HARAMAYA UNIVERSITY

COLLEGE OF HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF MIDWIFERY

Professional Ethics
By Dawit Tamiru(BSC,MSC)

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 Introduction to MW

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 Definition of MW
A midwife is a person who has:
 Successfully completed a midwifery education program that
is duly recognized in the country where it is located and
that is based on the ICM Essential Competencies for Basic
Midwifery Practice and the framework of the ICM Global
Standards for Midwifery Education;
 Who has acquired the requisite qualifications to be
registered and/or legally licensed to practice midwifery and
use the title ‘midwife’; and
 Who demonstrates competency in the practice of
midwifery.
12/16/2023
ICM,2011 3
 Scope of Practice

 Midwife is recognized as a responsible and accountable professional

who works in partnership with women to give the necessary support,
care and advice during pregnancy, labour and the postpartum period,
to conduct births on the midwife’s own responsibility and to provide
care for the newborn and the infant.

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 This care includes:

 Preventative measures,

 The promotion of normal birth

 The detection of complications in mother and child

 The accessing of medical care or other appropriate

assistance and the carrying out of emergency

measures.

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 The midwife has an important task in health counseling and
education, not only for the woman, but also within the family
and the community.
 This work should involve pre-conception and antenatal
education and preparation for parenthood and may extend to
women’s health, sexual or reproductive health and child care.

 A midwife may practice in any setting including the home,

community, hospitals, clinics or health units.

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 Midwifery in Ethiopia
• Historical documents show that professional midwifery began
in Ethiopia in 1961 when the first three mid- wives graduated
from a training program that utilized the nurse-midwife model.

• This model includes three years training in nursing followed

by midwifery training.

• Since 1997, five other generic midwifery training models have

been practiced.

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 Midwifery in Ethiopia…
• Started in Asmara and Gondar
• Addis Ababa after 10 year dis.
• Advanced in Gondar
• Currently around 29
• GC, 1500 per year
• Around 16,000 MW
• 116.4 million popn.
• Standard 1:5,000

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Professional Code of Ethics and Conduct for Midwives

 Developed for the midwifery profession in Ethiopia.

 It is intended to be relevant to all midwives in all
areas of maternity services including those
encompassing the midwifery direct practice,
management, education, and research domains.
 It made complementary to the ICM Code of Ethics
(2010).

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 PHILOSOPHY OF MIDWIFERY CARE

 Midwifery care is based on respect for pregnancy as a state of

health and childbirth as a normal physiologic process and a
profound event in a woman’s life.

 Midwifery care respects the diversity of women’s needs and the

variety of personal and cultural meanings which women,
families and communities bring to the pregnancy, birth, and
early parenting experience.

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 Midwifery care includes education and counseling,
enabling a woman to make informed choices.
 Midwives promote decision-making as a shared
responsibility, between the woman, her family, and her
caregivers.
 Midwives regard the interests of the woman and the
foetus as compatible.
 Focus their care on the mother to obtain the best
outcomes for the woman and her newborn.
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 ETHICAL ISSUE IN MIDWIFERY

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 What is Ethics?

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 Ethics defined
• Ethics is derived from the Greek word “ethos”, meaning
“custom” or “character”.
• Ethics is the branch of philosophy dealing with standards of
conduct and moral judgment.
• There are three kinds of judgment applied to human conduct:
– Acts that a human being SHOULD perform
– Acts that a human being SHOULD NOT perform
– Acts that allow the human being a CHOICE of either
performing it or not performing it.
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 cont’d
• Ethics : is the area of philosophy that attempt to answer
questions involving concepts such as right/wrong,
good/bad, moral/immoral etc.
• Ethics refers to the practices or beliefs of a certain
group
• It also refers to the expected standards as described in
the group's code of professional conduct.
• It is the principle or standard of conduct that governs
individual or group
15
 Divisions/branch of ethics
 It is divided into three primary areas.
1. Meta–ethics(the study of concept of ethics)
 Investigates where our moral principles come from, and what
they mean.
 E.g. What we mean by ‘right’ and ‘wrong’.
2. Normative ethics (the study of how to determine ethical
values)
 Concerned with finding moral principles to govern how we
should act.
3. Applied ethics (the study of use of ethical values).
 The branch of ethics that tries to answer questions relating
to specific, concrete moral problem
 Considers applying our moral principles to particular real
world situations
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There are 3 classifications of applied ethics

1. Bioethics

2. Environmental ethics

3. Professional ethics

17
Bio-ethics:
Ethics of life or death sometimes
Ethics surrounding biology, medicine or the study of medical
morality
Eg. Euthanasia, abortion
Environmental ethics
What are our obligation to the environment?
Moral obligation to the environment
Is environment valuable itself, or
Is it valuable only because we value it 18
Professional ethics:

• The branch of applied ethics that tries to answer

specific, concrete questions that arise for
professionals or with in the profession

• It inquires in to ethical problems that confront

employees, employers, and customers

19
 Values

• Values: ideas or concept that gives meaning to

individual life

• Value: is defined as something that is desirable or

esteemed for its own sake; or something we
cherish

• Values are most commonly derived from social

norms, religion, and family orientation and serve
as the framework for making decision and taking
certain actions in everyday life
20
 Cont.

• Ideas, belief, customs, mode of conduct, qualities, or

goals that are highly prized or preferred by an

individuals, groups, or society

• Usually not written down

21
• Value conflicts: internal or interpersonal conflict
that occurs in circumstance in which personal
values are at odds with those of patients,
colleagues or intuitions

• Value conflicts often occur in everyday life and

can force an individual to select a higher priority
value over a lower priority value
22
 Morality
 Is concerned with the distinction between right and
wrong or good and bad behavior.

 A person's standards of behavior or beliefs

concerning what is and is not acceptable for them
to do

 Standards of behavior that are considered good or

acceptable

 Morality can be influenced by: Family, Education,

Religion, Media, Peer groups

23
 Comparison of morals and ethics

Morals Ethics
• Principles and rules of right • Formal responding process
conduct. used to determine right
• Private, and personal. conduct
• Professionally and publicly
• Commitment to principles
stated
and values is usually
• Inquiry or study of principles
defended in daily life.
and values
• Pertain to an individual‘s
• Process of questioning, and
character.
perhaps changing, one’s
• Are fundamental standards of
morals
right and wrong that an • Speaks to relationships
individual learns and between human beings`
internalizes.
24
 Ethics Vs Moral
• Ethics deals with the “rightness "or “wrongness”
of human behavior

• A formal process for making logical and

consistent decisions based on moral beliefs

• Concerned with the motivation behind the

behavior

25
 Morals

• An individual's own code for acceptable behavior

• They arise from an individual's conscience

• They act as a guide for individual behavior

26
 Midwifery and ethics
Midwifery is “morally central health care
profession”

• The sprits and substance of midwifery are based

on social and individual moral codes

• MW is not only just scientific knowledge and

technical skills, but a profession founded on
specific human values.

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 Midwifery ethics
 is a branch of applied ethics that concerns itself
with activities in the field of midwifery.

Ethical issue in midwifery– ethical issues are

concerned by professional group that nobody
interferes with it
E.g. Midwifery association

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 Why is an understanding of ethics important?

 Patients have moral rights

 Issues that relate to your practice:
• Decision making
• Empowering the client
• Informed decisions
• Debate
• Defense
 Protection of human beings/patients

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 Why are morals/morality important?

Underpins our actions

It is translated into our thoughts and actions by

principles and concepts that we have learned from
childhood

It affects the care we provide to others

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 Code of Ethics
• Code of ethics: written list of professional values and
standard of conduct

• The Code of Conduct and Ethics is a statement of the

ethical commitments of a midwife to those they serve

• A code serves as the written word, or the public

document, declaring how professionals think of
themselves individually and collectively and the
serious responsibilities they have embraced

32
 Purpose of Code of Ethics
• Guide professional behavior

• Help teacher to plan education

• Prevent to practice below standard

• Protect professionals if falsely accused of guide

direction for legal action

• Important for decision making

34
 Components of the code of ethics
1. Accountability and Responsibility
 The fundamental responsibility of the health care
provider is : to promote health, prevent illness, and
restore health and to alleviate suffering
 Midwives act in a manner consistent with their
professional responsibilities and standard of practice
 Midwives work in accordance with dependent,
independent and collaborative function of midwifery
35
 Cont.

2. Respect, Rights and Dignity

• The midwife in providing care, unrestricted by
consideration of nationality, race, religion, or social
status

 The midwife respects the value, customs and spiritual

belief of the individual

 The midwife identifies health needs of a client, helps

them to express their concern and offers appropriate
information and service
36
 Cont.
3. Confidentiality

 Midwives safeguard the trust of the clients

 Midwives maintain privacy during therapeutic

diagnostic procedures

37
 4. Advocacy
Midwives promote safety, prevent intentional or
unintentional harm and take appropriate action to
safeguard the individuals

Midwives should advocate for discussion of ethical

issues among health team members, patients and
families

Midwives should advocate for a change to policy,

legislation or regulations in concrete with other
colleagues and their professional association
38
 5. Professional development
• Midwives play the major role in determining and
implementing desirable standards of midwifery,
education, management and research

• The midwife participates in professional

organizations and advocates equitable social
and economic working condition

39
 Ethical Principles

1. Autonomy (self-determintion)

2. Beneficences (doing good)

3. Nonmalficence (avoiding harm)

4. Veracity (truth telling)

5. Confidentiality (respecting privilege information)

6. Fidelity (keeping promises)

40
7. Justice (treating people fairly)
 1. Autonomy
 The term autonomy implies;

• The autonomous person is respected

• The autonomous person must be able to determine
personal goals.
 The person must be able to understand the meaning of the
choice to be made and deliberate on the various options,
while understanding the implications of possible
outcomes.
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 Autonomy cont’d

 Generally, it encompasses the following essential concepts.

 It is the fundamental right applied in these areas
 Respect for personal self-determination
 Respect for privacy (access to a person’s private
sphere)
 Respect for confidentiality
 Informed concept
 Protection for persons with diminished autonomy due
to: Illness , Mental disability , Circumstances

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 Autonomy cont’d

Rights in relation to health care are usually taken to

include:

The right to information

The right to privacy
The right to confidentiality and
The right to appropriate care and treatment

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 Autonomy cont’d

 The autonomy of persons to make decisions, while

taking responsibility for those decisions and
respecting the autonomy of others, is to be
respected.
 For persons who are not capable of exercising
autonomy, special measures are to be taken to protect
their rights and interests

“Article 5 – Universal Declaration on Bioethics

and human rights – 19 October 2005 ”
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 Autonomy cont’d
 “Any preventive, diagnostic, and therapeutic medical
intervention is only to be carried out with the prior, free, and
informed consent of the person concerned, based on adequate
information.

 In no case should a collective community agreement or the

consent of a community leader, a hospital director, or other
authority substitute for an individual’s informed consent ”

Article 6 Universal Declaration on Bioethics and human

rights – 19 October 2005 -

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 Autonomy cont’d
Four factors for violations of patient autonomy
 MW may assume that patients have the same values and
goals as themselves
 Failure to recognize that individuals’ thought processes are
different
 Assumptions about patients’ knowledge base
 Focus on work rather than caring

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Autonomy…
• From ethical perspective, health professionals have
the obligation to respect their decision, even if those
situations where they disagree with the patient

• There are complex exception to these general

situations, such as;
 When parents decide on a course of action for their
child that is harmful and might lead to death
 In emergency situation

49
 Paternalism

 Restricting others autonomy to protect from

perceived or anticipated harm.
 Thus, the prevention of any evil or harm is greater
than any potential evils caused by the interference
of the individual’s autonomy or liberty.
 Paternalism is appropriate when the patient is
judged to be incompetent or to have diminished
decision-making capacity.
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 Informed consent

 It is the process by which a fully informed patient can

participate in choices about their health care.

 It is a process by which patients are informed of the

possible outcomes, alternatives and risks of treatments and
are required to give their consent freely including to refuse
medical recommendation.

 It assures the legal protection of a patient’s right to personal

autonomy in regard to specific treatments and procedures.

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 Informed…
Types of consent
1. Express Consent:
• Consent by direct words which are written or oral.

2. Implied Consent:
• Consent arising from the inference from a patients behavior.

E.g. Waiting in line for a vaccination implies that the person

wants the vaccination.
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 Informed cont’d
Elements of Informed consent
• Voluntarism
• Capacity
• Disclosure
• Understanding
• Decision

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 Informed cont’d

Requirements for informed consent

1. Competence- capacity to give consent
2. Information- being informed about relevant facts
3. voluntariness – voluntarily or freely given consent

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 Informed consent cont’d

1. Competence
Three elements of competence:
 Ability to communicate and understand relevant
information about options

 Ability to reason and deliberate about alternative options

 Ability to evaluate options and their consequences by

relating them to a stable set of values and goals

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 Informed consent cont’d

2. Information
 purpose of treatment, diagnostic or therapeutic
procedure, or any health care , research and expected
duration

 Procedure: What, how, where (location), when, how

much time do it take, level of pain

 Reasonably: foreseeable risks (of harm) or discomfort,

and anticipated benefits

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 Informed cont’d
Information cont’d
 Alternative treatments or procedures
 Extent of confidentiality of records
 Compensation for injuries, and medical care if more than
minimal risk (Research)
 Statement that participation is voluntary and that refusal
or withdrawal will involve no penalty
 Opportunity to ask questions and to withdraw at any time
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 Informed cont’d
3. Voluntariness
Coercion violates Voluntariness:
• Coerced treatment
• Coerced consent

Manipulation violates Voluntariness:

• Outright deception – information deliberately
withheld
• More subtle manipulation – manner and tone of
voice, manner of presentation

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 Informed cont’d
Infants,
Young children,
Mentally handicapped or incapacitated people, or
Comatose patient

They do not have the capacity to participate in decision

making about their health care.

If the client becomes unable to make decisions for

himself/ herself, this “surrogate decision maker”
would act on the client's behalf.
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 Informed consent cont’d

The surrogate’s obligation

 The best interests principles
– The surrogate act in the best interest of the patient,
disregarding the interests of others including the
interests of the family, society and of the surrogates
 The rational choice principle
– The surrogate should choose what the patient would
have chosen when competent

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 Informed cont’d
The commonest points considered for a minor to
consent are:

 If the minor is self-supporting, married, and a parent,

he/she can give consent.

 In the military in addition, most western laws allow

treatment with out parental consent for STDs, pregnancy
and drug or alcohol abuse
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 Informed cont’d
Barriers to informed consent
If a person is:
• Unable to take in or retain information
• Unable to understand the information provided
• Unable to weigh up the information as part of the decision-
making process.
• People who are mentally incapacitated:
- Sedatory medicines
- Mental illness
- Coma or unconsciousness
• Absence of choice
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 Informed cont’d
Basic consent
 Basic consent entails letting the patient know what you would
like to do and asking them if that will be all right.
Suitable for:
 Decisions that require a low-level of patient involvement
because there is a high-level of community consensus.
e.g. Drawing blood.

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 Informed consent cont’d
Presumed/implied consent
 The patient's consent should only be "presumed", rather than
obtained, in emergency situations.
If the patient is:
 Unconscious or incompetent and no surrogate decision
maker is available
1. The principle of respect - obligates you to do your best to
include the patient in the health care decisions that affect
her life and body,
2. The principle of beneficence may require you to act on the
patient's behalf when her life is at stake
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 Informed cont’d

Signing the Consent Form

© Once an individual/patient is agreed or decided to
participate in the health care process,
© He/she has to sign and date the consent form.
© The consent form should be documented.

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 Informed cont’d

Non-compliance
 It is unwillingness of the patient to participate in health
care activities.
 Lack of participation in a regimen that has been
planned by the health care professionals to be carried
out by the client.

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 Informed cont’d

Noncompliance may result from two factors:

1. When plans seem unreasonable to the patient

2. Patients may be unable to comply with plans for a

variety of reasons including resources, lack of
knowledge, psychological and cultural factors that are
not consistent with the proposed plan of care

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 2. Beneficences (doing good)
• Views the primary goal of health care as “doing
good” for clients
• Client approached in holistic manner or to assist
clients in meeting all their needs, i.e.
Biological
Psychological
Social
Spiritual
68
 3. Nonmalficence (avoiding harm)

• Requirement that health care provider “do no

harm” to the client’s intentionally or
unintentionally

• This principle requires to protect individuals who

are unable to protect themselves

69
 Beneficences Vs Nonmalficence

One can find conflicts between beneficence and

nonmalficence in almost any clinical situation

The dichotomy between the two principles is the

foundation for “risk/benefit” analysis

70
 Beneficences Vs Nonmalficence
Example
A physician wishes to protect his patient from tetanus
by giving an injection of tetanus vaccine (beneficence),

• But, in order to provide this benefit he must breach his

duty of nonmaleficence and harm the patient by
inserting needle through the skin, causing pain and the
possibility of side effects and infection

In the conflict in this example, beneficence is ranked

above nonmaleficence
12/16/2023 71
 4. Veracity (truth telling)
This principle implies “truthfulness”

Requires the health care provider to tell the truth

and not intentionally deceive or mislead clients

Midwives need to be truthful to their clients, even

in their life.

Veracity is an important component of building

trusting relationship
72
 5. Confidentiality (respecting privilege information)

Anything stated to health-care providers by the clients

must remain confidential

The only times this principle may be violated are:

 If clients may indicate harm to themselves or others

 For those providers helping us

 If the client gives permission for the information to be

shared
73
 6. Fidelity (keeping promises)

• The promise to fulfill all commitment

• The individual's obligation to be faithful to

commitments made to self and others

74
 7. Justice (treating people fairly)

• Every individual must be treated equally

• Obligation to be fair to all people

• This requires to be nonjudgmental

75
 Ethical Dilemma
 Is a situation that requires an individual to
make a choice between two equally
unfavorable alternatives.
 Conflict between one individual’s rights and
those of another, or between one individuals
obligation and the rights of another, usually
form the basis of the dilemma.

76
 Analysis of Ethical Dilemma
Step I: Collect, Analyze, and Interpret the
Data

 Important to know include the patient’s wishes,

the family wishes, the extent of the physical or
emotional problems causing the dilemma

 Understand how mentally competent the patient

is to make a decison, what the patient’s desire
are.

 What the family think about the situation 77

 Cont.
Step II: State the Dilemma
Reduce the dilemma in to a statement or two that
resolves around the key ethical issues.
It involves a question of conflicting rights or basic ethical
principles
E.g. The patient’s right to death with dignity verses the
midwives/ nurse’s obligation to preserve life and do no
harm
The principle of competent patient wishes is unequivocal
case the patient is unresponsive before expressing
his/her wishes, consider seriously the family’s decision
78
 Cont.

Step III: Consider the Choice of Action

List all the possible courses of action that can

resolve the dilemma without their considering
their consequences

79
 Cont.

Step IV: Analyze the Advantages and

Disadvantages of each Course of Action

• Code of ethics could be an important tool for

guidance when making decisions on ethical
dilemma

80
 Cont.
Step V: Make the Decision
• The most difficult part of the process is actually
making the decision and living with consequences
• By nature ethical dilemma produce difference of
opinion
• The best decision that can be helped for is one that
is based on a sound ethical decision making process
• The patient wishes usually supersede independent
decision on the part of health care professionals
81
 Case study
• Mr X is admitted in the hospital with diagnosis of
HIV/AIDS due to homosexual, now Mr X asked the
hospital to be discharged and get home based care
with nurses, his family agree with his idea.

• Then as the intuition polices indicate that giving

home based care is one of the nurses job
description and order the nurses to do it, however
the nurse complained about it because my religion
and value can’t permit to give home based care for
homosexual HIV positive patients as his sin

82
 Step I: Collect, Analyze, and Interpret the Data
• Patient wishes: To be with his parents and has
home based care

• Family wishes: To take their son home and

peacefully die
• Nurses wishes: Not to give home based care for
homosexual HIV positive patients because of his
sin
• Institutional polices concerning duty and
responsibility of nurses written on consultant
contract form should be collected- nurse job
description 83
 Step II: State the dilemma

• The patient’s right to get home based care

versus religious belief and value on
homosexual HIV positive patients

84
 Step III: Consider the choice of Action

• Taking disciplined action on the nurse

• Rejecting the request of patient and family home

based care

• Changing other experienced nurse who is more

interested in providing care for that patients

85
 STEP IV: Analyze the Advantages and
Disadvantages of each course of Action

• Taking disciplined action might lead to further strike s

among other workers for their religious belief and value

• This dropping of the request denies the patients right to

care /home based care/ and do no harm principles

• Changing of nurse is better from other courses of actions

and advantageous in that it balances the risk and benefits
86
 Step V: Make a decision
• The patients wishes almost always supersede
independent decision of the part of health care
professionals

• So after analyzing the advantages and disadvantage of

the course of action, as the a director of the agency, is
better to change the nurse to more interested nurse in
providing care for the patient

87
 Legal concept
• Law is a standard or rule of conduct established
and enforced by the government of a society

• Law can be defined as those rules made by

humans who regulated social conduct in a
formally prescribed and legally binding manner.

• Laws are based upon concerns for fairness and

justice.
• Laws are intended chiefly to protect the rights of
the public
88
Functions of Law in health
• The law serves a number of functions:
 It provides a framework for establishing which
health care actions in the care of client are
legal.
It differentiates the midwives’ responsibilities
from those of other health professional.
 It helps establish the boundaries of
independent midwifery action.
 It assists in maintaining a standard of practice
by making providers accountable under the
law.
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 Patient bill of rights
The patient’s rights are as follows:
 They have the right to considerate & respectful
care
 They have the right to get complete, current,
understandable information about his/her
diagnosis, treatment & prognosis.
 They have right to make decision about the plan
of care
12/16/2023
They have the right to get advice 94
 Patient bill of right
 They have the right to get to every consideration
of privacy
 They have right to expect all communication,
records pertinent to him should be treated
confidential.
 They have the right to expect that within its
capacity a hospital must make reasonable
response to the request of a patient for their
services.
 The hospital must provide evaluation, service,
and/ or referral as indicated by the urgency of
the case.
12/16/2023 95
 Patient bill of right…

 The patient has a right to obtain information

as far as his care is concerned/treating him.

 They have right to consent or decline to

participate in proposed research study

 They have right to expect reasonable

continuity of care
12/16/2023 96
 Patient bill of right…

 They have the right to know what hospital rules

and regulations apply to his/her conduct as a
patient.
 They have right to review the record
pertaining to his medical care

12/16/2023 97
 The Dying Patient’s Bill of Right’s
• Have the right to be treated as living human being until I die

• Have the right to maintain a sense of hopefulness however

changing its focus may be
• Have the right to express my feelings and emotions about my
approaching death in my own way
• Have the right to participate in decisions concerning my care

• Have the right to have my questions answered honestly

• Have the right to die in peace and dignity

98
 Midwifery Rights
• To economize rewarded which commensurate
(proportionate) to qualification & responsibility.
Which include
Salary

Paid vocation

Paid sick day

Pension plan & Insurance.

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 To working in the condition which do not
jeopardize their physical & mental health
or well-being
Examples
 Unsafe environment.
 Excessive hour (days with out off
duties) etc.

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 To pursue (allow) activities which would
lead to professional growth i.e.

Seminar

Workshop

Formal structural education.

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 To control professional practice- this practice
should be defined by law which is involved &
informed in decision.
To collective action-i.e. they have the right to
involve in organization (association), political
activity which raises the profession.
To set standards on service or education.

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 Standard of Practice
• Standards of practice are to describe the responsibilities for
which practitioners are accountable.
• The standards:

 Reflect the values and practices of the profession

 Provide direction for professional practice
 Provide a frame work for the evaluation of the practice
 Defines the profession’s accountability to the public and
the client outcomes for which they are responsible.

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 MIDWIFERY STANDARDS OF PRACTICE

• The Standard of Midwifery Care Practice in Ethiopia is

based on the Scope of Practice for Ethiopian Midwives

• The term ‘scope of practice’ refers to the range of roles,

functions, responsibilities and activities that a registered
midwife is educated, competent and authorized to
perform.

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 MIDWIFERY STANDARDS OF PRACTICE…

• The scope of practice is intended to protect the public

from malpractice by defining the limits of practice.

• The scope establishes the three levels of midwifery

practice present in Ethiopia (Level IV Midwife; Midwife
Professional; and Midwife Specialist) and their related
competencies.

12/16/2023 109
 Midwifery Standard of practice cont’d
• The Standard of Midwifery Care Practice in Ethiopia
document contains 14 standards each accompanied by its
associated rationale and competencies.

The standards are:

1. Practice in accordance with ethical, legal and professional
guidelines
2. Provide focused antenatal care with emphasis on health
status of pregnant woman

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 Midwifery standards of practice cont’d
3. Provide appropriate management to the woman during the
whole process of labor and delivery
4. Demonstrate ability to resuscitate and care for the newborn
5. Utilize body of scientific knowledge to provide post-partum
care to the mother and the baby
6. Demonstrate ability to assess and manage complications
7. Demonstrate ability to provide high quality family planning
services to promote health family life, planned pregnancies
and positive parenting
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 Midwifery standards of practice cont’d
8. Demonstrate ability for promoting community
midwifery care

9. Communicate effectively with clients, family and

other members of the healthcare team

10. Support the development and provision of care

within a clinical governance framework

11. Act to enhance the personal and professional

development of others

12/16/2023 112
 Midwifery standards of practice cont’d

12. Assume responsibility for professional

midwifery leadership and management functions
13. Document midwifery care in a format that is
accessible and complete
14. Demonstrate ability to assess and manage
common gynecological problems.

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 Professional and Legal Regulation of midwifery
Practice

Credentialing: is a term that refers to ways in which

professional competence is ensured and maintained
Three process are used for credentialing in midwifery

1. The first is accreditations, which is the process by which

an educational program is evaluated and then recognized as
having met certain predetermined standards of education

114
 Cont…
2. A second is licensure, which is the process by which a
state determines that a candidate meets certain
requirements to practice in the profession of his or her
choice and grants a license to do so

3. A third is certification, which is the process by which a

person who has met certain criteria established by a
government or non governmental association is granted
recognition

115
 Licensure and Registration
• Licensure: is a specialized form of credentialing
that has a legal basis in laws passed by a
legislative body

• A license is a legal document that permits a person

to offer to the public his/her skills and knowledge
in a particular jurisdiction, where such practice
would otherwise be unlawful without a license

• License and registration are mandatory and both

must be renewed periodically
116
• Licensure or Registration Revocation:
• The state boards may revoke or suspend
a professional/registration for many
unprofessional acts or conduct, including
fraud, deceptive practice, criminal acts, or
previous disciplinary action

117
 AREA OF POTENTIAL LIABILTY IN
MIDWIFERY

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 Liability
Liability: means legal responsibility
• A midwife is legally responsible for actions that
fail to met the standard of care or failing to act
and thereby causing harm

• Fail to follow the ethical principles

119
 Health related legal issues in
midwifery

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 Health related legal issues in Midwifery
1. Abortion (Article 551 )

2. Death

3. Suicide

4. Organ Transplantation

5. Fertility Matter

6. EUTHANASIA
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 Euthanasia
• It is the act of painlessly putting to death persons suffering from
incurable or distressing diseases.
• It is commonly referred as “mercy killing

Classification
– Voluntary euthanasia (assisted suicide).
– Non voluntary euthanasia
– Involuntary euthanasia
– Active euthanasia
– Passive euthanasia

122
 Euthanasia Cont’d
• Voluntary euthanasia
– Defn :- Killing one who wish to die (terminally ill, in
severe unrelievable pain, or who asked to be killed).
– Example: Cancer patient.
• Non voluntary euthanasia
– When the person who is to be killed make no request
and made no consent is called non-voluntary
euthanasia.
– Not competent to make a consent like incase of
irreversible coma.

123
 Euthanasia Cont’d

– Involuntary euthanasia

• Killing people who wish not to die. (murder,

execution; capital murder, war, not justified killings

such as self defense).
• It is called murder.

• Example: Mohammed Gadaphi's case.

– Active euthanasia (by action)

• Intentionally causing a person death by presuming

or giving lethal medication. 124

 Euthanasia Cont.

– Passive euthanasia (by omission)

– Letting die, death with dignity by withholding

or with drawing life sustaining treatments.

– Example: ventilation/oxygen

125
 Advance Medical Directives
 Advance Medical Directive is a written document
that directs patients wish before they die when
the patient don’t have capacity to make decision
for her/him self.
 Two types;
Living wills/treatment directives and
Power of attorney or health
proxies/appointment directives
126
 Cont.
• Living Will

• A written document voluntarily executed by the

declarant in accordance with the requirements of
legal code.
• It state what medical treatment you choose to omit
or refuse in the event that you are unable to make
these decisions by yourself and are terminally ill.
– Example: Cancer patient
127
 Cont.
 Durable Power of attorney

 Appoints a proxy-usually a relative or trusted friend to

make medical decisions on your behalf if you can no
longer decide for yourself.
 It has broader application than living will

 Applies only if you are unable to make your own

decisions because you are incapacitated

Eg. Not competent to make a consent like incase

of irreversible coma 128
 Cont’d

• An advance directive does not need to be

written, reviewed , signed by an attorney.
• It must be witnessed by two people.

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 Court case and professional
witness

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 Professional witness
 The court has legal power to call any professional as
a witness .
 When you are called, you may not only be asked to
testify facts but also to give your opinion on the facts.
 Witness can either be common witness (which
testify fact that are coming under observation) or
expert witness (based on one’s specialized
knowledge).
12/16/2023 131
 Types of witness
1. Fact witness
• Limited to testify facts; matters of which she/he
is personally knowledgeable – “This is what I
saw”.
• Person having knowledge about circumstances
surrounding the events.
• Phrases like “ I think”, “on the other hand”, e.t.c
should be forbidden.
132
 Types of witness Con’t

2. Character witness-
– can attest /show, confirm, demonstrate/ to that
individual’s in the community.
3. Expert witness-
 one so qualified through their knowledge,
education, and experience that the court
recognizes that individual as an expert.
 Most of the time they are to defendant side. 133
 Types of witness Con’t
• Standard of care in malpractice is mostly
determined by expert witness.
• The role is to describe the “reasonable care that
is required under the circumstances.
• Expert testimony/witness is needed to educate
judges who does not have the training and
experience to make decisions.

134