ETHICAL FRAMEWORKS FOR DECISION-MAKING

I. Ethical system and Principles

Not all ethical principles are applicable in all situations because of the different variables that may
affect every situation. The moral principles help us in making a moral Analysis of ethical issues
in our professional Practice. It is important for the individual to determine which principle is
applicable or carries more weight to a specific situation.

II.Patient’s Bill of Rights – This enumerates the privileges the patient duly deserves and the ethical
behavior that the health care professionals should observe.

1. The PATIENT has the right to considerate and respectful care.

2. The PATIENT has the right to and is encouraged to obtain from physicians and other direct
caregivers relevant, current, and understandable information concerning diagnosis, treatment
and prognosis. Except in emergencies when the patient lacks decision-making capacity and the
need for treatment is urgent, the patient is entitled to the opportunity to discuss and request
information related to the specific procedures and/or treatments, the crisis involved, the
possible length of their recuperation, and the medically reasonable alternative sand their
accompanying risks and benefits.
The patient has the right to know the identity of physicians, nurses, and others involved in
his/her care, as well as when those involved are students, residents, or trainers. The patient also
has the right to know the immediate and long-term financial implications of treatment choices,
insofar as they are known.(
(RIGHT to relevant information-informed consent)

3. The PATIENT has the right to make decisions about the plan of care prior to and during the
course of treatment and to refuse a recommended treatment plan of care to the extent
permitted by law and hospital policy and to be informed of the medical consequences of this
action. IN case of such refusal, the patient is entitled to other appropriate care and services the
hospital provides or transfer to another hospital. The hospital should notify patients of any
policy that might affect patient choice within the institution.
(RIGHT to decide plan of care)
4. The PATIENT has the right to have an advance directive (such as a living will) concerning
treatment or designating a surrogate decision maker with the expectation that the hospital will
honor the intent of that directive to the extent permitted by law and hospital policy.
Healthcare institutions must advise patients of their rights under state law and hospital policy to
make informed medical choices, ask if the patient has an advance directive, and include that
information in patient records. The patient has the right to timely information about hospital
policy that may limit its ability to implement fully a legally valid advance directive.(RIGHT to
have advance directive)

5. The PATIENT has the right to every consideration of his privacy. Case discussion, consultation,
examination, and treatment should be conducted so as to protect each Patient’s privacy.
 6. The PATIENT has the right to expect that all communications and records pertaining to his care
should be treated as confidential by the hospital, except in cases such as suspected public health
hazards where reporting is permitted or required by law. The patient has the right to expect that
the hospital will emphasize the confidentiality of this information when it releases it to any
other parties entitled to review information in these records.(RIGHT to confidentiality of
records)
7. The PATIENT has the right to review the records pertaining to his medical care and to have the
information explained or interrupted as necessary except when restricted by law.(RIGHT to
review one’s medical records)
8. The PATIENT has the right to expect that, within its capacity and policies, a hospital will make
reasonable response to the request of a patient for appropriate and medically indicated care
and services. The hospital must provide evaluation, service, and/or referral as indicated by the
urgency of the case. When medically appropriate and legally permissible, or when a patient has
so requested, a patient may be transferred to another facility.
The institution to which the patient is to be transferred must first have accepted the patient for
transfer. The patient must also have the benefit of complete information and explanation
concerning the need for risks, benefits, and alternatives to such a transfer.(RIGHT to request
relevant care)
9. The PATIENT has the right to ask and be informed of the existence of business relationships
among the hospital, educational institutions, other health care
Providers, or players that may influence the patient’s Treatment and care.(RIGHT to disclosure
of business interests)
10. The PATIENT has the right to consent or to decline to participate in proposed research studies or
human experimentation affecting his care and treatment or requiring direct patient
involvement, and to have those studies fully explained prior to consent. A patient who declines
to participate in research or experimentation is entitled to the most effective care that the
hospital can otherwise provide.(RIGHT to refuse participation in research)
11. The PATIENT has the right to expect continuity of care when appropriate and to be informed by
the physician sand other caregivers of available and realistic patient care options when hospital
care is no longer appropriate.(RIGHT to continuity of care)
12. The PATIENT has the right to be informed of hospital policies and practices that relate to patient
care, treatment, and responsibilities. The patient has the right to be informed of available
resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient
representatives, or other mechanisms available in the institution. The patient has the right to be
informed of The hospital’s charges for services and available payment Methods.(RIGHT to
information on hospital policies)

III.ProfessionalCodeofEthics

This outlines how midwives should practice the profession in ethical and moral manner. This guides
the midwives in her practice, in establishing interpersonal relationship with colleagues, patient,
superiors and other significant others involved in patient care.

III.InstitutionalPolicies
 The set rules, regulation and policies of the institution may affect the decision making of the
midwife. This guides the midwives in her practice in the institution where she is connected.

IV.Laws

It is an ordinance promulgated for the common good by one who has Legitimate authority. In
general, a rule of being or of conduct, established by an authority able to enforce its will; a
controlling regulation; the mode or order according to which an agent or a power acts.

In morals, law is the will of God and as the rule for the disposition and conduct of all responsible beings
toward him and toward each other; a rule of living, conformable to righteousness; the rule of action as
obligatory on the conscience or moral nature.

PRINCIPLES OF BIOETHICS

- Decision making in the field of bioethics has become increasingly complex. There is no
predetermined order of preference; each is essentially of equal importance. In different
situations a particular principle may assume a greater or lesser priority.
•Autonomy
•No maleficence
•Beneficence
•Justice
•Veracity

ETHICAL ISSUES

Abortion

While infanticide is legally and socially treated as murder and few in our culture would approve of it,
the killing of unborn infants (often called foetuses in order to still the conscience and minimize the social
stigma) has become both legally and socially acceptable.(Euthanasia)

Living Wills

The “living will” Is a written document which speaks for the patient if he becomes incompetent and
helps protect the physician from legal liability. These laws are binding upon the physician so that if he
does not wish to observe the “will” He must cooperate in transferring the patient to another physician.
(DonationofOrgansandtheBody)

Principles that will Guide the Midwife in her Practice

I.TheGoldenRule.

This states that “Do Unto others what you would like others to do unto You”.

For a midwife to follow this principle she should:

• Treat others according to how one would like others to treat them;

• Treat others as you would like to be treated;

• Not Treat others in ways one would Not Like to be treated

MIDWIFERY ETHICS

• It is a system of principle governing conduct of midwives (Robles). The term connotes the conduct or
behavior of midwifery Practitioners, which by reason of public Approval or practice of the group, has
become customary among practicing midwives.

CODE OF ETHICS FOR MIDWIVES

Adopted June 30,1988

Section I

The primary objective of the midwifery profession is for its members to render service within the scope
of their legitimate functions, having in mind that their patients, regardless of religion, social or economic
status, deserve respect as human beings. A midwife should endeavor to deserve the confidence of the
patients under her care by rendering to each of them dedicated and selfless service to the full extent of
her skill and competence.

Section II

A midwife should try her best to continually improve her knowledge & skill for the benefit of her patient
sand to share with her co-practitioners any valuable practical knowledge that she may have gained by
experience in the practice of her profession.

Section III

A midwife is expected to practice on a scientific basis and to desist in the performance of any midwifery
procedure which is of doubtful or questionable propriety from the standpoint of medical or scientific
principles.

Section IV

The midwifery profession should contribute to the safeguarding of public health and should protect
itself against the admission into its membership midwives who are deficient in professional competence
and requisite moral character. It is incumbent upon every midwifery practitioner to observe the law, to
uphold the honor and dignity of her profession, and to adhere faithfully to professional discipline. It is
the professional duty of every midwife to bring to the attention of the proper authority, through
legitimate procedures, the illegal or unethical conduct of any co-member of the midwifery profession,
without bias or personal animosity, but solely for the maintenance of the good name of the profession
as well as public interest and welfare.

Section V

A midwife who has accepted a patient under her care should render service to the patient the best of
her ability. She should not neglect the patient under any circumstance within her control.

Section VI

A midwife should not compromise her services to the patients under terms or conditions which would
impair the quality of patients- care.

Section VII

In the practice of midwifery, a midwife must confine the source of her income to the midwifery services
she has actually rendered. Her fees should be commensurate with the services performed and, if need
be, with The patient’s ability to pay. It is highly improper for a Midwifery practitioner to pay or receive a
commission for referral of patients made to or by her.

Section VIII

A midwifes- legitimate functions cover performance of midwifery services only to normal pregnant
women and normal newborn infants. Accordingly, in doubtful or difficult case, she should seek
consultation or refer such case to a qualified obstetrician or physician. She should not persist in handling
the case and thereby risk liability for any injury that may arise.

Section IX

A midwife is bound by professional ethics not to reveal any information given by her patient in the
course of the Patients- care or treatment, whether such information is addressed to her or to the
attending physician, unless under the law, she is required to testify on such information to serve the
ends of justice.
Section X

The ideals of service envisioned by the midwifery profession call for a dedication of the midwifes
capabilities not only individual but also to the community in which she practices to the end that she may
be able to contribute to the improvement of the health of her patients and to the health and well-being
of her community.

Section XI

A midwife should participate in research activities or in any effort of the midwifery profession to
improve midwifery training and practice, and to take part in establishing and maintaining conditions of
employment conducive to high-quality maternity and infant care

Section XII

As a member of the health team, a midwife should work with interest and concern, together with other
members of the health team, in promoting efforts to meet the health needs of the public. The
formulation of a code of midwifery ethics that is complete and all-embracing is not feasible. A registered
midwife, in the course of her professional practice, will realize that a code of ethics, however, well it is
formulated has certain limitations.

Section XII

The code for instance, may not point out how a midwife may resolve or reconcile a conflict between
personal and professional views. The code may not likewise indicate a remedy for resolving conflict that
may stem from changing social principles, goals and standards which are held or may later be accepted
by the midwifery profession.

Section XII

Such inadequacy of the code ultimately leaves the midwife to herself in deciding what moral principles
should govern her course of action when faced with ethical problems in the practice of her profession.
In brief, a code of midwifery ethics, like any other code of professional ethics, cannot be expected to
cover in detail all the activities of the midwife.

Section XII

Hence, a midwife is not duly bound to confine herself to the ruleset by any adopted code of midwifery
ethics. However, it is incumbent upon her to observe at all times the ideals of her profession and to
adhere faithfully to the well-recognized unwritten ethical and professional rules generally accepted by
the midwifery profession.
Section XIII

This code shall take effect upon approval by the Commission and after fifteen (15) days following its
publication in the Official Gazette. Done in the City of Manila, this 30 th day of June, 1988.

PHILIPPINES

A midwife must be able to give necessary supervision, care and advice to women during pregnancy,
labor and the post partum period, to conduct deliveries on her own responsibility and to care for the
newborn and the infant; this care includes preventive measures, the detection of abnormal conditions in
the mother and child, the procurement of assistance and the execution of emergency measures in the
absence of medical help.

•A midwife has an important task in the counseling and education, not only for the patients but also
within the family and community. The work involves antenatal education and preparation for
parenthood and extends to certain areas of gynecology, family planning, and child care. A midwife may
practice in a hospital, clinic, health unit, domiciliary services or in any other services.

SKILLS AND ABILITIES OF PROFESSIONAL MIDWIFE

I. Technical Skills

Are that a midwife should apply in performing the procedures assigned to her.

Examples of such skills are:

• Provision of sound family planning information andadvice

• Diagnose

- Pregnancies and monitor normal pregnancies; to carry out examinations necessary for the monitoring
of the development of normal pregnancies

•Formulation of program for parenthood preparation and a complete preparation for childbirth
including advice on hygiene and nutrition

II. Communication Skills

Are the skills of the midwife that should be used and applied in expressing her thoughts either orally or
in writing.

• Examples of such skills are:

• Maintain adequate, accurate and contemporary records of practice, include all documentation
required under legislation, documentation of care Given, response to care and evaluation of care.

•Keeping a detailed record of observations, care given and problems of all mothers and babies.

• Report to the relevant

Person or authority any circumstances in the care environment/settings, which could jeopardize
standards of practice or where appropriate care cannot be provided

III.Analytical Skills

Are that are used in decision making. These may include:

• Ensure that adequate strategies are in place for referral to a relevant health professional or agency as
part of providing midwifery care and in the event of potential or actual problems for the woman and her
child.

• Protect all confidential information concerning the woman obtained in the course of professional
practice and make disclosures only with the consent of the woman or when legally obliged/required.

THE MIDWIFERY LICENSURE EXAMINATION

Qualifications of applicants

• In order to be admitted to the midwifery examination, an applicant shall, at the time of filing of his/her
application therefore, establish to the satisfaction to the Board that he/she:

1. Is in good health and of good moral character

2. Is a graduate of midwifery in a government recognized and duly accredited institution at the time of
the issuance of a certificate of registration;

3. The applicant shall be a citizen of the Philippines; at least eighteen (18) years of age. In case the
applicant is below 18 years old who successfully passes the examination shall not be permitted to
practice midwifery until he/she reaches the legal age.

Scope of the Examination

1. Infant care and feeding;

2. Obstetrical anatomy and physiology
3. Principles of bacteriology as applied to midwifery practice
4. . Obstetrics
5. . Midwifery procedures
6. Domiciliary midwifery
 7. Community hygiene and first aid
8. Nutrition
9. Ethics of midwifery practice
10. Primary health care
11. Professional Growth and Development
12. .Family planning; and Other subjects which the Board may deem necessary for addition or
inclusion from time to time.

Passing the Examination

• To pass the board examination for midwives, a candidate must obtain a general rating of seventy five
percent(75%) in the written test with no grade lower than fifty percent (50%) in any subject.

•Results of the examination

• The board shall, within one hundred twenty (120) days after examination, report the ratings obtained
by each candidate to the Commissioner of the PRC.

REGISTRATIONOFMIDWIFE

•Issuance of certificate

• The Certificate of Registration as midwife shall, upon payment of the required fees, be issued to any
applicant who passes the examination. Every certificate of registration shall show full name of registrant,
have a serial number, bear the signatures of the members of the Board, be attested by the Secretary of
the board, I be duly authenticated by the official seal of the Board. The issuance of a certificate of
registration by the Board to the registrant shall be evidence that the person named herein is entitled to
all rights and privileges of a registered midwife until said certificate, for jut case, is suspended
temporarily or revoked.

REGISTRATIONOFMIDWIFE

• The applicant for registration must comply with the following requirements before the certificate will
be issued the applicant must:

1.Have passed the licensure examination

2. Be a citizen of the Philippines

3. Be at least 18 years old;

4.Not have convicted of a crime involving moral turpitude;

5 Not have found guilty of immoral and Dishonorable Conduct

6. Pay the required registration fee.

• In case the Board shall refuse to issue certificate, the Board shall give the applicant a written
statement setting forth the reason or reasons for its action, which statement shall be incorporated in the
records of the Board
Inhibition against practice of midwifery

• No person shall practice or offer to practice midwifery in the Philippines, as defined in this Act, without
holding a valid certificate of registration & professional license as midwife.

• A midwife must be registered and licensed to practice Midwifery in the country. This means that she
has to pass the Midwifery Licensure Examination and comply with the registration requirements before
she can practice the profession.

REVOCATION AND SUSPENSION OFCERTIFICATES/LICENSE

• A licensed is a right to a person under certain circumstances or condition. Failure to comply with the
condition that goes with it may mean revocation or suspension by the agency or licensing board entitled
to issue the license.

•Revocation Is the cancellation of the Midwife’s Certificate or license due to failure to meet the
condition that is inherent to her license or certificate or many commission of act that is not within the
scope of her practice. This means that the professional midwife can no longer practice the profession
and all the rights and privileges accorded to her as professional midwife will be withdrawn.

Suspension Is the temporary withdrawal of a right, privilege or license to practice midwifery profession.
Temporarily the midwife is prohibited to practice midwifery for a certain period of time but she remains
a member of the profession and is expected to practice the Code of Conduct for Midwives.

• The board of Midwifery has the power to revoke or suspend the license or certificate after due
process.

“Due Process of law implies the right of the person affected thereby to be present before the tribunal
which pronounces judgment upon the question of life, liberty, or property, in its most comprehensive
sense; to be heard, by testimony or otherwise, and to have the right of controverting, by proof, every
material fact which bears on the question of right in the matter involved. If any question of fact or
liability be conclusively presumed against him, this is not due process of law.” (Black’s Law Dictionary,
6ThEdition, page 500)

CAUSES OF REVOCATION

•Criminal Offense

- Is an act punishable by law; usually considered an evil act.

Moral Turpitude

• It is gross violation of standards of moral conduct, vileness, such that an act involving moral turpitude
was intentionally evil, making the act a crime. It is a personal conduct which goes against public morals.
Such conduct is regarded as a black mark against Someone’s Reputation, and may cause problems in
the future after conviction because people who have been committed of crimes involving moral
turpitude maybe regarded as less trustworthy or honorable.

Negligence

• Is the commission of an act that a prudent person would not have done or the omission of a duty that
a prudent would have fulfilled, resulting in injury or harm to another person.

• It can also be defined as any action or an omission in reckless disregard of the consequences to the
safety or property of another. Negligence is a

‘legal cause ‘Of damage. If it directly and in natural and continuous sequence produces or contributes
substantially to producing such damage, so it can reasonably be said that if not for the negligence, the
loss, injury or damage would not have occurred.

Malpractice (Professional Negligence)

In particular, in a malpractice suit, a professional person is negligent if harm to a client results from such
an act or such failure to act, but it must be proved that other prudent members of the same profession
would ordinarily have acted differently under the same circumstances. Negligence may be misfeasance,
malfeasance, or nonfeasance.

(Mosby’s Medical Dictionary, 8ThEdition, © 2009, Elsevier).

Misfeasance

Improper and unlawful execution of an act that in itself is lawful and proper (The American Heritage
Dictionary of the English Language).

Malfeasance

Is the doing of an act which a person ought not to do at all. A midwife who caused uterine inversion to
a woman by pulling the umbilical cord during the third stage of labor to hasten placental expulsion is an
example of this act.

Nonfeasance
 Means the omission of an act which a person ought to do. An eclamptic patient falls out of bed and
sustained an injury convulsion because the midwife failed to raise the side rails is an example of this act.

Malpractice

Is any professional misconduct, lack of ordinary skill, or breach of duty in the performance of a
professional service that results in injury or loss. The plaintiff must usually demonstrate failure by the
professional to perform according to the Field’s Accepted standards.

Incompetence

This means that a midwife has no adequate ability, knowledge, fitness, and qualities to meet
requirements to perform her duties properly and skillfully.

Ignorance

Webster defines ignorance as “lack Of knowledge or awareness of a particular

Thing”. In midwifery practice, ignorance will denote the inability of the midwife to apply professional
skills in the delivery of her duty. This lack of professional skills can cause damage or injury to patient
under her care.

Fraud and deceit

Fraud

Is an international perversion of truth for the purpose of obtaining some valuable thing or promise from
another . Fraud is a crime, and also a civil law violation.

Deceit

Is the fraudulent representation of a material fact made with knowledge of its falsity, or without
reasonable grounds for believing its truth and with intent to induce reliance on it. Both terms means
giving false impression causing someone to believe something that is false.

The types of criminal fraud that a midwife may commit may include:

1. Benefit fraud, committing fraud to get government benefits

2. Embezzlement, taking money which one has been entrusted with on behalf of another party

3. False advertising

4.False billing
5. Documents or signatures

6. Health fraud, for example selling of products known not to be effective

7.Not reporting revenue or illegally avoiding taxes

Five primary forms of deception that a midwife may commit are:

1. Lie is giving information that is opposite or very different from the truth.
2. Equivocation is making an indirect, ambiguous, or contradictory statement.
3. Concealment is omitting information that is important or relevant to the given context, or
engaging in behavior that helps hide relevant information.
4. Exaggeration is an overstatement or stretching the truth to a degree.
5. Understatement is minimization or downplaying aspects of the truth.

Misconduct

Is a legal term meaning a wrongful, improper, or unlawful conduct motivated by premeditated or

intentional purpose or by obstinate indifference to the consequences of

One’s Acts. It is where something is seen as unacceptable but it is not a criminal offence like poor
timekeeping, absenteeism, use of workplace facilities, personal appearance, negligence or sub-standard
work.

Gross Misconduct

Is where a midwife can be dismissed straightaway because it is serious enough to justify suspension and
revocation of license. Midwives would include intoxication (whether from drink or drugs), fighting or
other physical abuse, indecent behavior, theft, dishonesty, sabotage, serious breaches of health and
safety rules, offensive behavior (such as discrimination, harassment, bullying, abuse and violence) and
gross insubordination as examples of gross misconduct.

THE MIDWIFERY PROFESSION

OPPORTUNITIESOFTHE MIDWIFE ABROAD

Abroad all midwives wish to work abroad to have a better opportunity not only in terms of experience
but as well as for greener pasture. Through the Philippine Overseas Employment Agency (POEA),a
midwife may know job vacancies abroad. Hiring here is done through government

– Government basis. Aside from POEA, different recruitment agencies are available for job placement
but placement fees are being charged to them. Another way working abroad is the direct hiring scheme
where the employers hire directly the midwives. They take care of the processing of their papers
including the visa, employment contract and the tickets.
Documents needed when traveling abroad

• Passport is a document that provides One’s

Nationality and is issued by the department of foreign affairs. For the midwife to acquire a passport

She must have: birth certificate, marriage contract, and two 2 x 2 pictures

And the processing fee.

•Visa is a document that allows a person to enter a foreign country issued by the foreign embassies in
every country, a visa maybe categorized: student, tourist, working and immigrant. Documents needed in
applying for a visa are:

•Six 2 x 2 photos

• High school Diploma authenticated by the DipEd

• Midwifery Diploma, transcript of Records, and Clinical Experience authenticated by CHED

•Board Rating and Board Certificate authenticated by the PRC

• Birth certificate and Marriage Contract authenticated by the NSO

• National Bureau of Investigation (NBI) Clearance

•Certificate of employment

•The above documents are brought to the Department of foreign affairs for

Authentication and to the foreign embassy for final authentication

Responsibilities of the Midwife Working Abroad

Maintain her dignity and professionalism.

•Maintain loyalty to people and country.

• Always respect laws, tradition, and culture of the country where she is working.

• Maintain good traits and attitude as a Filipino working abroad.

• Follow Code of Midwifery Ethics of the host country.

THE MIDWIFERY PROFESSION

PROFESSIONALORGANIZATION

•Integrated midwives association of the Philippines, inc.(IMAP,Inc.)

Is a non-profit, non-stock, and non-governmental national organization of the registered midwives in

the Philippines, accredited by the Professional Regulation Commission.

• IMAP, Inc. is committed to serve the Filipino people through ineffective delivery of basic health
services in the country. It also aims to elevate the standards of midwifery profession, provide continuing
midwifery education and professional growth, and foster and maintain the ideas of integrity conduct

•WHAT DOES IT OFFER?

1.Continuing professional education

– This aims to improve the competency of midwives in the practice of their profession and give service
that meets professional standards.

2.Scholarship Program

–Offers a Three-Year Midwifery Program to deserving children of bonafide members of the association
willing to take up the course at the IMAP Foundation School in Iloilo City.

3.Outreach Programs

•Project ABCC

–A joint with the Philippine Obstetrical and Gynecological Society and NESTLE Philippines which has
generated cancer awareness and consciousness among women and the

Importance of preventive health care.

•Operational Tule

– Conducted in depressed areas for children whose parents cannot afford the operating costs and
medicine for circumcision.

•Christmas Gift-Giving

– A yearly project since 1996. The organization conducts gift-giving program at depressed barangays
inGuimaras.

•Basic life support program

– A community health emergency preparedness and response program conducted for midwives to
enable them to respond to emergencies in the community (initiated under the STOP DEATH program of
the DOH).
Classification of IMAP members

• The members of the Association are classified as follows:

•Active

– Are graduate registered midwives with a right to vote and participate.

•Affiliate

– Are members of a graduating class with no voting privilege but is to be represented.

•Associate

– A registered nurse and a registered midwife can be a member but she has no right to vote.

•Honorary

–Not necessarily a graduate registered midwife but any individual who has rendered meritorious work
in the development of the midwifery profession or assisted in the promotion of the interest and welfare
of the association.

PERSONALITY DEVT

1.Manners

– Refer to polite, civil, well-breed behavior (Funk and Wagnalls).

2Good Manners

– Are always important in all contacts of life but they must spring from kindness of spirit, or they will
not ring true. Genuine concern for another person is so vital to good manners that it is better to be kind
than to be correct. Manners are the heart of courteous behavior.

3.Manners and etiquette

– Used synonymously but etiquette means the conventional rules of behavior, the customs that are
handed down to us or the ones we formulate to meet specific situations.

4.Everyday manners and etiquette

• Please, thank you

• Shaking of hands/nice to meet you

• Cover your mouth when sneezing or coughing

• Avoid burping, passing gas or rude bodily voices

• Wait for your turn to talk

• Remove hat when entering a room

• Say hello

•When Dining(ProperTableManners)

• Use silverware if offered to you. Use them correctly

• Do not blow your nose on the table

• Never speak when your mouth is full of food

• Avoid keeping your elbows on the table and put your hands in your lap

When not in use.

• Always turn off your cell phones before entering the restaurant

• Do not start eating unless everybody is seated and served

When in public

• Wait for your turn when your are falling in line

• Turn off devices while watching a movie in the cinema and refrain from talking

• Be careful with your words

•When Entertaining

• Always say thank you or send a thank you note when receiving a gift or a good deed has been done for
you

• It is improper to ask a guest to remove his shoes. When

Expected to be shoeless, slippers must be provided

• Introduce guests to one another

• Keep conversation flowing and avoid awkward pauses. Change subject when vulgar or rude and
controversial matter Arises

• Offer refreshments to each guest upon entering social room

Personality Development

DEFINITION: Enhancing and dressing One’s Outer and inner self or the organized pattern of behaviors
and attitudes that makes a person distinctive.
PERSONALITY: Dynamic and organized set of characteristics possessed by a person that uniquely
influences his or her cognitions, emotions, motivations, and behaviors in various situations.

– Refers to individual differences in characteristic patterns of thinking, feeling and behaving.

GROOMING: Art of cleaning, grooming, and maintaining parts of the body

UNIFORM: Wearing the prescribed uniform

VOICE: Develop voice quality, voice tone, pitch, pace and voice modulation

POISE: Carrying One’s Self and professional bearing

CONDUCT: How you act, or deal with other people

THE LAW AND THE SOCIETY

•Negligence

–Refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person
in the same or similar circumstance would or would not do, and acting or the non-acting of which is the
proximate cause of injury to another person or his property

• Elements of a Professional Negligence

• Existence of a duty on the part of the person charged to use due care under circumstances

• Failure to meet standard of due care

• The foreseability of harm resulting from failure to meet the standard

•The fact that the breach of this standard resulted in an injury to the plaintiff

Examples of Negligence

1. Burns resulting from hot water bags, heat lamps, vaporizers or sitz baths

2.Objects left inside the patients body such as sponges

3.Drugs given to the wrong person

4. Wrong medicine, wrong concentration, wrong route or wrong dose

Doctrine of RES IPSA LOQUITUR- “the thing speaks for itself”

•Rule: When a thing which has caused an injury is shown to be under the management of the party
charged with negligence and the accident is such as in the ordinary course of things will not happen if
those who have such management use proper care, the accident itself affords reasonable evidence in
the absence of explanation by the parties charged, that is rose from the want of proper care.

• Three conditions required to establish a Defendant’s

Negligence without proving specific conduct:

1. That the injury was of such nature that it would not normally occur unless there was a negligent act
on the part of someone
2. That the injury was caused by an agency within control of the defendant
3. That the plaintiff himself did not engage in any manner that would tend to bring about the injury.
Example of such case is the presence of sponges in the Patient’s Abdomen after an operation.
Doctrine of force majeure

– Means an irresistible force, one that is unforeseen or inevitable.

• Rule: When a debtor is unable to comply with his obligation because of force majeure he cannot be
held liable for such performance. In the absence of stipulations to the contrary, impossibility of
performance, without the negligence of the parties, prevents the enforcement of bond or contract.

• Circumstances such as floods, fire earthquakes and accidents falls under this doctrine and nurses who
fail to render service during these circumstances are not held negligent.

Doctrine of respondent superior

– Let the master answer for the acts of the subordinate.

• Rule: The master is responsible for the want of care on the part of the servant toward those to whom
the master is under the duty to use care, provided the failure of the servant to use such care occurred in
the course of his employment.

• Example of this is that if the hospital will decides to hire under board nurses or midwives in place of
professional nurse in an effort to cut down on expenses and these persons prove to be incompetent
then the hospital will be held liable.

•Incompetence

– Lack of ability, legal qualifications of fitness to discharge the required duty.

SITUATIONS AND CIRCUMSTANCES WITH LEGAL IMPLICATIONS

•Registrations of births

• Every birth must be registered in the Local Civil Registrar. The physician or the midwife who attended
the birth of the child is required to register the child. If the physician who attended the birth of the child
is unavailable, the midwife can gather the information from the mother and the father maybe adequate
for the registration.

•Birth certificate should be correctly accomplished accurate information and data.

Hospital records as evidence

Proves the condition of the patient at the time of confinement because written records are the best
forms of evidences to be presented. Hospital records kept in the hospital is a form of privilege
communication.
Privilege Communication

Is a communication concerning which one cannot legally be compelled or required to divulge or reveal.
This privilege is lost if the patient is permitted to read his record or has asked a nurse who made a part
of the hospital record or a hospital personnel to be a witness or testify as to the part of the contents of
the same record.

Incident Report

Is used by the healthcare agencies to document the occurrence of anything out of ordinarythat results
in, harm to a patient, employee or visitor.

The Midwife and Crimes Crimes Punishable by Law

Felony

Quasi

Offenses

Negligence

The Midwife and Crimes

Crime is defined as an act committed or omitted in violation of the law. Criminal offenses are composed
of two elements:

•Criminal act and

•Evil/criminal intent In criminal action, the state seeks the punishment of the wrongdoers.

• Conspiracy to commit a crime: A conspiracy to commit a crime exists when two or more persons agree
to commit a felony and decide to do it.

• Person who commit felonies are either principals, Accomplices or accessories.

• Principals – are those who take a direct part in the execution of the act: who directly force or induce
others to commit it: or Who cooperate in the commission of the offense by another Act without which it
would not have been accomplished.

• Accomplice – are those persons who, not being principals, cooperate in the execution of the offense
by previous or Simultaneous act.To hold the person liable as an accomplice, it must be shown that he
has knowledge of the criminal intention of the principal. This may be demonstrated by previous or
simultaneous that contribute to the commission of the Offense as aid thereto, whether physical or
moral.
 Person who commit felonies are either principals, accomplices or accessories.

Accessories – are those who, having knowledge of the commission of the crime and without having
participated therein either as principals or accomplices, take part subsequent to its commission by
profiting themselves or assisting the offender to profit from the effects of the crime By concealing or
destroying the body of the crime, or the effects or instrument thereof, in order to prevent its discovery
of by harboring, concealing, or assisting in the escape of the principal of the crime, provided the
accessories act with abuse of their public functions or are known to be habitually Guilty of some other
crimes.

Criminal Actions: Criminal actions deal with acts or offenses against public welfare. These vary from
minor offenses and misdemeanors to felonies.

• A misdemeanor is a general name for a criminal offense which does not in law amount to felony,
punishment is usually a fine or imprisonment for a term of less than one year .

• A felony is a public offense for which a convicted person is liable to be sentenced to death or to be
imprisoned in a penitentiary or prison. It is far more atrocious in nature than misdemeanor.

A felony is committed with deceit and fault.

• Deceit

– Exists when the act is Performed with deliberate intent and there is fault when the wrongful acts
result from imprudence, negligence, or lack of skill or foresight.

Criminal negligence may be classified into:

1.Reckless imprudence – It is reckless imprudence when a person does an act or fails to do itvoluntary
but without malice, from which material damage results immediately.

2.Simple imprudence

– Means that the person or midwife did not use precaution and the damage was not immediate or
the impending danger was not evident or manifest.

3.Criminal intent is the state mind of a person at the time the criminal act is committed, that is, he/she
knows that an act is not lawful and still decided to do it anyway.

• To be criminal, an act must be defined as a crime.

Classes of Felonies: Felonies are classified according to the

Degree of the acts of execution which produces the felony into:

1. A felony is consummated when all the elements necessary for its execution and accomplishment are
present.

2. It is frustrated when the offender performs all the acts or

Execution which will produce it by reason of causes independent of the will of the perpetrator

.3. There is an attempt to commit a felony when the offender commences the commission of the same
directly by overt

(open or manifest) acts, and does not perform all the acts or

Execution which shall produce the felony, by reason of some cause or accident other than this own
spontaneousdesistance.Consummated felonies, as well as those which are frustrated And attempted,
are punishable.

Felonies are also classified according to the degree of punishment

Attached to the felony whether:

• Grave felonies

– Are those to which the law attaches the capital punishment (death) or penalties which in any of their
periods are afflictive (imprisonment ranging from six (6) years and one (1) day

To life imprisonment or a fine not exceeding P6.000.00).

•Less grave felonies – are those which the law punishes with penalties which in their maximum period
are correctional(imprisonment ranging from one month and one day to six (6)years, or a fine not
exceeding P6.000.00 but not less thanP200.00).

•Light felonies – are those infractions of law for the commission of which the penalty of arresto menor
(imprisonment for one (1) day to thirty (30) days or a fine not exceeding P200.00 or both of which are
imposed). Light felonies are Punishable only when they have Been consummated, with the exception of
those committed Against a Person or property.
The best defenses a midwife can have against being sued by Patients are to remain competent in skills
and knowledge, practice nursing at the Highest standards of care, and document thoroughly.

• Midwives have the minimal ethical obligation or duty of No maleficence, which means doing no harm
to patients. If nothing else, remaining competent in One’s

Skills and knowledge helps prevent injury to patients. Another important factor in preventing lawsuits is
to establish a friendly, trusting relationship With the patient and his or her family.

• Most patients and their families have an inherently positive attitude toward midwives, whom they see
as the only ( Aiken,2003)

Circumstances affecting criminal liability

•A.JustifyingCircumstances A person may not incur criminal liability under the following circumstances:

1.When he/ she acts in defense of his person or rights provided

That:

(a) there is unlawful aggression on the part of the offended or Injured Party;

(b) there is reasonable necessity for the means employed By the person defending himself/herself to
prevent such aggression; and © there is lack of sufficient Provocation on the part of the Person
defending himself.

2.When he/she acts in defense of the person of the rights of His/her spouse, ascendant, descendants, or
legitimate or natural or adopted brothers or sisters, or relatives by affinity in the same degree, provided
that the first and second requisites presented in the next preceding circumstances are present, and
further Requisite, in the case of provocation was given by the person Attacked, that one making defense
had not part therein.

3.When he or she acts in defense of the person or rights of

Stranger provided that the first and second requisites mentioned in the first circumstance and that the
person defending is not induced by revenge ,resentment or other evil motives.

4. When any person who in order to avoid an evil or injury, does An act which causes damage to
another provided that the evil sought to be avoided actually exists, the injury feared is greater than
that done to avoid it and there is no other practical and less harmful means to prevent it.
5. When he/she acts in the fulfillment of a duty or lawful exercise of a right or office.
B.ExemptingCircumstances

• These are certain circumstances under which the law exempt

A person from criminal liability for the commission of a crime. The following persons under the
circumstances stated are expressly exempted by law from criminal liability for the crime they may have
committed:

• An imbecile or an insane person unless the latter has acted a lucid interval.

• A person under nine years of age.

• A person over nine years of age and under fifteen unless he acted With discernment.

• Any person who, while performing a lawful act with due care, causes an injury which is merely an
accident without fault or intention of causing it.

• Any person who acts under compulsion of an irresistible force.

•Any person who acts under the impulse of an uncontrollable fear

Of an equal or greater injury.

•Any person who fails to perform an act required by law, when prevented by some lawful or insuperable
cause.

C.MitigatingCircumstance

• Are those which do not constitute justification or excuse of

The offense in question but which, in fairness and mercy, may be

Considered as extenuating or reducing the degree of moral culpability. Following are some of the
circumstances considered by law to be mitigating and, as such, lessen the criminal liability of the
offenders.

– Circumstances which are otherwise justifying or exempting

Were it not for the fact that all requisites necessary to justify the act or to attempt the offender from
criminal liability in the respective cases are not attendant.

– When the offender has no intention to commit so grave a Wrong as the one committed.

–When the offender is under eighteen years of age over seventy years old.

–When sufficient provocation or threat on the part of the offended party immediately precedes the act.

- the act is committed in the immediate vindication of a Grave offense to the one committing the felony,
his or her spouse, ascendants, descendants, legitimate, natural or adopted brothers or sisters, or
relative by affinity within the same degree.
 – When a person acts upon an impulse so powerful as naturally To have produced obfuscation
(confusion).

– When the offender voluntarily surrender himself to a person in authority or his agents, or that he/she
voluntary confesses

His/her guilt before the court prior to the presentation of the

Evidence for the prosecution.

– When the defender is deaf and dumb, blind or otherwise suffering from some physical defect which
thus restrict his/her means of action, defense or communication with his/her fellow

Beings.

–When the offender is suffering from such illness as would diminish the exercise of his/her willpower
without, however, depriving him/her of consciousness of his/her acts.

D. Aggravating Circumstances are those attending the commission of a crime and which increase the
criminality liability of the offender or make his guilt more severe. Some of the circumstances considered
by law as aggravating the guilt of the offender are the following:

• When an offender takes advantage of his public position.

–When the crime is committed in contempt of or with insult to public authorities:

– When the act is committed with insult or in disregard of the respect of the offended party on a
account of his/her rank, age, or sex or that it is committed in the dwelling of the offended party, if the
latter has not given provocation:

– When the act is committed with abuse or confidence or obvious ungratefulness:

– When the crime is committed in a place of worship:

-When the crime is committed on the occasion of a conflagration, shipwreck, earthquake, epidemic or
other calamity or misfortune:

– When the crime is committed in consideration of a Price, reward, or Promise:

– When the crime is committed by means of inundation, fire, Poison, explosion, standings of a vessel or
intentional damage thereto, derailment of a locomotive, or the use of any other artifice involving great
waste and ruin:

–When the act is committed with evident premeditation or after an unlawful entry:

– When craft, fraud, or disguise is employed: and

– When the wrong done in the commission of the crime is deliberately Augmented by causing other
wrongs not necessary for its commission.