Ethics goes for a walkies

After being at my first clinical block for a few weeks I started developing a very unethical approach to patient’s sessions.  Thinking about this issue every day I felt guilty about the same thing and guess what, nothing changes for the next day. After receiving my patient’s names for the day ahead I would hope for a certain thing once I start walking to the wards.  This hope would be that the patient is either discharged or has gone for some or another investigation test so that I had one less patient for the day.  I have had a few cases where my patient had gone for a casual walk and the nurses were not aware of when he was going to come back.  One would generally be worried about the where about of your patient.  That day I just acknowledged he went out of the ward and I walked on to carry on with my other patients.  When I get to the ward and my patient isn’t there I get a little happy inside knowing the work load has decreased and I have more time with my other patients.  I have realized that what I was thinking was completely unethical and we as Professional Health practitioners have the responsibilities and should have our patient’s best interest at heart to improve and take care of their well-being. 

According to the HPCSA’s patients’ rights charter (HPCSA, 2008), all patients have the right to medical treatment and rehabilitation. I have acknowledged that I have infringed on my patient’s rights to get treatment and rehabilitation when I get to the patient’s bedside and they are not there and an effort to return later the day is not made.  The patient then goes the day without treatment and therefore I have purposively revoked them of their rights to treatment.   According to the HPCSA’s General ethical guidelines for health care professions, it states that health care professionals should have their patient’s best interest or well-being when being treated.  In my opinion, I think that not all health care practitioners are aware of all the rights that the patients have and of course the rights that the practitioners have as well.  Greater emphasis should be placed on the guidelines that are set for us as Health care workers. 

The finish line

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We look back in life so often but do we really take in and evaluate what has happened and how we can learn from it.  This online ethics has not moved mountains for me, but has taken me down roads that would never have been thoroughly worked through in a lecture or textbook. There have been a few topics that you would initially look at and think that there is a very straight forward and obvious answer to it, until you read other peoples post, views and challenging questions that get posed to you.  Then you realise, it isn’t that simple.  This post will cover a few topics that intrigued me and that I thought I took something away from. To conclude my introduction to this post, I will like to ensure you that I will follow a process- and content oriented approach to the evaluation of an initially perceived ethics module that is chaotic, but thought-provoking.

Firstly, I can definitely say that I learnt a lot when it comes to the process of blogging.  Links, hyperlinks, media and networking with other professionals, class mates and fellow physiotherapists across the world is fascinating. I saw myself as a pretty well educated, technologically savvy individual; not until I didn’t know how to add a video to a post.  I now take many tricks from this experience.  Most of all, I believe that it is important to build on your social presence in online spaces. Not only does it indicate that you are searchable and present, but that you hold capture a very unique subjective reality that you can share with millions of others. This platform also enable us to share our perspectives in what I consider a safe and controlled environment, thus stimulating each individual to have confidence to engage across difference and professions.

When I first thought about this ethics course I saw our class sitting in a lecture room gunning each other’s views and opinions like we at war because that’s just how our strongly opinionated class enjoy discussing things.  I found that doing this course in this manner taught me to appreciate and take in other individual’s views and feel free to question and discuss issues at hand.  Not everyone is loud and overly expressive in person, which gives us the platform to express our views without being judged or be at a loss for words if discussed in front of a class.  Like Mae mentions in her final post that it gives people a voice when they usually don’t use it in these types of discussions. I believe in a metaphoric saying which goes like this “with limited resources (knowledge) come limited possibilities (solutions)”. I trust that with us sharing knowledge and perspectives, I believe that we can achieve much more than our single, narrow-focused perspective.

I found that when you received a comment on your post, you were immediately being confronted on your personal views.  At first I felt a bit reluctant to still entertain it but as the weeks went by you realise that you would never ask yourself those questions.  Receiving others questions, ideas and views leaves you with an open mind.  I then relooked at the situations at hand and found myself scratching my head not having answers to those which were posed.  Interacting with others left me with an open mind.  To look at a situation and be willing to re-evaluate oneself and be willing to adapt takes a lot of acceptance to the fact that your view is just one of many out there.  This just enables me to take this into practice and remember these learning curves when I find myself facing an ethical dilemma. 

The topics I enjoyed most were equality, morality and empathy.  Equality is a huge issue in our country and discussing the instances in the medical field broadens the issue into a whole new way.  No matter what we believe in, we as health professionals have guidelines that we have to follow that the HPCSA have drawn up.  The morality topic really interested me as I strongly believe in what I was taught and how I was raised.  Questions about how I will adapt if I was faced with something completely different threw me a bit as I wouldn’t know how to proceed if I was faced with apposing ideas. 

My favourite saying of late: “The only certainty in the world is that multiple realities exist and that there is no objective reality besides time and space”. As human beings we find comfort and peace in what we are sure of-objective reality. Since objectivity cannot be found in subjectivity, but that subjectivity can still be found in our objectivity, we should therefore strive for multiple perspectives on ethically and morally ambiguous situations. Echoing my single expectation of the course, which was to increase knowledge and understanding of principles related to professional ethics, I can confidently state that I deepened my world view on confusing issues that confront us on a daily basis. I appreciate each and every contribution to my posts and the course, and I hope that we will continue to use social constructivism as our paradigm to create new knowledge that is socially and contextually sensitive. This is of importance if we would like to make a change in South Africa.

 

Euthanasia indignifies autonomy?

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When is euthanasia ok? Easy answer would be never, but this orientation is somewhat ill-conceived since it only takes into perspective the cultural stigma of the community in which I conduct my life and its perspective. Like I thought, many sociologists, anthropologists and professionals interested in the human rights of individuals have started with the de-tabooing of euthanasia.

Many times we as individuals construct our perspective of a life situation or tragedy from past experience, what we hear from our family, friends and community. In essence this latter influence results partly in our moral standards and beliefs of reality. However, in the world, multiple realities do exist, thus our morals and believes could be directly opposing to that of different cultures and beliefs. We differ on simple things such as the role of the husband and wife, what is considered offensive clothing and whether multimedia is as promising as it seems. I am sure that euthanasia will definitely result in much debate locally and globally.

Euthanasia, or elsewhere mentioned as physician- assisted suicide could be motivated for and against, using multiple perspectives. We as individuals do have the right to make decisions concerning our lives, whether to consent for surgery and even engagement in risky behavior which could ultimately lead to our death. This right is fully enabling us to practice our autonomy, which is central to profession ethics, and that is fully endorsed by the State.

As a physiotherapist in training I do allow my patients to exercise their autonomy, but knowing that they are fully informed about the possible consequences of their decision. The much debate around euthanasia surely indignifies the patients’ autonomy and self- determination.  Individuals will have mental capacity to comprehend, reason and reflect on their choice should be given the will to exercise their autonomy, since it would not impact any other individual, system or service. I do have a question regarding physicians making decisions about patients and their health. Although physicians do have the knowledge and understanding of the functioning and prognosis of the human body, why do they get it wrong sometimes or why do certain people wake up from their death-bed if it wasn’t scientifically warranted? Probability- wise, how often do they get it right or wrong? So, are we to trust the judgment of the physician ten out of ten times with regard to assisting suicide or should the person or proxy be given the final decision?

We are confronted by death on a daily basis, and we do exercise our autonomy on a situation-by-situation basis, knowing of the consequences and that it could results into our detriment. I advocate for autonomy of the individual involved to take precedence over that of another person or governing body. 

Till next time

H

Unstrain the restrained

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This topic cant possibly have a positive side to it.   I personally believe that there is no right to this at all.  Torture is never right.  While doing some research on the topic many stories of evil and wrong immediately came up.  

Whilst thinking about this I immediately thought about watching the movie and illustration of “Passion of the Christ” and where Jesus was tortured on his way up the hills with the cross he had to bear on his back.  Watching this scene broke my heart, it is not only sad to watch but inhuman to torture anyone in that way.Image

I read up on a few laws that our country has regarding torture and what is allowed in our country.  Interesting enough I came across a journal that speaks of The betrayal of Steve Biko – South Africa’s Initial Report to the UN Committee against Torture and responses from civil society.  Although we now have strict laws against torture we had a sad and sorry past of the torture and murder of Steve Biko.  

I cannot stress enough about how wrong it is to torture anyone.  As a matter of fact, torture anything. No one has the right to hold anyone against their own will and inflict any sort of danger to them.  

“I ask for water to wash myself with and also soap, a washing cloth and a comb. I want to be allowed to buy food. I live on bread only here. Is it compulsory for me to be naked? I am naked since I came here.” – The words of Steve Biko to his torturers as he went through the pain and suffering.  Torture should never be acceptable or allowed in any environment or country.  We are all human (although some act as animals) and therefore we should be treated like humans and not like objects that have no feelings and rights.

Here is a link to journal article mentioned above:

http://www.saflii.org/za/journals/LDD/2008/3.pdf

 

Free pass for ALL

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We are all equal.  Yes in a perfect world that statement would be the ultimate truth, not in this “new SA”. Being born out of the struggle I never experienced the extreme borders of inequality.  Although, we now live in the aftermath of Apartheid we still busy experiencing inequality in all walks of life.  As much as we would like to think that we are now all equal because we are a democratic country, that aint happening anytime soon lovies.  This fact aint fiction!

There are so many people that become highly frustrated at how the government now want to “right the wrong”.  Going around throwing around bursaries at previously disadvantaged people that do not even pitch for class and burn transport facilities because they did not receive their transport money.  Honestly, how can one burn out what was given to you for free.  When one reads their University application forms and is asked what degree they applying for, you read “Baasary”.  Then you think again, how can you honestly say you writing the wrong of past when you jeopardising the world of tomorrow with such a mentality.  I believe that if you are worthy of things one should receive it, not because you of such a race or gender.  This topic can become highly debatable amongst a group of strong willed people, which is an issue that will never fade in our country.

I recently come from holiday in Europe.  It is so refreshing to be around people where there is no judgement if you pick up trash, be a cleaner, a bus driver, pretty blonde that works at McDonalds, a CEO or a Professor.  Everyone is equal.  I greet you like everyone else and you respected like my equal.  Yes and one can say but they mostly have first world countries blah blah blah… Are you saying you can see yourself greeting the cashier in the shop like you would greet your boss?  Small changes like respecting everyone equally can make one another feel like they are on the same level as everyone else. 

Equality may perhaps be a right, but no power on earth can ever turn it into a fact.
Honore de Balzac 

Till next time

H

Right, wrong and in-between

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Morality is one topic that can be debated for hours on end.  I can see the group of diverse people sitting in a room, discussing a moral issue and never coming to a conclusion.  Right, wrong and a whole lot of inbetweeners.

I find this topic quite interesting as morals is not a blanket set of rules that everyone follows.  Everyone follows their own morals depending on where they draw it from.  I find that morals are very important in life as a whole.  I personally get my moral beliefs from religion.  Throughout my life I was taught right from wrong through the eyes of God. Other than religion I believe culture plays an imperative role in setting morals.  Looking at different cultures, a large difference can be noted on how one conducts their life according to the morals they were introduced to and how past generations were brought up.  Personally my parents brought me up the way their parents taught them when they were younger. As modern day approaches us, I find that strong moral beliefs are not easily found within the youth as they find judgement will take place within friend groups if they say their say.

I do find it challenging when I find myself listening or being approached with moral issues when dealing with patients.  I have listened to patients that have done the wrong things in their lives and now they are living the consequences, well I see those issues as wrong according my moral beliefs.  Being faced with all these scenarios I have come to my own conclusion.  I have taken the attitude to treat them the way our conduct states and try not to judge.  The most important thing I take from these situations is that this just makes my beliefs stronger in making sure I don’t do the same “wrong” thing in my life and continue to stay strong in what I believe what is right and wrong.

Everyone lives with their basket of morals, so who is right and who is wrong?  A question never to be successfully answered.

“Do not be deceived: bad company corrupts good morals.”

Jump suit empathy

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As I sit thinking about this week’s topic my TV happens to be on in front of me.  I see a man in orange attire with black words that form many circles all around the jumpsuit and he is talking about something on a talk show.  The sound is off so I can’t hear what is going on.  Raising the volume, this bloke explains why he raped and killed a lady.  With sadness and tears in his eyes he explains he was drunk when he committed this crime.  So you probably want to know why I started off with this story.  Well empathy is described as the ability to understand and share the feelings of another person.  I feel zero empathy for the man due to the situation that brought about his sad and regretful emotional.  Is it wrong to not empathise for someone just because you personally don’t believe in what they did?  Where are you meant to feel empathy for someone? When is it okay to empathise and when is it acceptable to not show that emotional feeling towards another? There will be times when we as physio’s will have to treat patients that have police assisting them, hand cuffed and being watched because they just committed a crime, but they still apparently have the right to proper health care (almost like that victim had their right to live a life, sigh* that is another issue).   I can’t see myself understanding and sharing the feelings of a criminal. I honestly couldn’t care less for what they think or feel after taking a life that God has granted us all.  Ofcourse I will see the patient but to empathise is debatable.  So here I find myself in an ethical dilemma.  Where does one draw the line to empathy?

I personally believe that empathy comes with each one of us.  We just show it in different situations.  As we believe, empathy cannot be taught.  Empathy is experienced and not caused.  It is not something we decide we are going to feel now or later.  It is felt once a personal connection is found and one can understand and share their feelings alongside them.  There is no feeling sorry for the person but explaining to them that you understand what others might be thinking or feeling, in other words, putting yourself in their shoes. 

”If you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view, until you climb inside of his skin and walk around in it.” Atticus Finch in To Kill a Mockingbird (1962)