Code of ethics in health education
Outline:
] Introduction:
With the increasing number of wellness and health
promotion programs appearing in hospitals, clinics, industry. business ,
schools, and the community, it seems an appropriate time to address ethical
concerns relating to health promotion programs. We can’t say that an action is
good or bad without a base of ethics we have to focus on a point that ethics do
not conflict with freedom and here we mean individual freedom, because freedom
doesn’t mean to act as we please, it is the freedom to act morally and on the
base of ethics. Health educators, nurses, medical personnel, and psychologists
are often involved in programs dealing with health promotion and behavior
change leading to more positive health practices.
] Definitions
of basic ethical concepts:
ü Ethics:
· Is a branch of
philosophy that’s concerned with the study of principles that govern human
behavior in our social world.
· The principles
of conduct governing one’s ethical relationship with others.
Or
· It’s the
science of study of moral and activity in the academic context that concerned
with the formulation of rules that defining what is right or wrong.
ü Nursing Ethics:
· It refers to
all kinds of ethical and bioethics issues from the perspective of
nursing theory and practice (john stone 1999).
ü Least Harm:
· When you must
choose between evils, choose the least evil.
ü Consistency:
· Moral reasons,
including moral actions, if they are valid, are binding on all people at all
times in all places given the same relevant circumstances.
ü Morals
· Modes of
conduct that are taught and accepted as embodying principles of right and good.
ü Morality
· The rules and
guidelines, the mores, which an individual or a group has about what is right
or wrong, good or evil.
ü Values
· Those qualities
of behavior, thought, and character that society regards as being intrinsically
good, having desirable results, and worthy of emulation by others.
ü Value System
· The ways in
which we organize, rank, prioritize, and make decisions based on our values.
ü Ethical Conflict
· When two
ethical principles enforce opposite results in the same situation, this is an
ethical conflict. Solving ethical conflicts may require establishing a
hierarchy or priority of ethical principles, or examining the situation through
another ethical system.
ü Ethical Dilemma
· This is an
ethical problem in which the ethical choice involves ignoring a powerful
non-ethical consideration. Do the right thing, but lose your job, a friend, a
lover, or an opportunity for advancement.
· Is a situation
in which choice has to be made between two alternatives that both are
undesirable.
ü Law
· They are
man-made rules of social conduct that protect society and are based on concern
about fairness and they are enforced by police equally to all people to protect
the right of the public
ü Right
· It is the claim
that’s owned to individual on legal or ethical basic and it extend to include
privilege concessions and freedoms.
ü Respect for persons
· The duty to
honor others, their rights, and their responsibilities. Showing respect others
implies that we do not treat them as a mere means to our end.
ü Equality
· The duty to
view all people as moral equals.
ü Advocacy
· Advocacy is
frequently defined as the active support of an important cause (Fry 1995). In a legal context, the term 'advocacy'
refers to the defense of basic humor.
· Rights on
behalf of those who cannot speak for themselves (Annas 1974).
For example, some hospitals in developed countries employ patient advocates to
defend the rights of very ill patients who cannot voice their concerns or
choices.
q Ethical principles
] Principle of Non-maleficence.
] Principle of Confidentiality.
] Principle of Fidelity.
] Principle of human
dignity.
] Principle of informed
consent.
] Principle of religious
freedom.
] Principle of integrity
and totality.
q Principle of Autonomy:
-
Autonomy means that the patients are able to make independent
decisions. This means that nurses should be sure patients have all of the
needed information that is required to make a decision about their medical care
and are educated. The nurses do not influence the patient’s choice. Examples of
nurses demonstrating this include obtaining informed consent from the patient
for treatment, accepting the situation when a patient refuses a medication, and
maintaining confidentiality.
ü Respect for autonomy is a principle frequently
associated with a number of different concepts, including:
■
Privacy.
■
Voluntariness.
■
Self-mastery.
■
Free choice.
■
Choosing
one's own moral position.
■ Accepting responsibility for one's own
(Faden and Beauchamp 1986).
ü Autonomy is the
duty to maximize the individual's right to make his or her own decisions.
ü The word
autonomy literally means self-governing, having the freedom to make choices and
decisions free from lies, restraint or coercion about personal goals that
affect one's life.
q
Concept of autonomy contain "4" basic
elements which are:
1. The autonomous
person is respected.
2. The autonomous
person must be able to
determine personal goals,
E.g. Patient with an ankle injury may have a goal to
return to athletic play within "2"
weeks of the injury or may simply wish to
be pain free.
3. The autonomous
person has the capacity to decide on a plan of action.
ü The person must
be able to understand the meaning of choice to be made and deliberate of the
various options, while understanding the implications of possible outcomes
ü When we believe
that a patient isn't able to comprehend the meaning of choices, goals, or
outcomes, we say that the person is incompetent to make decisions or lacks
decision making capacity.
ü There are
certain groups of patients that are generally thought of as unable to make
informed choices. Children, fetuses, and the mentally impaired are among these
groups.
4. The autonomous
person has the freedom to act upon the choices.
ü In situations
where persons are capable of formulating goals, understanding various options,
and making decisions, yet are not free to implement their plans, autonomy is
either limited or absent.
ü Autonomy may be
limited in situations where the means to accomplish autonomously devised plans
don't exist.
E.g.
poor person may choose to have a pancreas transplant in lieu of insulin injection, but
doesn't have the financial means to meet this goal.
ü Beneficence is the duty to go good both individually
and for all.
ü Beneficence is
that requires nurses to act in ways that benefit patients.
Nurses are obligated to act beneficently;
beneficent acts are morally and legally demanded by our professional role. (Beauchamp&
Walters, 2002)
ý
Beneficence has "3"
major components which are:
1. Do
or promote well :
E.g. consider a case of a patient who is in the
process of a painful, terminal illness. There are those who believe that life
is a sacred and should be preserved at all costs, other believes that death is
preferable to a life of pain and dependence.
2. Prevent
harm :
In
fact, some believe that doing no harm, and preventing or moving harm is more
imperative than doing good. All codes of nursing ethics require us to prevent
or remove harm. "The nurse must be alert to and take appropriate action
regarding any impaired practice by any member of health care team or health
care system.
3. Remove
harm:
· Expressing
concern to the person carrying out the questionable practice.
·
Reporting the practice to the appropriate
authority within the institution and if not concerned, reporting the problem to
other appropriate authorities such as practice committees of the patient
professional organization.
q Principle of Non maleficence:
-
This
means that nurses must do no harm intentionally. Nurses must provide a standard
of care which avoiding risk or minimizing it, as it relates to medical
competence. An example of nurses demonstrating this principle includes avoiding
negligent care of a patient., This harm may be physical, emotional, social or
economic
(Burns and Grove 1995).
For example:
· Sticking a
child with needle for the purpose of causing pain bad, there is no benefit.
q Principle of Veracity:
Telling the truth
(patient's bill of rights)
· Truth fullness
is widely accepted as a universal virtue.
· Nursing
literature promotes honesty as a virtue and truth telling as an important
function of nurse (John Staurt, Mill).
· As related to
nurse: telling the truth provides meaningful communication and building of
therapeutic nurse patient- relationship.
· Violating the
principle of veracity shows lack of respect.
· Manipulating
information for the purpose of controlling other is like using coercion to
control them. (Jameton.1984). In essence this keeps them from participating in
decisions
q Principle of Confidentiality:
· Respect privacy
of information and action.
· The term
confidentiality and privacy are interrelated.
Privacy: refer to the right of an individual to control
the personal information.
Privacy:
is a fundamental right of individual (O'keefe 2001).
Confidentiality requires that one maintain the privacy of
another.
o
The nurse holds in confident personal
information and uses judgment in sharing this information necessary to provide
patient care.
o
The ability to maintain privacy in one's life
is an expression of autonomy and the capacity to choose what other knows about
us.
q Privacy is a value of personal autonomy:
To take this value of privacy seriously is to
subscribe to a number of familiar precepts:
1.
We should be reluctant to pry.
2.
We should respect personal confidences.
3.
When we enter into relationship earth others
that render us to sensitive or intimate personal information.
4.
We should be careful about passing this
information on, even in the absence of any specific request, not to do so.
Maintaining confidentiality of patient is an expression of respect for
persons and is essential to the nurse patient relationship.
· Treat all
fairly, distributing the risks and benefits equally.
· Distribute
justice focus on services.
· There is a finite
supple of services and it's impossible for all people to have everything they
might want or need.
ý Levels
of distributive justice:
1.
Government is responsible for deciding policy
about broad public health access issues, such as children's immunization and
Medicare for the elderly.
2.
Institutional level :( hospital organization).
·
Who will occupy intensive care bed?
·
Which type of patient will be accepted in
emergency room?
3.
Nurse and other health providers, frequently
make decision of distributive justice e.g. having assessed the need of patient,
the nurse decide how best to allocate their time.
The ethical
principle relates to the concept of faithfulness and practice of keeping
promises.
·
Fidelity relates to loyalty within the nurse-patient
relationship.
·
Fidelity is the core stone of a trusting
nurse-patient relationship.
·
In every case, harmful consequences of the
promised action should be weighed against the benefits of keeping the
promise.
q Principle of Human dignity:
· The intrinsic
worth that inheres in every human being.
· Human dignity
is the conceptual basis for human rights.
While providing the foundation for many normative claims, one direct normative
implication of human dignity is that every human being should be acknowledged
as an inherently valuable member of the human community and as a unique
expression of life, with an integrated bodily and spiritual nature.
· In Islam as in
the order religious traditions, human rights are concerned with the dignity of
the individual, the level of self-esteem that secures personal identity and
promote human community.
· The religion of
Islam establishes a social order designed to enlarge freedom, justice and
opportunity for the perfectibility of human beings.
· Other
perspectives, both religious and secular, may conceive of human dignity in
similar terms with a similar sense of its inherent worth or value and other
implications, but may posit different sources for that dignity.
q Principle of Informed consent:
· It is the right
and responsibility of every competent
individual to advance his or her own welfare.
· This right and
responsibility is exercised by freely and voluntarily consenting or refusing
consent to recommended medical procedures, based on a sufficient knowledge of
the benefits, burdens, and risks involved.
· The ability to
give informed consent depends on:
1) Adequate disclosure
of information.
2) Patient freedom
of choice.
3) Patient comprehension
of information.
4) Patient capacity for
decision-making.
· By meeting
these four requirements, three necessary conditions are satisfied:
1) That the individual’s decision is
voluntary.
2) That this decision is made with an appropriate
understanding of the
circumstances.
3) That the patient’s choice is deliberate
insofar as the patient has carefully
considered all of the expected benefits,
burdens, risks and reasonable alternatives.
· Legally, adequate
disclosure includes information concerning the following:
1) Diagnosis.
2) Nature and
purpose of treatment.
3) Risks of
treatment.
4) Treatment
alternatives.
q Principle of Integrity and Totality:
· These
principles dictate that the well-being of the whole person must be taken into
account in deciding about any therapeutic intervention or use of technology.
· Therapeutic
procedures that are likely to cause harm or undesirable side effects can be
justified only by a proportionate benefit
to the patient.
· "Integrity" refers to each individual’s duty to
"preserve a view of the whole human person in which the values of the
intellect, will, conscience, and fraternity are pre-eminent.
· "Totality" refers to the duty to preserve intact the
physical component of the integrated bodily and spiritual nature of human life,
whereby every part of the human body "exists for the sake of the whole as
the imperfect for the sake of the perfect.
q Principle of Religious freedom:
· All persons
have a right to religious freedom, which has its foundation in human dignity.
· This principle
implies that competent
individuals should never be forced to act in a manner contrary to their
religious beliefs and that they have the right to refuse participation in any
treatment or procedure that is contrary to their conscience,
nor should they be restrained from acting in accordance with their own beliefs,
within due limits.
· This principle applies equally to patients,
physicians, nurses and others who work in any health care facility.
] Code
of Ethics for the Health Education Profession
§ The Code of
Ethics :
·
The American
Speech-Language-Hearing Association (ASHA; hereafter, also known as “The
Association”) has been committed to a framework of common principles and
standards of practice since ASHA’s inception in 1925. This commitment was
formalized in 1952 as the Association’s first Code of Ethics.
Ø
is grounded in fundamental ethical principles
that underlie all health care services: respect for autonomy, promotion of
social justice, active promotion of good, and avoidance of harm which is :
1:
Responsibility to the Public
·
A Health Educator's ultimate responsibility is
to educate people for the purpose of promoting, maintaining, and improving
individual, family, and community health.
·
Health Educators support the right of
individuals to make informed decisions regarding health, as long as such
decisions pose no threat to the health of others.
· Health
Educators accurately communicate the potential benefits and consequences of the
services and programs with which they are associated.
2:
Responsibility to the Profession
- Health Educators maintain, improve, and expand their
professional competence through continued study and education; membership,
participation, and leadership in professional organizations; and
involvement in issues related to the health of the public.
- Health Educators model and encourage nondiscriminatory
standards of behavior in their interactions with others.
- Health Educators contribute to the
development of the profession by sharing the processes and outcomes of
their work.
3:Responsibility to Employers
·
Health Educators recognize the boundaries of
their professional competence and are accountable for their professional
activities and actions.
·
Health Educators accurately represent their
qualifications and the qualifications of others whom they recommend.
·
Health Educators use appropriate standards,
theories, and guidelines as criteria when carrying out their professional
responsibilities.
·
Health Educators maintain competence in their
areas of professional practice.
4:
Responsibility in the Delivery of Health Education
·
Health Educators promote integrity in the
delivery of health education. They respect the rights, dignity,
confidentiality, and worth of all people by adapting strategies and methods to
the needs of diverse populations and communities.
·
Health Educators are sensitive to social and
cultural diversity and are in accord with the law, when planning and
implementing programs.
·
Health Educators communicate the potential
outcomes of proposed services, strategies, and pending decisions to all
individuals who will be affected.
5: Responsibility in Research and Evaluation
·
Health Educators support principles and
practices of research and evaluation that do no harm to individuals, groups,
society, or the environment.
·
Health Educators ensure that participation in
research is voluntary and is based upon the informed consent of the
participants.
·
Health Educators respect the privacy, rights,
and dignity of research participants, and honor commitments made to those
participants.
6: Responsibility
in Professional Preparation
- Health Educators select
students for professional preparation programs based upon equal
opportunity for all, and the individual=s academic performance, abilities,
and potential contribution to the profession and the public's health.
- Health Educators strive
to make the educational environment and culture conducive to the health of
all involved, and free from sexual harassment and all forms of
discrimination.
- Health Educators
provide adequate supervision and meaningful opportunities for the
professional development of learners.
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