Case study 7.1 clearly addresses the issue of confidentiality between a health professional and a client. It also raises a number of questions about autonomy and informed consent, which you'll learn about below. In this section, you can learn about two important ethical concepts that may be new to you, but are relevant to your practice. These are called beneficence and nomalficence.
The term charity tells you what it means to “do good” to your client, for example, through immunization. Based on your own experience of receiving or witnessing health services at the community level, can you suggest some examples of health interventions that demonstrate the beneficence of health workers? On the other hand, the concept of non-malefic tells you to “do no harm”, either intentionally or unintentionally, to your customers, for example, not to abandon a customer who needs your services. As you have seen in case study 7.1, Chaltu should not abandon Almaz and let him solve his problems without professional help. However, there are circumstances in which it is impossible to “do good” and “avoid doing harm” at the same time.
For example, you can plan to provide contraception to all the women in your area who need them, but the availability of resources, the cultural beliefs of the community, the reaction of customers to the service, and other factors may prevent you from doing good to the greatest number of women. In addition, you can't always avoid harming a customer; for example, when a contagious disease emerges in your area, you may have to suggest isolating infected people against their will to contain the spread of the disease and for the good of the majority. Distributive justice means that people have the right to receive the same treatment regardless of ethnicity, gender, culture, age, marital status, medical diagnosis, social position, economic status, political or religious beliefs, or any other individual characteristic. Everyone should be treated the same way.
In both examples, justice is not being done. It is not fair for a person to receive poorer services because they come from a particular family that is in dispute with the health extension professional (lack of social justice) or because they live too far away (lack of distributive justice) to be included in preventive health activities. If you are not fair to the people and community groups in your environment while you practice your profession, you will not be able to earn the trust of the public and this will negatively affect your practice. As a health extension professional, you must be fair and maintain high ethical standards at all times, including confidentiality and truthfulness with all your clients alike.
However, as some of the examples from this study session have demonstrated, you will face dilemmas that are difficult to resolve in harmony with the concepts of respecting autonomy and informed consent, and reconciling the demands of beneficence and non-malefficence. In study session 8, there will be more examples of ethical dilemmas to think about and learn from. Can you give an example of charity and an example of non-evil that a health extension professional can demonstrate? Benevolence is an ethical principle that focuses on “doing good”. A practical example could be providing specific prenatal care to a pregnant mother.
Non-malefic is an ethical principle that reflects both the idea of not causing intentional harm and of not participating in actions that risk harming others. A practical example could be that the health extension professional does not abandon people just because of their economic situation. What is the difference between distributive justice and social justice? Give an example of each type of justice related to the health system. The principle of justice is based on the obligations of fairness, equality and impartiality in relation to the treatment of individuals and groups within society.
Social justice is equity for all groups of people within a community and is based on the application of equity, rights, access and participation. The role of health extension professionals is to support the inclusion and empowerment of people to fully participate in public decisions; for example, to ensure that the entire community participates in a malaria control campaign from the planning stage to its evaluation. Distributive justice is equity for people who live in the community, regardless of their status in the community; for example, all people should receive treatment when they are sick, no matter who they are. There are several ethical concerns that could influence this situation.
The health extension professional will be concerned with doing everything possible for everyone involved (charity) and not harming any of the people involved (not maliciousness). It will be important to be honest at all times when handling this situation and maintaining confidentiality. While all members of the immediate family seem to know what is happening, personal details about this situation should not be further disclosed to the community. The mother of the baby must give informed consent to any intervention performed during pregnancy or, of course, during the abortion, if that is what she ultimately decides.
Download the poster “The Seven Golden Ethical Principles”. Then we move on to explaining and elucidating the mid-level ethical principles that constitute the content, the cornerstone of the framework; and the educational approach it attempts to model. This approach, which focuses on the application of seven mid-level principles to cases (non-maliciousness, beneficence, maximization of health, efficiency, respect for autonomy, justice, proportionality), is presented in this article. For example, someone who believes that lying is always wrong, even if a lie can be beneficial to people and society, follows the principles of deontology, although they may have never heard of that theory.
Therefore, a moral principle of efficiency would require, for example, the use of the empirical basis and the conduct of cost-benefit analyses to decide what should be done and how to do it. In the same way, these principles may not be fully accepted and may be questioned, which makes them very useful for encouraging reflection and debate. In this study session, you will address the concepts and principles of ethics that are relevant to your work as a health extension professional. .
