The document outlines the course objectives for a Professional Ethics for Midwives program at Bahir Dar University, aiming to equip students with essential knowledge and skills in midwifery. It covers the history, definitions, functions, and roles of midwives, emphasizing the importance of ethical practice and effective communication in the profession. The document also explores the evolution of midwifery practices and the various opportunities available in the field.

1. BAHIR DAR UNIVERISITY
DEPARTMENT OF
M. ethics
PROFESSIONAL ETHICS FOR
MIDWIVES

2. Course Objectives and Competences to be Acquired
 At the end of the session students be able to:
 Acquire basic knowledge and skill about midwifery
profession
 Identify and full fill client need
 Promote Effective communication system that
enables to foster health promotion well being of the
client.

3. Objectives cont’d…
 Discuss the right and wrong practices related to midwifery
profession
 Describe the history of midwifery profession
 Discuss the major contents of the Ethiopian legislation relative to
forensic medicine
 Describe the various situations in which the Midwife is called to
testify or advise the courts and the police in medico legal
matters.
 Outline the contents of a medico legal report.

4. UNIT ONE: Foundation and trends
of midwifery
Unit Objectives
 Professional ethics
 Definitions of midwifery
 Foundation of midwifery practice
 Scope and trends of midwifery practice
 Functions and duties of midwives
 Profession, occupation and
 professionalism

5. 1.Definitions
 professional ethics- is codes of conduct and accepted
behaviors of individual in certain registered job as a
profession
 A midwife - is a person who having been regularly
admitted to a midwifery educational program fully
recognized in the country in which it is located, has
successfully completed the prescribed course of studies
in midwifery and has acquired the requisite

6. Defn cont’d…
 These is the definition of international
confederation of midwives ( ICM) lately
adopted by federation of gynecology and
obstetrics(FIGO) and world health
organization (WHO) in 1992.
 Midwifery a profession providing assistance
and medical care to women undergoing labor
and childbirth and her newborn.

7. 2.Brief history on foundation of Midwifery
 Practice of midwifery is as old as history of
human species, and its existence is back to 500
BC
 References from the holy bible at genesis 35:17
says ”and it come to pass, when she was in
hard labor that the midwife said un to her, fear
not Rachel, it is another boy”
 In exodus 1;15 it is recorded that the king of

8. Foundation cont’d…
 i.e shiprah and pauh are the two
Hebrew midwives, claimed to be the first
to be found recorded in literature.
 Countries like Greek, Egypt, Rome &
India are set in many literature as a root
of existence of midwifery practice.

9. Foundation cont’d…
 Hippocrates (460 BC) - father of
modern medicine
 Organized, trained and supervised
midwives.
 Believed that the fetus had to fight its
way out of the womb and the membrane
 The effort of Hippocrates were not

10. Foundation cont’d…
 Aristotle (384-322BC)- fathers of
embryology
-Described uterus and female pelvic
organs
-Discussed essential qualities of midwives
 Soranus (2nd century)- the first to
specialize in obstetrics and gynecology.

11. Foundation cont’d…
 5th -15th century –
untrained midwives
controlled the practice
of midwifery
 Leonardo davinci
(1452-1519)
-famous craft men
- Made anatomical
drawing of pregnant

12. Foundation cont’d,..
 In 1513, the first book on midwifery was
printed on Germany based on teaching of
soranus then translated to English in
1540.
 Vesalius in 1543, opened the full term
pregnant uterus in lower animal and
extracted the fetus

13. Foundation cont’d…
 Ambrosie pare (1510-1590)
- laid foundation for modern obstetrics
- performed internal podalic version
- used bed instead of birthing stool
- suture perinea lacerations
- founded school for midwives in Paris
 Louise bourgeois
– midwife trained by Ambrosie pare
- Attended the ladies of the French court
- She recommends induction of labor for pelvic
contraction/contracted pelvis.

14. Foundation cont’d…
 In between there are number of individuals had
contributed their part in the development of
midwifery practice.
 Their contribution varies from development of
simple theory to utilization of different materials
and performing maneuvers.
 William smellie (1697-1763) father of British
midwifery had explained labor to be a mechanical
process, and pelvimetry, cephalometry and

15. Foundation cont’d…
 Laennec in 1816 invented stethoscope.
 Françoise mouricean in 1818
first recognized fetal heart sound in pregnant
women
mauricean-smellie maneuver to breach
delivery.
The first antenatal clinic was started about the
time of the First World War.

16. Foundation cont’d…
 In relation history of cesarean section dates
back to 715 BC and the operation derives its
name from the notification lex cesarea a
roman law.
 It provided for an abdominal delivery in dyied
women
 with a hope to get alive baby or
 To perform abdominal delivery for separate

17. Brief Hx of Midwifery In Ethiopia
 Historic background of midwifery in ethiopia is not
clearly documented.
 but from some sources midwifery education is
started before 56 years as apost basic training at
princess tsehay memorial hospital at addis
ababa and Asmera school of nursing and total
of 5 individuals were graduated.
 Gondar univerisity is the 1st organized midwifery
school providing BSC in 2000.

18. Brief Hx con’t…
 After here AAU, HU, and haromaya university began
to run the program and currently universities are
providing the track.
 in hand with national level, midwives are training in
health science college in diploma level in many
regions of the country.
 but currently a total of approximately 7000 midwives
in education and work as well.

19. 3.Trends and scopes of midwifery practice
For many years midwifery activities were limited to
dealing with women in labor.
Now a days this trends and limited scope get widen
and midwives are at least entitled to take up and
pursue the following activities.
 To provide sound family planning service
 To diagnose and monitor normal pregnancies
including use of u/s.
 Prescribe, advice and examine during pregnancy

20. 3.Trends and scopes cont’d…
 To assist mother in labor
 To conduct spontaneous vaginal delivery
 evaluate and perform episiotomy
 attend urgent case of breach delivery.
 To recognize warning sign during pregnancy, labor and
post patal including early referral.
 To examine and care for newborn and infants.
 To care for and monitor mother in post natal period.
 To carry out the treatments prescribed by concerned
professional

21. 4. Functions and duties of midwives
Generally any of activities, functions and duties of
health professional falls under one of the three
categories.
1.Dependant function- is implementing based on
order of licensed professional
2.Inter dependant function - actions resulting from the
collaborative relationship with other health care
provides

22. Functions and duties cont’d…
3. Independent function- Autonomous actions
interventions in the health care system.
- are function based on own professional
judgment

23. 5. Profession and occupation
Profession- Is a job requiring special training and
formal qualification
- It generally distinguished from other kinds of
occupation by
A. requires prolonged special training pertinent
to the role to be performed.
B. an orientation of the individual to ward
service either to community or organization.

24. Comparison between profession and occupation.
Occupation
-Training may occur on job
-Varied length
-Value beliefs and ethics are
not prominent feature.
- varied commitment and
personal identification
- Work are supervised.
- Peoples often change jobs
-Accountability rests with employee
profession
 Education takes place in college
and university
 definite and prolonged length
 value, belies are integral parts
 Strong commitment and personal
identification.
 Work are autonomous
 People unlikely to change jobs
 Accountability rests with
individual

25. Professional characteristics of
midwives
1. Expertise- having high level of specialized skill
and knowledge
2. Accountability- being answerable to ones actions
3. Autonomy – having power and authority to control
various aspects of work.
4. Authority- having legitimate power and
sovereignty granted by stature, based on contract with
society.

26. Benners stage of expertise
 There are five steps/ levels of expertise
the midwife/professional should pass in
progress and acquire new knowledge,
attitude and practice.

27. Benners stage cont’d…
Expert (highly proficient)
-highly skilled with analytical power
↑ - not relies only on rules and guidelines
Proficient (3-5 years of experience)
↑ -holistic perspective of situation
Competent (2-3 years of experience)
↑ -has organizational and planning ability
Advanced beginners
- demonstrate accepted performance
-recognize meaning full aspects of real
↑ situations
Novice
-no experience
-performance is limited and inflexible

28. UNIT -TWO
Role of midwives at different
setting

29. Roles of midwives cont’d…
 Midwives take a wide range of roles
indifferent setting
 Their task begins at home and reaches
to highest institutions with varies roles in
different setups

30. Major roles of midwives
1. Care giver provider
- all health professional are care providers for the
patient client with their respective Scope
- is the most essential role
- provides direct care at hospital, health center
and promotes health in the Community
2. Teacher (formal or informal)
- Provides information and helps the client to
acquire new knowledge and technical skill.
- Encourage compliance with prescribed drugs
-Teach students and the community as well

31. Major roles con’t…
3. Counselor
-help client to recognize and cope with stressful
psychological and social problems
-focus to develop new attitudes, feelings and
behavior of client conducive to healthy life
4. Change agent
-they initiate or assist clients to make modification
5. Client advocator
- involves concern for client and actions on behalf
of the clients to bring about a change
-promotes what is best for their client /patient

32. Major roles cont’d…
6. Leader
-monitor and supervise works and takes the front line
in tasks
7. Manager
-make decisions, coordinates activities, allocate
resource in different setups.
- Work as a staff and administrators as needed

33. Major role cont’d…
8. Researcher
- participate in identifying significant
researchable problems in community
- participate in scientific investigation and
must be consumes of research findings.

34. Fields and Opportunities in midwifery
1. Hospital/Institutional midwife- midwife working in an
institution with patients
2. Public Health midwifery/Community Health midwifery –
usually deals with families and communities.
3. Private Duty/special Duty midwife – privately hired
4. Industrial/Occupational midwife – a midwife working in
factories, office, companies
5. midwifery Education – midwife working in school, review
center and in hospital as a Clinical Instructor.
6. Independent midwifery Practice – private practice, home

35. Unit Three: The communication
process
Learning objectives
 Describe the communication process
 Describe the elements of communication
 Apply the principles of effective communication
 Identify factors that influence communication
 List verbal & non verbal techniques of
communication

36. COMMUNICATION
INTRODUCTION
Communication:- is defined as the effective
exchange of information, ideas and feelings to
achieve desirable interpersonal relationships,
which will be beneficial to the client's growth
towards a healthy living.
 So, effective communication announces helping
relationship.
 The health provider interacts with the client for

37. Communication cont’d…
 The use of self in a therapeutic way in which the
client's needs are the central focus, characterizes
communication interactions.
 Communication is the hallmark of a therapeutic
midwive - client relationship

38. Communication cont’d…
 If you were to try to explain the process of human
interaction, you might define it as a huge and very
complex communication system.
 Nevertheless, it is essential that you develop and
maintain an understanding of the methods and skills of
communication in order to meet the needs of the patient.
 The quality of care you can provide is, in many ways,
dependent on the quality of communication that exists
between you and your patient.

39. Communication cont’d…
 Through your direct contact, the patient must
perceive your intention of support and your positive
expectations.
 You must accurately assess the patient's physical
and emotional symptoms.
 Communication has only taken place if the message
being sent was accurately received.

40. Purposes of Communication
Major Purpose
To send, receive, interpret, and respond
appropriately and clearly to a message, an
interchange of information.
 Supportive Purposes
To correct the information a person has about
himself and others.
To provide the satisfaction or pleasure of

41. Essential Components of Human
Communication
There are five essential components of
communication;
 Sender--the originator or source of the idea.
 Message--the idea.
 Channel--the means of transmitting (either verbally
or nonverbally) the idea.
 Receiver--someone to receive and interpret the
message.

42. Levels of communication
There are four levels of communication
 Intrapersonal
 Interpersonal
 Group communication
 Organizational communication
(e.g mass communication???)

43. Forms of communication
There are two forms of communication
 Verbal and
 Nonverbal methods of communication

44. Forms of communication
cont’d…
 Verbal Communication - refers to the use of the spoken
& written words to acknowledge, amplify, confirm,
contrast, or contradict other verbal and nonverbal
messages.
 Nonverbal Communication- exchange of information
without the exchange of spoken words (facial expressions,
body language, etc.)
 It usually express more than verbal.
 Essential Relationship- Verbal communication is always
accompanied (go with) by nonverbal expression.

45. Method of Nonverbal
Communication
 Rapport - the harmonious feeling experienced by two
people who hold one another in mutual respect,
acceptance, and understanding
 Empathy- empathy is that degree of understanding, which
allows one person to experience how, another feels in a
particular situation.
 Empathy is neither sympathy (feeling sorry for another
person) nor compassion (that quality of love or tenderness
that causes one person to suffer along with another).

46. Body Language
Actions speak louder than words- A person will generally pay more
attention to what you do than what you say.
Think about the following nonverbal messages and what they might
reveal.
 Facial expressions (smile, grimace, etc)
 Gestures/mannerisms ( toe tapping, clenched fists)
 Eye behaviors (avoiding eye contact, staring, wide eyes)
 Use (and avoidance) of touch or physical contact.
 Posture (erect, leaning toward/away from someone).
 Walk
 Gait

47. Non verbal cont’d…
Silence- silence can be an extremely effective
communication tool. It can be used to express a wide
range of feelings.
 it can be used to communicate the deepest kind of
love and devotion, when words are not needed.
 Silence can be a cold and rejecting sort of
punishment.
 Silence can be used in an interview or conversation
to encourage the other person to "open up."

48. Non verbal cont’d…
 Listening- as a patient speaks, think about what he
must be feeling.
 Sometimes, as a listener, you must cut through
layers of words to get to the real message.
 You must read between the lines. Pick up the
underlying meaning of the message (intent); don't
rely entirely upon the obvious or superficial meaning
(content).

49. Guidelines for Communicating
with Patients and their Families
 Convey to the patient and family that they are
important to you and that you want to help them.
 Convey honesty and trustworthiness.
 Try not to overwhelm the patient with
embarrassing or personal questions. When it is
necessary to ask personal questions, explain
why and keep it short and matter-of-fact.
 Don't make promises you can't keep.

50. Guidelines cont’d…
 Communicate with each patient as an individual.
(This is especially important in a hospital setting,
where patients often experience a loss of identity.)
 In order to do so, you must try to know the
patient by listening to him.
 Put yourself in his place.
 Accept and respect the patient despite the
symptoms of his illness.

51. 1, list and describe the 5 components of
communication?
2, what is mean by
- essential r/n s/p
- congruency
-in congruency of comunication
3, mention at least 5 types of non verbal
communication
EX

52. Techniques for Communicating
with Patients
1.Establishing the Setting
 Provide comfortable environment (lighting,
temperature, furnishings).
 Establish a relaxed, unhurried setting.
 Sit down when speaking to the patient. Although you
probably have dozens of things you need to be doing
at that moment, try to relax.

53. Techniques cont’d…
 Don't stand at the doorway or sit on the edge of
your seat, as if you are preparing to jump and run
as soon as you can get away.
 Face the speaker and maintain eye contact.
 Provide for privacy
 Avoid interruptions and other distracting
influences

54. 2. Verbal Communication
Skills.
 Let the patient do the talking.
 Keep questions brief and simple.
 Use language that is understandable to the patient. Avoid
acronyms and medical jargon if the patient is nonmedical.
 Ask one question at a time and give the patient time to
answer.
 Clarify patient responses to questions, not just for your
own use, but also to let the patient know that you are
listening and that you understand.

55. Verbal Communication
cont’d…
 Avoid leading questions -you want the patient to
tell you what he is feeling, not what he thinks you
want to hear. So avoid putting words in his mouth.
For example, it might be better to ask, "How are you
feeling?" rather than "I suppose you're feeling rested
after your nap.“
 Avoid how or why questions; they tend to be
intimidating.
 Avoid the use of cliché statements like, "Don't worry;

56. Verbal Communication
cont’d…
 Avoid questions, which require only a simple
"yes" or "no" response. You want to encourage
the patient to talk to you.
 Avoid interrupting the patient. If you need to
ask a question, wait until he has completed his
thought

57. Verbal Communication
cont’d…
Interviewing Techniques
The following terms represent skills often used to foster better
communication.
Before using these techniques, remember that you must do what
feels comfortable and natural to you.
 Even though you may have the best of intentions, if you do not
sound sincere, what are the chances of someone really opening
up to you?
 Also, keep in mind that your patients are individuals; if you sense
that a particular patient may not respond well to a certain
technique, you are probably right.

58. Verbal cont’d…
 Reflection- Repeating content or feelings. You might
simply repeat what the patient has said, to give him time
to mull (think Longley) it over or to encourage him to
respond. Or, and often more effectively, you can reflect on
what you think the patient is feeling.
 "It sounds like you're concerned about your family." or
 "I don't think you're very happy about this
 By reflecting on his feelings, you may be encouraging him
to talk about something he may have been hesitant to

59. Verbal cont’d…
 Restating- Rephrasing a question or summarizing a
statement. "You're asking why these tests are
needed?" or "In other words, you think you're being
treated like a child.“
 Facilitation- Occasional brief responses, which
encourage the speaker to continue. A nod of the
head; an occasional verbal cue, such as "go on" or "I
see;" and maintaining eye contact throughout the
conversation all implies that you are listening and

60. Verbal cont’d…
 Open-ended questions- Questions that encourage the
patient to expand on a topic. If you want to encourage
the patient to speak freely, you might ask
 "How are you feeling?" rather than "Are you in pain?“
 Closed-ended questions- Questions, which focus the
patient on a specific topic. If you want a short, straight
answer, ask a question which will allow only for a direct
response, such as
 "When was your accident?" or
 "Do you have pain after eating?"

61. Verbal cont’d…
 Silence- A quiet period that allows a patient to
gather his thoughts. Of course, this would be an
occasional practice, used when you feel that the
patient could use a little time to think about his
response to a question or just to think.
 Broad openings- A few words to encourage the
patient to further discuss a topic; for example,
 "and after that..." or "you were saying..."

62. Verbal cont’d…
 Clarification- Statements or questions that verify a
patient's concern or point. "I'm a bit confused
about...Do you think you could go over that again
please?“

63. Therapeutic Communication
 Establishing and maintaining a therapeutic
relationship, require therapeutic communication.
 Too often, guidelines deal with "DONT'S". Positive
guidelines may however be more important in
promoting effective therapeutic communication in
health

64. Verbal cont’d…
 The following are the "DOS" of effective therapeutic
communication.
1. provide/select a private, quiet, safe environment in
which to hold interactions.
2. listen twice as much as you speak.
3. think of the unique situation you face before
responding and consider alternatives.
4. acknowledge and build a positive self-regard.
5. be simple, clear and direct in communication

65. Verbal cont’d…
6. be congruent in communication.
7. be alert and responsive to small changes in
communication.
8. observe all non verbal cues in communication.
9. be non-judgmental in interactions.
10. allow the client to proceed at his/her pace

66. Verbal cont’d…
11. accept people as they present themselves with
their strengths and weaknesses.
12. provide an atmosphere for the exploration of
thoughts and feelings through silence.
13. remember that there is always the potential for
growth and healthy living. There are no "hopeless'
individuals/

67. Therapeutic Communication
 Practicing therapeutic communication is in many
ways simply developing a good bedside manner.
 When your patient asks you a question or discusses
something with you, be careful to respond in a
helpful and caring manner.
 By encouraging the patient to speak up, you are
probably helping him/her to decrease his level of
stress and thereby his recovery time.

68. Critical elements of effective
therapeutic communication
 Be able to decipher (discover the meaning
written badly) the patient's message; get to
know the patient well enough to discover the
underlying meaning (intent) of his/her
communication. Convert code into ordinary
language
 Be alert and perceptive enough to pick up the
correct message. Many people feel

69. Elements of effective cont’d…
 Be realistic in your relationships with people;
avoid making assumptions or judgments about
your patients' behavior.
 If you have negative thoughts about something
a patient says or does, try to keep in mind that
he is an adult, responsible for making his own
decisions.

70. Elements of effective cont’d…
 Be emotionally mature enough to postpone
the satisfaction of your own needs in
difference to the patient's.
 Find sources other than the therapeutic
relationship to meet your own needs.

71. Components of the midwife-client
relationship
 There are five components to the midwife-client
relationship:
trust, respect, professional intimacy, empathy and
power.
 Regardless of the context, length of interaction and
whether the midwife is primary or secondary care
provider, these components are always present.

72. Components of the midwife-client
relationship
 Trust. Trust is critical in the midwife-client relationship
because the client is in a vulnerable position. Initially,
trust in a relationship is fragile, so it’s especially
important that a you keep promises to a client. If trust
is breached, it becomes difficult to re-establish.
 Respect. Respect is the recognition of the inherent
dignity, worth and uniqueness of every individual,
regardless of socio-economic status, personal
attributes and the nature of the health problem.

73. Components of relationship cont’d…
 Professional intimacy. Professional intimacy is
inherent in the type of care and services that midwife
provide.
 Professional intimacy can involve physical,
psychological, spiritual and social elements that are
identified in the plan of care.
 Empathy. Empathy is the expression of
understanding, validating and resonating with the

74. Components of relationship cont’d…
 Power. The midwife-client relationship is one of
unequal power.
 Although you may not immediately perceive it, you
have more power than the client.
 You have more authority and influence in the health
care system, with specialized knowledge, access to
privileged information, and the ability to advocate for
the client and the client’s family.

75. Interventions for Patients with
Special Communication Needs
Blind Patients
 Always speak to the patient when you enter the room so
she/he will know who is there.
 Speak directly to the patient; do not turn your back.
 Speak to the patient in a normal tone of voice; he is blind,
not deaf.
 Speak to the patient before touching him/her.
 Offer to help with arrangements for patients who may
enjoy hearing tapes or reading Braille literature.

76. Interventions cont’d…
Deaf Patients
 Look directly at the patient when speaking with him/her.
 Do not cover your mouth when speaking because the
patient may read lips.
 If the patient does not lip-read, charts with pictures may be
used, or simply writing your questions or comments on a
piece of paper may be helpful.
 Charts with hand signs are available at the local society for
deafness and/or hearing preservation.

77. Patients Speaking a different Language
 Obtain a translator if possible.
 Have a chart with basic phrases .Consider using
charts with pictures.
Interventions cont’d…

78. Factors influencing
communication
 Developmental level
 Gender
 Socio cultural difference
 Roles & responsibility
 Space and territoriality
 Physical mental and emotional state
 Values
 Environment

79. Non-therapeutic Technique
1. Overloading
 talking rapidly, changing subjects too often, and
asking for more information than can be absorbed at
one time.
 “What’s your name? I see you like sports. Where do
you live?”
2. Value Judgments
 giving one’s own opinion, evaluating, moralizing or
implying one’s values by using words such as “nice”,

80. Non-therapeutic cont’d…
3. Incongruence
 Sending verbal and non-verbal messages that
contradict one another.
4. Underloading
 Remaining silent and unresponsive, not picking up
cues, and failing to give feedback.
5. False reassurance/ agreement
Using cliché to reassure client
“It’s going to be alright”.

81. 6. Invalidation
Ignoring or denying another’s presence, thought’s or
feelings.
Client: How are you? midwife responds: I can’t talk
now. I’m too busy.
7. Focusing on self
Responding in a way that focuses attention to the
professional instead of the client
“This sunshine is good for my roses. I have beautiful
Non-therapeutic cont’d…

82. 8. Changing the subject
 introducing new topic inappropriately, in pattern that
may indicate anxiety.
9. Giving advice
Telling the client what to do, giving opinions or
making decisions for the client, implies client
cannot handle his or her own life decisions.
“If I were you… Or it would be better if you do it this
way…”
Non-therapeutic cont’d…

83. 10. Internal validation
 Making an assumption about the meaning of
someone else’s behavior that is not validated by the
other person (jumping into conclusion).
 The care provider sees a suicidal clients smiling and
tells to other as the patient is in good mood.
Non-therapeutic cont’d…

84. Non-therapeutic cont’d…
Other ineffective behaviors and responses:
 Defending – Your doctor is very good.
 Requesting an explanation – Why did you do that?
 Reflecting – You are not suppose to talk like that!
 Literal responses – If you feel empty then you
should eat more.
 Looking too busy
 Appearing uncomfortable in silence

85. Non-therapeutic cont’d…
 Being opinionated
 Un voidance to sensitive topics
 Arguing and telling the client is wrong
 Having a closed posture-crossing arms on chest
 Making false promises – I’ll make sure to call you when you
get home.
 Ignoring the patient – I can’t talk to you right now
 Making sarcastic remarks
 Laughing nervously
 Showing disapproval – You should not do those things

86. Unit Four: Ethico-Legal Aspects In
Midwifery
I. Ethics in midwifery
Learning objectives
 Define ethics & midwifery ethics
 Identify ethical principles
 Describe ethical principles
 Discuss ethical theories
 Explain ethical dilemmas
 Discus ethical decision making models

87. Definition of terms
 Ethics: - comes from Greek word ethos, which
means character/culture
Applied ethics: - the branch of ethics that tries
to answer questions relating to specific,
concrete moral problems. It consists of a
number of different branches

88. Ethics are not …
 Ethics is not the same as feelings
 Ethics is not religion
 Ethics is not following the law
 Ethics is not following culturally accepted
norms
 Ethics is not science

89. Ethics are …
 Moral Principles
 What is good and bad
 What is right and wrong
 Based on value system
 Ethical norms are not universal – depends
on the sub culture of the society

90. Defn. cont’d…
 Acts :- that are ethical often reflect a
commitment to standards beyond professional
preference on which individual’s professionals and
societies agree
 Bioethics:- the study of ethical problems arise in
living things resulting from scientific advances
 Code of ethics:- set of statements encompassing
rule/principles or law that apply to people in
professional roles

91. Defn. cont’d…
 Values: ideas of life, customs and ways of behaving
that society regard as desirable.
 Personal values :-is a personal belief about worth
that acts as a standard to guide behavior and it is
the basis for what a person think about, choose,
feels for and action.
 Value clarification :- a process by which people
attempt to examine the values they hold on and
how each of those values functions as part of a

92. Defn. cont’d…
Deliberate refinement of one’s own personal value
system.
 Ethical theory :- is a system of principles by a
person to determine what should and should not
be done.
 Ethical principles:- basic ideas that are starting
point of understanding and working through a
problem with common grounds b/n the care provider
and patient & family/ health care provides with

93. Introduction
 Midwifery has evolved over years to distinct
profession. Midwifery needs increased
education competency & technical skills; as the
profession increased in scope so did the legal
accountability and ethical boundaries setted for
the profession.

94. Introduction cont’d…
 Ethics ; are declaration of what is right or wrong and
what ought to be
It usually presented as a system of valued behaviors
and beliefs ; serve the purpose of governing conduct
to ensure the protection of an individual‘s rights.
 Ethics exist on several levels ,ranging from the
individual or small group to society as the whole. The
concept of ethics and morals are similar in both their
development and purposes

95. Ethics is based on/ emanates from
 Popular beliefs
 Standard of practices
 Religious concepts
 Law- a guardian of moral
Introduction cont’d…

96. Morality: - refers to traditions of beliefs about
right and wrong human conducts set by social
institutions.
 are a code of learnable rules.
 It exists before we are instructed trans-
individual .
 It cannot be purely a personal policy rather
social code.
Introduction cont’d…

97.  Moral rules: - general guides governing actions
 Moral principles:-more general and more
fundamental. Justifying reasons in accepting
rules
 Determinants of the Morality of Human Act
The object
The end
The circumstance
Introduction cont’d…

98. Types of ethics
There are three types of ethics having their own
distinct ideology
1 Descriptive ;describes the values and belief of
various cultures, religion, or social group.
2 Normative; study of human activities in abroad
sense in attempt to identify human actions that
are right or wrong .
3 Analytic ; analyses the meaning of moral term
and seeks reason why these activity/ attitude is
right or wrong.

99. Ethical theories
 Ethical theories are bodies of principles and rules
that are more or less systematically related.
 Ethical theories provide a structured approach to
moral reasoning.
 Ethical issues in midwifery are better understood if
the midwife explores the various methods of moral
reasoning that are used to make judgments about
the moral value of an action.
 Not all reasons are good reasons; not all good

100. Ethical theories cont’d…
 There are three classes of theories used most
often for moral reasoning.
1 Teleological/utilitarian theories - teleological - is
derived from the Greek word "telos" meaning
end and the word "logos" meaning science.
 It is an ethical theory stating that the best
decision is one that brings about the greatest
good to the most people.

101. 2 Deontological / principle based theories -
deontological - is derived from the word "deon"
which refers to duty .
 An ethical theory stating that the moral rule is
binding.
3 Relational /caring theories
a perspective of caring and responsibility is used
to determine what might be a morally correct act.
Ethical theories cont’d…

102.  The utilitarian ; theories follow the line of moral
reasoning that suggests that an act is morally good
or bad based on its outcome or effect.
 Under this line of reasoning the action that brings
the most good to the most numbers of people
would be considered to be a "good" or morally
correct act.
 It proposes that no action by itself is right or
Ethical theories cont’d…

103.  The deontological; Duty or principle based
theory
 An act is right if it conforms to an overriding
moral duty
For example – do not tell lies, do not kill.
E.g. Christian ethics – The Ten Commandments
 When trying to reason out what is the most
moral action to take it is not the nature of the
outcome that is judged.
Ethical theories cont’d…

104.  Relational caring:-These theories bring an entirely new
perspective to the process of moral reasoning for ethical
issues in health.
 Actions are not judged according to the outcome or the
principles of duty and obligation. But rather a perspective
of caring and responsibility is used to determine what
might be a morally correct act.
 In others words the morally good act is the one that
shows caring and concern for other people and what
might be important to them.
Ethical theories cont’d…

105.  Often when people disagree about "doing
the right thing" it is because they are using
different methods of moral reasoning to
make a decision about the correct course of
action.
 This becomes more obvious when these
theories are examined in light of the
questions that might be asked to make the
Ethical theories cont’d…

106. Teleological Theories Deontological
Theories
Relational
Theories
What is the action that will
bring about the best
consequence?
What is my duty or obligation
in this case?
What is the nature of
the relationships to be
considered in this
decision?
What is the best thing to do
here that will bring about the
most good for the most
people?
To whom or what principle
must I remain true?
How does my caring
influence my action or
my beliefs about what I
should do?
What rights do the people
involved have and whose
rights supersede the rights of
others?

107. Ethical Principles
 Ethical principles are basic ideas that are a
starting point for understanding and working
through a problem.
 Ethical midwifery care means promoting the
values of client well-being, respecting client
choice, assuring privacy and confidentiality,
respecting sanctity and quality of life, maintaining
commitments, respecting truthfulness, and

108. Four basic Principles of
Medical Ethics
 Autonomy
 Beneficence
 Non maleficience
 Justice

109. 1. Autonomy – the right/freedom to decide for
oneself.
 Respect a person’s right to make their own
decisions
 Teach people to be able to make their own
choices
 Support people in their individual choices
 Do not force or coerce people to do things
 ‘Informed Consent’ is an important outcome of
Ethical principles cont’d…

110. The challenge of autonomy
Paternalism :- an action and attitude when the
provider tries to act on behalf of the patient’s interest .
 Paternalistic model: The doctor is the professional.
He/she gives the order, the patient obeys.
 Strengths: Emphasizes the expertise and knowledge of
the doctor
 Weaknesses:
 Ignores the autonomy of the patient
 Ignores non-health related but morally legitimate
values of the patient

111. 2. Non – maleficence (to do no
harm
 do not to inflict harm on people
 do not cause pain or suffering
 do not incapacitate/disable
 do not cause offence/crime
 do not deprive people
 do not kill

112. 3. Beneficence (to do good)
 Our actions must aim to ‘benefit’ people – health,
welfare, comfort, well-being, improve a person’s
potential, improve quality of life
 ‘Benefit’ should be defined by the person themselves. It’s
not what we think that is important.
 Act on behalf of ‘vulnerable’ people to protect their rights
 Prevent harm
 Create a safe and supportive environment
 Help people in crises

113. Double Effect Principle
When an act has both good and bad effects, it is
permissible if:
 The direct freely chosen effect is morally good and the
indirect foreseen (know about something before
happened ) but not desired may be harmful,
 The action/ object must not be evil,
 The foreseen beneficial effect must be greater or equal to
the foreseen evil effect
 The beneficial effect must follow directly from the action or
at least as immediate as the harmful effect

114. 4. Justice
 equality/fairness in terms of resources and
service
 Treating people fairly
 Not favouring some individuals/groups over
others
 Acting in a non–discriminatory / non-prejudicial
way
 Respect for peoples rights

115. Justice
Distributive Justice – sharing the scarce
resources in society in a fair and just manner
(e.g. health services, professional time)
 How should we share out healthcare
resources?
 How do we share out our time with patients?
 Deciding how to do this raises some difficult
questions

116. Justice
Patients should get…..
 an equal share ?
 just enough to meet their needs ?
 what they deserve ?
 what they can pay for ?

117. The Four Ethical Rules
 Veracity – truth telling, informed consent, respect
for autonomy
 Privacy – a persons right to remain private, to
not disclose information
 Confidentiality – only sharing private information
on a ‘need to know basis’
 Fidelity – loyalty, maintaining the duty to care for
all no matter who they are or what they may have
done

118. 1. Veracity
Veracity – the act of truthfulness
-telling the truth is always right ,to tell lie is wrong
- controlling the truth by with holding some or
all of the relevant information until an
appropriate time for disclosure .
 Conflicts would arise when Patients expect
accurate and precise information that is revealed
in un honest and unrespect full manner

119. Truth - can alleviate anxiety, better
informed & more trust full of the care
provider .
 increase pain tolerance (acceptance)
 enhance cooperation with treatment
1. Veracity cont’d…

120.  N.B :-to tell the truth could have harmful effect
,but might equally have beneficial effects,
therefore ,we need to consider all the deciding
factors in judging whether an action is right
or wrong in the intended consequences .
 whether priority will be given to the patient‘s
right to know or to professional’s duty to
protect the vulnerability of the patient ,his
1. Veracity cont’d…

121. Ethical Dilemma (difficult to
choice
There are many ethical issues that suggest two or
more equally compelling courses of action that
appear to be morally right.
 The midwife trying to make an ethical decision
may recognize that one specific course of action
will uphold some ethical principles but not all of
them.
 Ethical conflicts is inherited in the practice -not

122.  Each time midwives reflect on ethical theories or
consider ethical principles develop critical
thinking skills.
 A good example of an ethical dilemma in
midwifery practice is when a women refused to
have episiotomy in second stage of labor.
 The midwife may not be able to follow the
principles of autonomy and beneficence at the
same time because respecting patient autonomy
Ethical Dilemma cont’d…

123.  In this instance as long as the patient is
conscious and competent the principle of
patient autonomy would take priority.
 It is always considered a higher priority for
an individual to have the right to self
determination than the health worker to fulfill
the duty.
Ethical Dilemma cont’d…

124.  When ethical issues in midwifery arise the
values in this professional ethical code must take
precedence over a personal set of values.
 Value based judgments are used to decide a
morally correct path of action. Values are at the
foundation of ethical decisions so it is important
to understand what values are and how they
influence decisions about what is right or morally
Ethical Dilemma cont’d…

125. Ethical Decision making
process
 What is the purpose of Ethical decision
making process?
 The chief goal of ethical decision making
process is determining right from
wrong in situations where clear
demarcations do not exist or are not
apparent to the midwife faced with the

126. Ethical Decision cont’d…
 Ethical decision making process is a step- by-
step approach for making ethical decisions
.Ethical approaches requires the use of a
reasoned process of view and ethical problem.
 Decisions based only on experiences is
not adequate to solve ethical dilemma
problem. Ethical theories & principles provide
us a frame work for aspects of ethical

127. Ethical Decision-Making Process (Aiken, 1994)
1. Collect, analyze, and interpret the data or
information
2. State the dilemma clearly
3. Consider the choices of action based on ethical
principles.
4. Analyze the advantages and disadvantages of
each action.
Ethical Decision cont’d…

128. M.O.R.A.L. Model (Crisham, 1992)
1. Massage the dilemma
2. Outline the options / possibilities
3. Review criteria and resolve
4. Affirm the position
5. Look back
Ethical Decision cont’d…

129. Informed Consent
 The legal doctrine of informed consent is based
on respect for the principle of patient autonomy.
 In order to practice ethically midwives must
respect the patient's individual values and
uphold the right of patients to choose or refuse
treatment

130. Informed cont’d…
 Informed consent is the process by which a fully
informed patient can participate in choices about
her health care.
 It originates from the legal and ethical right the
patient has to direct what happens to her body
and from the ethical duty of the physician to
involve the patient in her health care.

131. Accepted complete informed consent includes the
following elements:
1. The nature of the decision/procedure
2. Reasonable alternatives to the proposed
intervention
3.The relevant risks, benefits, and uncertainties
related to each alternative intervention
4.Assessment of patient understanding
Informed cont’d…