663970
Ethics in midwifery
- Framework and theories
- When first exploring the ethics of a situation it is helpful
to have a framework with which to work.
- Level one: judgements
- What is important to remember is that it is often an instant judgement
that has been made, possibly biased, and it may not necessarily have
been well thought through or based on all available evidence. It can be
helpful to reflect on past judgements and consider whether, in retrospect
they were well founded or based on personal bias or prejudice.
- What is important to remember is that it is often an instant judgement
that has been made, possibly biased, and it may not necessarily have
been well thought through or based on all available evidence. It can be
helpful to reflect on past judgements and consider whether, in retrospect
they were well founded or based on personal bias or prejudice.
- Level two: rules
- Rules govern our daily lives and differ depending on the society or culture in which we live. When looking
at ethics, rules are what guide our practice and control our actions. Rules can be enabling, they can define
the limits or boundaries of practice and can allow freedom to act knowing the safe limits o f those actions.
E.g. those set by the NMC. Supporting rules is the NMC Code (NMC 2008a). Codes are less formal or
obligatory than rules and are seen as guidelines to support safe practice
- Rules govern our daily lives and differ depending on the society or culture in which we live. When looking
at ethics, rules are what guide our practice and control our actions. Rules can be enabling, they can define
the limits or boundaries of practice and can allow freedom to act knowing the safe limits o f those actions.
E.g. those set by the NMC. Supporting rules is the NMC Code (NMC 2008a). Codes are less formal or
obligatory than rules and are seen as guidelines to support safe practice
- Level three: principles
- respect for autonomy.
- non-maleficence (= avoiding harm.)
- beneficence (= doing good or balancing the benefits against the harms in a given situation)
- justice (= means to be treated fairly)
- respect for autonomy.
- Level four: ethical theories
- Utilitarian theory
- It is based on the idea o f balancing the consequences of following
certain actions or rules. This can be thought of as a very large pair
of scales, with the benefits of an action on one side and the harm or
consequences of taking the action on the other. There is a need to
tip the scales in favour of the benefits over the possible harms that
could occur. Many aspects of midwifery care have been organized
on utilitarian principles. Antenatal clinics allow many women to be
seen by skilled professionals under one roof.
- It is based on the idea o f balancing the consequences of following
certain actions or rules. This can be thought of as a very large pair
of scales, with the benefits of an action on one side and the harm or
consequences of taking the action on the other. There is a need to
tip the scales in favour of the benefits over the possible harms that
could occur. Many aspects of midwifery care have been organized
on utilitarian principles. Antenatal clinics allow many women to be
seen by skilled professionals under one roof.
- Deontology theory
- 'deon' meaning duty. As health professionals you would all say you have a duty towards your
clients/patients. But there is a need to explore where else your duty lies. Recognizing that you have a duty
o f care is one thing, balancing the competing demands o f those duties is quite another. Conflicting duties
can cause dilemmas in deciding the best course o f action It is often difficult to prioritize such duties, but
some prioritization needs to occur to enable decision making to be meaningful. the emphasis on respect for
persons. To this end, he believed that people are individual and should be treated with respect not merely
as a means to an end.
- Duty of care to... • Self • Colleagues •
Clients/patients • Relatives • Fetus/baby •
Employer Profession (NMQ
- Duty of care to... • Self • Colleagues •
Clients/patients • Relatives • Fetus/baby •
Employer Profession (NMQ
- 'deon' meaning duty. As health professionals you would all say you have a duty towards your
clients/patients. But there is a need to explore where else your duty lies. Recognizing that you have a duty
o f care is one thing, balancing the competing demands o f those duties is quite another. Conflicting duties
can cause dilemmas in deciding the best course o f action It is often difficult to prioritize such duties, but
some prioritization needs to occur to enable decision making to be meaningful. the emphasis on respect for
persons. To this end, he believed that people are individual and should be treated with respect not merely
as a means to an end.
- There are a number of
theories that could be
explored and applied to
midwifery/healthcare. E.g.
Liberalism, communitarianism,
casuistry, feminism. Generally,
theories are taken to mean the
two main ethical theories of
utilitarianism and deontology.
- Utilitarian theory
- Level one: judgements
- When first exploring the ethics of a situation it is helpful
to have a framework with which to work.
- Consent/information giving
- Consent within ethics means that the client has
listened, understood and agreed to the procedure or
treatment being proposed.
- This may not be realistic. Hindrance to this...
- • lack of time • clients will forget • most clients do not want to know • most clients would not understand • it
could be harmful if clients refused treatment based on information given • considering all these, gaining
informed consent is impracticable.
- • lack of time • clients will forget • most clients do not want to know • most clients would not understand • it
could be harmful if clients refused treatment based on information given • considering all these, gaining
informed consent is impracticable.
- Health professionals have a duty to keep up-to date and be able to inform their clients to the best of their
ability. To ensure that the consent given is valid, the midwife will have to hold wide-ranging discussions on
such things as antenatal screening tests, ultrasound scanning, birth choices and birth interventions such as
pain relief, positions for birth and active management of the third stage of labour. the midwife will have to
explore the woman's views and recommend what she believes is 'best practice'.
- Respecting a person's right to exercise choice and dedsion-making can be difficult.
What if Susan was requesting something that did not meet the standards o f best
practice? How would the midwife be expected to react then? The Midwives Rules and
Standards (NMC 2004) can be used in such a situation to inform and enable the
midwife to act in the woman's best interests. The midwife would have backup support
systems from both her supervisor of midwives and her immediate line manager.
Enabling informed consent to occur and empowering women to dedde what is best for
them are fundamental parts of 'respect for autonomy. For a health professional it can
be very difficult to respect a person's autonomy when current evidence tells you their
request is not best practice.
- Respecting a person's right to exercise choice and dedsion-making can be difficult.
What if Susan was requesting something that did not meet the standards o f best
practice? How would the midwife be expected to react then? The Midwives Rules and
Standards (NMC 2004) can be used in such a situation to inform and enable the
midwife to act in the woman's best interests. The midwife would have backup support
systems from both her supervisor of midwives and her immediate line manager.
Enabling informed consent to occur and empowering women to dedde what is best for
them are fundamental parts of 'respect for autonomy. For a health professional it can
be very difficult to respect a person's autonomy when current evidence tells you their
request is not best practice.
- This may not be realistic. Hindrance to this...
- Consent within ethics means that the client has
listened, understood and agreed to the procedure or
treatment being proposed.
- Advocacy and collaborative relationships
- When faced with clients who, despite all information, support and encouragement, are still reluctant to act
or speak up for themselves, many midwives are finding they need to take on an advocacy role on their
behalf. Advocacy is seen as speaking out on another's behalf (Cates 1994). There is, again, a fine dividing
line between advocacy and paternalism. Put simplistically, paternalism is acting on another's behalf,
whereas advocacy is speaking out on another's behalf. When taking on the role of advocate there is a need
to be dear on a number of points. Acting as an advocate can be difficult and involves putting personal
views or values aside. Advocacy means speaking out for someone's rights.
- When faced with clients who, despite all information, support and encouragement, are still reluctant to act
or speak up for themselves, many midwives are finding they need to take on an advocacy role on their
behalf. Advocacy is seen as speaking out on another's behalf (Cates 1994). There is, again, a fine dividing
line between advocacy and paternalism. Put simplistically, paternalism is acting on another's behalf,
whereas advocacy is speaking out on another's behalf. When taking on the role of advocate there is a need
to be dear on a number of points. Acting as an advocate can be difficult and involves putting personal
views or values aside. Advocacy means speaking out for someone's rights.
- Law and ethics
- Human rights
- Justice and fairness
- Research
- Current ethical issues
- 'the basic principles and concepts that guide
human beings in thought and action'. The area
of ethics is complex, difficult and could be
seen, by some, as off-putting. This need not be
so. It should be used as a daily tool to support
decision making and to enable rather than
disable practice. Being ethically aware is a
step towards being an autonomous
practitioner. It means taking responsibility. 55
empowering others and facilitating professional
growth and development. ethics is often about
exploring values and beliefs and clarifying what
people understand, think and feel in a given
situation, often from what they say as much as
what they do.
Media attachments
Want to create your own Mind Maps for free with GoConqr? Learn more.