Medical Ethics and Professionalism – Extended Notes – Professional Values

Medical Ethics and Professionalism – Extended Notes – Professional Values

• Professional Values and
• Provision of Quality Health
• Services

Learning Objectives

• By the end of this session, students are expected to be able to:
• Define the terms values and integrity
• Explain the link between values and a profession
• Describe values in the provision of quality health services
• Sub-Enabling Outcome: Utilize professional
• values in providing quality health care
• services
• a) Define the terms values and integrity
• b) Explain the link between values and a profession
• c) Describe values in the provision of quality health care services
• Definition of Values
• DISCUSS: “What is the difference between values and ethics?”
• Although there is a definite link between ethics and values, the two
• concepts are not identical.
• Values can be defined as relatively stable convictions about what is good or
• desirable.
• principles or standards of behaviour; one's judgement of what is important in life. "
• they internalize their parents' rules and values"
• The difference from ethics here is clearly that one can have values that are
• not ethical or that have nothing to do with ethics.
• Some values examples:
• Respect
• Transparency
• Fairness
• Justice
• Values and Profession
• The values of a profession will be reflected in their ethical code of
• practice.
• Values of a profession will be reflected through the behaviour of their
• professional members, who have to practice in a specific manner
• accepted by ethical code of practice, ethical principles and standards
• of the profession.
• Professional values include:
• Punctuality
• Commitment
• Respect
• Fairness and equality
• Quality of services
• Creativity and innovativeness
• For any profession to function optimally, good relations and interactions
• between stakeholders are required.
• In order to ensure such good relations and interactions occur, members of
• the profession need to commit themselves to specific ethical codes of
• practice and professional ethics.
• Integrity within the Profession
• Integrity is another concept that is closely aligned to ethics.
• Integrity is however a more restricted concept than ethics.
• It refers specifically to human character.
• A person is regarded as someone with integrity when she/he
• consistently adheres to a set of ethical standards.
• the quality of being honest and having strong moral principles.
• the state of being whole and undivided.
• Integrity, is often associated with concepts like
• Fairness
• Consistency
• Uprightness
• Wholeness
• These characteristics make a person of integrity, reliable and
• trustworthy.
• The person with integrity will always adhere to her or his values
• People with good moral characters can turn to unethical behaviour
• if they find themselves in organizations where unethical conduct is
• the norm.
• People can be restrained from unethical behaviour if they find
• themselves in organizations that do not tolerate unethical behaviour,
• but reward ethical behaviour.
• Ethical behaviour should not only be addressed on the individual
• level, but also on the system or organizational level.
• Characteristics of Quality Health Services
• Every person regardless of age or condition is afforded access to
• quality health care.
• The service is to be timely, reliable and adequate.
• Services to be provided to all in need guaranteeing equal access to
• medical services.
• Service that allow exercise of moral and religious freedom when
• receiving health care.
• Services where medical personal do not harm, do positive good, and
• respect the autonomy of persons, and adhere to principles of justice.
• Services that create a bond of trust between patients and health care
• providers which is built on shared decision-making.
• Services where patients or their relatives are provided with complete
• information in order to participate fully in their own care.
• Services that recognize the quality and availability of health care
• services for women affect the health and wellbeing of their children
• and families so that limitations to these services have a profound
• long-term effect on the public’s health.
• Services where medical professionals exercise their professional
• judgment in the best interests of their patients; and recognizing the
• professional obligation of medical providers to support access to
• medical care for all people in the interest of the public good.
• Services which respect and protect the dignity and autonomy of each
• person regardless of the person’s health issues, religious views or
• social status.
• Respecting every person’s dignity means that each person should
• enjoy the right to health, to health care, to direct access to health
• care, and to the continuation of that care, regardless of the
• ownership of the institution from which they seek care.
• Services where patient expects and has the right to expect the health
• care professional to employ the highest standard of care and best
• medical practices
• Services that respect transplantation of organs from living donors is
• permissible when such a donation will not sacrifice or seriously impair
• any essential bodily function of the donor
• Values and Provision of Quality Health
• Services
• In the provision of quality care, there are many values which result in
• the desired behaviour of a practitioner. These include:
• Good therapeutic relationship.
• The term ‘therapeutic relationship’ includes all professional interactions
• between care providers, individually or as a team, and recipients of care.
• Good therapeutic relationships are centered on the needs and informed
• choices of the person receiving care.
• Such relationships are based on respect and mutual giving and receiving.
• Good therapeutic relationships help to prevent conflicts about the goals and
• means of care.
• A good therapeutic relationship is founded on mutual trust and respect
• between providers and recipients of care.
• When care providers lose this sense of mutuality, they become mere experts
• and the human quality in the relationship is lost. xx
• When persons receiving care lose this sense of mutuality, they experience a
• perceived or real loss of control and increased vulnerability. xx
• Because persons receiving care are often weakened by their illness and may
• feel powerless in the health care environment, the primary responsibility for
• creating a trusting and respectful relationship rests with the care providers.
• The needs, values and preferences of the person receiving care
• should be the primary consideration in the provision of quality health
• care.
• Sensitivity to and understanding of the personal needs and
• preferences of persons receiving care, their family members and
• significant others is the cornerstone of a good therapeutic
• relationship.
• These needs and preferences are diverse and can be influenced by a
• range of factors including cultural, religious and socioeconomic
• backgrounds.
• Open communication, within the confines of privacy and
• confidentiality, is essential.
• All those involved in decision-making should be encouraged to
• express their points of view, and these views should be respectfully
• considered.
• Health Care providers should ensure that they understand the needs,
• values and preferences of the person receiving care
• Health care providers to avoid misunderstanding or confusion, they
• should make their communications direct, clear and consistent.
• They should verify that, the person receiving care understands the
• information being conveyed, silence should not be assumed to
• indicate agreement.
• The person receiving care should be provided with the necessary
• support, time and opportunity to participate fully in discussions
• regarding care.
• The competent person must be involved in decisions regarding his or
• her care.
• The primary goal of care is to provide benefit to the person receiving
• care.
• The competent person has the right to determine what constitutes
• benefit in the given situation, whether with respect to physical
• psychological, spiritual, social or other considerations.
• Informed decision-making requires that the person receiving care or
• a relative be given all information and support necessary for assessing
• the available options for care, including the potential benefits and
• risks of the proposed course of action and of the alternatives,
• including palliative care.
• The competent person has the right to refuse, or withdraw consent
• to any care or treatment, including life-saving or life-sustaining
• treatment.
• Although parents or guardians are normally the primary decision
• makers for their minor children, children should be involved in the
• decision-making process to the extent that their capacity allows, in
• accordance to the existing regulations and policies.
• When the person receiving care is incompetent, that is, lacking in
• adequate decision making capacity with respect to care and
• treatment, every effort must be made to ensure that health care
• decisions are consistent with his or her known preferences.
• These preferences may be found in an advance directive or may have
• been communicated orally
• In situations where decision making concerning care and medical
• treatment for incompetent persons is specifically addressed in law,
• the requirements of that legislation should be met.
• When an incompetent person's preferences are not known and there
• is no family member to represent the person, decisions must be
• based on an attempt to ascertain the person's best interests, taking
• into account:
• Person’s diagnosis, prognosis and treatment options.
• Person’s known needs and values.
• Information received from those who are significant in the person's life and
• who could help in determining his or her best interests.
• Aspects of the person's culture, religion or spirituality that could influence
• care treatment decisions.
• When conflicts arise despite efforts to prevent them, they should be
• resolved as informally as possible, moving to more formal procedures
• only when informal measures have been unsuccessful.
• In cases of disagreement or conflict, the opinions of all those directly
• involved should be given respectful consideration.
• Disagreements among health care providers about the goals of care
• and treatment or the means of achieving those goals should be
• clarified and resolved by the members of the health care team so as
• not to compromise their relationship with the person receiving care
• Disagreements between health care providers and administrators
• with regard to the allocation of resources should be resolved within
• the facility or agency and not be debated in the presence of the
• person receiving care.
• Health care authorities and health facilities should develop conflict
• resolution policies for dealing with such issues and monitor their use.
• When the needs, values and preferences of the person receiving care
• cannot be met, he or she should be clearly and frankly informed of
• the reasons for this, including any factors related to resource
• limitations.
• Health care providers should not be expected or required to
• participate in procedures that are contrary to their professional
• judgement or personal moral values or that are contrary to the values
• or mission of their health facility
• Health care providers should declare in advance their inability to
• participate in procedures that are contrary to their professional or
• moral values.
• Health care providers should not be subject to discrimination or
• reprisal for acting on their beliefs
• The exercise of this provision should never put the person receiving
• care at risk of harm or abandonment.
• Health care providers have a responsibility to advocate together with
• those for whom they are caring in order that these persons will have

access to appropriate treatment.

108: Key Point

• Values are convictions about what is good or desirable.
• Values of a profession will be reflected through the behaviour of the
• professional.
• A person of integrity is reliable and trustworthy and adheres to
• professional values.
• Every person, regardless of age or condition, is afforded access to
• quality health care.
• A good therapeutic relationship is founded on mutual trust and
• respect between providers and patients/clients.
• Evaluation
• What are values?
• What is integrity?
• What are the values that a health profession needs to observe?
• List characteristics of quality services.

References

• Beauchamp, T.L. and Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). New York: Oxford University

Press.

• Burkhardt, Margareth A. & Nathaniel, A.K. (2007) Ethics and Issues in Contemporary Nursing. (3rd ed.) New

York: Thomson.

• Devettere, R.J. (1995). Practical Decision Making in Health care Ethics: Cases and Concepts. Washington DC:
• Georgetown.
• Furrow, D. (2005). Ethics: Key Concepts in Philosophy. New York, Continuum
• International Ethics Guidelines for Biomedical Research Involving Human Subject, CIOMS, Geneva, 1993.
• Mason, J.K., McCall Smith R.A. & Laurie, G.T. (1999). Law and Medical Ethics. London: Butterworths
• Mellish, J.M. & Paton, F. (1999). An Introduction to the Ethics of Nursing. Capetown: Heinemenn.
• Tanzania National Health Research Forum (2001). Guidelines on Ethics for Health Research in Tanzania.
• World Medical Association (2009). Medical Ethics Manual (2nd ed.). France: World Medical Association.
• Moral Standards and

Society

Learning Objectives

• Explain the social role of a profession
• Identify the reasons for conflicts between health professionals and
• the society
• Describe health personnel obligations to patients and the society
• Describe the challenges of dual loyalty
• Describe the challenges of resource allocation
• Describe clinicians ethical responsibilities in public health issues
• Sub-Enabling Outcome: Describe the
• relationship between clinician and society in
• providing quality health care services
• a) Explain profession personal obligation to the society
• b) Define dual loyalty
• c) Describe the challenges of dual loyalty
• d) Describe the challenges of resource allocation
• e) Describe clinicians’ ethical responsibilities in public health issues
• f) Explain the health personnel’s responsibility for his/her own actions
• g) Explain the importance of workers taking responsibility for own actions
• h) Describe how health personnel can take responsibility for own actions
• Social Role of a Profession
• The social role of a profession is to prepare practitioners with the
• knowledge and skill necessary for the practice of that profession.
• The public must be able to trust the profession and believe that all
• its members will posses a particular level and quality of knowledge
• and skill.
• The public should trust members of the profession as:
• Persons with high moral standards.
• Having genuine desire to help those who are in need of their service and that
• will do so with integrity and compassion.
• Persons characterized by a particular set of moral virtues and ethical
• guidelines that they exercise even when unobserved.
• These requirements are necessary in order for social trust
• (sometimes called a social contract) to exist.
• The professionals must be competent in both knowledge and
• technique of its practice
• The professionals must continue to learn throughout life, to practice
• with virtue, to seek to enhance the knowledge base of the
• profession itself and to observe the moral guidelines of the
• profession
• 117• Thus both the education and professional associations are essential
• to the moral life and excellence of the profession.
• Reasons for Conflicts Between Health
• Professionals and Society
• Reasons for Conflicts
• Unethical behaviour of the clinician
• Drunkenness during working hours
• Soliciting bribery (including sexual favours)
• Harsh language to patients/clients
• Favouritism (biasness)
• Putting your interests ahead of those of patients/clients
• Superiority/inferiority complexes
• Not adhering to privacy and confidentiality of patients information

• Community Factors

• Over expectation of the patients/clients from a clinician. (Some health issues
• not managed by the clinician – too difficult for him/her)
• Negative attitudes of the community towards clinician (tribalism)
• Religious segregation
• Gender sensitivity
• Personal grudges
• Political biasness
• Obligations to Patients and to Society
• Medicine is a profession and the term “profession” has two distinct,
• although closely related meanings:
• An occupation that is characterized by dedication to the well-being of others
• , high moral standards, and a body of knowledge and skills, and high level of
• autonomy.
• Individuals who practice that occupation.
• Medical profession involves not just the relationship between a
• clinician and a patient, and relationship with colleagues and other
• health professionals but it also involves a relationship with society.
• This relationship can be characterized as a social contract whereby
• society grants the profession privileges, including exclusive or
• primary responsibility for the provision of certain services and high
• degree of self-regulation, and in return, the profession agrees to use
• these privileges primarily for the benefits of others and only
• secondarily for its own benefit.
• Medicine is today, more than ever before, a social rather than strictly
• individual activity.
• The Medical Profession and the Society
• The term society refers to the community or nation.
• It is not synonymous with government, government not always
• representing the interests of the society, but even when they do,
• they are acting for society, not as society.
• Clinicians are also called upon to play a major role in the allocation of
• society’s scarce healthcare resources, and sometimes they have a
• duty to prevent patients from accessing services to which they are
• not entitled.
• Implementing these responsibilities can raise ethical conflict,
• especially when the interest of the society seems to conflict with
• those of the individual patients.
• Challenge of Dual Loyalty
• When clinicians have responsibility and are accountable both to
• their patients and to a third party and when these responsibilities
• and accountabilities are incompatible, they find themselves in a
• situation of dual loyalty.
• Third parties that demands clinicians’ loyalty include governments,
• employers, insurers, military officials, police, prisons officials and
• family members including the law
• It is generally accepted that medical practitioners may in exceptional
• situations have to place the interests of others above those of the patient.
• The ethical challenge is how and when to protect the patient and face the
• pressure from third parties.
• At one end of spectrum are requirements for mandatory reporting of
• patients who suffer from designated diseases such as cholera and HIV
• although patients should be informed that such reporting will take place
• Clinicians should report to appropriate authorities any unjustified
• interference in the care of their patients, especially if fundamental
• human rights are being denied.
• They should resolve any conflict between their own interest and
• those of their patients in their patients favour.
• Conflict of interest can happen when the clinician has been
• supported by a pharmaceutical company or medical devices
• manufacturers.
• A common underlying motive for such company is to convince the
• clinician to prescribe or use the company’s products, which may not
• be the best one for the patients and may add unnecessary cost.
• Challenge of Resource Allocation
• Justice entails a more social approach to the distribution of resources
• , one that considers the needs for other patients.
• According to this approach, clinicians are responsible not just for
• their own patient but, to a certain extent, for others as well.
• In circumstances where a choice must be made between potential
• patients for a particular treatment which is in limited supply, all such
• patients are entitled to a fair selection procedure for that treatment.
• That choice must be based on medical criteria and made without
• discrimination.
• One way clinicians can exercise their responsibility for the allocation
• of resources is by avoiding wasteful and inefficient practices, even
• when patients request them to do so.
• The overuse of antibiotics is just one example of a practice that is
• both wasteful and harmful.
• Clinicians have a moral responsibility to advocate for expansion of
• these resources where they are insufficient to meet patient’s needs.
• This usually requires that clinicians work together, in their
• professional association, to convince decision makers in government
• and elsewhere of the existence of these needs and how best to meet
• them.
• Ethical Responsibilities in Public Health
• Issues
• Public health measures such as vaccination campaigns and
• emergency responses to outbreaks of contagious diseases are
• important factors in the health of individuals but social factors such as
• housing, nutrition and employment are equally significant.
• Clinicians can contribute, even if indirectly, to long term solutions of
• health problems by participating in public health and health
• education activities, monitoring and reporting environmental hazards
• Clinicians should attempt to find ways to minimize any harm that
• individual patient may suffer as a result of meeting public health
• requirements.
• When reporting is required, the patient’s confidentiality should be
• protected to the greatest extent possible while fulfilling the legal
• requirement.
• 134 Key Points
• Clinician should resolve any conflict between their interests and
• those of their patient
• One way clinicians can exercise their responsibility for allocation of
• resource is by avoiding wasteful inefficiency practices even when
• patient request them.
• Clinician has to participate in solving health problem in public health
• and health education activities, monitoring and reporting
• environmental hazards.
• Evaluation
• What are the causes of conflict between the clinician and the
• community?
• What are the challenges of dual loyalty?
• What are the challenges that can be encountered during allocation of
• medical resources?

References

• Beauchamp, T.L. and Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). New York: Oxford University

Press.

• Burkhardt, Margareth A. & Nathaniel, A.K. (2007) Ethics and Issues in Contemporary Nursing. (3rd ed.) New

York: Thomson.

• Devettere, R.J. (1995). Practical Decision Making in Health care Ethics: Cases and Concepts. Washington DC:
• Georgetown.
• Furrow, D. (2005). Ethics: Key Concepts in Philosophy. New York, Continuum
• International Ethics Guidelines for Biomedical Research Involving Human Subject, CIOMS, Geneva, 1993.
• Mason, J.K., McCall Smith R.A. & Laurie, G.T. (1999). Law and Medical Ethics. London: Butterworths
• Mellish, J.M. & Paton, F. (1999). An Introduction to the Ethics of Nursing. Capetown: Heinemenn.
• Tanzania National Health Research Forum (2001). Guidelines on Ethics for Health Research in Tanzania.
• World Medical Association (2009). Medical Ethics Manual (2nd ed.). France: World Medical Association.

Workers’ Responsibility for

Own Actions

Learning Objectives

• Explain the worker’s responsibility for his/her own actions
• Explain the importance of workers’ responsibility for own action
• Describe how workers can take responsibility for own action

Definition of Workers’ Responsibility for

Own Actions

• Taking responsibility for own action is being answerable or
• accountable, as for something within one’s power, control, or
• management.
• People want to feel responsible for successes when they occur, but
• it’s not easy taking responsibility for failures.
• Acknowledging failure is the initial stage of developing sense of
• responsibility for own action and being aware of ones capability for
• growth and development.
• Importance of Workers’ Taking
• Responsibility for Own Action
• “What is the importance of workers taking responsibility their own
• actions?”
• Taking responsibility is a very important principle.
• One is solely responsible for all own actions and blaming others or
• circumstances for the things that are not right are an attitude of selfdestruction.
• When we accept and take responsibility for our actions, then we are
• in a better position to move forward and to learn from our mistakes
• Taking responsibility of own action results in building self-esteem to
• higher levels.
• Many smaller problems you experience regularly such as negative
• thinking, self-defeating behaviour and troubled relationships with
• yourself and others start to correct themselves as your self-esteem
• improves.
• You gain an inner stability and can create your own positive feelings
• without the help of validation from other people
• Taking responsibility for own action is a sign of wisdom and maturity;
• You come to terms with the realization that your decisions cause your
• rewards and consequences.
• You are responsible for your life, and your ultimate success depends
• on the choices you make.
• One of the key determinants of how we perform in life, is not defined
• by what actually happens to us, but rather how we respond to the
• events life puts in our way.
• The reality is that if you had approached the situation in a positive
• and open frame of mind, the outcome would almost certainly have
• been considerably different, with a positive outcome.
• If you own up your actions, your life becomes better and smoother.
• In medical services one is trying to ‘do well’ and prevent harm in all
• cost, but mistakes can occur, it is very ethical to report the error so
• that immediate action can be taken to save life
• In situation where you did a mistake in the course of your care, it is
• very ethical to admit the mistake and take the consequences, which
• shows a level of maturity and self-actualisation
• The Consequences of Not Being
• Responsible for Own Actions
• The inability to accept responsibility for own actions and behaviours
• is a result of insecurity.
• By accepting responsibility one feels they are admitting to being
• weak, powerless, or an opportunity to lose the respect of others.
• It may cause one to feel they will lose their sense of value and
• importance.
• Accepting responsibility is a sign of personal growth and maturity
• and definitely not a sign of weakness.
• The Consequences of Not Being Responsible for Own
• Actions CNTD
• The consequences for not taking responsibility can be very serious
• indeed and result into personality disorder and spoiling whole life.
• The typical indicators for failing to take responsibility are:
• Dependent on others for recognition, approval, affirmation, and acceptance
• Angry, hostile or depressed.
• Fearful of taking action being afraid of doing it wrong again.
• The Consequences of Not Being Responsible for Own
• Actions CNTD
• Unable to trust yourself to take a risk or make a decision, frightened of
• everything.
• Over responsible and guilt ridden.
• Unable to trust or to feel secure with others.
• Resistant to vulnerability, fear of being vulnerable, often linked to past
• trauma
• The Consequences of Not Being Responsible for Own
• Actions CNTD
• Terms used to describe those who have not accepted personal
• responsibility include:
• Self-pitying, depressed, losers, quitters, chronically angry, dependent
• personalities, complainers, addictive personalities, blamers, stubborn,
• persons in denial, troubled people, stuck, fearful, pessimists, despondent,
• mentally unstable, obstinate, hostile, aggressive, irresponsible, weak, guilt
• ridden, resistant to help, passive, irrational, insecure, neurotic, obsessed, lost.
• The Consequences of Not Being Responsible for Own
• Actions CNTD
• Accepting responsibility results to positive attitude and growth. As
• when we accept responsibility we are accepting the blame for our
• actions and also accepting the responsibility for making
• improvements in our lives.
• Accepting responsibility is a measure of one's self-worth, their level
• of security, and the true sign of strength and courage.
• It will empower you to grow in ways that would bring you great
• rewards and accomplishments in your life.
• Developing Ability to Take Responsibility
• for Own Actions
• Identification and accepting that, you do have a problem in this area
• and learning ways of taking responsibility for your actions, in this way
• you are taking your life to a higher level of existence.
• You will find yourself feeling more vibrant and happier.
• Let go of feelings of victimization and learn to see yourself as a victor
• and not a victim.
• Develop your spiritual life by adding a spiritual dimension to your life
• which can help to bring more self-awareness
• Developing Ability to Take Responsibility for Own Actions
• CNTD
• Take your degree of success to a higher level.
• Build your self-confidence as when you are confident in your abilities,
• you won't become defensive when you make a mistake and therefore,
• owning your contribution to a situation and taking responsibility
• becomes natural.
• Giving of self in service to others, teaches empathy and compassion,
• characteristics helps one to overcome self-centeredness.
• Learn ways to let go of fear since fear can create insecurities.
• Developing Ability to Take Responsibility for Own Actions
• CNTD
• Acceptance of who you are, learn to love yourself unconditionally
• and accept who you are.
• Learn how to see things objectively without bias and prejudice.
• Accept responsibility for your responses to the people, actions, and
• events in your life.
• Accept that you are completely responsible for your own choices
• Be open to change, new ideas or concepts about life and the way life
• is.
• Get help from others
• Let go of fear and irrational beliefs.
• Release anger, fear, blame, mistrust, and insecurity.
• Take some risks, be prepared to become vulnerable to change and
• growth in your life.
• Open up and use positive affirmations.
• A sense of personal responsibility for one’s own actions is at the root
• of it all.
• All people want world peace, but this will only start at individual
• level; taking ownership of own actions.
• Take responsibility for own actions, including errors, recognition and
• acceptance of limitations and need for supervision and self

assessment.

Key Points

• Taking responsibilities for own action is being answerable or accountable,
• as for something within one’s power, control, or management.
• Once accepting and taking responsibilities for our actions, then we are in a
• better position to move forward and to learn from our mistakes.
• Taking responsibility of own action results in building self-esteem to higher
• levels.
• Many smaller problems you experience regularly such as negative thinking,
• selfdefeating behaviour and troubled relationships with yourself and others
• start to correct themselves as your self esteem improves.
• The consequences for not taking responsibility can be very serious
• indeed and result into personality disorder and spoiling whole life.
• Accept that you are completely responsible for your own choices.
• Evaluation
• What is workers responsibility for own action?
• What is the importance of workers responsibility for own action?
• How can workers develop abilities to take responsibility for own
• action?

References

• Beauchamp, T.L. and Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). New York: Oxford University

Press.

• Burkhardt, Margareth A. & Nathaniel, A.K. (2007) Ethics and Issues in Contemporary Nursing. (3rd ed.) New

York: Thomson.

• Devettere, R.J. (1995). Practical Decision Making in Health care Ethics: Cases and Concepts. Washington DC:
• Georgetown.
• Furrow, D. (2005). Ethics: Key Concepts in Philosophy. New York, Continuum
• International Ethics Guidelines for Biomedical Research Involving Human Subject, CIOMS, Geneva, 1993.
• Mason, J.K., McCall Smith R.A. & Laurie, G.T. (1999). Law and Medical Ethics. London: Butterworths
• Mellish, J.M. & Paton, F. (1999). An Introduction to the Ethics of Nursing. Capetown: Heinemenn.
• Tanzania National Health Research Forum (2001). Guidelines on Ethics for Health Research in Tanzania.
• World Medical Association (2009). Medical Ethics Manual (2nd ed.). France: World Medical Association.