Ethics and Morality in the Heath Care Service

Definition of Terms

1 The Class’ Understanding of Ethics and Morality

2 A Difference: Ethics being more legal and Morality, personal.

3 Health Services needs to be carried out with a good integration of a legal and personal character.

General Knowledge of the Oaths and Pledges Health Professionals take
 Significant Issues like Dedication to duty, unique mode of operation, institution goals and objectives, Knowledge of rights and responsibilities.

2 Hippocratic Oath
 Florence Nightingale Pledge
 Ripples’ Pledge or Oath

General Issues and actions that witnessed in the health care service delivery system

1 Abortions, Strikes, The falling in love of a client and service provider, Harassment and Euthanasia,

A look at three major issues in health care service delivery

1 Confidentiality in tensions between the Public and individuals’ good E.g. an HIV patient womanizer do you disclose it to the community?

Caring for client whose identity can be a fortune to you when broke

2 Strike actions of health professional and its consequences

3 Health service – Profit or People oriented

Conclusion: all actions should be judged by

1 General Legal, Professional and Societal requirements.



Short Notes on the Topics

Ethics: a system of moral principles: the ethics of a culture or the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc.: medical ethics; Christian ethics.

Morality: pertaining to, or concerned with the principles or rules of right conduct or the distinction between right and wrong; ethical: moral attitudes or founded on the fundamental principles of right conduct rather than on legalities, enactment, or custom: moral obligations.

The difference
The difference between ethics and morals can seem somewhat arbitrary to many, but there is a basic, albeit subtle, difference. Morals define personal character, while ethics stress a social system in which those morals are applied. In other words, ethics point to standards or codes of behavior expected by the group to which the individual belongs. This could be national ethics, social ethics, company ethics, professional ethics, or even family ethics. So while a person’s moral code is usually unchanging, the ethics he or she practices can be other-dependent. Ethics refers to professional conduct. Morals refer to personal conduct.

Example
One’s Moral outlook towards HIV might be different from what his/her profession as a health worker expects from her.

Oaths and Pledges
Statements and Utterances that are binding and demand a level of rights and responsibility on the part of those taking it and for whom it is being taking

The Nightingale Pledge was composed by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan.
~~~
I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.



Hippocratic Oath, By the Greek Hippocratus father of Medicine
Considered in part: “I solemnly pledge myself to consecrate my life to the service of humanity; … I will practice my profession with conscience and dignity. The health of my patient will be my first consideration; …. I will not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and the patient; I will maintain the utmost respect for human life from the time of conception; even under threat; I will not use my medical knowledge contrary to the laws of humanity. I make these promises solemnly, freely and upon my honour”.

Health service – Profit or People oriented
The ethical implications of the growing commercialization of health care have become a matter of heated controversy. Those favoring the trend toward health care for profit claim that an increased role for entrepreneurs and competition in the delivery of health care will result in a more efficient and effective health care system. For others, the pursuit of profit is antithetical to the values central to medicine.

For the Notion of People Oriented
They argue that a society has a moral obligation to meet the basic needs of all of its members rich or poor alike should have access to the health care he or she needs. The rise of for-profit health care only increases the growing problem of access to care.

In view of the benefits health care institutions derive from society, it is unfair for them to refuse to help society serve those who can't afford care or are too costly to treat. All hospitals benefit from government subsidized programs, medical research and medical education paid for by taxpayers' money. In fairness, hospitals have an obligation to serve society's needy.
In a system of for-profit health care, the opportunities for patient manipulation and exploitation are endless. Society must not allow the motive of economic gain to enter so directly into the practice of medicine, placing the well-being of patients in serious jeopardy, and undermining the trust so essential to the physician-patient relationship.
The commercialization of medicine will lead to the abandonment of certain virtues and ideals that are necessary to a moral community. The ideal of service to humankind, caring, compassion, charity, a sense of community, and altruism have been perpetuated by physicians whose primary concern has been the alleviation of human suffering and the restoration of health.






For the Notion of Profit Oriented
For-profits have greater and quicker access to capital at lower costs than do non-profits. At a time when massive investments of capital are needed to keep up with the state of the art in medicine, non-profits are experiencing increasing difficulty in attracting funding.
They maintain that all persons have a basic right to freedom and thus a right to use their property in ways they freely choose. They argue that owners of for-profits have no special obligation to provide free services to the poor. While public funds may indeed subsidize research and medical education, it is patients and doctors who benefit from this education and research, not the owners of hospitals. If there is any obligation to serve the community in return for such subsidies, it is with patients and doctors that it lies.
Health care is like food, clothing and shelter. Just as these "basic needs" are sold on the market and distributed according to ability to pay, so too should health care. If some cannot afford to pay for such basic needs, it is up to the government or voluntary agencies to see that they secure it.

Historical Perspective to Health Care

• HISTORICAL PERSPECTIVE TO HEALTH CARE IN GHANA
• Ripples Health Care Training Department
• Batch 13

• James Arthur - Amoah





• Pre-Colonial Ghana before the 15th Century
• In relation to health, the territory known as present day Ghana had its own system of health care enshrined in the Socio-Political and economic lifestyle of the people depending on where they find themselves. There were not united as one people but the fact was each group had its own system of taking care of their sick through various traditional ways.
• Era of Traditional Medicine: Pre – Colonial Ghana
• Before the Arrival of the European onto the shores of Ghana
• Various means of Traditional Healing
• Enshrined in the Customs, beliefs, lifestyle etc.
• Mode of Practicing it
• On a thanksgiving basis with each village having its own physician recognized by the whole village
• Specialized treatments were given by specialized persons

• The Traditional Medicine Practice Act of Ghana defines traditional medicine as "practice based on beliefs and ideas recognized by the community to provide health care by using herbs and other naturally occurring substances" and herbal medicines as "any finished labeled medicinal products that contain as active ingredients aerial or underground parts of plants or other plant materials or the combination of them whether in crude state or plant preparation".
• “Traditional medicine (TM) refers to the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness. Traditional medicine covers a wide variety of therapies and practices which vary from country to country and region to region. In some countries, it is referred to as "alternative" or "complementary" medicine (CAM)”. (WHO)
• Traditional medicine therefore formed the very core when it came to the health needs of the people. Public health care took the form of using various taboos at ensuring that preventive measures are taken before one will contract a particular disease and therefore the need for physician’s attention. Primary health care centered mostly on the various shrines and places of healing.
• Specialized treatments were given by specialized healers. People could move from a particular location to another because their health needs might not be in the domain of the local healer. These healers were recognized and respected by the community in which they lived and were indeed trained to offer the services they rendered.
• As to the efficacy of the treatment and the conditions under which it was practiced, traditional medicine had its own strengths and weakness but nonetheless, it was able to cater for the health needs of the people.
• Colonial Era – Arrival of the Portuguese by 1471
• Because of the prominence and the strategic position that the coast of the present day Ghana had in promoting trade in Ivory, Gold and later on Slaves, various western powers established forts and castles along the coasts of the then Gold Coast. The first were the Portuguese in around 1471 under the patronage of Prince Henry the Navigator and the Elmina Castle built by Diego d’Azambuja ordered by King John II of Portugal in 1782. The Dutch followed in 1598 and others like the British, Danes and Swedes also came along.
• The belief is that every Ship that landed on the shores of the coast had its own priest and Physician. Western Medicine came to the shores of Ghana with the advent of the traders and explorers unto the coast of the Gold Coast. They attended to the health needs of their people but as we are made to believe with time, they extended their service to their servants and the Elites in the Society like the Chiefs and clan heads.
• Medical Apartheid
• The Arrival of the European on the coast of the country - 1482
• Discriminatory treatment of Europeans, indigenous servants and important men in society like the Chiefs and the clan heads with Western Medicine.
• Both Traditional Medicine and Western Medicine were practiced simultaneously
• Native Customs Regulation and Preventive Ordinance was enacted to regulate traditional practices that are were not understandable by the human mind Traditional Medicine inclusive

• The Native Customs Ordinance in 1892 limited the use of traditional medicine as a means of treatment since some of the treatment procedures and methods were contrary to the understanding of the western mind. Some do believe that in order to care for the health needs of its own people they needed to bring into force rules that will ensure that the local people will not infect them with infections which they will get from their traditional healers and their practices.
• Health centers were built and the first is believed to have been in Cape Coast the major one however being the Korle Bu Teaching Hospital. The hospital was founded in 1923 as the Gold Coast Hospital. The then Governor, Gordon Guggisberg laid the foundation for Korle Bu Hospital in 1921, and it was finally opened on 9 October 1923. Because of free medical care most people started seeking health care from the medical centers. Despite the fact that Traditional Medical Practices were banned the natives never gave up on it.
• Post Independence Era – After 1957
• The same system continued to exist when it came to seeking treatment but the high cost of treatment and sometimes the nature of the disease forced the people to seek medical treatment in the Traditional Places. With the Establishment of the Traditional Medicine Council and the emergency of various centers of therapy is moving the health system of the Country into a multi – dimensional approach where health care is not only restricted to the hospital or clinic.
• The New Wave
• Alternative and Complimentary forms
• Strengthening of Public Health
• “In Ghana, about 70% of the population depends exclusively on traditional medicine for their health care. There is approximately one traditional medicine practitioner for every 400 people, compared to one allopathic doctor for every 12 000 people. With over 100 000 traditional medicine practitioners uniformly distributed nationally, they are not only more accessible to the public, but also the backbone of the health care delivery system” C.f. Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review (WHO; 2001)
• The strengthening of Public Health aimed at preventive measures rather than curative has also taken centre stages with various program put into place by the Ministry of Health and the Ghana Health Service and various individual NGOs in health.
• E.g. Malaria Control, and Sanitation Campaigns
•
A new wave of an all inclusive health system

• Traditional Medicine reemergence
• The Idea of Care and Hospice
• Various Complimentary and Alternative Therapies
• All these are no longer limited to the Western Medicine Environment.

• So from the Traditional Medical Practices only through to the era of western medicine only now we found ourselves in multi dimensional systems where opportunities in Alternative and Complimentary medicines are being explored.
• Health Care is not restricted to the health centers E.g. Ripples taking care to clients in their residence