Concepts and Definitions
Ethics is a branch of philosophy dealing with standards of conduct, and moral judgment. It is a system of principles concerning the actions of the providers on her/his relationships with clients, clients’ family members, other health care providers and supportive staffs, policy makers and society as a whole.
Ethics is also defined as the distinction between what ought to be and what won’t, between right or wrong, good or bad. Health care ethics pertain to how health professionals fulfill their responsibilities and provide care to clients.
Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research.
Professional Values
Values are standards for decision making that endure for significant time in one’s life. It has four parts: Thinking, Choosing, Feeling and Behaving.
When choosing between alternatives and making decisions, value system help people decide which values are most important.
Essential values and behaviors of professionals
Altruism: concern for the welfare of others
Equality: having the same rights, privileges or status
Esthetics: qualities of events, objects, services, and persons that provide satisfaction
Freedom: capacity to exercise choices with confidence
Human dignity: treating with respect regardless of background
Justice: upholding moral and legal principles
Truth: faithfulness to facts and reality
Bioethics and Autonomous Decision making
Bioethics looks at how to maintain respect for, and protection of, the individual in the areas of:
Clinicat practice: confidentiality in clinical practice and décision making
Research: informed consent in research involving human being
Policy and public Heath:priority setting and selection of interventions.
Principles of Bio-ethics
In 1978, the Belmont Report stressed the four principles which have offered a landmark in the history of modern bioethics.
AUTONOMY
Dignity
I. BENEFICENCE
Potential harm = potential good
III. NON MALEFICIENCE
Do no harm
IV. JUSTICE (AND EQUITY)
AUTONOMY
Refers to a subject’s right to make their own decisions
Demands the obligation from providers to deliver clear, concise, true, comprehensive information in a confidential way;
In the health care, respecting adolescents and youth autonomy includes obtaining informed consent for treatment; facilitating and supporting patients’ choices regarding treatment options; allowing patients to refuse treatments; disclosing comprehensive and truthful information, assessment, diagnoses, and treatment options to patients; and maintaining privacy and confidentiality
I. BENEFICENCE
Beneficence means people take actions to benefit and promote the welfare of other people.
Consists of performing deeds of mercy, kindness, friendship, charity and the like.
Because of professional standards and social contracts, health service providers have a responsibility to be beneficent in their work. Health-care information and services should benefit the adolescent and youth by improving their well-beings.
III. NON MALEFICIENCE
. Aims to protect clients from harm
It stresses the Hippocratic principle of “primum non nocere” (first do no harm)
Non-maleficence requires intentional avoidance of actions that cause harm which means the health care provider commits himself to relieve suffering and pain.
The ultimate goal is to increase the benefits and minimize the risks linked with any intervention
4. Justice/Equity
Ensure for individuals a fair share of social and medical resources Such that individuals are free to make effective and autonomous judgments in living their lives.
Ensure that the policies and public health interventions don’t encourage social inequities or exclusion of certain groups.
Additional Principles
Applying bioethics to other contexts than that of research (e.g. clinical care and public health) means relying on additional values, such as: Dignity, Integrity, Solidarity, Participation, Vulnerability
Additional protection should be given to those who are vulnerable (children, women, disabled, prisoners)
Applications of Bioethics and Ethical Guidelines
The application of ethical guidelines is strongly linked with the legal framework.
The concept of competence, confidentiality and informed consent should be considered for people who are under the age of majority, as often times there are conflicts with the law, and ethics.
Age Concept
Age of “majority” is the threshold of adulthood as it is conceptualized in law. Chronological moment when children legally take control of themselves.
In Ethiopia is 18 years old and above
Mature Minors – is a concept relevant in some countries where underage minors are given adult responsibilities.
Age of “license” is the age at which the law permits an individual to perform specific acts and exercise certain rights: Allowed to vote, Enter into legally biding contracts, Operate a motor vehicle, purchase or consume alcoholic beverages, Can engage in relationship and marriage.
Dealing with conflicts and Ethical dilemmas
Bio-ethics works ultimately to benefit, or minimize the damage not to harm.
However, in practice, health-care providers may encounter conflict of interests of several stakeholders, patients, and other factors. For instance when should an HIV+ve orphaned boy be informed his status? should he start dating?, if he has already started when should he tell? Can a chronically sick adolescent request for euthanasia?
An ethical dilemma is a situation in which an individual is compelled to choose between two actions that will affect the welfare of a sentient being, and both actions are reasonably justified as being good, neither action is readily justified as being good, or the goodness of the actions is uncertain. One action must be chosen.
Dilemmas and conflicts should be viewed through the lenses called the three C’s: consent, confidentiality and competence (autonomous decision making capacity).
These are Important in deciding;
When can you break confidentiality?
Who decides what is in the best interest of the child?
The young person himself?
Parents? Social workers?
When can an adolescent (15?) decide not to be treated?
Anorexia? Cancer treatment?
Informed consent
An individual who is considered competent has the right to make his/her own decisions about any health intervention that involves him/her Such as: A laboratory test,(a young person has the right to give informed consent to HIV test at age 14, being prescribed a medication, or ), Undergoing surgery, etc
An individual who is NOT considered competent still has the right to be informed of interventions
Such information should be adapted to his level of understanding, But he cannot say no if the intervention is in his best benefit such as A laboratory test, Being prescribed medication, or Undergoing surgery etc
Confidentiality
Confidentiality in healthcare ethics is respecting the privacy of information revealed by a patient to his or her health care provider, as well the limitation of healthcare providers to disclose information to a third party.
Any ‘competent’ person has the right to demand that his/her physician/health care provider does not disclose any information, Unless he/she has been given express permission to do so by the client.
Evaluating Competence: autonomous decision making capacity
Competence refers to the fact that a person is able to understand the situation that requires a decision
All individuals who have attained their majority are considered competent unless they suffer from major psychiatric disturbances.
there are competent adolescents who have not reached their majority.
Assessing competence
In assessing competency, these four conditions must be considered:
Understanding the disclosed information about the nature of the decision and the procedure,
Appreciation of the effects of treatment (or failure of treatment) on one’s actual/future health,
Ability of reasoning in the process of deciding about the treatment, with a focus on abilities to compare alternatives in the light of their consequence
Expressing a choice about participation
Summary of Steps to address ethical dilemma and autonomous decision making:
Define the ethical dilemma
Identify contributing factors, e.g., legal framework, medical facts
Identify main stakeholders involved
Checkout that adolescent fully understands the issues by asking him to rephrase the information which has been presented
Explore with him/her the medical and non-medical consequences of each option
Discuss the advantage and disadvantages linked to each option
Discuss different ethical values involved
Discuss which are the best options for the client with him/her and if possible, with stakeholders
Final decision depends on the result of the competence assessment, and this decision is often negotiated. If she/he is judged totally competent then the decision depends on her/him with the support of service provider. However, if she/he is not judged competent, then the decision depends on the service provider and parent/guardians.
Motivated, competent and compassionate (MCC) HEALTH WORKFORCE to adolescents and youth HEALTH
1. MOTIVATION
The word “motivation” comes from the Latin verb ‘motive’ meaning “to move”.
Motivation in the work context is typically defined as the willingness to exert and maintain an effort towards organizational goals.
A motive is a reason for doing something concerned with the strength and direction of behavior and factors that influence people to behave in certain ways.
The three components of motivation are:
Direction – what a person is trying to do.
Effort /intensity/– how hard a person is trying?
Persistence – how long a person keeps on trying?
2. COMPETENT
Competence is defined as the “condition of being capable” or “ability” and having “a specific range of skill, knowledge, or ability”.
Health Work Force(HWF) competencies is defined as the essential complex knowledge based acts that combine and mobilize knowledge, skills, and attitudes with the existing and available resources to ensure safe and quality outcomes for patients and populations.
3. COMPASSIONATE
the term "compassion" comes from the Latin word "compati," which means "to suffer with."
Compassion is defined as a feeling or character that promotes warmth, compassion, empathy, love and belongingness among individuals, service providers, and the community, and it is critical for the delivery of high-quality, ethically acceptable health care.
What is Motivated Competent and Compassionate (MCC) mean?
MCC refers to ensuring availability of an adequate number and mix of quality health workforce that are Motivated, Competent and Compassionate (MCC) to provide quality health service.
Creating motivated, competent and compassionate health workforce depends on several but inter-related factors including: well-regulated, high-quality pre-service education, in-service training, and CPD to build the required number of well-qualified professionals and managers; fair recruitment, selection, orientation, and placement; and creation of an enabling work environment with clear roles and responsibilities etc.
Attributes of compassionate care
1. Motivation
Motivation is the fundamental component that shapes compassions other attributes. Individuals who are motivated to help others rather than having ego-focused goals have better social relationships, less conflict and greater wellbeing.
2. Sensitivity
It is the capacity to be sensitive and to maintain open attention, enabling us to notice when other need help. It is the opposite of ‘turning blind eye’ or being too pre –occupied to be able to notice- or too aware that one doesn’t have time to notice’ and so gradually one doesn’t notice.
3. Sympathy
Sympathy is an emotional response to distress.
It is the sort of ‘emotional connectedness’ that happens when we see a child who is playing happily falling over and hurting themselves.
The spontaneous feeling of being moved to help would be familiar to most of us. Therefore, sympathy is linked to sensitivity plus an urge to relieve suffering.
4. Distress tolerance
It is our ability to bear difficult emotions both within ourselves and others.
People who feel overwhelmed by another’s distress may feel psychologically unable to face it and so have to turn away. Alternatively, because the suffering feels too distressing, they have to act as rescuers under compulsion to turn off the others distress as fast as possible.
5. Empathy
It is both emotional (affective) as well as cognitive (thinking) components. It necessitates not just the ability to perceive another person's feelings, motivations, and intentions, but also the ability to comprehend their sentiments and our own emotional responses.
6. Non-condemning and non-judging
It entails not passing judgment on a person's suffering or grief, but rather accepting and validating it. Compassion also entails being nonjudgmental, as in not passing judgment.
SUMMARY
Health care ethics pertain to how health professionals fulfill their responsibilities and provide care to clients following four principles [Respect (Autonomy & Dignity), beneficence, nonmaleficence, justice/equity]
Young people are quite explicit about what they want from health-care providers, hence competence in terms of knowledge, attitude and skills on how to deal with them is very crucial
For this purpose, the provision of compassionate care is very essential
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