Principles of ethics AND VIRTUE ETHICS.pptx

NOTES FOR PUBLIC HEALTH

1. PRINCIPLES OF ETHICS TUTOR PRISCILLA

2. Key Concepts in Ethics/Ethical Principles Autonomy : Is the right of self determination, independence and freedom. It refers to the patient’s/client’s right to make health care decisions for themselves, even if the HCP does not agree with those decisions. Autonomy, as with other rights, is not absolute, such that under certain conditions, limitations occur when one individual’s autonomy interferes with another individual’s right to health or well being e.g. a client can use his right to autonomy by refusing any or all treatments e.g.

3. Autonomy cont’d in case of mental illness, the individual can be forced by the health care systems to take medications or even be admitted into hospital by the health care and/or legal systems (emergency admission of some mentally sick people (Ref. Mental Health Act). This ethical concept is related to the concept/principle of Standard of Best Interest , which describes the type of decision made about a client’s health care when the client is unable to make the informed decision for his or her own care.

4. Autonomy cont’d The Standard of Best Interest is based on what health care providers (usually a team) and the patient’s family decide is the best for that patient. It is very important to consider the individual client/patient’s expressed wishes, either formally in a written document (such as a living will) or informally in what may have been said to family members.

5. Autonomy cont’d The Standard of Best Interest should be based on the Principle of Beneficence. Making of a unilateral decision by health care providers that disregards the client’s wishes implies that the providers alone know what is best for the client and is termed paternalism.

6. Cont’d Paternalism: Involves overriding pt’s /client’s autonomy because you think it is for their own good. In the past it was very common but now it is far less acceptable. Thus, you must have a good enough reason to do so. Justification for paternalism- good reasons for acting Paternalistically The patient is at risk of significant, preventable harm The paternalistic action will probably prevent the harm. The pt’s capacity for rational reflection is either absent or significantly impaired At a later time it can be assumed that the pt will approve of the decision taken on his/her behalf. The benefits to the pt of the intervention outweigh the risks.

7. Justice: Is the obligation to be fair to all people and is usually expanded to what is called distributive justice , which states that individuals have the right to be treated equally, regardless of race, sex, marital status, medical diagnosis, social standing, economic level or religious belief. Strategies such as affording equal access to health care for all, conform with this Ethical Principle. As with other rights, limits can be placed on justice when it interferes with the rights of others.

8. Beneficence – doing good and not harm to others (patients/clients under your care). Under this principle, the term good includes more than providing technically competent care for patients/clients. Good care requires that the HCP takes a holistic approach to the client/patient, including the client/patient’s beliefs, feelings, socio- economic circumstances and wishes, as well as those of her/his family and significant others.

9. Nonmaleficence – is the requirement that one should not do harm to another, either intentionally or unintentionally. It is the opposite of beneficence. In current health care practice, this principle is often violated in the short run to produce a greater good in the long-term treatment of a patient e.g. before tooth extraction, the patient is given a painful local anaesthetic injection, in order to carry out a painless tooth extraction or filling, which may be of longer duration .

10. Nonmaleficence cont’d It is also not unusual for a Midwife or Obstetrician to raise his/her voice for a woman in child birth in order to secure safety of the baby as she/he descends into the world. This should not be done with abusive language or physical violence.

11. Veracity – Truth telling, truthfulness. It requires the HCP to tell the truth, and not to deceive or mislead intentionally. As with other rights and obligations, limitations to this ethic exist. The primary limitation is when telling the client the truth would seriously harm (a clash with nonmaleficence) the client/patient’s ability to recover or if the truth would result into greater illness.

12. Veracity cont’d Many times, HCPs feel uncomfortable giving patients bad news and have a tendency to avoid answering their questions truthfully. This is not a good enough reason to avoid telling the clients the truth about their diagnosis, treatments or prognosis. Patients have a right to know this information

13. Fidelis – is the obligation to be faithful to commitments made to self and others. In health care, fidelity includes the professional’s faithfulness or loyalty to agreements and responsibilities accepted as part of the practice of the profession. Fidelis is the main support for the concept of accountability. Conflicts in fidelity might arise from obligations owed to different individuals or groups. E.g. A HCP who was just finishing a busy and tiring 12 hour shift may experience a conflict of fidelity between herself, the employer, the profession and clients/patients.

14. How to respect patient’s autonomy NB: There is a moral requirement to show respect for autonomy. i.e not interfering with the people without their consent. Communication: effective communication. It is the single most important way of securing your pt’s cooperation and compliance. It involves listening to patients and talking to them in a language they understand. It also involves being sensitive to and respecting cultural differences i.e beliefs, values and practices. Truthfulness: It’s an obligation for a nurse to be honest with the patient. Patients have a right to be told the truth- especially when they ask specific questions. It reflects an attitude towards another person that aims at creating an open and mutually respectful communication.

15. Cont’d iii. Voluntariness: Making decisions freely by the patient/client without being under the control of another’s influence. Thus patients sh’d not be coerced (forced) into accepting treatment they do not want. Nor sh’d they be manipulated e.g by having information withheld from them. iv. Giving information: if patients are not given accurate information, they cannot make meaningful and rational choices. A health care provider/ nurse has a moral obligation to disclose: Those facts or descriptions that pt’s usually consider material in deciding whether to refuse or consent to the proposed intervention. Information that you as a professional believe to be material Your professional recommendations The purpose of seeking consent

16. Cont’d v. Accepting patient’s Preferences: Respecting your patient’s autonomy means accepting their choices. i.e their right to decide whether or not to undergo any health care intervention, whatever the outcome

17. Conclusions to principles These principles emphasize a person’s actions and choices. However, it is broad enough to also include what is known as virtue ethics. Virtue ethics is ethics based on character. Its fundamental idea is that a person who has acquired the proper set of dispositions will do what is right when faced with a situation involving a moral choice.

18. Virtue ethics The central focus of Virtue ethics is the character of a person (rather than his/her actions). In health-care contexts, Virtue ethics is concerned with the virtues you need to be a good nurse, midwife, etc. The kind of person you ought to be and not just what you ought to do in your particular role. It is an approach that helps you know when and when to put the ethical principles to work.

19. Cardinal Virtue ethics for health care professionals Discernment: The ability to make judgement and reach decisions without being unduly influenced by such things as fears and personal attachments. Compassion: The ability to imagine yourself in someone else’s place so that you can respond sensitively and with sympathy to their misfortune. Trustworthiness: Trust rests on a confident belief that another will act with the right motives and will respect accepted moral values. Integrity: Claimed by some as the primary virtue-people with integrity act according to their beliefs and values and do not compromise themselves by acting insincerely or hypocritically. Conscientiousness: You act conscientiously if you are motivated to do what is right. It means putting effort into working out what is right.