Chapter 2 Health Care Ethics ___final_revised_June__24_2017.pptx

Federal Ministry of Health
NATIONAL COMPASSIONATE,
RESPECTFUL AND CARING
TRAINING
CHAPTER TWO
HEALTH CARE ETHICS
1/29/2023
National CRC training CH-I-1

Chapter introduction
Ethics in the previous and current
health care curriculum
 Concepts of ethics and its basic
principles
Preventive ethics, ethics and law
1/29/2023
National CRC training CH-II-5

Chapter Objective
Participants will be able to
provide ethically acceptable
healthcare services
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Enabling objectives
 Discuss the basic concepts of
principles of healthcare ethics
 Describe confidentiality and informed
consents in CRC model healthcare
Identify preventive ethics as a standard
practice for the health workforce
Recognize the relationship of ethics
and law to exercise CRC
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Outline
 2.1 Principles of health care ethics
2.2 Confidentiality and informed
consent
2.3 Preventive ethics in the aspect
of CRC
2.4Ethics and law as enablers of
CRC
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Session 2.1
Definitions and principles of
health care ethics
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Session objectives
Define ethics and health care
ethics
List principles of health care ethics
Discuss each of healthcare ethics
principle
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Definitions of Ethics
and Health Care Ethics
Discussion question:
What is ethics in general, and health
care ethics in particular? ( 5 min)
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Definition of Ethics and
Health Care Ethics Continues
Ethics : derived from the Greek
word “ Ethos” meaning “ custom” or
“Character”
Ethics: is the study of morality—
careful and systematic reflection on
and analysis of moral decisions and
behavior
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Definition of Ethics
continues
Ethics can be defined as the branch
of philosophy dealing with standards
of conduct and moral judgment.
Health care ethics: a set of moral
principles, beliefs and values that
guide us in making choices about
health care.
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Principles of healthcare ethics
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What are the fundamental principles
of healthcare ethics?
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There are four fundamental
principles of healthcare ethics.
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
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Ethical principles---
Ethical principles are the
foundations of ethical analysis
They are the viewpoints from
which guidance can be obtained
along the pathway to a decision.
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Autonomy
Independent choice, self-
determination and freedom of action
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Autonomy ---
Case one
Please read and discuss the case
scenario on the participants’ manual
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Beneficence
Beneficence is “doing what is best
to the patient”.
In favor the wellbeing and interest
of the patients.
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Beneficence...
Case two:
scenario on participants’ manual
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Non-maleficence
Non-maleficence refers to “avoid
doing harm”, which can occur by
omitting or committing the care.
Always, benefit has to weigh over
harm .
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Non-maleficence…
Examples:
Nurse who carelessly delays patient’s
medication.
Laboratory technologist who carelessly
does and report wrong results.
Finance manager who carelessly delays
the procurement of drugs and equipment.
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Justice
Justice is fair handling and similar
standard of care for similar case;
fair and equitable resource
distribution among citizens.
Regardless of gender, educational,
income or any other personal
background.
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Justice…
Please read examples on the
participant manual and discuss
Case study: Refer the manual
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Summary
What are the main principles of
health care ethics?
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Thank you for your participation!
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Session 2.2
Confidentiality and Informed consent
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Session objectives
Describe confidentiality and
informed consent
Practice confidentiality and
informed consent in the healthcare
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CONFIDENTIALITY
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Confidentiality
 Confidentiality refers to the
privacy of patient’s information
Ensures patient’s respect.
 The autonomy of patient.
Trustful relationship with patient.
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Confidentiality…
All identifiable information about:
A patient’s health status,
Medical condition,
Diagnosis, prognosis and treatment
 All information's of a personal kind
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Confidentiality …
Exception to maintain confidentiality:
In health institutions
Inform the family members of a
deceased person about the cause of
death
Jurisdiction related
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Confidentiality…
Case three
Please read and discuss case
scenario on participant manual
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Confidentiality…
Confidentiality related law
Please read and discuss the
FMHACA-Council of Ministers
Regulation No 299/2013, Article 77-
professional confidentiality on
participant manual
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INFORMED CONSENT
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Informed consent
Informed consent refers to legal
document whereby a patient signs in
writing before he/she receives the
care intended.
The document with complete
information about the purpose,
benefits, risks and other alternatives
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Informed consent…
Informed consent is a body of
shared decision-making process;
not just an agreement.
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Informed consent---
For consent to be valid, it must be:
1. Voluntarily: by the person
themselves, free of influence
2. Informed: given all the necessary
information
3. Capacity: person must be capable
of giving the consent
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Informed Consent--
Informed consent has to be taken
After adequate & clear
communication
Before any medical treatment
Timing: when the patient is best able
to understand and retain the
information
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Informed consent…
Professional has to know his/her
level of practice and responsibility
Handle appropriately when patient
is incompetent to make a decision
Respect patient’s decision to
refuse treatment
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Informed consent …
Informed consent related law
Please read and discuss
EFMHACA-CoM regulation NO-
299/2013, Article 52 on participant
manual
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Informed consent and
confidentiality…
Case study 2
study on the participant manual
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Summary
What is informed consent?
What are the necessary conditions
for informed consent to be valid ?
Do we always need informed
consent?
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Session 2.3
Preventive ethics in the
aspect of CRC
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Session objectives:
At the end of this session participants will be able to
1. Explain preventive ethics and its relevance for CRC and
quality of care.
2. Identify ethical dilemmas and apply systematic ethical
case analysis.
3. Explain healthcare priority setting/rationing to handle
resource scarcity issues.
4. Identify practical support mechanisms for the
implementation of preventive ethics.
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Preventive ethics…
Definition
Preventive ethics is a systematic
application of ethical principles and
values to identify and handle ethical
dilemmas, challenges and errors
appropriately and fairly.
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Why PE in CRC-model healthcare
Engages health workforce,
patients/families and the
community at large
 Thus, enhances honesty and
transparency among stakeholders
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PE activities can be carried out by
individuals or a group on behalf of
healthcare organization.
Step-by-step analyze and
identifies the ethical quality gap
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 Predict, identify, analyze,
synthesize and manage ethical
dilemmas, challenges and errors
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Support mechanism for PE
1. Develop functional tools,
documentation, case banks,
research, monitoring and evaluation
system
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2. Educate to build capacities and
capabilities
Knowledge, skills and attitude
Teaching health care ethics (at pre
and in-service training) tools to
handle ethical dilemmas
Evidence generation and use
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3. Ethical consultation
Definition:
A service provided by an individual or group
to help patients, families, surrogates, health
care providers, or other involved parties.
It address uncertainty or conflict regarding
value laden issues that emerge in health
care.
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Ethical consultation goal
To maximize benefit and minimize
harm to patients, families,
professionals and institutions.
Fostering a fair and inclusive
decision making process.
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Ethical consultation goal…
To facilitate resolution of conflicts in a
respectful atmosphere with attention
to the interests, rights, and
responsibilities of those involved
To enable the health workforce in
charge to make final evidence base
decisions.
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How do we organize for ethical
consultation committee?
Include representative of various
constituencies in your institution.
Include outside members –
community representatives.
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Ethical dilemmas
Definition
Ethical dilemmas arise when
principles cannot be respected and
people disagree on what the best
solution is; as legitimate solutions
philosophically or practically.
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Ethical dilemmas…
Ethical dilemmas encounter in:
Resource scarcity
Refusal of treatment
Disclosure and truth telling
End of Life dilemma
Disagreement/conflict
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Ethical dilemmas step-by-step
analysis
Please read on the participant
manual and discuss.
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Priority setting and rationing
Priority setting
Definition
Priority setting in health care is the
ranking of health services and the
ranking of recipients of these services
Priorities are often set through a
process of decision-making
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Rationing
Is defined as withholding of health services
that could be of benefit to the patient on the
ground of resource scarcity
Resources should be understood broadly
to include health personnel, time,
equipment, infrastructure, medicines, beds,
operating rooms, and money.
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Levels of priority setting
1. International
2. National
3. Meso: health facility level
4. Micro: at the bed side level
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Preventive ethics
Summary
Do you think preventive ethics is
applicable in our setup?
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Session 2.4
Ethics and law as enablers of
CRC
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Session objectives
 Recognize the relationship
between ethics and law
Practice the laws of the land
related to health in their daily
practice
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The relation between
Ethics and law
Ethics: a standard of behavior
Concept of right and wrong beyond what
the legal consideration is in any given
situation
A law is defined as a rule of conduct or
action prescribed or formally recognized
as binding or enforced by a controlling
authority
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The relationship between
health ethics and the law
Ethics is similar but not identical with law
Ethics serves as fundamental source of
law
Ethical values are subjective. The law
ensures uniformity of conduct.
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Ethics Vs Law
29/01/2023 67
Regulations
Proclamations
Ethical
guidelines Criminal
law
Civil laws
The laws are enacted
on the basis of
accepted standard in
the medical
community
Directives
Standards

Ethics and law…
Laws regulating health care
practice in Ethiopia
Proclamation 661/2009 and
Regulation 299/2013 outlines ethical
requirements.
Civil law, penal law, the constitution
other proclamations and regulations
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Ethics and law…
Main Responsibilities of Health
Professionals toward patients
Discussion
Read and discuss on the participant
manual ?
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Inter professional communication
and teamwork among health
workers
Discussion
Read and discuss on the participant
manual
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Ethics and law…

Ethics and law…
Duty to report
FMHACA CoM regulation no -
299/2013 under article 95 clearly
states that
Any person who believes that a health
professional is unfit to practice or
commits unprofessional conduct shall
notify the appropriate organ
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Case scenario on the participant
manual
Read and discuss on the case
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Ethics and law…

Ethical liability of health
professionals
Read on the participant manual as
a pair and discuss
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Ethics and law…

Ethics and law…
Professional ethics committee
Discussion
Pair and read on the participant
manual and discuss
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Ethics and law…
Patients right and responsibility
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Ethics and law…
Patient’s rights
 World Medical Association
declaration of Lisbon put the
following rights for patients
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1.The right on medical care of good
quality
2.The right to freedom of choice
3.The right to self determination(
refusal to treatment, to give or
withdraw consent)
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Ethics and law…

Patient right…
4. The unconscious patient
5. Legally incompetent patient.
6. Procedure’s against patients will(
diagnostic procedures and
treatment) against patients’ will if the
law permitted to do so
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Patient right…
7. Right to information( to receive
information)
8. Right to confidentiality.
9.Right to heath education.
10. Right to dignified care.
11. Right to religious assistance.
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Patients responsibilities
Please read individually on the
manual about patient
responsibilities and discuss
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Case scenario: on Patient
right
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References
1. Medical Ethics Manual, World Medical Association, 2nd Edition 2009
2. WHO, Global Health Ethics, Key Issues, 2015
3. ESA, Comprehensive Specialized Hospital Requirements, Ethiopian Standard: ES3618/2012
4. Exploring Integrity in medicine, The Bander Center for Medical Business Ethics Casebook,
5. FDRE, Proclamation No. 661/2009, Food, Medicine and Health Care Administration and Control
Proclamation
6. FDRE, Regulation No ,299/2013, Food, Medicine and Health Care Administration and Control,
Council of Ministers Regulation
7 Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 7th Edition, 2009
8. EMA, Code of Ethics for Doctors practicing in Ethiopia, 2009
9 Royal Pharmaceutical Society of Great Britain, Code of Ethics for Pharmacists and Pharmacy
Technicians, Aug, 2007
10Physicians top 20 ethical dilemmas: survey results slide shows
http://www.medscape.com/features/slideshow/public/ethical-dilemmas
1/29/2023

Thank you
1/29/2023

Chapter 2 Health Care Ethics ___final_revised_June__24_2017.pptx

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