Transcript Ethical dilemma

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.
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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.
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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.
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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).
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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
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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.”
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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
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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 .
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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.
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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.
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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
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•
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
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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.
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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.
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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
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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.
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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.
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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
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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.
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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.
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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
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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
.
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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
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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
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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
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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;
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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
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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
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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
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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
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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
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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
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