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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