Professional Codes of Ethics and Conduct in Midwifery PDF

PROFESSIONAL CODES OF ETHICS AND CONDUCT IN MIDWIFERY PRACTICE By: Racquel Burton- Edwards MScN Ed,BScN,RM,RN Theories of Ethics Ethical theories/frameworks are systems that attempt to explain how we should live and why. Acti...

PROFESSIONAL CODES OF ETHICS AND CONDUCT IN MIDWIFERY PRACTICE By: Racquel Burton- Edwards MScN Ed,BScN,RM,RN Theories of Ethics Ethical theories/frameworks are systems that attempt to explain how we should live and why. Action-guiding theories fall into 2 main categories: Deontology Utilitarianism Deontology Deontology: https://youtu.be/wWZi-8Wji7M Action, is in compliance with formal rules of ethical behaviour, and is compulsory regardless of their result". actions are good or bad according to a clear set of rules. It places particular emphasis on the relationship between duty and the morality of human actions. It is only about following the rules and does not require weighing the cost and benefits of the situation.  Example 1:Deontology Action CHEATING If someone cheats on us, we imagine that person as very wrong and untrustful because we think of cheating as wrong. For example, suppose you’re a software engineer and learn that a nuclear missile is about to launch that might start a war. You can hack the network and cancel the launch, but it’s against your professional code of ethics to break into any software system without permission. And, it’s a form of lying and cheating. However, in letting the missile launch, thousands of people will die. Example 2: Deontology Action A nurse may agree that certain abortions yield better consequences than allowing an unplanned and unwanted pregnancy to continue, but believe that the act of abortion is nonetheless ethically wrong because no consequences justify the taking of innocent life  Utilitarianism Utilitarianism: https://youtu.be/-FrZl22_79Q The act is morally right if it brings about a greater balance of good over evil than any other action that could have been taken“ It is a theory of morality that advocates actions that foster happiness or pleasure and oppose actions that cause unhappiness or harm. The two most basic types of utilitarianism are: *Act-utilitarianism; suggest people will choose actions in any given circumstances that will increase the overall good. *Rule-utilitarianism; suggest people will choose rules that when followed consistently, will maximize the overall good. Example: Utilitarian Action/Argument An example of rule utilitarianism is tiered pricing for a product or service for different types of customers. In the airline industry, for example, many planes offer first-, business-, and economy-class seats. Customers who fly in first or business class pay a much higher rate than those in economy seats, but they also get more amenities—simultaneously, people who cannot afford upper- class seats benefit from the economy rates. This practice produces the highest good for the greatest number of people. And the airline benefits, too. The more expensive upper-class seats help to ease the financial burden that the airline created by making room for economy-class seats. Example : Utilitarian Action/Argument Pharmaceutical companies release drugs that have been governmentally approved, but with known minor side effects because the drug is able to help more people than are bothered by the side effects. Act utilitarianism often demonstrates the concept that “the end justifies the means”—or it's worth it. Example 1: Utilitarian Action/Argument A nurse may believe that abortion is ethically justified in situations that result in the best consequences for the woman, child, and society. (Act Utilitarianism) Deontology Utilitarianism 1. Deontologic: An action is right or wrong 1. Utilitarian: The rightness or wrongness of an independent of its consequences action depends on the consequences of the action. 2. Deontology: Action, is in compliance with 2. Utilitarianism: An act is morally right if it brings formal rules of ethical behaviour, and is about a greater balance of good over evil than any compulsory regardless of their result". other action that could have been taken”. 3. "one which holds that at least some acts are 3. "one should act so as to promote the greatest morally obligatory regardless of their good (pleasure) of the greatest number of people. consequences for human weal or woe". 4. the end justifies the means. 4. "doing one's duty." 5. concerned with benefiting the majority, rather 5. No purpose to the duties that deontology than the needs and desires of individuals. proposes beyond the duties themselves. Duty of Care The legal obligation to take reasonable care to avoid causing harm. According to The National Competency Standards for the Midwife (ANMC): midwives owe a single and comprehensive duty to the women they provide care to. The responsibility of the midwife and the practice reflect recognition that the relationship is special and built on trust. Duty of Care cont’d Ethical rules binds the midwife to her/his duty of care. Midwife has a duty of care to: The midwife’s primary *Self *Fetus/ Baby responsibility is to the *Colleagues *Employer women, families and communities requiring *Clients/patients *Profession midwifery care. *Relatives Duty of Care cont’d If the person suffered a If Health professionals foreseeable injury: fall short of expected standards of care they The employer owed a duty of may be charged with care and the failure to eliminate negligence which is the risk showed a lack of breech in "duty of reasonable care. care." Duty of Care cont’d To Self The midwife: * has the personal responsibility and accountability for his/her midwifery practice, and for maintaining competence by continual learning. *uses judgment regarding individual competence when accepting and delegating responsibility. Duty of Care cont’d To clients, baby and relatives The midwife: * promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. *ensures that individuals receive sufficient information on which to base consent of care and related treatment. Duty of Care cont’d To clients, baby and relatives (cont’d) The midwife: *holds in confidence personal information and uses judgment when sharing this information. *shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction. Duty of Care cont’d To clients, baby and relatives (cont’d) The midwife: *shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, especially those in the vulnerable populations. *ensures that the use of technology and scientific advances are compatible with the safety, dignity and rights of people. Duty of Care cont’d Profession The midwife: * Assumes the major role in determining and implementing acceptable standards of clinical midwifery practice, management, research and education. * Is active in developing a core of research based professional knowledge. * Acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in midwifery. Duty of Care cont’d Colleagues The midwife: *Sustains a co-operative relationship with co-workers in midwifery and other fields. * Takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. Duty of Care cont’d Employer The midwife: *Have a legal and moral obligation to the institution when she/he accepts employment for payment of services. Key Ethical Principles Beneficence Common good Distributive justice Human dignity Principle of informed consent Principle of respect for autonomy Principle of toleration Key ethical principles Beneficence (“doing good”) Beneficence has Midwives should implement three main actions that benefit clients and components: their support persons. *To do or promote ‘Benefit’ should be defined by good the person/patient themselves. It’s not what the midwife think *Prevent harm is important. Beneficent acts are morally and *Remove evil or legally demanded by the harm professional role. Key ethical principles cont’d Common Good It is to the advantage or benefit of all people in society or in a group. That is ….the good of the community; whether one's local community or the world community, Common Good takes precedence over the good of the individual. Key ethical principles cont’d Distributive Justice sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time) It is an arrangement whereby goods and services are distributed by an authority (e.g. MOH) on the basis of a commonly accepted standard. Key ethical principles cont’d Distributive justice can be done using the following methods: * To each according to the * To each equally person’s right * To each according to need *To each according to individual effort * To each according to merit * To each as you would be done by *To each according to social * To each according to the greatest distribution good to the greatest number Key ethical principles cont’d Professional behaviours showing human dignity include the Human Dignity: following: Is Respect for the *Provides culturally competent inherent worth and and sensitive care uniqueness of *Protects the patient’s privacy individuals and *Preserves the confidentiality of populations. patients and healthcare providers Reflected when the *Designs care with sensitivity to midwife values and individual patient needs respects all patients and colleagues. Key ethical principles cont’d Informed Consent A process by which clients are informed of the possible outcomes, alternatives, risks of treatments and are required to give their consent freely. It gives the client autonomy to choose in their care, and assures the legal protection of their rights. The choice includes the right to refuse interventions or recommendations about care and to choose from available therapeutic alternatives. Key ethical principles cont’d Professional behaviors showing principles of autonomy include Principle of respect the following: for Autonomy (self governing ; the right to *Plans care in partnership with self-determination) patients Reflects autonomy *Honors the right of patients when the midwife and families to make decisions respects patients’ about healthcare rights to make *Provides information so that decisions about their patients can make informed own healthcare. choices Key ethical principles cont’d Toleration This is the practice of tolerating something, in particularly differences of opinion or behavior. It is a moral principle. It is a behaviour that one may only engage in when in society with others. Professional Values cont’d Professional behaviors showing social justice include Social Justice the following: is upholding moral, legal, *Supports fairness and non- and humanistic principles. discrimination in the delivery This value is reflected in of care professional practice *Promotes universal access when the nurse/midwife to healthcare works to assure equal *Encourages legislation and treatment under the law policy consistent with the and equal access to advancement of nursing quality healthcare. care and healthcare Ethical Guidelines Legality Honesty Confidentiality Quality Fairness Professionalism Ethical Guidelines Legality An act, agreement, or contract that is consistent with the law or state of being lawful or unlawful in a given jurisdiction. No person is to be superior to the law. This means that ignorance of a law is almost never recognized as a legitimate defense Ethical Guidelines cont’d Honesty (Refers to): a facet of moral character and connotes positive and virtuous attributes such as integrity, truthfulness, straightforwardness, including straightforwardness of conduct, along with the absence of lying, cheating, theft. honesty means being trustworthy, loyal, fair, and sincere.  Ethical Guidelines cont’d Confidentiality “Applies to protected patient information, including basic identifiers of the patient’s past, present, or future physical or mental health conditions, including the provision of health services and payment for those services.” Ethical Guidelines cont’d For example: Quality a patient undergoes a surgical procedure: From a technical quality perspective, the Technical quality operation was perfectly executed, (e.g., clinical and from a service quality perspective, the indicators) patient was perfectly satisfied with the care and service quality he received. (e.g., patient *So the care was of high quality, right? satisfaction) *Well, not necessarily: but Ethics quality is - Imagine that the patient was never really also important. informed —or was even misinformed —about the procedure he received. This would indicate a problem with ethics quality. Ethical Guidelines cont’d Professionalism Fairness The methods, the quality of making characteristics, skill, judgments that are free good judgment, polite from discrimination. behavior and attitudes of a person is usually used to describe the type of behavior you would expect from a professional person (a person who is trained to do a job well). ICM code of Ethics Please refer to email Hand-outs for reading Interpersonal Processes Midwifery: value Belief Attitudes  Interpersonal Processes cont’d Values are learned and are greatly influenced by a person’s sociocultural environment (e.g. demonstrate honesty, folk healer, observation and experience) Midwifery Values: are freely chosen, lasting beliefs or attitudes about the worth of a person, object, idea, or action **Once a person becomes aware of his/her values, they become an internal control for behavior, thus, a person’s real values are manifested in consistent pattern of behavior** 41  Interpersonal Processes cont’d Beliefs § Ethics: refers to the practices, Morality: individual’s personal beliefs, and standards of belief/standards of what is right and behavior of a particular group wrong in conduct, character, and such as nurses/midwife. attitude (custom or habit). Morals is similar to ethics and are It also refers to the method of sometimes used interchangeably. inquiry that assists people to Morals are based on religious beliefs, understand the morality of social influence and group norms. human behavior (study of morality) 42 Interpersonal Processes cont’d Attitudes manner, disposition, feeling, position, etc., with regard to a person or thing; tendency or orientation, especially of the mind: a negative attitude; group attitudes. a feeling or opinion about something or someone, or a way of behaving that is caused opinion. Professionalism The skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well: *A high level of professionalism is expected when working with clients. *A midwife is highly respected for her/his professionalism. Core Elements of Professionalism  Deportment  Social graces  Confidentiality  Patient/client relationship Characteristics of the midwifery profession 1. Excellent people skills providing professional support and reassurance to a huge diversity of women, during some of the most emotionally-intense periods in their lives. 2. Good communication and observation Be a good at listening and communicating with women, their partners and families. 3. Interest in the physical, psychological and process of pregnancy and birth have an in-depth understanding of foetal and child development. important to update your knowledge and utilize it in the clinical space to gain experience Characteristics of the midwifery profession cont’d 4. Ability to answer questions and offer advice must be able to answer their questions, share your knowledge and skills with patients, their families and friends and make sure their needs are recognised by the rest of the team. 5. Happy to work as part of a team be part of a multidisciplinary team liaising with GPs, health visitors and social workers. Good collaborative care allows smooth efficient care for the pregnancy and birth. 6. Dealing with emotionally charged situations stay calm and alert in times of stress, and enable women to feel confident and in control. On the rare occasions where something goes wrong, you have to be ready to react quickly and effectively. Core Elements of Professionalism cont’d Deportment has to do with how you behave and Social graces are skills used to present yourself. Being interact politely in social situations. polite, well-dressed, and They include manners, etiquette (the specific accepted rules within a soft-spoken shows culture for the application of universal excellent deportment. manners), deportment and fashion. Examples, please, thank you, excuse me, Hello-nice to meet you, knock on closed door, ask if you can help Core Elements of Professionalism cont’d Confidentiality is one of the The patient/client core duties of medical practice. relationship is an It requires health care interaction aimed to providers to keep a patient's enhance the well-being of a "client,"... This makes the personal health information relationship safe and private unless consent to establishes trust. The patient release the information is should feel comfortable provided by the patient. disclosing personal information and asking questions.  Regional Nursing Body  Regional examination for midwives Regional Nursing Body (RNB) Sets and maintains standards of Nursing/ Midwifery Education and practice bearing in mind that nursing & midwifery regulates itself. The ultimate objective is the provision of a sufficient quantity of adequately prepared nursing personnel to meet the health care needs of the countries of the Region. The RNB recommended that Nursing & Midwifery Education should be in the mainstream of tertiary education (Universities) which now exist. Regional examination for midwives It was felt that the best way to ensure a common standard was through the establishment of a Regional Examination for Nurses and licensure exam for Midwives. A policies and procedures document for the evaluation of Schools of Nursing was developed and used as the guide for the assessment. An important step was the establishment of a pool of qualified persons who would act as Regional Nursing Examiners for the regional examination and for the Midwifery Liscensing exam. Written paper offered 2x per year April and October, Prerequisite: successful completion of University modules, practical hours, O&P exams (midwifery) Nursing Council of Jamaica (NCJ) Nursing/ midwifery are health professions that can pose risk or harm to the public if practiced by people who are unprepared or incompetent. § Nursing Council of Jamaica (NCJ) are authorized to enforce the Nurses and Midwifery Practice Act, and to develop administrative rules and regulations and any other responsibility delineated within this Act, such as monitoring the quality of nursing and midwifery programs. § NCJ achieve the mission of regulation by creating standards for safe nursing/midwifery care and by issuing licenses to practice nursing and midwifery. NCJ (cont’d) Nursing Council of Jamaica Regulates midwifery intake, education, examination, Regulates midwifery practice, Keeps register of qualified and licensed midwifes, Disciplinary Committee. Appeals Tribunal and Discontinue practice. § Once a license is issued, it is the responsibility of the Board of Nursing (NCJ) to continually monitor the licensees' compliance with the laws and to take action against any nurse who exhibits unsafe nursing/midwifery practice. § Relicensing is done biannually § Individuals who serve on Boards of the Nursing Council are appointed to their position. Ethical framework for midwifery research Caring Consent Confidentiality Codes Committee Ethical framework for midwifery research Caring “Nurses and midwives use evidence-based knowledge and apply best practice standards in their work. Nurses and midwives value research which is central to the nursing and midwifery professions. Research informs standards of care and ensures that both professions provide the highest quality and most cost-effective services to society. Delivery of safe and competent practice is based on best available evidence and best practice standards.”  Ethical framework for midwifery research cont’d Codes Nurses/midwives involved in research activities must adhere to the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives The aim of the International Confederation of Midwives (ICM) is to improve the standard of care provided to women, babies and families throughout the world through the development, education, and appropriate utilization of the professional midwife. In keeping with its aim of women's health and focus on the midwife, the ICM sets forth the following code to guide the education, practice and research of the midwife. This code acknowledges women as persons, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust, and the dignity of all members of society.  Ethical framework for midwifery research cont’d Consent The right to self-determination, which means that a person has the right to choose whether or not to participate in a research study The right to full disclosure, ensuring that a person has received information outlining the nature of the study, including the likely risks and benefits, allowing them to make an informed choice. The right to self-determination and the right to full disclosure are major components on which informed consent is based. Ethical framework for midwifery research cont’d Confidentiality The researcher is responsible for ensuring confidentiality and privacy of the research participants and the data obtained from them. Personal information obtained by the researcher must not lead to identification of research participants and this information should not be made available to others without their consent.  Ethical framework for midwifery research cont’d Committee It is important that research practices are continually monitored, audited and evaluated. Many healthcare services/institutions and higher education institutions utilise research ethics committees to ensure proper scrutiny of research and clinical trials. These committees have stringent standards, guidelines and policies to which researchers must adhere. It is the responsibility of the researcher to obtain ethical approval prior to initiating a research study. When applying to ethics committees for approval, all the ethical issues must be identified clearly in the written proposal and the researcher must demonstrate how these will be addressed in the conduct of the research study.  Does the Midwife have rights? Midwife Rights Recognize the importance of respect for her own rights as a care provider. The right to refuse care to clients with whom no relationship has been established The right to discharge clients from her care, provided adequate referral to other care is provided The right to receive honest, relevant information from clients upon which to base care The right to be remunerated for services rendered The right to refuse care if the client acts irresponsibly, in any way that would cause the client to become high risk  Reference Burkhardt, M., & Nathaniel, A.(2008) Ethics and issues in contemporary nursing. Delmar Cengage Learning Daly, J., Speedy, S., Jackson, D., Lambert., V. & Lambert, C. (2005). Professional Nursing:Concepts, Issues, and Challenges : Concepts, Issues, and Challenges. New York, US: Springer Publishing Company, 2005. ProQuest ebrary. Web. 27 July 2016. Deontology example Retrieved from https://studiousguy.com/real-life-examples-of-deontology/ Meehan T. (2004) Nurses and Midwives Ethical Responsibility in Relation to Research. Paper presented at An Bord Altranais Conference – Enhancing Ethical Practice in Nursing and Midwifery on 22nd June 2004 in Tullamore, Co Offaly, Ireland. Polit D. and Beck C. (2004) Nursing Research: Principles and Methods. 7th Edition, Philadelphia: Lippincott, Williams and Wilkins https://youtu.be/-wkh_2mI3Co