Hi everyone, this writing piece focuses on the topic: Morality and Ethics. My topic choice is based on something that I have recently experienced during my last clinical block. This event that took place was to my surprise, mildly shocking and unexpected.

 

So what is morality? According to Jones, “the simplest answer is that morality is the human attempt to define what is right and wrong about our actions and thoughts, and what is good and bad about being who we are”(2018). Now as human beings, we are not perfect and we do not ALWAYS stick to what is morally correct. We are bound to perform acts that are immoral and based on the outcome of certain experiences we learn different lessons that may be beneficial in future occurrences that may present in a similar manner to previous experiences. Immoral behavior and unethical acts performed by a physician in relation to a patient may result in a patient feeling liked or not by the physicians and comfortable or not in their care. Patients may pick up physical and verbal cues from physicians during patient-physician interactions that may lead to either a good or a bad relationship between a patient and a physician (Jones, 2018).

One cannot merely rate anothers sense of morality and ethical behavior in the work place based on one experience. However, it takes one immoral or unethical act to create an unpleasant rapport between a physician and a patient which in turn may negatively affect the outcome of treatment sessions. Thus, it is crucial that as health professionals, we aim to maintain a level of morality and practice behavior that is ethical at all times in aid of preventing the occurrence of a negative patient-physician rapport (Jones, 2018)

In order to do so, constant reflection on the principles of ethics and morality may be beneficial. Forester-Miller & Davis Identified five moral principles that are viewed as the cornerstone of our ethical guidelines (1987). The five principles includes: Autonomy, Justice, Beneficence, Non maleficence, and Fidelity (Forester-Miller, Ph.D. & Davis, Ph.D., 1987).

A few weeks back I was assigned to assess and treat a young (18 year old) male who sustained a gun-shot wound to the left lower limb. The patient was waiting to have a skin graft performed on that particular day. While reading the patients notes, the doctor entered the room and assessed the patient. I noticed that he was in the process of opening the patients wound dressing in aid of examining the site of injury.

I was somewhat curious and decided to observe what the doctor was doing. While removing the bandage, the doctor initiated a conversation regarding the events that took place which lead to the patients hospital admission.  This heightened my level of attentiveness as I had not performed a subjective assessment as yet, and I knew that this information would be beneficial to me as it forms part of my assessment.

During the conversation I noticed that the patient started showing signs of discomfort and pain (which at this point, I have deduced that it was as a result of the removal of the wound dressing). This was when I observed the manner in which the doctor removed the patients wound dressing. The doctor was merely snipping the bandage with a pair of scissors and occasionally pulling the dressing from the skin(which may amplify the level of pain). Even though I was aware that the removal of the dressing will be slightly painful and discomforting I knew that I would not have appreciated the manner in which the doctor removed the dressing had I been the patient in the current scenario. In the same time period, the doctor asks the patient whether he was on the wrong territory when he was shot- insinuating that the patient may be a gangster. The patient replied by saying that he was “At the wrong place, at the wrong time”. The doctor smirked in response to the patients answer and said the following: “Yes, you all say that”. The patient asked the doctor what he meant by that statement and the doctor merely ignored the patient.

Once the doctor left the room, the patient mentioned that he feels that the doctor intended to hurt him during the removal of the wound dressing. He mentioned that he did not feel comfortable with the manner in which the doctor was addressing him. Without asking whether or not he is involved in gangterism or not, he mentioned that he in fact is not a gangster and that he was shot during a cross-fire, on his way to the shop. In addition, he mentioned that he felt as though the doctor disliked him based on the mechanism of injury and assumed that he is a gangster.  I suggested that the patient should not allow the actions of others to affect him negatively or allow it to define him as a person. I sat down with him and we made a list of goals he would like to achieve (in relation to physiotherapy). My aim was to encourage him and elevate his self esteem in aid of lightening up his dampened mood. In addition I wanted to create a happier and a more supportive relationship with the intention of overshadowing the bad experience the patient just had.

Reflecting on this experience, I was disturbed by the manner in which the doctor addressed this patient in general. The more I thought about it the more puzzled I became. It was as though I was trying to convince myself that the doctor may have had a “bad day”, which may explain his behavior during the interaction with that patient. However, I could not fathom the fact that there may be more patients experiencing the same type of treatment. The reasoning behind the previous statement is that majority of the patients admitted to that particular ward’s mechanism of injuries includes gunshot wounds and in fact are involved in gangsterism within their communities. However, it does not override the fact that these are patients are human beings. Nor should it define the type of treatment the patient receives. This experience has highlighted how a health professional’s manner of interaction with a patient may affect their attitude towards themselves (patient) and the health professional in general.

In addition I have realised that whether it may or may not be the general manner of interaction that the doctor may be having with his patients, I know that I should focus on, maintaining( and improving whenever I can) my methods of patient- therapist interactions. The essence of this scenario is not how “bad” the patient was addressed by the health professional. In contrary it is an experience that has encouraged me to treat patients in a manner that in morally correct and prevent the occurrence of immoral or unethical behavior during patient-physician activities.

 

Moral sensitivity (recognizing the presence of an ethical issue) is the first step in ethical decision making because we cannot solve a moral problem unless we first know that one exists (“Ethical Decision Making and Behavior”, 2018). Moral failures stem from ethical insensitivity (“Ethical Decision Making and Behavior”, 2018). In the scenario narrated above, the doctor lacked to express a sense of sensitivity towards the patient.

 

Empathy and perspective skills are essential to this component of moral action. If we understand how others might feel or react, we are more sensitive to potential negative effects of our choices and can better predict the likely outcomes of each option (“Ethical Decision Making and Behavior”, 2018).

 

 

According Ethical Decision Making and Behavior to factors preventing us from recognizing ethical issues may be as a result of the following (2018):

 

• “We may not factor ethical considerations into our typical ways of thinking or mental models”.
• “We may even deceive ourselves into thinking that we are acting morally when we are clearly not, a process called ethical fading”.

 

According to Ethical Decision Making and Behavior,  practicing the following  steps listed below may be beneficial in  enhancing  our ethical sensitivity (2018):

 

• Active listening.
• Imagining other perspectives.
• Stepping back from a situation to determine whether it has moral implications.
• Avoiding euphemisms
• Refusing to excuse misbehavior
• Accepting personal responsibility
• Practicing humility and openness to other points of view

 

 

 

 

Bibliography:

1. Cavallo, J. (2018). Addressing Discrimination and Bias in Medical Education – The ASCO Post. Retrieved from http://www.ascopost.com/issues/january-25-2017/addressing-discrimination-and-bias-in-medical-education/

 

2. Ethical Decision Making and Behavior. (2018). Retrieved from https://uk.sagepub.com/sites/default/files/upm-binaries/39590_Chapter7.pdf

 

 

3. Forester-Miller, Ph.D., H., & Davis, Ph.D., T. (1987). A Practitioner’s Guide to Ethical Decision Making. Retrieved from https://www.counseling.org/docs/ethics/practitioners_guide.pdf

 

4. Jones, L. (2018). What is Morality? – Definition, Principles & Examples. Retrieved from https://study.com/academy/lesson/what-is-morality-definition-principles-examples.html