stages of childhood development. oral behavior is usually in accordance with a group’s beliefs, norms/customs or traditions/culture. Morals: is similar to ethics and many people use the two wards interchangeably (closely associated with the concept of ethics) Dérived from the Latin “mores”, means custom or habit. Morals » Principles and rules of right conduct ® Private, and personal tment to principles and yalues is usually defénded in daily life ertain to an individual‘s character Comparison of morals and ethics Ethics ® Formal responding process used to determine right conduct ® Professionally and publicly stated ® Inquiry or study of principles and values ® Process of questioning, and perhaps changing, one’s morals ® Speaks to relationships between human beings Definition of Terms cont'd ights: /Something owed to an individual according to just claims, legal guarantees or moral and ethical principles. Many times, individuals tend to claim things as rights, when what they are claiming are really privileges, concessions or freedoms. In order to avoid confusion in claims, rights are classified in the ing three types: Welfare rights (also called legal rights) based on a legal entitlement to some good or benefit. hose rights are guaranteed by law e.g. The Nurses Act, Pharmacy Act etc. A violation of such rights can be punished under the legal systems e.g. all rightly trained and certified HCPs have a right to professional registration and practice, regardless of , sexual preferences or religion. thical rights (also called moral rights) are based onamoral or ethical principle. Ethical rights do not usually need to have the power of law in order to be enforced. However, popular acceptance of ethical rights can give them the force of a legal right. Optional rights: These are rights that are based on a fundamental belief in the dignity and freedom of human beings. Optional rights give individuals freedom of choice and the right to live their lives as they choose, but within a given set of prescribed boundaries e.g. people may wear whatever clothes they choose, as long as they wear some type of clothing and don’t walk naked. Definition of Terms cont'd iii) Inthe USA and other democratic countries, people may choose to live a gay/lesbian live, as long as they are not forced into it or force others into it. The goals of laws are preserving the species and promoting peaceful and productive interactions between individuals or groups of individuals by preventing the actions of one citizen from infringing on the rights of another. The two important aspects of laws are that; y are enforceable through some type of police force, ™/ they should be applied equally to all persons. inition of Terms cont'd Ethical Dilemma/Challenge: Is a situation that requires an individual to make a choice between two equally unfavorable alternatives. One’s obligations and another person’s rights

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:

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 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 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 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