Caring: a basis for ethics

Caring: a basis for ethics Miss Shurouq Qadose 3/4/2011

One of the main beliefs in midwifery is that patients will get better with good care. • Another belief may be that this, rather than other work, is ultimately satisfactory.

Midwives provide care and assistance to women throughout pregnancy and childbirth and help new mothers with newborn infant care.

Professional Relationships The code of ethics requires all professional midwives to respect the basic human rights of their clients and all people. The code also requires the midwife to respect his own rights and dignity, including his professional integrity.

Professional Practice As professionals, midwives should never discriminate against clients on a basis of age, health status, income, lifestyle or sexual orientation. A midwife should foster an environment of healthy communication, in which the client can freely discuss issues with him without fear of loss of privacy or embarrassment. A midwife must be able to share information with his client that he feels she must have to make educated decisions about her own care.

Confidentiality should be maintained, unless it is required by law that the midwife disclose the situation to authorities. The midwife should remain current on all skills and knowledge he needs to perform his duties to the best of his abilities, and protect his clients from any illegal or unethical practice by whatever means necessary, even if it means reporting these practices to legal authorities.

Professional Obligations Midwives have an ethical obligation to work for the well being of women and families on a societal level as well. A midwife must be an advocate for equality of access to health resources and support the development of midwifery as a profession as a whole by promoting standards of education, research, practice and policy for the betterment of communities as well as the families in them.

Elements of caring: • Receptivity قابلية- the other is received as she, he or it is. • Relatedness- receiving someone or something means to be in relation to her, him or it. • Responsivity- receiving alone is not enough; receiving comes alive through responding

Five Cs as value of caring: • Compassion شفقة • Competence • Confidence • Conscience ضمير • Commitment

1. Compassion : • Compassion may be defined as a way of living born out of an awareness of one’s relationship to all living creatures. • Compassion requires us to be weak with the weak, vulnerable with the vulnerable, &powerless with the powerless. Compassion means full immersion in the condition of being human.

Compassion is more than simple kindness. It is also more than caring; we can care without having compassion. Compassion is something both decisive and incisive حاسمة وقاطعة

2. Competence : • Competence is the state of having the knowledge , judgment, skills, energy , experience & motivation required to respond adequately to the demands of one’s professional responsibilities. • Competence distinguishes the practitioner from the student.

It is that which every midwife longs for and works towards during basic and post –basic education and training. • Care has to be appropriate, adequate, & practiced with respect, considering the needs of those who are the recipients.

3- Confidence • Confidence is defined as the quality which fosters trusting relationships. • Most midwife would agree that at the basis of caring lies a trusting relationship. Without the whole ethos of caring is lost.

Confidence is reciprocal; both parties in a relationship need to trust each other. But when one of the parties is in a professional position, then the other needs to be really sure that the professional can be trusted. This will depend largely on the degree of honesty between them.

4- Conscience • Conscience is a state of moral awareness; a compass البوصلة directing one’s behavior according to the moral fitness of things. • Conscience is at the basis of ethical behavior.

Is the caring person attuned to the moral nature of thingsis the call of care and manifests itself as care. • Professional caring is reflected in a mature conscience.

5- Commitment • Commitment is a complex affective response characterized by a convergence التقاء between one’s desires & one’s obligations, and by a deliberate choice to act in accordance with them.

The care-giver • Caring is something practical, something done to someone by someone. Therefore we need to look at the persons who give and receive care. • The Five Cs shows, that care-giver has to have a great deal of self-knowledge, self- understanding and self- assertiveness.

Caring involves for the care-giver first of all a “feeling” with the other . This is perhaps best captured in the word “ empathy” which basically means ‘suffering- in’. Suffering is subjective; it is a ‘feeling’. To understand suffering, a person has to be ‘in’. It is not a question of being in the sufferer’s shoes, nor even ‘how would I feel in that position

Principles of helping which , when applied to caring, becomes values : • Being: Before we can do we need to be : be ourselves, one human person with another human person. This entails that we are trustworthy, honest, and dependable.

Clarity: A willingness to be expressed itself in clarity towards the other. If we feel uneasy we say so, otherwise the relationship may be harmed by playing games with each other.

Respect: We do always like someone at first sight. But in caring we respect a person , and this may lead to a mutual liking. • Freedom: For other person needs to be free to express himself or herself and be what he/she is even thought we may not like some types of freedom

Empathy: This is the ability to perceive the feelings of the person, and the ability to communicate this to him/her

Values of health care The values which apply to caring all begin with ‘C’: those which apply to health care seem to begin with ‘E’: • Economy • Efficiency • Effectiveness

Any midwife who holds any of these values cares deeply. And by doing so is not only ‘just’ committed to her job, but is also an agent of change, a professional, a partner and companion : • Be attentive • Be intelligent • Be reasonable • Be responsible • Be committed

Midwife-doctor relationship 1- Collaboration & cooperation a- Assessment & application of clinical information b- Both are responsible for totality of health &illness care (Dependent. Interdependent, & Independent) 2- Midwives , physicians, & patients. (Sake & involve)

Midwife should: • Speak up. • Keep a sense of humor & perspective. • Enhance academic preparation. • Document, observe & be reported. • Exercise pt, advocacy role. • Keep open mind. • Be diplomatic

The Midwife- Patient relationship Code of ethics stressed "obedience to the physician even to the point of lying to the patient if the physician desired". Changes in midwifery :- • Faithful servant to a master • Midwives are not to be free to make decisions • They are the instruments of the orders of the physician

Midwife – Patient – Family Relationship Unavoidable Trust When patients enter the health system, they are usually entering a foreign and forbidding environment. Intimate conversations and activities, such as touching and probing حبس , that normally do not occur between strangers, are commonplace between patients and health care professionals.

Patients are stripped of their clothes, made to sit alone in cold and barren rooms, and forced to wait anxiously for frightening news regarding the continuation of their very being. Patients, in most cases, have no option but to trust midwife and other health care professionals when they need care. This unavoidable trust creates an asymmetrical, or uneven, power structure in professional – patient and professional – family relationships.

Midwifes responsiveness to this trust must include promising to be the most excellent midwife that they can be. Health care professionals must promise “ not only to take care of, but to care for the patient and family – to be candid, sensitive, attentive, and never to abandon them”

Personal Dignity Dignity characterized as being related to persons who are in a position to use their capabilities. In general terms, a person has dignity “ if she is in a situation where her capabilities can be effectively applied”.

Caring: a basis for ethics