Healthcare Ethics for Practitioners - BMC PDF

CH.1 HEALTHCARE PRACTITIONER ETHICS ETHICAL STANDARDS The following are examples of ethical standards that healthcare practitioners should demonstrate and work on developing within him/herself and among those who work with him/her; especially when he/she recognizes that he/she is a member...

CH.1 HEALTHCARE PRACTITIONER ETHICS ETHICAL STANDARDS The following are examples of ethical standards that healthcare practitioners should demonstrate and work on developing within him/herself and among those who work with him/her; especially when he/she recognizes that he/she is a member in a group whose members complement each other in the medical field.  (A) DEVOTION AND FEELING THE WORSHIP OF ALLAH (SWT) - Among the values a healthcare practitioner should possess is earnest devotion to Allah (SWT), perceiving His presence through sincere spiritual commitment and worship. - ِ ‫نس ِإّلُ ِليَعْبد‬ Allah (SWT) said: ﴾‫ون‬ ِ ْ ‫ ﴿ َو َما َخلَقْتُ ْال ِجنُ َو‬56‫ اية‬،‫سورة الذاريات‬ َُ ‫اْل‬ - “I created the Jinn and mankind only that they might worship Me” (Adh-Dhariyat, 51:56). Consequently, if Allah (SWT) did not create mankind other than to worship Him; then worship of Allah (SWT) is in all our deeds, including what we do as healthcare practitioners making it one of the most mandated duties. - The messenger of Allah (PBUH) said, “The reward of deeds depends upon the intentions and every person will get the reward according to his intentions.”1 - Therefore, it is up to each individual Muslim healthcare practitioner to have devotion in all his/her deeds for the sake of Allah (SWT), and perceive the presence of Allah (SWT) in all his/her activities, plus understand that he/she will be judged for every small and big act he/she has done. (B) DEMONSTRATION OF THE BEST OF MANNERS 1. Truthfulness: It is the main trait of a faithful person, as Allah (SWT) said in the Holy Quran: ]119 :‫ينُ﴾ُ[التوبة‬ َ ِ‫ُوكونواُ َم َعُالصا ِدق‬ َ ‫واَُّللا‬ َ ‫“ ﴿ُيَاُأَيُّ َهاُال ِذينَ ُآ َمنواُاتق‬you who have believed fear Allah and be with those who are true.” (Tawba, 119). - Truthfulness is not only about telling the truth, it is also about truth of the intention, truth in the deed and performance as well. Thus, it includes all human relations. - It is not appropriate for someone who is a role-model to others, in knowledge and honesty, to be accused of lying let alone being known as a liar. - Of course, there is no doubt that the healthcare practitioner, whom people seek due to their calamities of pain and sickness with complete trust in his/her deeds and words, should not be found otherwise [a liar]. If found to be a liar, his/her knowledge and skills will not help him/her restore the lost trust. HONESTY AND INTEGRITY 2. Honesty and Integrity: Healthcare practitioner is entrusted with human souls and bodies, thus, he/she should reflect upon it appropriately. - Allah (SWT) said describing the faithful: ]8 :‫ون﴾ُ[ المؤمنون‬ َ ُ‫ُراع‬ َ ‫﴿ُوال ِذي َنُه ْم ُِِل َ َمانَاتِ ِه ْم‬ َ ‫ُو َع ْه ِد ِه ْم‬ َ - “Who are true to their trusts and their covenants.” [Muпminun, 8]. HUMBLENESS AND RESPECT FOR OTHERS 3. Humbleness and Respect for Others: Healthcare practitioner should be humble and never display arrogance towards his/her patients or demean them, whatever be their position. - He/she has to respect all those he/she deals with, including the patients and/or their family members. This makes him/her in a more respectful status. And whoever humbles him/herself for the sake of Allah (SWT), He will raise his/her position. - The messenger of Allah (PBUH) said, “He, whoever has even a weight of a mustard-seed’s weight of arrogance in his heart, will not enter paradise.” PATIENCE AND FORBEARANCE 4. Patience and Forbearance: The medical profession is a challenging and hard career. Healthcare practitioners deal with different types of people in the community which requires a high level of patience, forbearance and tolerance. - A patient healthcare practitioner tolerates the behavior of his/her patients and excuses the annoyance of some [patients] considering their pain and illness. - Healthcare practitioners should not confront the patients’ irritability with anger or retaliation by stopping to treat a patient who has used inappropriate language, or by dereliction in fulfilling the patient’s right to full care. PASSION AND LOVE 5. Passion and Love Healthcare practitioners should be loving, passionate and lenient towards his/her patients as well as refrain from insulting them by saying what could make them weak or lose hope. - A successful healthcare practitioner considers the psychological state of his/her patient, and uses ways that would help them get rid of illusions by delivering the truth about their illness in a considerate manner with diligence and accuracy that suits the level of the patient’s understanding, intellectual and psychological abilities MODERATION AND FAIRNESS 6. Moderation and Fairness: Moderation is considered one of the basic principles which Islam calls for - no surfeit and no negligence. Allah (SWT) said, ُ‫اُلتَكونوا‬ َُ ً ‫﴿ُو َك َٰذَ ِل َكُ َجعَلْنَاك ْمُأمة‬ ِ ً‫ُو َسط‬ َ ﴾ُۗ‫ُويَكونَ ُالرسولُ َعلَيْك ْمُ َش ِهيدًا‬ ِ ‫ش َه َدا َءُ َعلَىُالن‬ َ ‫اس‬ ]143 :‫[ البقرة‬ - “Thus We have appointed you a middle nation, that you may be witnesses against mankind, and that the messenger may be a witness against you.” (Baqarah, 143). - Therefore, a healthcare practitioner should be fair and unbiased in treating his/her patients. This is because they submit their affairs to the healthcare practitioner, based on their trust in him/her and their need for his/her advice as well as service. - It is not permissible for a healthcare practitioner to abuse this trust and look down on the patients’ rights, whether it is the right to appropriate medical care or in terms of financial costs that overburden the patient, patient’s guardian or employer. (C) SELF-ACCOUNTABILITY - Self-accountability Healthcare practitioners have to judge themselves before being judged by others, or having their mistakes widely publicized. Self-accountability includes everything, even the smallest of blunders and lapses. For example, to compliment some people at the expense of others (even to a small extent), irrationally give advantage or delay, be late for his/her patients’ appointments, or speak irresponsibly. D) AVOIDANCE OF TRIVIALITIES AND PETTINESS - It is not appropriate for a healthcare practitioner to indulge in affairs that are religiously repugnant or socially reprehensible, like backbiting, tale-bearing, talking too much, arguing, laughing too much, or saying socially unacceptable words - especially while performing his/her duties. - It is also preferable for a healthcare practitioner to refrain from the demeanors of virility, though it may not be religiously prohibited, such as chewing gum while working, untidy appearance, wearing strange and socially unacceptable clothes, which may be acceptable in other countries other than the Kingdom. CH.2 HEALTHCARE PRACTITIONER’S DUTIES TOWARD PATIENTS (A) GOOD TREATMENT OF PATIENT 1. Being welcoming by smiling at patients. 2. Listening attentively to patient’s complaints and empathizing with his/her suffering. 3. Being discreet when asking a patient questions related to his/her condition by choosing the most appropriate words for the situation which does not embarrass the patient, unless needed, especially when other people or patients are near. 4. Show humility and refrain from arrogance, demeaning, mocking, sarcasm towards a patient, regardless the patient’s scientific or cultural status. (B) ACHIEVING PATIENT’S INTEREST AND GUARDING HIS/HER RIGHT 1. Limit the medical investigations, prescriptions or surgical procedures to the extent needed for the patient’s condition. 2. Refrain from using diagnostic or therapeutic measures that are not recognized or scientifically proven, unless within the known scientific and regulatory restrictions. 3. Tell the patient or whoever is acting on his/her behalf as soon as possible about the patient’s health condition, its causes, its possible complications, as well as the benefits of the diagnostic and therapeutic procedures. Additionally, introduce them to appropriate alternatives in diagnoses and treatment in a clear and honest way. (C) PATIENT’S CONSENT 1. The healthcare practitioner should present enough information in a language that the patient can understand about what he/she will do, and what is required from the patient, the possible consequences of the patient’s decisions, as well as potential complications and risks. 2. The patient should be able to understand and appreciate the information that he/she has been provided so that he/she decides with full consciousness, awareness and conviction. 3. The patient’s consent should be made voluntarily without pressure or coercion. Woman’s Consent - The conscious adult woman has the right to give consent to any medical interventions that is related to her, including surgical operations, except for what is related to reproduction, like the use of family planning methods, hysterectomy or other procedures. In such procedures, the acceptance of the husband must be obtained too. In emergency and life-threatening conditions, the woman’s consent is sufficient. Incompetent Patient’s Consent -If the patient cannot give an informed consent, for example in case of unconsciousness, or whose consent is not usually considered valid like children. 2 or the insane; his/her legal guardian should be the person to give this proxy consent, whether for surgical or alike interventional procedures. If obtaining the consent of the legal guardian was not possible, amid fears of potential loss of life or severe harm to the patient, then the healthcare practitioner can do these interventions without consent. For the non- interventional procedures on an incompetent patient, it should be sufficient to have the consent of one of the present parents or accompanying healthy person, if he/she is competent to give such a consent. (D) REASSURANCE OF PATIENT 1. Look out for and explore the patients’ psychological needs. 2. Provide the patient with sufficient clear information about his/her condition, which would help to reassure and eliminate his/her fears. 3. Positive interaction with the patient’s feelings and concerns, and to correct his/her wrong conceptions and information about his/her illness and treatment. PRAYING FOR THE PATIENT - It is from the helping factors for the patient to cope with his/her illness and have his/her spirit soothed when the healthcare practitioner demonstrates the manners of the noble prophet (PBUH) in praying for his patient to be cured, as it was from his guidance (PBUH) that if he comes to a patient, he holds the patient’s hand and says, "O Allah! The Lord of the people, the Remover of trouble! (Please) cure (Heal) (this patient), for You are the Healer. None brings about healing but You; a healing that will leave behind no ailment" and said, “whoever visits a patient whose time (of death) did not come, and says near him seven times, I ask the Glorious Lord (Allah), the Lord of the glorious throne to heal (cure) you; Allah will cure him from that illness”. BREAKING BAD NEWS - There is no contradiction between reassuring the patient and telling him/her about his/her condition, even if it is serious and fatal. It is the right of the patient to know his/her health condition, illness, symptoms, and prognosis in general terms. If the patient requires more details, he/she should be answered with that [request]. Informing the patient is the duty of the treating doctor and should not be left to doctors more junior to him/her, especially if these doctors do not have sufficient experience. When breaking such news, the following should be considered: 1. Gradual approach and preparing the patient psychologically to receive the sudden undesirable news. 2. Limit [yourself to] the information that suits the patient’s knowledge and understanding of his/her health condition without the minutiae that would increase his/her worry. (E) MAINTAINING PATIENT’S SECRETS - CONFIDENTIALITY 1. If the disclosure is to protect the patient’s contacts from being infected or harmed, like contagious diseases, drug addiction, or severe psychological illnesses. In this case, disclosure should be confined to those who may become harmed. 2. If the disclosure is to achieve a dominant interest of the society or to ward off any evil from it. In this case, the disclosure should be made only to the official specialized authorities. Examples of this condition are the following: a. Reporting death resulting from a criminal act, or to prevent a crime from happening. b. Reporting of communicable or infectious diseases. c. If disclosure is requested by a judiciary authority. (F) PHOTOGRAPHING PATIENTS AND RECORDING THEIR VOICES 1. To inform the patient with the significance of this imaging, its importance and purpose before imaging or recording, and tell the patient how and where it (i.e. the image or the record) will be used. 2. Obtain the consent from the patient or the patient’s proxy decision maker before photographing or recording (G) DEALING WITH PATIENTS WHO REFUSE A MEDICAL PROCEDURE 1. Make sure that the patient is aware of the consequences of his/her decision to refuse the medical procedure. 2. Listen to the patient’s point of view and respect his/her wish. 3. Explain the importance of the medical procedure, and the consequences of not having the procedure honestly and without exaggeration. (H) CONSCIENTIOUS OBJECTION TO REFRAIN FROM TREATING A PATIENT - The healthcare practitioner can - in a non-emergency situation, refrain from treating a patient for personal or professional reasons that would jeopardize the quality of care provided by the healthcare practitioner to the patient, on condition that this [refrain] does not harm the patient’s health, and that there is another practitioner who is capable of treating the patient instead of him/her. CH.3 HEALTHCARE PRACTITIONER’S DUTIES TOWARD COMMUNITY The healthcare practitioner enjoys a noble status in the community. The community has positioned the healthcare practitioner in a special social status that is not available to other members of the society. In return, the community expects the healthcare practitioner to use this position in the service of the patient and show commitment to the highest moral standards through his/her manners. The healthcare practitioner should contribute to the community service through his/her profession, and with all possible resources required for the public’s interest. This could be reflected in the following: 1. Become a role model for the community members through his/her faith and maintaining human affairs away from suspicions 2. The healthcare practitioner is a member of the community, and the position that he/she holds enables him/her to have a leading role in any community reform. The healthcare practitioner who lacks moral values in his/her personal life cannot pretend to have them in his/her professional practice, even if he/she holds the highest academic qualifications. The healthcare practitioner is an effective member in his/her community and interacts with its local and public issues. Thus, he/she should not live in his/her ivory tower away from the problems and issues of the community. 3. Recognize that the community and environment are important factors in the health of individuals by helping the community to deal with the social and environmental determinants of diseases. 4. Practice the profession with the highest attainable level of knowledge, efficiency, trustworthiness, and integrity while keeping updated with the advances of his/her specialty. 5. Recognize his/her responsibilities in the empowerment of justice among the community members in the utilization of health resources. Questions? Thank You