As a physiotherapist, or any health professional, there are four fundamental ethical principles that are at the core of what we set out to do. These include beneficence, non-maleficence, respect for patient autonomy and justice.
Beneficence
This concept involves the obligation for our actions to be good and emphasises the importance of preventing harm (The Open University, 2018). As health care professionals we should be actively promoting health and the well-being of our patients (Syracuse University School of Education, 2018).
Non-maleficence
As health professionals, we should not cause harm. Furthermore, we should minimise the harm we cause if there is no way of preventing harm entirely and we should avoid increasing harm (The Open University, 2018).
You can then combine the principles of beneficence and non-maleficence to state that all actions must result in more good than harm (The Open University, 2018).
Respect for patient autonomy
This concept largely revolves around human dignity, in that we need to respect others’ autonomy and respect their decisions regarding their own lives, as they have the right to make decisions regarding their life (The Open University, 2018). We may not make decisions for competent individuals and in turn we need to empower those around us. We need to be honest and display transparency in clinical practice. Patients should be well informed regarding their condition and prognosis so that they are able to provide informed consent when being treated. This is only possible through a relationship of trust between the health care professional and patient. Furthermore, a patient has the right to refuse treatment for whatever reason. You can try to explain to them the benefits of treatment and how it will improve their future life, however if they still refuse treatment their decision must be respected.
Justice
All people have the right to be treated fairly, equally and impartially. Therefore, health professionals are required to ensure that all patients are treated fairly, equally and impartially. Justice can be divided into distributive justice and social justice. Distributive justice entails that individuals have the right to equal treatment regardless of their medical diagnosis, ethnic group, gender, age, etc. Social justice, although similar, focuses on the application of equal rights amongst individuals in terms of access and participation in all aspects of goods and services, regardless of their personal characteristics (The Open University, 2018). A simple way to view Justice is through the golden rule that states “Treat others the way you would wish to be treated”.
By combining the principles of beneficence and justice, it states that we are obligated to work for the benefit of those who are unfairly treated (The Open University, 2018).
I recently encountered a scenario within my clinical practice that made me think of the four fundamental principles of ethics. At this specific clinical block, there are two wards that we work with, one primarily consisting of CVA patients and the other Spinal Cord patients. Over the last two weeks, a recurring scenario has been at play, in that the spinal cord patients are never ready for treatment from 9am which is the starting time for therapy (By 9am they should be out of bed ready for treatment in that they have already eaten breakfast and taken their medication). At 9am, I would walk to the wards and find my spinal cord patients still lying in bed, most of them having not been washed yet. Majority of the times the patient’s were found lying in their own excrement. I would then call the nurses and alert them as the patient was booked for therapy at 9 am. They would then apologise and tell me that the spinal cord patients are never ready by 9am and they are only supposed to be booked from 10am.
This was strange as for the first few weeks when I was at this block, I never had this problem, and spinal cord patients were able to be seen from 9am. I alerted my clinicians and they stated that all patients are supposed to be ready for treatment from 9am, spinal cord patients included. I managed to reschedule my patients so that I could see my spinal cord patients from 10am rather. I was appalled to find the above patients still lying in bed in their undignified state (lying in excrement) at 10-11am. When asked, they stated that they had not seen a nurse all day. I then complained again to the nurses and they gave me the same speech as before. This event was one that occurred multiple times throughout the two weeks.
This scenario in my opinion directly contradicts the principles of ethics I have described above. In terms of beneficence, the spinal cord patients’ health and well-being was not being cared for. The actions of the various health care professionals to not clean and feed the patients at the appropriate times were not good actions and they in turn often led to the patient missing their therapy sessions thus causing harm. When looking at the concept of non-malificence, these spinal cord patients are being harmed in that they are being subjected to unsanitary conditions. Furthermore, by leaving the patients lying in their own excrement, there is a risk of infectious diseases which may be bacterial, viral or parasitic (Mana, 2017). In terms of respect for patient autonomy, these spinal cord patients’ human dignity is not being respected and no patient should ever be subjected to such appalling conditions. This is not the kind of treatment that they were consenting to when they were admitted into the facility. Lastly, when looking at justice, these spinal cord patients were not being treated fairly and equally in comparison to the CVA patients in the other ward. They are receiving different treatment based on their medical diagnosis, in that a spinal cord patient may take longer to clean and care for as they are more impaired in some cases; however this is not a good enough reason for them to be treated any differently in comparison to another patient.
Ultimately, this experience has taught me about how neglecting simple actions such as cleaning a patient, can directly contradict the fundamental ethics principles. In other words, for me it has re-emphasised how the neglect of a simple action can have a much larger detrimental reaction.
References:
- Mana, L. (2017). What makes human feces a health risk? Retrieved October 06, 2018, from https://www.quora.com/What-makes-human-feces-a-health-risk
- Syracuse University School of Education. (2018). Ethical Principles. Retrieved October 06, 2018, from http://soe.syr.edu/academic/counseling_and_human_services/modules/Common_Ethical_Issues/ethical_principles.aspx
- The Open University. (2018). Health Management, Ethics and Research Module: 7. Principles of Healthcare Ethics. Retrieved October 06, 2018, from OpenLearn Create: http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=225&printable=1
3 thoughts on “Basic Principles of Ethics – Melissa Ann Cola 3551856”
Good day Mellisa
It is very fortunate and both unfortunate that we work as a multi-disciplinary team, because when one of the profession cease to perform its duties the rest of the teams are affected. In your situation your hands were tied due to the nurses that failed to play their role within the multi-disciplinary team. its even worse when you encounter such situations as a student because in most cases your opinions or advice are not really valued by qualified professions.
I love the fact that you protected yourself and reported the matter to your superiors, and engaged with the nurses concerning the matter. I love the fact that you explained the ethics principles individually and then incoperated them in your experience. Regarding the patients right to refuse treatment, please read on the patients responsibilities as it is also the patients responsibility to comply with treatment or rehabilitation procedures.
Your piece was easy to follow and understand, and your reference format was correct as well. I enjoyed reading your piece. And it really stood out to me the fact that working as a multi-disciplinary team can have such disadvantages, but that can be addressed if the leaders of the teams can engage and work out a strategy to combat the negatives that are affecting the effectiveness of the team.
Hi Melissa
Thank you for sharing your clinical experience. I completely agree with your writing piece. It is important that every professional in the MDT do their job/duties. If the one professional fails to comply, then there will be an unbalance which can cause poorer outcomes for the patient.
Your experience also reminded me of a similar experience that I went through whilst I was at a clinical block. I was about to see and treat my patient when I realised that his nappy was dirty. I informed the clinician about the situation. He said to inform the nurse in charge and rather see the patient tomorrow, as it must be very uncomfortable treating a patient while his nappy is dirty. I did what I was told and informed the nurse about his dirty nappy. She said that she would clean him up and change the nappy as soon as she was done with her current patients. I said thank you and continued to see other patients. The next morning, I went to see the same patient and found that he has not been changed and was still dirty. I went to speak to the nurse again, and then she went to change the nappy immediately. I thought this was unacceptable as the patient’s right was violated. Similar to your writing piece, this professional failed to adhere to the principles of ethics.
I suppose people may argue and say that the professional had their reasons (whether it be personal reasons or whatever the case may be), but in my opinion, it still does not justify their actions. They have a duty to do and they need to take the responsibility and do it. I also understand that sometimes the work load gets too much, but then the professional should inform you that their work load is a bit heavy at the moment and if possible that you go speak to another professional to help you out.
I also admire how you stood up for your patients by speaking to the nurses about your concerns. Sometimes confronting other professionals may be difficult as you do not want to come across as disrespectful. I think you handled the situation well – speaking to your clinician first and then speaking to the nurses.
Your writing piece had a logical flow and was easy to follow. It was straight-forward and to the point. I think you would also be nice to speak about how to deal with situations like these, so that other readers can use your management techniques in their scenario.
Overall, your grammar is good. The referencing is correct.
Thank you.
Hi, Melissa.
What a good piece! I would like to start off by saying that this piece had a very good flow. I liked how you started off by explaining the components and then highlighting (the absence of) them in your clinical experience.
I definitely think that what you, and our colleague, Chulumanko, has said is extremely true: When one profession in the MDT does not adequately do their duties, the rest of the MDT is directly affected.
This piece made me think about how this is extremely prevalent in especially neurological facilities, where a patient “becomes too much effort” for a team member.
I was at a neurological based facility where there were mostly CVA patients and when my colleagues and I were mobilizing a patient in the dining room, he urinated. This was due to the affected pelvic floor muscles’ activation being decreased as a result of the CVA. Some members of the nursing staff then started giggling at the patient when we had asked them to please clean him up. They did not do it, and only about 10 minutes later, they came to clean the patient up. When we did ask them to do it previously, they mostly just stared at us and went back to type on their phones. Not only is this extremely unprofessional, but the poor patient had to stand in his urine in front of his peers. He did not have any dignity left after that incident. In addition, he did not want to mobilize outside if his room anymore for fear if the embarrassment occurring again. This also affected his beneficence toward treatment.
However, I would just like to ask that you summarize your thoughts and theory slightly better to make the read shorter for readers to stay captivated throughout the piece.
Thank you for this good, thought provoking, in-depth, well referenced and easy to follow piece.