management

1. Study Session 8
Ethical Dilemmas in
Health Service Delivery
By:Alemayehu E(BSC,MPH)
@Nekemte,Oromia,Ethiopia

2. Ethical Dilemmas in
Health Service Delivery
When you have studied this session, you should be able
to:
• Define and use correctly all of the key words printed
in bold.
• Identify the ethical dilemmas that exist in a case
study presented to
you.
• Describe two theories that can help you resolve
ethical dilemmas that may arise in your health work.
• Understand a decision making process that may be
able to help you to resolve ethical conflicts.

3. Ethical dilemmas and conflicts
• Ethical dilemmas arise when a difficult problem is seemingly
incapable of a solution that will satisfy everyone who is
involved.
• The same dilemma might occur when a situation arises that
involves a choice between equally unsatisfactory alternatives
• In ethical conflicts, the decision maker is confronted with
more than one course of action that respects personal,
professional and societal morality, but by deciding on one
course of action the other course is harmed in some way.

4. cont
• You are morally and legally obliged to keep patient
information confidential.
• At the same time, you may be required to disclose
sensitive information because breaking the rules of
confidentiality would benefit the family or the wider
community.

5. cont
• Common ethical issues
1 Practitioner-client relationship
2 Privacy and confidentiality
3 Shared decision making
4 Allocation of scarce resources
5 Stigma and illness
6 Reproductive health care

6. Privacy and confidentiality
• Confidentiality may involve more complex issues in
rural rather than urban settings.
• People who live in rural areas may well know many
of the details of each other’s lives and this intimacy
makes ethical conflicts related to privacy and
confidentiality more challenging compared to urban
settings.

7. Shared decision making
• Is a dialogue in which both client and practitioner share
information, leading to a decision regarding the client’s
health care.
• Shared decision making is based on trust, truthfulness, and
respect for the client’s choice.
• For this to be effective good communication skills are crucial.
• Example about transfer to a hospital for further treatment,
the patient might be concerned about their own issues, such
as their values, religious and cultural beliefs and finances

8. Allocation of scarce resources
• As a manager and healthcare provider in your community,
you may face ethical conflicts with regard to resource
allocation.
 Steps for decision making
1 Identify the nature of the problem.
2 Gather information and consider the possible ways to resolve
the problem.
3 Communicate openly and honestly with the community
served.

9. Stigma and illness
• Stigma is defined as a negative perception that is assigned to
an individual because of any feature that, in the view of
others, discredits and diminishes them from other people.
• The stigmatised person becomes a person who is discounted.
• In rural healthcare settings, stigma takes on special
importance because of the close relationships that exist in
small communities.

10. Reproductive health care
• During this part of your work it is essential to
develop trust with each individual and with the
community as a whole.
• This service requires appropriate levels of care,
confidentiality and truth-telling– possibly more than
any other part of the health services.

11. THANK YOU