1.
Federal Ministry of Health
NATIONAL COMPASSIONATE,
RESPECTFUL AND CARING
TRAINING
CHAPTER TWO
HEALTH CARE ETHICS
1/29/2023
National CRC training CH-I-1

2.
Federal Ministry of Health
Chapter introduction
Ethics in the previous and current
health care curriculum
 Concepts of ethics and its basic
principles
Preventive ethics, ethics and law
1/29/2023
National CRC training CH-II-5

3.
Federal Ministry of Health
Chapter Objective
Participants will be able to
provide ethically acceptable
healthcare services
1/29/2023
National CRC training CH-II-5

4.
Federal Ministry of Health
Enabling objectives
 Discuss the basic concepts of
principles of healthcare ethics
 Describe confidentiality and informed
consents in CRC model healthcare
Identify preventive ethics as a standard
practice for the health workforce
Recognize the relationship of ethics
and law to exercise CRC
1/29/2023
National CRC training CH-I-4

5.
Federal Ministry of Health
Outline
 2.1 Principles of health care ethics
2.2 Confidentiality and informed
consent
2.3 Preventive ethics in the aspect
of CRC
2.4Ethics and law as enablers of
CRC
1/29/2023
National CRC training CH-I-5

6.
Federal Ministry of Health
Session 2.1
Definitions and principles of
health care ethics
1/29/2023
National CRC training CH-I-6

7.
Federal Ministry of Health
Session objectives
Define ethics and health care
ethics
List principles of health care ethics
Discuss each of healthcare ethics
principle
1/29/2023
National CRC training CH-II-5

8.
Federal Ministry of Health
Definitions of Ethics
and Health Care Ethics
Discussion question:
What is ethics in general, and health
care ethics in particular? ( 5 min)
1/29/2023
National CRC training CH-I-8

9.
Federal Ministry of Health
Definition of Ethics and
Health Care Ethics Continues
Ethics : derived from the Greek
word “ Ethos” meaning “ custom” or
“Character”
Ethics: is the study of morality—
careful and systematic reflection on
and analysis of moral decisions and
behavior
1/29/2023
National CRC training CH-I-9

10.
Federal Ministry of Health
Definition of Ethics
continues
Ethics can be defined as the branch
of philosophy dealing with standards
of conduct and moral judgment.
Health care ethics: a set of moral
principles, beliefs and values that
guide us in making choices about
health care.
1/29/2023
National CRC training CH-I-10

11.
Federal Ministry of Health
Principles of healthcare ethics
1/29/2023
National CRC training CH-II-5

12.
Federal Ministry of Health
What are the fundamental principles
of healthcare ethics?
1/29/2023
National CRC training CH-II-5

13.
Federal Ministry of Health
There are four fundamental
principles of healthcare ethics.
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
1/29/2023
National CRC training CH-II-5

14.
Federal Ministry of Health
Ethical principles---
Ethical principles are the
foundations of ethical analysis
They are the viewpoints from
which guidance can be obtained
along the pathway to a decision.
1/29/2023
National CRC training CH-II-5

15.
Federal Ministry of Health
Autonomy
Independent choice, self-
determination and freedom of action
1/29/2023
National CRC training CH-I-15

16.
Federal Ministry of Health
Autonomy ---
Case one
Please read and discuss the case
scenario on the participants’ manual
1/29/2023
National CRC training CH-II-5

17.
Federal Ministry of Health
Beneficence
Beneficence is “doing what is best
to the patient”.
In favor the wellbeing and interest
of the patients.
1/29/2023
National CRC training CH-II-5

18.
Federal Ministry of Health
Beneficence...
Case two:
Please read and discuss the case
scenario on participants’ manual
1/29/2023
National CRC training CH-II-5

19.
Federal Ministry of Health
Non-maleficence
Non-maleficence refers to “avoid
doing harm”, which can occur by
omitting or committing the care.
Always, benefit has to weigh over
harm .
1/29/2023
National CRC training CH-II-5

20.
Federal Ministry of Health
Non-maleficence…
Examples:
Nurse who carelessly delays patient’s
medication.
Laboratory technologist who carelessly
does and report wrong results.
Finance manager who carelessly delays
the procurement of drugs and equipment.
1/29/2023
National CRC training CH-I-20

21.
Federal Ministry of Health
Justice
Justice is fair handling and similar
standard of care for similar case;
fair and equitable resource
distribution among citizens.
Regardless of gender, educational,
income or any other personal
background.
1/29/2023
National CRC training CH-II-5

22.
Federal Ministry of Health
Justice…
Please read examples on the
participant manual and discuss
Case study: Refer the manual
1/29/2023
National CRC training CH-II-5

23.
Federal Ministry of Health
Summary
What are the main principles of
health care ethics?
1/29/2023
National CRC training CH-II-5

24.
Federal Ministry of Health
Thank you for your participation!
1/29/2023
National CRC training CH-II-5

25.
Federal Ministry of Health
Session 2.2
Confidentiality and Informed consent
1/29/2023
National CRC training CH-I-25

26.
Federal Ministry of Health
Session objectives
Describe confidentiality and
informed consent
Practice confidentiality and
informed consent in the healthcare
1/29/2023
National CRC training CH-II-5

27.
Federal Ministry of Health
CONFIDENTIALITY
1/29/2023
National CRC training CH-II-5

28.
Federal Ministry of Health
Confidentiality
 Confidentiality refers to the
privacy of patient’s information
Ensures patient’s respect.
 The autonomy of patient.
Trustful relationship with patient.
1/29/2023
National CRC training CH-II-5

29.
Federal Ministry of Health
Confidentiality…
All identifiable information about:
A patient’s health status,
Medical condition,
Diagnosis, prognosis and treatment
 All information's of a personal kind
1/29/2023
National CRC training CH-II-5

30.
Federal Ministry of Health
Confidentiality …
Exception to maintain confidentiality:
In health institutions
Inform the family members of a
deceased person about the cause of
death
Jurisdiction related
1/29/2023
National CRC training CH-II-5

31.
Federal Ministry of Health
Confidentiality…
Case three
Please read and discuss case
scenario on participant manual
1/29/2023
National CRC training CH-II-5

32.
Federal Ministry of Health
Confidentiality…
Confidentiality related law
Please read and discuss the
FMHACA-Council of Ministers
Regulation No 299/2013, Article 77-
professional confidentiality on
participant manual
1/29/2023
National CRC training CH-II-5

33.
Federal Ministry of Health
INFORMED CONSENT
1/29/2023
National CRC training CH-II-5

34.
Federal Ministry of Health
Informed consent
Informed consent refers to legal
document whereby a patient signs in
writing before he/she receives the
care intended.
The document with complete
information about the purpose,
benefits, risks and other alternatives
1/29/2023
National CRC training CH-II-5

35.
Federal Ministry of Health
Informed consent…
Informed consent is a body of
shared decision-making process;
not just an agreement.
1/29/2023
National CRC training CH-II-5

36.
Federal Ministry of Health
Informed consent---
For consent to be valid, it must be:
1. Voluntarily: by the person
themselves, free of influence
2. Informed: given all the necessary
information
3. Capacity: person must be capable
of giving the consent
1/29/2023
National CRC training CH-II-5

37.
Federal Ministry of Health
Informed Consent--
Informed consent has to be taken
After adequate & clear
communication
Before any medical treatment
Timing: when the patient is best able
to understand and retain the
information
1/29/2023
National CRC training CH-II-5

38.
Federal Ministry of Health
Informed consent…
Professional has to know his/her
level of practice and responsibility
Handle appropriately when patient
is incompetent to make a decision
Respect patient’s decision to
refuse treatment
1/29/2023
National CRC training CH-II-5

39.
Federal Ministry of Health
Informed consent …
Informed consent related law
Please read and discuss
EFMHACA-CoM regulation NO-
299/2013, Article 52 on participant
manual
1/29/2023
National CRC training CH-II-5

40.
Federal Ministry of Health
Informed consent and
confidentiality…
Case study 2
Please read and discuss the case
study on the participant manual
1/29/2023
National CRC training CH-II-5

41.
Federal Ministry of Health
Summary
What is informed consent?
What are the necessary conditions
for informed consent to be valid ?
Do we always need informed
consent?
1/29/2023
National CRC training CH-II-5

42.
Federal Ministry of Health
Thank you for your participation!
1/29/2023
National CRC training CH-II-5

43.
Federal Ministry of Health
Session 2.3
Preventive ethics in the
aspect of CRC
1/29/2023
National CRC training CH-II-5

44.
Federal Ministry of Health
Session objectives:
At the end of this session participants will be able to
1. Explain preventive ethics and its relevance for CRC and
quality of care.
2. Identify ethical dilemmas and apply systematic ethical
case analysis.
3. Explain healthcare priority setting/rationing to handle
resource scarcity issues.
4. Identify practical support mechanisms for the
implementation of preventive ethics.
1/29/2023
National CRC training CH-I-44

45.
Federal Ministry of Health
Preventive ethics…
Definition
Preventive ethics is a systematic
application of ethical principles and
values to identify and handle ethical
dilemmas, challenges and errors
appropriately and fairly.
1/29/2023
National CRC training CH-II-5

46.
Federal Ministry of Health
Preventive ethics…
Why PE in CRC-model healthcare
Engages health workforce,
patients/families and the
community at large
 Thus, enhances honesty and
transparency among stakeholders
1/29/2023
National CRC training CH-II-5

47.
Federal Ministry of Health
Preventive ethics…
PE activities can be carried out by
individuals or a group on behalf of
healthcare organization.
Step-by-step analyze and
identifies the ethical quality gap
1/29/2023
National CRC training CH-II-5

48.
Federal Ministry of Health
Preventive ethics…
 Predict, identify, analyze,
synthesize and manage ethical
dilemmas, challenges and errors
1/29/2023
National CRC training CH-II-5

49.
Federal Ministry of Health
Preventive ethics…
Support mechanism for PE
1. Develop functional tools,
documentation, case banks,
research, monitoring and evaluation
system
1/29/2023
National CRC training CH-II-5

50.
Federal Ministry of Health
Preventive ethics…
2. Educate to build capacities and
capabilities
Knowledge, skills and attitude
Teaching health care ethics (at pre
and in-service training) tools to
handle ethical dilemmas
Evidence generation and use
1/29/2023
National CRC training CH-II-5

51.
Federal Ministry of Health
Preventive ethics…
3. Ethical consultation
Definition:
A service provided by an individual or group
to help patients, families, surrogates, health
care providers, or other involved parties.
It address uncertainty or conflict regarding
value laden issues that emerge in health
care.
1/29/2023
National CRC training CH-II-5

52.
Federal Ministry of Health
Preventive ethics…
Ethical consultation goal
To maximize benefit and minimize
harm to patients, families,
professionals and institutions.
Fostering a fair and inclusive
decision making process.
1/29/2023
National CRC training CH-II-5

53.
Federal Ministry of Health
Preventive ethics…
Ethical consultation goal…
To facilitate resolution of conflicts in a
respectful atmosphere with attention
to the interests, rights, and
responsibilities of those involved
To enable the health workforce in
charge to make final evidence base
decisions.
1/29/2023
National CRC training CH-II-5

54.
Federal Ministry of Health
Preventive ethics…
How do we organize for ethical
consultation committee?
Include representative of various
constituencies in your institution.
Include outside members –
community representatives.
1/29/2023
National CRC training CH-II-5

55.
Federal Ministry of Health
Preventive ethics…
Ethical dilemmas
Definition
Ethical dilemmas arise when
principles cannot be respected and
people disagree on what the best
solution is; as legitimate solutions
philosophically or practically.
1/29/2023
National CRC training CH-II-5

56.
Federal Ministry of Health
Ethical dilemmas…
Ethical dilemmas encounter in:
Resource scarcity
Refusal of treatment
Disclosure and truth telling
End of Life dilemma
Disagreement/conflict
1/29/2023
National CRC training CH-II-5

57.
Federal Ministry of Health
Preventive ethics…
Ethical dilemmas step-by-step
analysis
Please read on the participant
manual and discuss.
1/29/2023
National CRC training CH-II-5

58.
Federal Ministry of Health
Preventive ethics…
Priority setting and rationing
Priority setting
Definition
Priority setting in health care is the
ranking of health services and the
ranking of recipients of these services
Priorities are often set through a
process of decision-making
1/29/2023
National CRC training CH-II-5

59.
Federal Ministry of Health
Preventive ethics…
Rationing
Is defined as withholding of health services
that could be of benefit to the patient on the
ground of resource scarcity
Resources should be understood broadly
to include health personnel, time,
equipment, infrastructure, medicines, beds,
operating rooms, and money.
1/29/2023
National CRC training CH-II-5

60.
Federal Ministry of Health
Levels of priority setting
1. International
2. National
3. Meso: health facility level
4. Micro: at the bed side level
1/29/2023
National CRC training CH-II-5
Preventive ethics…

61.
Federal Ministry of Health
Preventive ethics
Summary
Do you think preventive ethics is
applicable in our setup?
1/29/2023
National CRC training CH-II-5

62.
Federal Ministry of Health
Thank you for your participation!
1/29/2023
National CRC training CH-II-5

63.
Federal Ministry of Health
Session 2.4
Ethics and law as enablers of
CRC
1/29/2023
National CRC training CH-II-5

64.
Federal Ministry of Health
Session objectives
 Recognize the relationship
between ethics and law
Practice the laws of the land
related to health in their daily
practice
1/29/2023
National CRC training CH-II-5

65.
Federal Ministry of Health
The relation between
Ethics and law
Ethics: a standard of behavior
Concept of right and wrong beyond what
the legal consideration is in any given
situation
A law is defined as a rule of conduct or
action prescribed or formally recognized
as binding or enforced by a controlling
authority
1/29/2023
National CRC training CH-II-5

66.
Federal Ministry of Health
The relationship between
health ethics and the law
Ethics is similar but not identical with law
Ethics serves as fundamental source of
law
Ethical values are subjective. The law
ensures uniformity of conduct.
1/29/2023
National CRC training CH-I-66

67.
Federal Ministry of Health
Ethics Vs Law
29/01/2023 67
Regulations
Proclamations
Ethical
guidelines Criminal
law
Civil laws
The laws are enacted
on the basis of
accepted standard in
the medical
community
Directives
Standards

68.
Federal Ministry of Health
Ethics and law…
Laws regulating health care
practice in Ethiopia
Proclamation 661/2009 and
Regulation 299/2013 outlines ethical
requirements.
Civil law, penal law, the constitution
other proclamations and regulations
1/29/2023
National CRC training CH-II-5

69.
Federal Ministry of Health
Ethics and law…
Main Responsibilities of Health
Professionals toward patients
Discussion
Read and discuss on the participant
manual ?
1/29/2023
National CRC training CH-II-5

70.
Federal Ministry of Health
Inter professional communication
and teamwork among health
workers
Discussion
Read and discuss on the participant
manual
1/29/2023
National CRC training CH-II-5
Ethics and law…

71.
Federal Ministry of Health
Ethics and law…
Duty to report
FMHACA CoM regulation no -
299/2013 under article 95 clearly
states that
Any person who believes that a health
professional is unfit to practice or
commits unprofessional conduct shall
notify the appropriate organ
1/29/2023
National CRC training CH-II-5

72.
Federal Ministry of Health
Case scenario on the participant
manual
Read and discuss on the case
1/29/2023
National CRC training CH-II-5
Ethics and law…

73.
Federal Ministry of Health
Ethical liability of health
professionals
Read on the participant manual as
a pair and discuss
1/29/2023
National CRC training CH-II-5
Ethics and law…

74.
Federal Ministry of Health
Ethics and law…
Professional ethics committee
Discussion
Pair and read on the participant
manual and discuss
1/29/2023
National CRC training CH-II-5

75.
Federal Ministry of Health
Ethics and law…
Patients right and responsibility
1/29/2023
National CRC training CH-II-5

76.
Federal Ministry of Health
Ethics and law…
Patient’s rights
 World Medical Association
declaration of Lisbon put the
following rights for patients
1/29/2023
National CRC training CH-I-76

77.
Federal Ministry of Health
1.The right on medical care of good
quality
2.The right to freedom of choice
3.The right to self determination(
refusal to treatment, to give or
withdraw consent)
1/29/2023
National CRC training CH-I-77
Ethics and law…

78.
Federal Ministry of Health
Patient right…
4. The unconscious patient
5. Legally incompetent patient.
6. Procedure’s against patients will(
diagnostic procedures and
treatment) against patients’ will if the
law permitted to do so
1/29/2023
National CRC training CH-I-78

79.
Federal Ministry of Health
Patient right…
7. Right to information( to receive
information)
8. Right to confidentiality.
9.Right to heath education.
10. Right to dignified care.
11. Right to religious assistance.
1/29/2023
National CRC training CH-I-79

80.
Federal Ministry of Health
Patients responsibilities
Please read individually on the
manual about patient
responsibilities and discuss
1/29/2023
National CRC training CH-II-5

81.
Federal Ministry of Health
Case scenario: on Patient
right
1/29/2023
National CRC training CH-II-5

82.
Federal Ministry of Health
References
1. Medical Ethics Manual, World Medical Association, 2nd Edition 2009
2. WHO, Global Health Ethics, Key Issues, 2015
3. ESA, Comprehensive Specialized Hospital Requirements, Ethiopian Standard: ES3618/2012
4. Exploring Integrity in medicine, The Bander Center for Medical Business Ethics Casebook,
5. FDRE, Proclamation No. 661/2009, Food, Medicine and Health Care Administration and Control
Proclamation
6. FDRE, Regulation No ,299/2013, Food, Medicine and Health Care Administration and Control,
Council of Ministers Regulation
7 Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 7th Edition, 2009
8. EMA, Code of Ethics for Doctors practicing in Ethiopia, 2009
9 Royal Pharmaceutical Society of Great Britain, Code of Ethics for Pharmacists and Pharmacy
Technicians, Aug, 2007
10Physicians top 20 ethical dilemmas: survey results slide shows
http://www.medscape.com/features/slideshow/public/ethical-dilemmas
1/29/2023
National CRC training CH-II-5

83.
Federal Ministry of Health
Thank you
1/29/2023
National CRC training CH-II-5