Introduction to Medical Ethics and Professionalism

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 usually form the basis of the dilemma/
• challenge. By the very nature of the ethical dilemma, there
• be no simple correct solution and whatever decision is
• ade, often must be defended by the decision maker, against

those who disagree with it.

Definition of Terms cont'd

• ‘Obligations:
• Are demands made upon an individual, a profession, a society or
• government to fulfill and honor the rights of others.
• Obligations are often divided into two categories:
• i) Legal obligations — are those which have become formal
• sfatements of law and are enforceable under the law e.g. a
• CP has a _ legal obligation to provide safe and adequate

care for patients/clients under his/her care.

ii) Moral obligations — Are those based —_ on moral or ethical

• principles but are not enforceable under the law e.g. in most
• countries no legal obligation exist fora HCP ona
• holiday/personal trip to stop and help a road traffic accident

, but it is an ethical/moral obligation to help such a

Obligations:

• What are the ethical obligations of a health care
• practitioner?
• What are Standards of professional practice of a
• health care practitioner?
• i. “What are the professional etiquette of a health care
• practitioner?
• List the legal obligations of a health care
• practitioner?
• What are the General obligations of a health care

practitioner?

Ethical obligations

• '@ Respect of the code of ethics
• ™ Respect for human rights
• ™ Respect of persons
• ™ Protection of privacy
• ™ Integrity
• ™ Agcess to health care services
• ™ Kespect of colleagues

Safeguard patients confidences

Obligation to the sick

• Shall preserve absolute confidentiality on all he/she knows about the
• patient even after the patient has died.
• ® Shall give emergency care as a humanitarian duty unless he/she is assured
• that others are willing and able to give such care.
• ways bear in mind the obligation of preserving life.
• Shall owe his patients loyalty and all the resources of his science. Whatever
• examination or treatment is beyond the HCP’s capacity, should summon

r refer to another who has the necessary ability.

Obligations to colleagues.

• ® Shall behave towards his/her colleagues as he would
• have them behave towards him
• ® Shall not entice patients from his/her colleagues
• ® Shall observe the principles in the Geneva

declaration(oath)

Legal obligations

• ® Follow the code of health care ethics and principle of medical
• ethics
• ® Observe the constitution of Uganda
• ® Follow the formal ways of delegation of care for patients under
• your care after assessing that the person being delegated is
• mpetent enough
• HCP shall all the times comply with the norms and standard, of
• professional conduct, care and competence generally accepted by

the profession.

Standards of professional practice

• ding to the international code of health care ethics, a
• practioner shall,
• i. Always maintain the highest standards of professional conduct
• il. Not permit motives of profit to influence the free and
• independent exercise of professional judgment on behalf of
• patients,
• iii.In allAypes of nursing practice, be dedicated to providing
• competent medical services in full technical and moral

independence, with compassion and respect for human dignity.

'® Deal honestly with patients and colleagues and strive to

• expose those deficient in character or competence, or who

engage in fraud or deception

Question

• ® What is the Importance of observing ethics in

health care practice.

Question

• ® What is the Importance of observing ethics in

health care practice.

Importance of nursing ethics to

• trainees.
• ® The teaching/learning of nursing ethics to students aims at
• instilling in students knowledge, skills and attitudes necessary to
• guide their conduct.
• I elps students in decision making as practicing medical

personnel

Assignment

• With clear and contemporary examples, discuss the
• various principles of ethics.
• _ Identify practices at your work places which seem

unethical.