Professional–Patient Relationship: III. Ethical Issues | relax-sakura.info
Physicians had a stronger opinion than nurses regarding practice of of the physicians and nurses in relation to healthcare ethics and law in. Physicians, Nurses, Confidentiality, Patient rights. This causes new discussions in the field of medical ethics and health law with regard to . It is emphasized that a private relationship exists between the patient and the health worker, and. Physician-nurse conflict, tension, and stress have been thought to be better than the physician does or have ethical qualms about the proposed action. . a relationship of collaboration and mutual respect that can act as a model for others .
This is because it may miss the individualistic perception of morality and ethics innate to every professional, which would have been constructed by one's own unique cultural, socioeconomic and geographical background [ 13 ]. Hence the curriculum of medical ethics should be tailored to the social and cultural background where it is taught. In order to formulate ethical curriculum germane to every region, the first step may be to determine the current basic knowledge and attitudes of the healthcare practitioners in the region.
There have been few standard yardsticks designed to measure what is known and practised, so that educational efforts may be better targeted [ 14 ]. Physicians and nurses work closely together for patient-care, but the professional relations between the two categories may have differences with respect to their attitudes towards patient-care [ 15 ].
With this background the present study is an attempt to elucidate the knowledge, attitude and practice of the physicians and nurses in relation to healthcare ethics and law in Barbados.
The Code of Ethics for Nurses
Methods A thirty item self-administered structured questionnaire about knowledge of law and ethics and the role of an ethics committee in the healthcare system was devised de novo and tested. It was made available to all levels of staff at the Queen Elizabeth Hospital in Barbados a tertiary care teaching hospital during April, May The questionnaire included a full range of response options, designed to identify the practitioner's knowledge, beliefs and attitudes towards patient care I relation to healthcare ethics and law.
Prior to distribution of the questionnaire a pilot study was done with a select group of healthcare workers who were asked to fill out the questionnaire and return with comments and criticism. Minor changes were made to the final instrument. The questionnaire is given in the 'Appendix' section. The initial part of the questionnaire consisted of demographics such as occupation, age, gender, the duration of work experience and the frequency of ethical or legal problems encountered in practice.
The second part of the questionnaire comprised of questions regarding the importance of knowledge of ethics and law to work, the source of knowledge of ethics and law and the preference for consultation regarding an ethical or legal problem should it arise.
Questions were asked whether the respondent knew of the presence of an ethics committee in the institution. Both of these concerns warrant careful attention and research. The principle of justice, stated simply, is that each should get his or her due. What is due must be derived from the high moral standards of healthcare and the information available about what will create the most benefit.
At the level of the professional—patient relationship, this has several implications. First, its relationship to beneficence is apparent: The patient can expect to be treated fairly. Persons seeking treatment should not be given advantage on the basis of arbitrary favoritism or be left out on the basis of arbitrary dislike. The rules will be applied consistently, taking into account legitimate departures from the norm. For instance, a procedural rule of first come, first served will be applied except in cases where greater need morally requires that the rule be flexible enough to allow for valid exceptions.
The principle of justice raises important ethical issues related to the allocation of scarce resources. Health professionals abide by a duty of beneficence, but that duty does not entail the prerogative of automatically providing a disproportionate amount of a scarce resource to any one person, even if that person's need could warrant receiving all of it.
The resulting allocation may have a relatively deleterious effect on one or more other patients because their optimum benefits are compromised. For example, a nursing shortage on a unit may require the nurses to make difficult though not arbitrary decisions about patient-care priorities. Compensation for harm also derives from our understanding of what justice requires. A patient who is harmed in the relationship through, say, professional error, has a right to know that the harm has occurred and may wish to seek compensation for the harm.
Serious barriers to justice often arise outside of the relationship. Societal discrimination against patients on the basis of race, ethnicity, religion, sex, and age are well documented, and continue to contribute to serious disparities in the distribution of U.
Other barriers are imposed by today's bureaucratic context of healthcare: The relationship does not stand in isolation from these influences, all of which have profound effects on it. The health professional who is committed to upholding the profession's moral ideals must work not only to preserve justice within the relationship directly but also to remove barriers to it on a broader scale so that the appropriate ends of healthcare can be realized.
Conflicts among Principles As illustrated by the issue of paternalism in truth-telling situations and the compromise of beneficence in situations of scarce resources, conflicts among this set of general principles inevitably arise in everyday professional—patient relationship situations. In actual situations, professionals usually can use the basic moral ideas imbedded in the principles as guides to set priorities consistent with the values of healthcare, the professions's moral codes and standards, and patients's informed preferences.
Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados
At the same time, not all conflicts can be resolved and sometimes principles seem to remove us a step further from the immediacy of the situation. Virtue in the Professional—Patient relationship Cognizant of the limitations in an ethics based entirely on conduct, Aristotle in Nichomachean Ethics suggested the alternative of a focus on virtues by those who are decisionmakers so that they approach moral conflict in the right frame of mind and heart.
A life of moral virtue is characterized by dispositions and attitudes that can be cultivated into habits of preparedness that enable a person to act in ways that further the good of a relationship or community. Aristotle also underscored the importance of the person's desire to become a good person, which in turn requires knowledge of ultimate goods and ends.
Aristotle did not divorce virtue from the realm of feelings and emotions, suggesting instead that acts arising out of various dispositions will give pleasure and that, at the same time, ethical action resulting from a virtuous disposition requires the exercise of reason.
Since the late twentieth century, several leading ethicists have led a lively re-examination of the virtues that should be expressed by health professionals.
Notable among them are Edmund Pellegrino and David Thomasma who propose that the contemporary reappraisal is not an attempt to demean the emphasis on rights-and-duty-based ethics, "but a recognition that rights and duties notwithstanding, their moral effectiveness still turns on dispositions and character traits of our fellow men and women" Pellegrino and Thomasma, p.
A challenge throughout the ages has been to identify dispositions that the professional should cultivate so as to further the good and proper ends of healthcare. Many virtues have been proposed, among them benevolence and kindliness, compassion, integrity, honesty, fairness, conscientiousness, fidelity beyond duty, and humility.
These virtues are as appropriate in today's professional—patient relationship as they have always been. However, some things about the relationship are understood differently today than in the past, and our understanding of human relationships in general continues to undergo new evaluation. It is not surprising that our understanding of the virtues also continues to evolve.
The following two illustrations of this evolution by no means exhaust the important work that is being conducted in this area. The traditional professional virtue of benevolence or kindness has enjoyed a long history in the writings on the professional—patient relationship. This character trait evokes pictures of a physician, midwife, or nurse sitting quietly at the bedside, reassuring a patient, an image consistent with a period in which the professional was viewed as a kindly person who used the limited technologies available to minister to the clinical and emotional needs of a trusting, mostly passive patient.
Today the notion of benevolence must be refined to adapt to a relationship in which patients are active participants in the interaction, suggesting that kindness met by blind trust taken alone are not adequate ingredients for the tasks of this relationship to be accomplished. At the very least an adequate notion of professional benevolence today must include an examination of how the professional's trustworthiness figures in the professional—patient relationship.
For example, traditionally confidentiality focused on the physician's duty.
The Code of Ethics for Nurses
To the extent that the physician had cultivated a benevolent disposition toward the patient, the duty would come more naturally. Today the moral focus has shifted to the patient, particularly to his or her right to expect confidentiality. Only trustworthiness based on the professional's authentic commitment to respecting the patient's rights and dignity assures the patient that he or she is in the hands of a benevolent professional.
Benevolence as traditionally understood is challenged further by a revitalized emphasis on professionalism in the medical profession. In this broader conceptualization benevolence commitments explicitly include competence, honesty, confidentiality, maintenance of appropriate boundaries, improvement of the quality of and access to care, and management of conflicts of interest, to name some.
Moreover, a rise in the literature on such dimensions of the physician's moral role as that of dealing positively with professionals' errors Kohn et al. Compassion also has long been viewed as a virtue that should characterize the professional—patient relationship. Compassion often has been interpreted according to its etymological root, "to suffer with. The cultivation of this disposition leads the professional to recognize that the key issue is not only "Have I done my duty?
The central notion of caring in the professional—patient relationship sheds light on important ways in which the virtue of compassion might manifest itself in the everyday work of professionals. Among contemporary bioethicists Warren Reich makes an important contribution to the understanding of compassion by relating different modes of compassion to different phases of a patient's suffering. Care in the relationship between health professional and patient also has been seen as an activity that reflects an attitude of sensitivity to the patient's deepest values and concerns.
Anne Bishop and John Scudder propose that "Being compassionate is not something that human beings can achieve by an act of will. It is possible, however, to be open to compassion, to be situated so that compassion is likely to be evoked…" p. They conclude that professionals who do not feel compassion but have a deep desire to show caring i. In some current approaches to professional care, compassion or other virtues are not invoked at all; rather the emphasis turns exclusively to conduct and behaviors that various professions describe as caring behaviors with the goal of incorporating them into an assessment of measurable outcomes in patient management Galt.
This latter approach diverges dramatically from the traditional and most contemporary research on the role of care and its relationship to compassion in the larger ethical context of the professional—patient relationship.
There have also been serious caveats raised about a professional ethic based primarily on the concept of care. Aware of problems created by sexism, and that caring and the care-giving role are associated with women, social devaluation of professions that promote care as a centerpiece of their identity could follow to the patient's detriment Nelson. Therefore, when a health professional expresses care to a patient he or she may also appear to condone injustices that derive from being in a society that devalues women in a care-giving role Condon.
At the same time, recipients of care may be forced into stereotyped roles of dependency. Eva Feder Kittay calls for a reassessment of the dichotomy often viewed as existing between caregiver and care receiver. Clearly, the role of care and its relationship to compassion warrants continued attention. Existential Dimensions of the Patient's Experience: Implications for the Professional—Patient Relationship The existential dimensions of the patient's experience also deserve consideration in the relationship.
Existential, as used here, refers to the human quest for meaning in the face of our limitations, among them illness and death. Especially significant are new insights regarding the health professional's role in exploring the existential meaning of illness for a patient. One aspect of the exploration has focused on the professional's desire and ability to individualize the patient's situation and story: Respect in the relationship rests on a premise that health professionals are called into a particular relationship with patients because of the importance of the illness experience to the patient, and the medium of that relationship is the patient's story Purtilo and Haddad.
The notion of patients's patterns is the term used by Margaret Newman to describe what has value—is meaningful—in a patient's life. The professional's skill in helping the patient recognize aspects of him- or herself that the person may not even be conscious of is the professional's act of pattern recognition. The professional, acting as facilitator, can show how the pieces fit. Once identified, professional and patient can work together toward mutually agreed upon health goals.
Bishop and Scudder capture the essence of the professional's position in this task as being a caring presence, a "personal presence that assures others of another's concern for their well-being" Bishop and Scudder, p.
Narratives, the patient's and the professional's, are the professional's means of gaining insight into the existential complexities of the professional—patient relationship Greenhalgh and Horwitz. Frank, drawing partially on his own illness experiences from patienthood to survivorship rolespowerfully illustrates how the moral responsibility of survivorship is to reconstruct, put back together, a life that had been altered by interventions and professional interactions.
Through that process the wounded also becomes healer, but the process requires the mutual effort of professional and patient.
When the professional, through narrative, shows to the patient a personality with emotions, likes and dislikes, fears and dreams, hopes and faults, the patient has a greater opportunity to understand that there is a person in the professional role, not just a bundle of competencies and technical skills.
Offer the nursing care regardless of race, nationality, religion, culture, gender, age, socioeconomic status, political conditions, physical or mental illness, or any other factor; and strive to eliminate injustice and inequality in society. Be sensitive to the challenges and ethical issues, in both community and workplace, that could undermine the sanctity of the nursing profession; and offer the appropriate solution when is necessary.
While cooperating and coordinating with other individuals, groups and social institutions, try to address social needs and resolve ethical issues raised in the area of health care. Pay special attention to vulnerable groups and individuals such as children, elderly, people with physical disability, mental illness, and so on. While have attention to the medical health at the local level, endeavor to achieve the health goals in national and international levels.
Nurses and the Profession The Nurse should: Take into account ethical responsibilities, as well as the legal and professional liabilities, when implementing the nursing interventions and making the clinical decisions. Nurses and Practice The Nurse should: Perform the nursing care based on current knowledge and common sense. When presenting or applying a new product in clinical practice, have a complete knowledge of its risks.
Be aware that no one has the right to consent in place of a competent adult. Apply the safety measures to be sure that nursing interventions are harmless, and when is necessary, consult this matter with other health team members.
Presentation of the result must be done without mentioning the name, address or any other information that could lead to identification of the patient. Respect the patient privacy when performing any nursing intervention. Provide the care for injured or patients in emergency situations, even outside the workplace.