Question

(TCO 1) The three-step approach to solving ethical dilemmas is based on

Answer 1

Ethical Dilemmas in Health Service Delivery:-

Ethical dilemmas arise when a difficult problem cannot be solved in a way that will satisfy everyone who is involved. The same dilemma might occur when a situation arises that involves a choice between equally unsatisfactory alternatives.

In ethical conflicts, the decision maker is confronted with more than one course of action that respects personal, professional and societal morality, but by deciding on one course of action the other course is harmed in some way. For example, as a Health Extension Practitioner you may face confidentiality conflicts. You are morally and legally obliged to keep patient information confidential; at the same time, you may be required to disclose sensitive information because breaking the rules of confidentiality would benefit the family or the wider community.

Common ethical issues:-

(1.)Practitioner–client relationship.

(2.)Privacy and confidentiality.

(3.)Shared decision making.

(4.)Allocation of scarce resources.

(5.)Stigma and illness.

(6.)Reproductive health care.

(1.)Practitioner–client relationship:-the core ethical concepts of autonomy, beneficence, nonmaleficence and justice. These basic principles should always form the basis for your working relationships. In addition to the above principles there are issues like confidentiality, privacy and trust that you also have to think about at all times.

(2.)Privacy and confidentiality:-The professional relationship between a Health Extension Practitioner and a client in a rural community is frequently long-term, and may involve the wider families and mutual friends. This closeness may well affect professional responsibilities.the ethical conflicts involving privacy and confidentiality in rural healthcare relationships. Confidentiality may involve more complex issues in rural rather than urban settings. People who live in rural areas may well know many of the details of each other’s lives and this intimacy makes ethical conflicts related to privacy and confidentiality more challenging compared to urban settings.

(3.)Shared decision making:-The key feature of the shared decision making process is a dialogue in which both client and practitioner share information, leading to a decision regarding the client’s healthcare. Shared decision making is based on trust, truthfulness and respect for the client’s choice. For this to be effective, good communication skills are crucial. If some decisions have to be made, for example about transfer to a hospital for further treatment, the patient might be concerned about their own issues, such as their values, religious and cultural beliefs and finances

(4.)Allocation of scarce resources:-Health resources, such as financial or human resources, are always scarce whether you are working in developed or developing countries. Using resources to their best effect needs appropriate planning and allocation of resources to areas where they bring about the best outcomes. As a manager and healthcare provider in the Health Post you may be faced with a scarcity of resources and need to make judgements to use your resources wisely so that you are able to satisfy the healthcare needs of the majority of your community (the principle of utility). As a manager and healthcare provider in your community, you may face ethical conflicts with regard to resource allocation.

(5.)Stigma and illness:-As a Health Extension Practitioner, you will be working in the rural areas where 80–85% of the population of Ethiopia lives. The healthcare practice in rural areas is different from that of urban centres. The closeness you create with individuals, families and the community may make it difficult to decide about any ethical conflicts (dilemmas) that may occur in your day-to-day practice.

One of the serious ethical issues that you may encounter is stigma. Stigma is defined as a negative perception that is assigned to an individual because of any feature that, in the view of others, discredits and diminishes them from other people. The stigmatised person becomes a person who is discounted. In rural healthcare settings, stigma takes on special importance because of the close relationships that exist in small communities. To be viewed negatively by others, to be avoided, and to be seen as less than a full member of the community is a major burden for a person in a rural community.

(6.)Reproductive healthcare:-

Oneof the primary healthcare services that Health Extension Practitioners are expected to provide is reproductive healthcare. During this part of your work it is essential to develop trust with each individual and with the community as a whole. This service requires appropriate levels of care, confidentiality and truth-telling– possibly more than any other part of the health services. However, you may face conflicting situations and ethical issues that hinder you from providing appropriate reproductive healthcare services.

several strategies organizations can implement to address ethical issues and reduce nurses’ and other clinicians’ moral distress::-

1. Support the nursing code of ethics:-The ANA Code of Ethics presents a framework for practice. Nurses should be familiar with the code and use it on a daily basis,Hospitals should incorporate behavior consistent with the code of ethics into job descriptions and consider that during annual performance reviews.

Additionally, some specialty nursing organizations have position statements related to ethical issues which nurses can use as a guide. Competencies for genetics and genomics include an ethics component.

2. Offer ongoing education:- the Code of Ethics should be included into job descriptions and daily practice.“Ethics, like most other disciplines, must be learned,” New employee orientation and all educational programs should include ethics content, with specific examples of how to apply theoretical principles to concrete issues.

3. Create an environment where nurses can speak up:-Having a practice environment that supports nurses in raising ethical questions and empowering them to address those concerns also is vital.

4. Bring different disciplines together:-Physicians and nurses experience shared suffering. Working together could prove beneficial in addressing moral distress.

5. Provide ethics experts:-On-site nurse ethicists or other ethics professionals who clinicians can confidentially talk with are valuable in helping people look at the situation from other perspectives.

6. Add unit-based ethics mentors:-everyday ethical issues need to be addressed,If you have someone unit-based, you could address the conflicts earlier and from a preventive ethics perspective, and therefore it could be readily resolved and not lead to further conflict.

7. Hold a family conference:-Family conferences bring everyone together and should be planned, with clinicians thinking through uncertainties and recommendations before the meeting.

8. Sponsor ethics journal or book clubs:-Book clubs and journal clubs offer an opportunity to focus on ethics. Hospitals often can organize them, so participants can obtain continuing education credits.

9. Reach out to professional associations:-Professional associations often provide resources to assist with training and handling of ethical issues.

10. Offer employee counseling services:-Nurses especially troubled by an ethical issue--perhaps relating to something happening in their personal lives or how the current situation rekindles past events--may benefit from individual sessions with a counselor from an employee assistance program (EAP).