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Ethics for Midwives Ethical Theories Ethical theories attempt to provide a system of principles and rules for resolving ethical dilemmas. Ethical theories consist of fundamental beliefs about what is morally right or wrong and propose reasons for maintaining these beliefs. Ethical theories provide the bases for professional codes of ethics. DEONTOLOGY Deontology is a theory of ethical decision making based on the discovery and confirmation of a set of morals or rules that govern the resolution of ethical dilemmas. The source of duty is the concept of autonomy and rational will Deontology attempts to determine what is right or wrong based on one's duty or obligation to act rather on the action's consequences. There are many kinds of deontological theory e.g., The 'Golden Rule‘ "Do unto others as you'd have them do unto you.” The most significant thing to understand about deontological moral systems is that their moral principles are completely separated from any consequences which following those principles might have. Because it emphasizes duty or obligation to another person, Deontology is the acceptable theory for ethical decision making in health care Any act in accord with one's duty or obligation is right. Thus, if you have a moral duty not to lie, then lying is always wrong - even if that results in harm to others. Limitations: Duties or obligations may conflict, requiring decision about which duty or obligation takes precedence over another. Questions commonly arise about the origin of a duty or obligation. Such as " who determined the duty?" Or " who identified the obligation?” Deontology can be inflexible. The problem with Deontology is that there is no consensus regarding a list of duties, or how to respond when two or more duties clash Teleology The word teleology comes from the Greek roots telos, which means end, and logos, which means science. Thus, teleology is the "science of ends. Teleological moral systems are characterized primarily by a focus on the consequences which any action might have (consequentalist moral systems) Thus, in order to make correct moral choices, we have to have some understanding of what will result from our choices. The central aim is the premise of 'maximizing the greatest good for the greatest number'. The 'good' referred to can be expressed in a variety of ways and may refer to values or 'utility' such as happiness, being pain or symptom free or another life enhancing outcome. In other words, judge an action by the total amount of happiness and unhappiness it creates It is the consequences, not the acts, that are right or wrong (the ends justify the means) Types of teleogical ethical theory Ethical Egoism an action is morally right if the consequences of the action are more favorable than unfavorable only to the moral agent performing the action. Ethical Altruism an action is morally right if the consequences of the action are more favorable than unfavorable to everyone except the moral agent. Ethical Utilitarianis an action is morally right if the consequences of the action are more favorable than unfavorable to everyone. 10 Application of Utilitarian Theory You attempt to help an elderly man across the street. He gets across safely. Conclusion The Act was a good act. Application of Utilitarian Theory You attempt to help an elderly man across the street. You stumble as you go, he is knocked into the path of a car, and is hurt. Conclusion The Act was a bad act. Limitations 1. Requires definition of good 2. Requires computation of amount of good 3. Places public good over private good (ignore individual) 4. Possible harmful to minorities and individuals, sacrificed for the majority 5. Difficult to predict the consequences of an action It is the consequences, not the acts, that are right or wrong (the ends justify the means) How do we decide which theory to use? In order to obtain complete understanding of a problem, it’s best to analyze the situation using multiple ethical theory rights and duty ethics should take precedence over utilitarian consideration because the right of individual should receive stronger weight than the need of the society as a whole. 14 Ethical Terms Values Concepts or ideals that give meaning to the life and provide frame work for decisions and action. Morals Standard of right and wrong learned by socialization and based on religious beliefs. Ethical code A written list of professions values plus standards of conduct. Statement of etiquette Describe expected professional behaviors established in ethical codes. 15 Laws Rules of social conduct designed to prevent the actions of infringing on the right of others. Rights Entitlements that one deserves according to just claims, legal guarantee, or moral law or principles. Ethical dilemma Situation requires a choice between two equally unfavorable alternatives (moral imperative). 16 Accountability Answerability for your practice and responsibility for your actions: Personal: to one self and patient. Public: to employer and society. Privacy refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual 17 Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals, being of equal value and worth irrespective of differences such as age, race, culture, gender, sexual orientation, social background, health or marital status, disability, religion or political conviction.” 18 Ethical Principles Autonomy I. Right to make decisions a bout one's health care without intimidation or influence . Never looking upon another. Woman must have all the relevant information including treatment option in language she understand 19 II. Beneficence Obligation to act in way which promote the well being of others. Midwife is obligated to do only good that is to implement action that benefit women and their support persons . 20 III. Non-maleficence: Do not harm and prevent the harm. Differs from beneficence in the sense that imposed fewer obligations.(deliberate harm, risk of harm and unintentional harm In midwifery, intentional harm is always unacceptable. 21 IV. Confidentiality Safeguarding a person’s health information from public disclosure is the foundation of trust Where the information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life. Also related to truth telling. There is a balance between people having the information required to make an autonomous decision and being distressed by the truth. 22 V. Respect For patient autonomy, dignity and liberty. VI. Veracity Obligation to tell the truth. Means the duty to be honest and avoid deceiving or misleading the woman 23 • This may cause conflict when the truth may harm the client by interfering with recovery or worsening the present condition • Avoiding truth is never justified when it is used to shield caregiver discomfort with bad news 24 VII. Altruism Protect the community & meet the health needs. VIII.Paternalism Protect the weak in the community IX . Egoism: The right to maximize personal benefits. 25 X. Fidelity Obligation to loyal for woman, newborn , family, community government, employer, midwife herself and profession midwife is obligated to be competent in performing midwifery skills and services required for safe and appropriate care through continuing education and follow code of ethics, institutional policy and laws. 26 XI. Justice • Be fair equitable to all patients • Mandates that woman be treated without discrimination according to age, race, religion, socioeconomic status, weight, marital status • Make fair decision for allocation of resources based on individual needs. Everyone should have equal distribution of goods and services 27 XII. Utilitarianism The greatest good for the greatest number. Maximize benefice or minimize harms. We have 2 approaches of moral theories: first focused upon consequences of actions (called consequence-based) and a second focused on moral duty (called duty based). utilitarian midwife does according to the first in decision making. 28 What is a Code of Ethics A code of ethics is a public declaration of the beliefs and values of a profession and the members of that profession. This code makes public the goals, values and morals of those who call themselves 'midwives' - a statement to the public about what the profession of midwifery defines as moral behavior for its practitioners. 29 Why to have a code? A code of ethics acts as a specific, identifying feature for a particular professional group, both for the professionals themselves and for the general public. In addition, the need for an explicit code has become more urgent in recent years, as an accelerated pace of social and technological change has produced situations that demand an ethical response. the increased speed and frequency of global communications have made the development of a formal statement of shared beliefs and values vital as an agreed point of departure or common language for the profession worldwide 30 ICM International Code of Ethics for Midwives Aim To improve the standard of care provided to women, babies and families throughout the world through the development, education, and appropriate utilization of the professional midwife. In keeping with its aim of women's health and focus on the midwife, the ICM sets forth the following code to guide the education, practice and research of the midwife. 31 This code acknowledges women as persons, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust, and the dignity of all members of society. 32 ICM International Code of Ethics for Midwives 1- Midwifery Relationships Autonomy and accountability of women Autonomy and 'human equalities' of women Justice/fairness in the allocation of resources Respect for human dignity Competence. Interdependence of health professionals, safety Respect for one another Moral self-respect, dignity 33 2- Practice of Midwifery Respect for others, do good, do not harm Client accountability for decisions, do not harm, safety Safety; cultural relevance Respect for human dignity, treat women as whole persons Health promotion: attain/maintain autonomy, good/no harm, allocation of resources Competence in practice . 34 ICM International Code of Ethics for Midwives cont… 3- The Professional Responsibilities of Midwives : Confidentiality Midwife accountability Midwife conscience clause: autonomy and respect of human qualities of the midwife Prevent human rights violations Health policy development: justice, do good 35 4- dvancement of Midwifery Knowledge and Practice Protect rights of women as persons Midwife accountability, safety, competence Professional responsibility: enhance competence of all professionals to do good, do not harm 36 Bills of right for women & midwives ICM calls for governments globally to recognize & support accessible and effective midwifery care as a basic human right of all women, babies and midwives. The issues for women around gender equity and access to education also extend to midwives as a womandominated profession. The Bill of Rights for Women and Midwives addresses those basic human rights of women and midwives that have been systematically denied 37 ICM believes women have a right to a midwife as the most appropriate care provider in most situations and midwives have a right to obtain adequate education, regulations to foster their practice and associations to forward their mission. the ICM believes that there should be recognition of the following as basic human rights for women and midwives across the globe; 38 Woman’s Rights Every woman has the right to receive care in childbirth from an autonomous & competent midwife Every newborn baby has the right to a healthy and well informed mother Every woman has a right to be respected as a person of value and worth Every woman has a right to security of her body 39 Every women has a right to be free from any form of discrimination Every woman has a right to up-to-date health information Every woman has a right to participate actively in decisions about her health care & to offer informed consent Every woman has a right to privacy Every woman has a right to choose the place where she gives birth 40 Midwives’ Rights Every midwife has the right to a midwifery-specific education that will enable her to develop and maintain competency as a midwife Every midwife has the right to practice on her own responsibility within the International Confederation of Midwives definition and scope of practice of a midwife 41 Every midwife has the right to be recognized, respected and supported as a health professional Midwives have the right to access a strong midwifery association that can contribute to midwifery and maternity policy and services at a national level 42 Women’s and Midwives’ Rights Midwives and women have the right to a system of regulation that will ensure a safe, competent and autonomous midwifery workforce for women and their babies. Midwives and women have the right to national midwifery workforce planning to ensure sufficient midwives to meet the needs of women and babies 43 Women and midwives have the right to be respected by governments and government institutions for health and education The midwifery profession has the right to be recognized as separate and distinct profession 44