ETHICS

Science which deals with moral conduct of human dignity which are concerned with good or bad; right or wrong Study of excellence or the virtues of character Science of the morality of human behavior, both of the human acts & acts of man

MIDWIVES ETHICS
has to do with the ideals, customs and habits which the members of the profession are, to a certain degree, accumulate the name and general characteristics of the woman known as a trained midwife

DEFINITION OF TERMS
Human Acts actions that involves the use of both free will and intellect Acts of Man actions that does nor involve the use of intellect and free will Conscience a practical judgment of reason Etiquette a set of formal rules for social conduct based on social considerations for others

 Ideals is an idea grasped firmly in mind, raised to a standard of action and pursued consistently Values are ideals and concepts that give meaning to an individuals life Law- an ordinance of reason promulgated for the common good Fidelity refers to the obligation of a person to be faithful to commitments Veracity the principle of truthfulness

 Obligations refers to the demands made on an individual, a society, a profession or government to fulfill and honor the rights of others. Standard of Best Interest When a client cannot make informed decisions, health care provider or family members decide what is best for the client Rights something owed to an individual according to just claims, legal guarantees, or moral an ethical principles

 Habit the second nature of man Morals deals with the conduct of man, the right and wrong behavior of man in his relationship with his fellowmen Mores customs enforced by social pressure

FUNCTIONS OF ETHICS
1. To distinguish what is right and wrong 2. To help us make sound judgment and decisions 3. To help us make correct decisions and actions in different situations in life 4. To attain a happy & fruitful life

Elements Determining Morality 1. Act itself Object 2. Purpose reason 3. Circumstances surrounding the act Conditions Affecting Morality 1. Ignorance 2. Fear 3. Conscupiscence 4. Violence 5. Habit

Principles of Judging Morality

1. An act is morally good if the act itself, the purpose and the circumstances are substantially good 2. If the act is intrinsically evil, the act is not morally allowable regardless of the purpose or circumstance 3. Circumstances may create, mitigate or aggravate the immorality of an act 4. If the act is itself good or at least indifferent, its morality will be

RIGHTS
1. Welfare rights also called legal rights 2. Ethical rights based on moral or ethical principles 3. Option rights based on fundamental belief in dignity and freedom of humans

HABIT
BASIC RULES TO FOLLOW IN FORMING GOOD HABITS
1. There must be strong desire or will power to form a habit 2. Repetition and uninterrupted practice must be religiously observed 3. No exemptions must be tolerated 4. The will must be daily strengthened by small sacrifices, penitential works and all other acts which tend to strengthen the will

HABIT
4 RULES OF ELIMINATING BAD HABITS
1. There must be strong desire or will power to break the habit 2. The breaking of the habit must be done gradually with no exemptions allowed 3. Following the law of disuse, the person must refrain from performing the bad habit 4. Substitute a (bad) habit for another (good habit)

Moral and SPIRITUAL responsibilities OF MIDIVES

Midwives must emphasize the importance of providing spiritual care as an important aspect of health care. Midwives must respect each clients spirituality and her/his expression. Midwives must uphold the sanctity of life. Midwives must be guided and respect basic moral principles/rules in the care of clients.

THE MORAL VIRTUES

1. Justice Is the virtue that allows man to give his neighbor what rightfully belongs to him. 2. Temperance is the virtue that moderates the possible overindulgence of the conscupiscible appetite. 3. Fortitude Is the virtue that gives courage to a man in times of overwhelming odds.

THE MORAL VIRTUES

4. Prudence Is the virtues of
knowing how things are to be done rightly and well.

ETHICAL SYSTEMS

Utilitarianism
Jeremy Bentham In the 18th century British philosopher Jeremy Bentham founded the ethical, legal, and political doctrine of utilitarianism, which states that correct actions are those that result in the greatest

Deontology
logic of moral obligation: the study of what is morally obligatory, permissible, right, or wrong

ETHICAL PRINCIPLES
Two Fold Effect A little more or less does not change the substance of an act Principle on the origin and destruction of life No one is held to the impossible The Utilitarian Principle Meeting others Halfway Defects of nature may be corrected

The Golden Rule

1. essential rule: a basic rule that must be followed 2. rule of conduct: the rule of conduct that advises people to treat others in the same manner as they wish to be treated themselves

ETHICAL ISSUES
Research on Human Subjects including fetuses When to withdraw /withhold treatment Abortion Euthanasia

IF YOU OBJECT TO PARTICIPATING IN ABORTION CASE:

- let your supervisor or appropriate person in your facility know in advance so you wont be given such an assignment. - express objections in terms of your moral, ethical, religious beliefs to protect yourself from retaliatory action. -when you become involved in the case that you object to and the patients life is in jeopardy, you are legally obligated to continue to case for

Correcting Genetic Diseases

Medical Transplants

Man on Life Support

Prenatal Testing

Assisted Reproductive Technologies

Genetic Engineering

 Be familiar with laws governing (RN May 1998) alternative modalities Check employers policies and job description Document: time, date, any teaching provided, nature of treatment and patients response, Obtain full consent from patient Determine authorized health care

Legal Risks in Alternative Theraphies

IF YOU OBJECT TO PARTICIPATING IN ABORTION CASE:

- let your supervisor or appropriate person in your facility know in advance so you wont be given such an assignment. - express objections in terms of your moral, ethical, religious beliefs to protect yourself from retaliatory action. -when you become involved in the case that you object to and the patients life is in jeopardy, you are legally obligated to continue to case for

ETHICAL ISSUES
Living Wills/advance directives patient designates a healthcare representative to make decisions for him when he is unable due to physical or mental incapacity to make his/her own healthcare decision (i.e. to accept or refuse any treatment, service, procedure or to provide,

ETHICAL ISSUES
Living Wills/advance directives - signed by the client -witnessed by two other persons - attached to the patients chart - must be respected

ETHICAL DILEMMA
AIKENS MODEL to Resolve Ethical Dilemma Collect, analyze and interpret the data State the dilemma, make a clear statement of the situation Consider the choices of action, all options open to the client Analyze the advantages & disadvantages of each course of action

1. 2. 3. 4.

BRANCHES of ETHICS
HEALTH CARE ETHICS study of moral issues that concern health care professionals in medicine, nursing, law, sociology, philosophy and theology. It deals with health care values, obligations, rights and needs

BIOETHICS
Study of Ethics that result from technological scientific advances in the areas of biology & medicine

Bioethics is the study of human conduct in the area of the life sciences and health care using moral values and principles.

 PROFESSIONAL ETHICS basic principles of conduct or right actions that a licensed practitioner must at all times observe and uphold in the practice of his profession

PRINCIPLES OF BIOETHICS
PRINCIPLE OF AUTONOMY what is clients choice PRINCIPLE OF BENEFICIENCE what is good for the client PRINCIPLE OF NONMALEFICENCE what is not harmful to

PRINCIPLE OF CONFIDENTIALITY what is private for the client PRINCIPLE OF JUSTICE what is client fair for the

PRINCIPLES OF BIOETHICS

PRINCIPLE OF VERACITY what is the truth for the client

MIDWIVES responsibilities in BIOETHICS

INFORM patient including his/her rights. PROTECT patient. RESPECT patients decision even when different/contradictory to personal values.

MIDWIFERY ETHICS
PHILIPPINE CODE OF ETHICS FOR MIDWIVES Aim: To help midwifery practitioners, as individuals and as a professional group, to pursue and maintain a high level of ethical conduct in the practice of midwifery * Principles of rules do not carry legal force or sanction

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 1 Primary Objective of Midwifery profession to render service within the scope of their legitimate functions, having in mind that their patients , of whatever religion and social or economic status, deserve respect as human beings. - A midwife should endeavor to deserve the confidence of the patients under her care rendering to each of them a dedication and service to the full extent of her skill and competence

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 2 a midwife should try her best to continually improve her knowledge and skill for the benefit of her pateints and to share with her copractitioners, any valuable or practical knowledge she may have gained by experience in the practice of her profession

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 3 A midwife is expected to practice midwifery on a scientific basis and not to voluntarily take part in the performance of any midwifery procedure which is doubtful or questionable propriety, from a standpoint of medical or scientific knowledge

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 4 -The midwifery profession should contribute to the safeguarding of the public health and should respect itself against the admission into its membership of midwives deficient in professional competence and requisite moral character. Section 5 a midwife should render service to her patient to the best of her ability

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 6 A midwife should not compromise her services to the patient under terms or conditions which would interfere with or hamper the exercise of her judgment or skills Section 7 A midwife must confine the source of her professional income to the midwifery services she has actually rendered

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 8 A midwifes legitimate functions cover performance of midwifery services only to normal pregnant women and normal newborn infants Section 9 A midwife is bound by professional ethics not to reveal any information given by her patient in the course of the patients care or treatment unless she is required to testify

PHILIPPINE CODE OF ETHICS FOR MIDWIVES

Section 10 she should contribute to the improvement of the patients health and the communitys as well Section 11 Participate in research activities Section 12 Should work with interest and concern, together with other members of the health team, in promoting efforts to meet the health needs of the public

PATIENTS BILL OF RIGHTS

1. Right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis 2. To give informed consent 3. Refuse treatment 4. To privacy 5. To confidentiality 6. Expect a hospital to make reasonable response to the request of the patient to service

PATIENTS BILL OF RIGHTS

7. Obtain information as to any relationship of his care is concerned 8. Refuse to participate any research projects 9. Expect reasonable continuity of care 10. To examine and receive explanation of his bill 11. To know what hospital rules and regulations apply to his conduct as a patient

MIDWIVES AND CONTRACTS

Essential requisites of a contract: consent of the contracting parties; object certain which is the subject matter of the contract and the cause of the obligation

NURSES AND CONTRACTS

A contract is an agreement which creates an obligation. It is an agreement upon sufficient consideration, to do or not to do A particular thing. It is the meeting of minds between two persons whereby one binds himself, with respect to another, to

INFORMED CONSENT
Proof of consent: Written statement to show that procedure was consented to i.e. xrays, special laboratory tests, blood transfusions, operations, cobalt therapy, etc.

INFORMED CONSENT
It is a persons agreement to allow something to happen, such as surgery, which is based on full disclosure of facts needed to make the decision intelligentlythe risks involved, alternatives, description of the benefits to be expected, material rights if any, the prognosis, if the recommended

parents/guardians in behalf of minors, wards, mentally ill. In cases of emergency, consent may be dispensed with. In cases of refusal, release form/waiver must be Philippine setting,Proper accomplished. with regard In the documentation must be to advance the nurse made by regarding the directives, DO NOT RESUSCITATE consent/refusal of ORDERS are patients. respected.

INFORMED Who must consent: CONSENT own behalf, Patient on his

Midwives and Negligence

Negligence is the doing of a thing which a reasonably prudent person would not have done or the failure of that thing a prudent person would have done in like or similar circumstances. It is the failure to exercise that degree of care and prudence which a reasonably prudent person would have exercised in like or similar manner.

Negligence
*Reasonable foresight of harm, followed by ignoring of the admonition born of this foresight is the constitutive fact in negligence. * Negligence encompasses the concepts of

Midwives and Negligence

In every case involving actionable negligence, there must exist three essential conditions: (a) the existence of a duty on the part of the person charged, to protect the complaining party from the injury received; (b) a failure to perform that duty; and an injury

Test of Negligence
WOULD A PRUDENT MAN/WOMAN, IN THE POSITION OF THE PERSON TO WHOM NEGLIGENCE IS ATTRIBUTED, FORESEE HARM TO THE PERSON INJURED AS A REASONABLE CONSEQUENCE OF THE COURSE ABOUT TO BE PURSUED?

DOCTRINE OF RES IPSA LOQUITOR When a thing which has caused an injury is shown to be under the management of the party charged with negligence, and the accident is such as in the ordinary course of things will not happen if those who have such management use proper care, the accident itself affords reasonable evidence, in the absence of explanation by the parties

DOCTRINE OF RES IPSA LOQUITOR - accident does not occur without negligence, accident caused within the control of defendant, accident must not be due to voluntary action contribution of plaintiff

EFFECT OF FORCE MAJEURE - it is a fact or accident which human prudence can neither foresee nor prevent. No person shall be responsible for those events which could not be foreseen, were inevitable, except in cases expressly specified by law, or when it is otherwise declared by stipulation, or when the nature of the obligation requires the assumption of risk

DOCTRINE OF RESPONDEAT SUPERIOR - relationship of master servant is present, while acting within the scope of authority - does not apply where the injury occurs while servant is acting outside the scope of

Midwives and Incompetence

Negligence is the doing of a thing which a reasonably prudent person would not have done or the failure of that thing a prudent person would have done in like or similar circumstances. It is the failure to exercise that degree of care and prudence which a reasonably prudent

MIDWIVES AND MALPRACTICE

Malpractice is any professional misconduct or any unreasonable lack of skill or fidelity in the performance of professional or fiduciary duties. It is objectionable practice or practice contrary to established rules. Malpractice is the failure to follow a reasonable, professional standard of care, resulting to injury to the patient. Malpractice action seeks to compensate a person for damages

MIDWIVES AND MALPRACTICE

HOW CAN NURSES PROTECT THEMSELVES FROM MALPRACTICE SUITS? PRACTICE within the scope of RA 9173. OBSERVE standards of care. ( standard id the desired and achievable level of performance against which actual practice is

ACTS OF MALPRACTICE
Fine (.>P50, 000 < P100,000 or imprisonment of >1 yr nor more than 6 yrs

What is punishable: Practicing midwifery in the Philippines 1. without a CR/PL/PIN or special temporary permit Without having been declared exempt from examination 2. using CR/PL/PIC/Permit of another 3. using invalid/suspended/revoked/cancelled/

ACTS OF MALPRACTICE
Fine (.>P50, 000 < P100,000 or imprisonment of >1 yr nor more than 6 yrs

What is punishable: Practicing midwifery in the Philippines 4. giving false testimony to BOM to obtain CR/PL/Permit 5. falsely posing or advertising registered and licensed nurse 6. appending RM without having been conferred

MIDWIFES PRAYER Dear Lord Jesus Christ, Thou great physician of our soul, who has healed the sick and even brought the dead back to life, I kneel before Thee and pray, since every good and perfect gift must come from Thee, who at rich for all who invoke Thee. Grant that mothers Thou hast placed in my care may be abundantly blessed, and not one of them be lost because of anything that is lacking in me, give me both wisdom and sympathy, kindness and understanding in my daily work. Inspire me with words of comfort and strength, and let me encourage all mothers in their great hour, guide my mind and hands , good Jesus, that I may help them all and be able to lift at least a part of their burden and suffering Assist me, dear Lord, to overcome human weakness and enable me to radiate the sunshine of joy upon the lives of those who are gathered around me day by day Let me never do anything that would bring disgrace upon your church and your most holy law. And one grace more, dear Lord, let me always inform the people right on time to call on you to the bedside of

MIDWIFES PLEDGE
I solemnly pledge that I will do my best Seeking GOD help and asking for His grace To keep my body healthy, strong and pure The task of a midwife, I must carry for sure To keep my mind alert and fully awake To the profession I have chosen for life, I will stick To be trustworthy, refined, polite and gracious in manner An inspiration always to those under my care To serve unselfishly and wisely everywhere Guiding the innocent, easing the sufferers To make my work filled with sweetness and beauty Where fellowship is bound in adversity; To be loyal to my patients, associate, country and God From whom I dearly owe my life and my love So help me God