Ethics Lecture Notes PDF

Ethics and the code of conduct Professor Sudeshni Naidoo University of the Western Cape Objectives of Presentatio Explore pertinent issues of the changing social environment that influences the practice of dentistry. It will provide an introduction to the fundamental pr...

Ethics and the code of conduct Professor Sudeshni Naidoo University of the Western Cape Objectives of Presentatio Explore pertinent issues of the changing social environment that influences the practice of dentistry. It will provide an introduction to the fundamental principles of ethics and the related values  Dentist’s Duty of Care Society’s changing demands: better educated public, conscious of it’s rights, encouraged by consumer organisations Continuing Education: maintain standards Clinical Audit & Peer Review Ombudsman Report Professional Conduct: SADA, SAMA, HPC for disciplinary action What do you understand by the terms: ETHICS? ETHICAL PRACTICE?  Some responses (2009)  Something that makes you do one thing over another  Something that stops you from doing certain things  Right versus wrong  Principles learnt from cultural, religious, legal, human rights sources, past experiences  Helps our judgement in the decisions we make Principles of Ethics Nonmaleficence (do no harm) Beneficence (do good) Autonomy Justice Ethical Dilemmas Everyday problems vs Ethical Dilemma Occurs when one or more ethical principles are in conflict Eg. Principle of nonmaleficence (do no harm) in conflict with principle of autonomy (patient’s wants) prophylactic antibiotics before surgery Nonmaleficence Founding principle of the health professional – Hippocratic oath Our first obligation is to do no harm Patient gives access to part of their body (mouth) – based on trust Fundamental to this trust is that the HCW will do no harm Nonmaleficence I will abstain from all intentional wrong doing and harm…” “Above all do no harm…” It is wrong to inflict harm on another person. For Example: It is wrong to do a treatment you know you are not capable of doing Nonmaleficence Obligation to: Keep one’s knowledge and skills current Know one’s own limitations and refer Over time definition has evolved: Not to inflict harm To prevent harm Remove harm Do or promote good Beneficence Found in all health care codes HCWs actions, behaviours & attitudes must be consistent with a commitment to benefit others Existing harm be removed Focus on “doing good” for the patient Take all appropriate actions to restore the patient to good health Autonomy Self determination & the ability to be self governing & self directing Autonomous person chooses thoughts & actions relevant to his/her needs Concept of permitting individuals to make decisions about their own health  Autonomy HCW must respect the autonomy of patients – allow them to make decisions about things that will affect their bodies Properly inform them about all aspects of diagnoses, prognosis and care being provided or offered Fully and adequately explain parameters of services they offer Often an area of conflict: HCW’s best interest vs pts own interest Respect for Autonomy “Tell the truth” “Respect the privacy of others” “Protect confidential information” “Obtain consent for interventions with patients” “When asked, help others make important decisions” Justice Providing individuals or groups with what is owed, due or deserved Described as the principle of equality Treat people with similar needs in the same manner, regardless of age, gender, social status, religion Public sector – issue of resource distribution: choices have to be made, benefits & burdens must be balanced  Conflicting principles A patient needs an operation to save their life. You know the operation can prolong their life and want to do all you can to promote the health of the patient (Beneficence) The patient does not want the operation even after all the facts have been explained and that the patient will die without it (Autonomy) You many not force the patient to have the operation. Values & Concepts Informed Consent Confidentiality Support the principles of ethics  Informed Consent Informed consent: a patient’s voluntary authorisation of a dental procedure based on his/her understanding of the relevant information provided Based on the principle of respect for autonomy that acknowledges the ability of the patient to comprehend knowledge, weigh alternatives & form judgements  Informed Consent Two-pronged process: Providing the patient appropriate information Understanding and assimilation of the information and then making a decision Informed Consent SOME EXCEPTIONS: 1. Unconscious patient 2. Needle-stick injury - HCW  Informed Consent Oral health care is elective OHCW can only treat or examine a patient with the informed consent of the patient Within our demographically diverse country, the concept of cultural sensitivity needs to be taken into account. Clear information, reasons and risks of treatment Confidentiality Critical aspect of trust, mentioned in all codes of ethics Trust is essential for exchange of personal or intimate information Related to respect for the patient Involves the patient exercising his/her autonomy in providing information to the HCW  Confidentiality “In my attendance of the sick, or even apart therefrom, whatsoever things I see or hear, concerning the life of men, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets.” Confidentiality I will respect the secrets confided in me, even after the patient has died.” DECLARATION OF GENEVA - adopted by the WMA(1983)  Confidentiality Patients are unwilling to disclose status especially infectious disease All patients have a right to privacy Can be passed onto other HCW – ONLY with patient’s permission Deliberate breach of this right constitutes an unlawful act  Breach of Confidentiality Confidentiality is not absolute & clinical information must sometimes be transmitted between HCW The ethical duty of the OHCW extends not only to the patients but others whose life & safety may be affected by non-disclosure Patients have to be consulted before disclosure to any third party Confidentiality EXCEPTIONS: Notifiable diseases (STIs) Child abuse Prevention of crime Risk to public Risk to spouse/partner- risk of being infected  HIV Issues HIV pandemic has challenged traditional ethical values of the profession The gravity, infectious nature and social stigma of the illness have led to a range of ethical dilemmas This talk is structured around issues of consent, confidentiality, right to treat, HIV Issues Patient’s duty to disclose status Dentist’s duty to treat Dentist’s duty to disclose own status Confidentiality & Notification To test or not to test? HIV positive Testing for HIV Testing for HIV should only be suggested if the degree of security it offers the HCW is substantially more than the potential harm it may cause the patient Only if test is deemed essential to the management of the patient  Refusal to treat There is no legal obligation on an OHCW to attend to a patient, however, the question of legal duty is complex Hippocratic oath affirms obligation to treat No need to modify care for HIV+ve patients All patients have the right to a high standard of care Differences in treatment? Except in an emergency or where no other treatment facility is available, the SA HCW is not legally obliged to accept a patient in his/her practice Ethical practice, conducted in the spirit of compassion that transcends the letter of the law No patient may be refused treatment because of his/her HIV  OHCW Status There is no professional obligation on the part of OHCWs to disclose their HIV status As long as a patient is not physically ill, there is no reason for an employer to discontinue, reduce or alter the employee’s duties  HIV OHCWs can only examine or treat patients who have provided their consent & may not routinely disclose HIV- related information Ethical obligation to provide care to patients who seek it Sero-positive HCW have no professional obligation to Concluding remarks Dental students must have good knowledge of ethics and the law so as to develop skills to be able to relate to patients in ways that are both ethical and empathetic. References HPSCA Ethical Guidelines Booklets www.hpcsa.co.za Ethics & Law in Dental Hygiene by Phyllis L Beemsterboer