M103/Professional Growth and Development

Second semester 2017-2018

Fundamentals of Ethics

Ethics

 Greek word “ethos” which means “a characteristic way of acting.”

 The study of standards of conduct and the moral judgment and values upon wich these standards are based.
(Cafferty)
 Rules of conduct recognize in respect to a particular group such as midwifery ethics.
 The study of Ethics was the study of excellence or the virtues of character. (Aristotle)
 It is defined as the principle of right or good conduct (Notter and Spalding 1976)
 It is a science of the morality of human behavior, both of the human acts and the acts of man ( De la Torre)
 Human Acts- are actions that involves the use of free will and intellect, these are actions performed
with the use of reason.
-It is performed consciously and knowingly.
 Acts of man- are action that does not involve the use of intellect and freewill, these are actions done
unconsciously and without reason.
-It is performed unknowingly and unconsciously.
 It is the philosophical study of voluntary human acts with the purpose of determining what is good, right and to be
done and what is bad, wrong and not to be done
 It is the study or practice of the “good life”, the kind of life people ought to live.

Function of Ethics

 Ethics teaches us to distinguish what is right from what is wrong.

 Help us to make sound judgment and decision.
 Ethics helps us to realize what is good for us by helping us to make correct decision and actions in different
situations in life.
 Teaches how good man can be.

Profession

 Is a occupation or calling requiring advanced training and experience in some specific or specialized body of
knowledge which provides advice to society in that special field.
 An occupation that properly involves a liberal education and its equivalent, and mental rather than manual
labor.
 A calling in which the members profess to have acquired special knowledge by training on by experience, or
by both, so that they may guide or advice or serve others in that special field.
 A calling requiring a specialized knowledge and often long and intensive academic preparation to qualify its
members to render a particular type of service to the public.
 It is committed to serve society; it is service-oriented and not profit-motivated.
 It has its own unique body of knowledge
 It is a means of employment, livelihood and occupation for its members.

Professional ethics as that branch of moral science which treats of the obligations which members of a profession owe
to the public, to the profession, to his colleagues and to his clients.

The concept of ethics has broadened to include not only the characteristics of the good person, but also the “best
practices” in various professions.

Professional ethics are basic principles of conduct or right actions that a licensed practitioner must at all times
observe and uphold in the practice of his profession.

1. Sets forth basic principles and regulations to serve as guidelines;

2. Serves as resources for the orientation for new practitioners in their duties, rights and privileges;
3. Serves as guides to identify and evaluate qualities synonymous with professional conduct;
4. Provides guidelines for the establishment and operation of educational programs to prepare future members for service
in the profession;
5. Identifies common practices to be followed and those to be shunned;
6. Provides a guide for considering the relationships of individuals with their employers, co-workers, society in general,
and to their own profession;
7. Serves as a basis for identifying standards of quality practice consisted with actions of the qualified, competent
practitioner;
8. Provides by implication, for legal action against incompetents and violators of the code and for liability of the
consequences of their actions;
9. Provides for due process under the law of practitioners unjustly accused for misconduct in the performance of their
duties.

Midwifery ethics- a system of principles governing conduct of midwives. (Robles)

The Philippine Code of Ethics for Midwives

Preamble
The principles and rules of conduct embodied in this Code are aimed at helping midwifery practitioners, as individuals and as a
professional group, to pursue and maintain a high level of ethical conduct in the practice of midwifery. These principles and rules
do not carry legal force or sanction. They are simply criteria or measure-sticks by which a midwife may properly guide herself in
her professional conduct or in her professional dealing and relationship with her patients, co-practitioners, members of allied
professions and the public at large.

Section 1

The primary objective of the midwifery profession is for its members to render service within the scope of their legitimate
functions, having in mind that their patients, of whatever religion and social or economic status deserve respect as human beings.
A midwife should endeavor to deserve the confidence of the patients under her care rendering to each of them a dedication and
service to the full extent of her skill and competence.

Section 2

A midwife should try her best to continually improve her knowledge and skill for the benefit of her patients and to share with her
co-practitioner, any valuable or practical knowledge she may have gained by experience in the practice of her profession.

Section 3

A midwife is expected to practice midwifery on a scientific basis and not to voluntarily take part in the performance of any
midwifery procedure which is doubtful or questionable propriety, from a standpoint of medical or scientific knowledge.

Section 4

The midwifery profession should contribute to the safeguarding of the public health and should respect itself against the
admission into its membership of midwives deficient in professional competence and requisite moral character. It is incumbent
upon every midwifery practitioner to observe the law, to uphold the honor and dignity of her profession, and to adhere faithfully
to professional discipline. It is the professional duty of every midwife to bring to the attention of the proper authority, through
legitimate procedure the illegal or unethical conduct of any co-member of the midwifery profession, without bias or personal
animosity, but solely for the good name of the profession and for public interest and welfare.

Section 5

A midwife who is accepted to take care of a patient should render service to the patient to the best of her ability. She should not
neglect the patient under any circumstances within her control.

Section 6

A midwife should not compromise her services to the patient under terms or condition which would interfere with or hamper the
exercise of her judgment or skills, or which would harm the quality of patient care.

Section 7

In the practice of midwifery, a midwife must confine the source of her professional income to the midwifery services she has
actually rendered. Her fees should be commensurate with the services performed and, if need be, with the patient’s ability to pay.
It is highly improper for midwifery improper for a midwifery practitioner, presumed to be guided in her professional conduct by
this Code, to pay or receive a commission for referral of patients made to or by her.

Section 8

A midwife’s legitimate function cover performance of midwifery services only to normal pregnant women and normal newborn
infants. Accordingly, in a doubtful or difficult care, she should seek consultation or refer such case to a qualified obstetrician or
physician. She should not persist in handling the case and thereby risk herself to liability for any injury that may arise.

Section 9

A midwife is bound by professional ethics not to reveal any information given by her patient in the courses of the patient’s care
or treatment, whether such information is addressed to her or to the attending physician, unless under the law, she is required to
testify on such information to serve the end of justice.

Section 10

The ideals of services envisioned by the midwifery profession call for a dedication of the midwife’s responsibilities not only to
the individual patients but also to the community in which she practices, to the end that she may be able to contribute to the
improvement of the health of the patients and to the health and well-being of the community.

Section 11

A midwife should participate in research activities or in any effort of the midwifery practitioner to improve training and practice,
and to take part in establishing and maintaining conditions of employment conducive to high quality of maternity and infant care.

Section 12

As a member of a health team, a midwife should work with interest and concern, together with other members of the health team,
in promoting efforts to meet he health needs of the public.

Guiding Principles in the Practice of Midwifery

Ethical principles are derived from ethical theories. Important ethical principles used in health care include:
  Respect for individuals
 Autonomy  Confidentiality
 Non maleficence  Fidelity
 Beneficence  Veracity
 Justice
Principle of Respect for Individuals

-is fundamental to recognition of the autonomy of individuals as it incorporates ethical convictions that individuals
should be treated as autonomous agent, and that person with diminished autonomy are entitled to protection. (Belmont Report,
1979)

Principle of autonomy

-“individuals are to be permitted personal liberty to determine their own actions” (Fowler and Fry, 1988)

Characteristics of Autonomy

1. Autonomy as free action

-to be considered a free action, it must be the intentional and conscious choice of the person.
Right to free action is violated by any suggestion of coercion, duress, undue influence or withholding of
information.
2. Autonomy as authenticity
-the action of the individual is consistent with his attitude, values, disposition, and life plans.
-the decision is aligned with his past usual pattern of behavior and their motivation.
-Inauthentic action is unusual or unexpected and has no apparent or preferred explanation.

3. Autonomy as effective deliberation

-pertains to action that is done only after giving it clear thought, giving proper considerations to the
alternatives and their consequences.

-an action is considered an effective deliberation when all information is available.

-the action is non-effective when all the information is not known to the person when his deliberation of the
alternatives is inconsistent with his values and priorities or when he has not fully understood the alternatives and
consequences

4. Autonomy as moral reflection

-The deepest and most demanding sense of autonomy.

-it involves a deeper level of self-introspection which involves the ability for rigorous self analysis,
awareness of alternative set of values, commitment to a method of assessing them and an ability to put them
in place.

Application of Autonomy in Health Care and Ethics

1. Informed consent
 Seek valid consent because the consenting party is an autonomous person.
 The primary task of the midwives or other health care providers is to inform the patient or the
persons responsible for the patient all the information there is about the options available including
their cost, procedure, benefits and risks and it is the patient and his family who shall make their
own voluntary choice and decision.

*Note: it must also be remembered that autonomy is not absolute for the law has set forth certain limitation.

2. Paternalism/ Parentalism

 Acting in a fatherly manner which involves engaging in behaviors associated with those of the
traditional roles of the father of a family such as leadership, decision-making, discipline and protection.
 In health care, the concepts of paternalism is applied when health care givers, especially physicians,
assume the authority to make decisions for the patients
 Paternalism is justified only to prevent harm to the patient.

3. Standard of Best Interest

 Pertain to health care providers making discussion about a client’s health care when they are unable
to make informed decision about their own care. In this situation, the health care provider must
decide what the best course of action for the patient is and carry it out.

Justification for overriding of Autonomy

1. Harm Principle
2. Offense Principle
3. Principles of Paternalism
4. Principle of extreme Paternalism
5. Principle of Legal Moralism
6. Social welfare Principle

The principles of justice

 Provides the obligation to be fair to all.

  This requires that social benefits and social burdens be distributed in accordance with the demands
of justice.

Justice

 Involves giving to each that which is his due. (Aristotle)

 Ethical principle can be examined in terms of fairness, desert, and entitlement. (Johnstone)
 Justice as fairness in terms if impartially
 When the principle of justice is expanded to “distributive justice”, it means that every person has the right to
be treated equally regardless of sex, race, marital status, medical diagnosis, social standing, economic level or
religious belief.

Different guidelines

1. To each person an equal share.

2. To each person according to need.
3. To each person according to contribution.
4. To each person according to free-market exchanges.
5. To each person according to merit.
6. To each person according to effort.

The Principle of Beneficence

 Demands that above all, and individual should do only good and contribute to the welfare of other.
 The principle is one of the oldest requirements of health care providers which illustrate primary role of doing
well for the client or patient under care.
 The goal of health care providers should be that which would benefit the patient ,as well as to take positive
slips to prevent and to remove harm from the patient.
 These goals applied both to individual patient and to the good of society as a whole
 This duty as beneficence becomes complex if two patients appeal for treatment at the same movement.

The Principles of Non maleficence

 Is based on a person’s rigorous obligation to avoid ensuring another individual.

 This principle obliges health care providers to DO NO HARM.
 An extension of this principle is the obligations of health care providers from harm those who cannot protect
themselves such as children, mentally incompetent and unconscious patients.
 This principle may justly be violated in some medical situation.

Confidentiality – or professional secrecy is both a legal and moral obligation of health care providers to their client means all
information gathered about the patient in the course as his health care by a health care professional should be safeguarded from
others, or should be a secret between the professionals involved in the patients health care and the patients.

3 classes of confidentiality

1. Natural secret –these are secrets which must remain hidden even if there is no obligation or promise to
keep it that way, for the revelation of it could harm the individual or society.
2. Promised secret – these are secrets that a person confides to another in exchange of a promise not to
reveal it to others. The commitment of the person entrusted the secret was gained after the secret was
known to that person.
3. Confided secret- these secrets are confided to another person only after that person has made the
commitment that it will not be made known to others.

Persons required to observed confidentiality

1. Physicians who deal with the patient even for a briefest time at various phases of the patient illness or treatment.
2. Pharmacist who prepares and dispenses the medication prescribed to the patient.
3. All other health care professionals involved in the care of the patients.
4. All other personnel who attended to the care of the patients.

When confidentiality may end

1. After the patient gives his consent to reveal information about him or his health care.
2. When its revelation is for the common good.

Fidelity

 Refers to the obligation of a person to be faithful to agreement, commitments and responsibilities that he has made to
himself and to others.
 It is the main principles that support the concept of accountability of midwives to patients and employers.

Veracity

 Refers to principles of truthfulness

In midwifery- veracity is applied in the midwife responsibility never to lead or cheat a patient.