Ethics and Human Rights 214 PDF

Ethics and Human Rights 214 Theme 1 Dr Z Ebrahim [email protected]  Objectives At the end of this theme the student should:  Understand the meaning of the term Ethics and Human rights  Know the core ethical principles that a health professional should adopt and live...

Ethics and Human Rights 214 Theme 1 Dr Z Ebrahim [email protected]  Objectives At the end of this theme the student should:  Understand the meaning of the term Ethics and Human rights  Know the core ethical principles that a health professional should adopt and live  Be able to discuss ethical theories applicable health care  Know the relevant applications of these principles and theories within Health care sector, i.e. the Bill of Rights, Patients Rights Charter and Batho Pele What is Ethics? What is Ethics?  Ethics is a generic term for various ways of understanding and examining moral life  The purpose of ethics theory is to enhance clarity, systematic order and precision of argument in our thinking about morality  Ethics is general term referring to both morality and ethical theory. Beauchamp and Childress  What is ethics? Another definition of Ethics is an attempt to arrive at an understanding of: The nature of human values How we ought to live What constitutes right conduct In practical terms- when we are faced with two or more equally important but competing values, how do we make the right choice? What is Human Rights? What are Human Rights? are the entitlements people claim relating to their basic needs because they are humans  Entitlements people claim relating to their basic needs because they are human  Fundamental to all human rights is respect for human dignity  Who is responsible, usually the State:  Respect rights  Protect rights The RPFP  Fulfill rights  Promote rights Health as a right  Health is a right  Constitution of the World Health Organisation 1946  “enjoyment of the highest standard of health is one of the most fundamental rights of every human being without the distinction of race, religion, political belief, economic or social condition”  Furthermore, the International Covenant of Economic, Social and Cultural Rights 1966, refers to highest standard of health being physical and mental health  Governments should put in place policies and action plans which leads to accessible health care in the shortest possible time WHO 2002  South African Constitution and Bill of Rights https://www.sahistory.org.za/article/bill-rights  Health Professions Council SA Protecting the public and guiding the professions Public Rights of Patients, rights with regard to health care practitioners, rights with regard to treatment Health care professionals Duties to patients, colleagues, other health care professionals, allocation of care and resources, duties to themselves, society, profession, environment, reporting misconduct HPSCA Core ethical values Respect for persons Confidentiality Best interest or well- Compassion being of patients: Tolerance Non-maleficence Justice Beneficence Human rights Professional competence and self- Autonomy improvement Integrity Community Truthfulness FMHS Values  Excellence (to be outstanding at what we do, to be relevant, world-class and internationally competitive)  Integrity (to be honest, open, ethical and professional)  Commitment (to be dedicated to achieving our goals)  Accountability (to accept responsibility for our decisions and actions)  Inclusivity (to embrace and support diversity, to create an environment in which people feel valued, respected and supported)  Innovation (to generate new ideas and strive to develop new products, processes and services that benefit society) THERE ARE 4 Basic Ethical Principles 1. Autonomy 2. Beneficence 3. Non- maleficence 4. Justice Beauchamp and Childress Principilsm  1. Autonomy  The right of every person to make decisions for himself Creates the following obligations  Informed consent  Telling truth  Confidentiality  Effective communication 2. Beneficence rescue persons in danger do good acting in the way that will benefit the others  Act for the benefit of others acting in the best interest of the patient prevent harm from happening to  Do good others  Protecting and defending the rights of others  Prevent harm from occurring to others  Remove conditions that will cause harm to others  Help persons with disabilities  Rescue persons in danger  NB act in the best interest of the patient  3. Non-maleficence to do no harm  Do not kill  Do not cause pain or suffering to others  Do not incapacitate others  Do not cause offence to others  Do not deprive others of a good life  4. Justice  Fair, equitable and appropriate  Respect for peoples rights – rights based justice eg. keeping appointments on time  Respect for morally acceptable laws- legal justice eg. prevailing laws  Fair distribution of limited resources- distributive justice eg public health sector  Ethical theories 1. Utilitarianism 2. Kantianism (Kantian deontology=rule morality) 3. Liberal Individualism 4. Communitarianism 5. Ethics of care 6. Casuistry 7. Character ethics (virtue ethics) 8. Principlism (‘4 principles’ in the framework of Beauchamp & Childress)  Ethical theories 1. Utilitarianism- consequence based  Action is described as right or wrong depending on it’s outcome  People are viewed as a means to an end  Better humanity and increased happiness  Based on principle of utility- good outcome is the greatest good, or happiness for the greatest number of people  Ethical theories 2. Kantianism – obligation based theory  Based on the correctness of an action, regardless of the possible benefits or harm it may produce  Deeds have inherent moral worth, irrespective of the consequences that these deeds may have  Ethical theories- clear, unified, account of ethical obligations 3. Liberal Individualism  A rights-based theory  Addresses both positive and negative rights  Positive rights permits or obliges action (e.g. health care, education, national security, minimum standard of living)  Negative rights permits or obliges inaction  (freedom of worship, freedom of speech, freedom from violent crime)  Links between rights and obligations are important eg Patients Rights Charter  3. Liberal Individualism South African Bill of Rights - Access to healthcare services and many determinants of health such as adequate water, social welfare, education, housing and lastly foundational rights such as life, equality, dignity, Patients rights charter  Launched in November 1999  12 Rights  10 responsibilities  Not a legally binding document  3. Liberal Individualism Government Initiatives to transform and improve public service delivery: Batho Pele- Sesotho: People First, addressing: 1. Consultation 2. Setting service standards 3. Increasing access 4. Ensuring courtesy 5. Providing information 6. Openness and transparency 7. Redress 8. Value for money Department of Social Development - Batho Pele (dsd.gov.za)  Ethical theories 4. Communitarianism  Community Based theory  Needs of the community, as a whole, are placed above the needs of the individual  Are not interested in which rights are at stake but rather,  How communal values and relationships will be affected  Popular in Africa; philosophy of Ubuntu  Ethical theories 5. Ethics of care  Based on relationships that exist between people  Notion of ‘care’ takes centre stage  Attitude of care and compassion within the context of the relationship is stressed  E.g. nurses who spend all day/night with patients, not only disease but the well-being of person  Ethical theories 6. Casuistry  Case based approach  Analysis of and decisions based on previous cases  Real-life cases are examined and generalisation/conclusions are subsequently developed  Ethical theories 7. Character ethics  Virtue based  Careful training until acquire the habit of being virteous  Choosing best approach for happiness, deliberating on general principles until the best decision is made  A professional person must display certain virtues and traits  Compassion  Trustworthiness  Integrity  Discernment  Ethical theories 8. Principlism  Refers to the approach to moral argumentation developed by Beauchamp & Childress in their book Principles of biomedical ethics, 2013.  Idea of “Four principles of biomedical ethics”.  The basic idea behind the approach is that moral problems can best be approached, though not always solved, by applying one or more of the four basic “moral principles” to them, i.e. autonomy, non-maleficence, beneficence and justice  Oath of Graduands in Dietetics ot the University of Stellenbosch Medical students: Oath of Hippocrates Oath of Graduands in Dietetics of University Upon receipt of my Degree in Dietetics from Stellenbosch University and entry into the profession, I solemnly declare that I shall:  Serve humanity through the promotion and maintenance of health and well-being;  Show respect for humankind by the dutiful, conscientious and dignified practice of my profession;  Treat my patients to the best of my ability;  Maintain the confidentiality of all information concerning my patients;  Ensure that my knowledge and skills are maintained;  Acknowledge my limitations and consult colleagues where appropriate;  Always conduct myself honourably towards my colleagues ;  Promote the honour of my profession;  Remain loyal to my University. IN THE NAME OF GOD, MOST COMPASSIONATE, MOST HIGH The Hippocratic Oath I do solemnly swear, by whatever I hold most sacred, that I will be loyal to the Profession of Medicine and just and generous to its members. That I will exercise the art of medicine solely for the cure of my patients, and will give no drug, perform no operation for a criminal purpose, even if solicited, far less suggest it; in like manner I will not give to a woman any kind of strange material to produce abortion, and I will maintain respect for human life from the moment of its conception. That whatsoever I shall see or hear of the lives of men or women which is not fitting to be spoken, I will inviolably secret. I will not carry out moral judgment of any patient, but will deal with its diseases to the maximum of my capacity without concerning the circumstances. The Hippocratic Oath- continued Knowing my own limitations and those of medicine in general, I will make an effort to cure when possible and always comfort. I will only request studies if I believe that they have reasonable probability to produce better results for my patients, and I will not carry out studies neither procedures nor surgery only for monetary gain. I will freely refer my patients to other doctors if I am convinced that they are more enabled than I to treat a certain problem. I will care for my patients and their families as I would have them care for me and my family. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and /or corruption; and, further from the seduction of females or males. The Hippocratic Oath- continued I will not experiment with patients unless they grant its consent after informing them truthfully, and I will continue being a student all my professional life. I will try to work like an expert for all my patients to be able to take care of them more indeed and to be able to apply the lessons that they provide to me in the care of other patients. I will offer care to all the patients who ask for it. No matter the sex, race, colour, creed or economic status. I will voluntarily offer part of my time for the care of the poor and the underserved ones. While I continue to keep this oath inviolated, may it be granted to me to enjoy the practice of the art of medicine, respected by all men, at all times! But should I trespass or violate this oath, that God and society demand these violations against me.  HOW TO RESOLVE ETHICAL DILEMMAS (HPCSA- Booklet 1-) https://www.hpcsa.co.za/Uploads/professional_practice/ethics/Booklet_1_Guidelines_for_Good_Pract ice_vDec_2021.pdf The core values and standards of the HPCSA are the foundation that grounds the general ethical guidelines and these guidelines may be applied to many different concrete cases. Health care practitioners may use these guidelines to make practical decisions or choices about the provision of health care, eg. how does a guideline apply in a specific case? And, how to handle difficult situations where two (or more) principles appear to be in conflict? Briefly, what is needed is ethical reasoning. In general, such ethical reasoning proceeds in four steps: 1. Formulate the problem: Determine whether the issue at hand is an ethical one once this has been done it must be decided whether there is a better way of understanding it. 2. Gather information: All the relevant information must be collected - such as clinical, personal and social data. Consult authoritative sources such as HPCSA guidelines, practitioner associations, respected colleagues and find out how practitioners generally deal with such matters. 3. Consider options: Consider alternative solutions in light of the principles and values they uphold. 4.Make a moral assessment: The ethical content of each option should be weighed by asking the following questions: a) What are the likely consequences of each option? b) What are the most important values, duties, and rights? Which weighs the heaviest? c) What are the weaknesses of the health care practitioner’s individual view concerning the correct option? d) How would the health care practitioner himself or herself want to be treated under similar circumstances – that is, apply the Golden Rule? e) How does the health care practitioner think that the patient would want to be treated in the particular circumstances? THEN: Discuss your proposed solution with those whom it will affect Act on your decision with sensitivity to others affected Evaluate your decision and be prepared to act differently in the future (Adopted from WMA – Medical Ethics Manual) Solving dilemmas- brief guide 1. Identify and articulate the ethical dilemma 2. Gather all the necessary info that will ultimately help you make a decision 3. After having collected info- analyse it 4. You may realise that you need more information- if so, gather more 5. Make informed decision and implement or make a recommendation