Ethical Issues in Maltese General Practice - a Look to the Near Future 121 Mary Anne Ciappara - Patient Empowerment in Pharmacy Practice
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Ethical Issues in Practice for Nurses, Midwives and Family Medicine Editor: M.N. Cauchi Conference Organisers: Dr Sandra Buttigieg Dr Pierre Mallia The Bioethics Consultative Committee, Ministry of Health, Malta 2003 Acknowledgements: The Bioethics Consultative Committee would like to thank all those who have participated in the preparation for these Conferences, as well as the individual speakers represented here in this publication. The views expressed here are those of the individual speakers and do not necessarily represent those of the Bioethics Consultative Committee. Previous Publications of the Bioethics Consultative Committee: Bioethics: Responsibilities and Norms for those involved in Health Care (Ed. Toni Cortis, 1989) Informed Consent: Proceedings of a Symposium of Medical and Paramedical Practitioners. ISBN 999090-68-68-3 (Ed M. N. Cauchi, 1998) Proceedings of the Conference on Bioethics and Disability. ISBN 99909-993-0-9 (Ed. M. N. Cauchi, 1999) Patients' Rights, Reproductive Technology, Transplantation. ISBN 99909-993-107 (Ed. M. N. Cauchi, 2000) Inter-Professional Ethics in Health Care, ISBN 99909-993-2-5 (Ed. M. N. Cauchi, 2001) Bioethical Issues at the Beginning and End of Life. ISBN: 99909-993-3-3 (Ed. M.N.Cauchi,2002) ISBN: 99909-993-4-1 © The Bioethics Consultative Committee, Malta 2003 Printed at the Government Press, Malta. Contents Section A: Ethical Issues in Practice for Nurses and Midwives Sandra Buttigieg - Introduction 7 John Rizzo Naudi - Historical Aspects 11 Ray Busuttil- The Universality of Ethics for Health Care Professionals 21 M.N. Cauchi - Ethical Issues in the Practice for Nurses and Midwives .......................................................................................... 25 Emmanuel Agius - Ethical Challenges of the Future for the Nursing Profession ............................................................................ 29 Antoinette Attard - Ethical issues in nursing and midwifery from a local perspective ................................................................................... 45 Bridget Gafa _ Nursing And Midwifery _ A Legal Perspective ................. 59 Donia Baldacchino - Patients' perceptions of information giving during hospitalisation .............................................................................. 65 Workshops Reports: Cecilia Xuereb & Ray Grixti - Information giving ................................... 81 Claire Farrugia & Jesmond Sharples - Confidentiality ............................ 85 Maria Abela & Winifred Buhagiar - Accountability ............................... 88 Sarah Saliba & Michael Bezzina - Significance of Code of Ethics and the Patients' Charter .............................................................. 90 Grace A. Jaccarini - Conclusion .................................................................. 92 Section B: Ethical Issues in Family Practice M.N.Cauchi - Introduction 95 G.K.Kimsma - The Ethics of Family Medicine: A Dutch Perspective ...... 97 Dr. Pierre Mallia - Ethical issues in Maltese General Practice - a look to the near future 121 Mary Anne Ciappara - Patient Empowerment in Pharmacy Practice ...... 129 Mary Ann Sant Fournier - Ethics and Solidarity in Health Care ............. 145 Anthony Fiorini - The elderly and collaboration between primary and tertiary care ....................................................................... 159 Pierre Mallia - Outcomes of First Meeting on Ethics in Family Medicine ................................................................................... 167 Section C: EPSMH Conference Pierre Mallia - Phenomenological approaches to the doctor-patient relationship ............................................................................................ 175 Emmanuel Agius - In Search of a European Approach to Bioethics: The Emergence of a Common Euro-Mediterranean bioethical Culture .................................................................... '" ......... 187 Biographical Notes .................................................................................... 211 Index Ethical Issues in Practice for Nurses and Midwives Dr Sandra Buttigieg Nurses are daily faced with questions of ethics. Most of these questions are minor everyday issues that individual nurses can resolve on their own. From time to time, however, issues with major implications for patient care will arise that require significant ethical decisions. The analysis of the facets of work in the everyday practice of nurses and midwives is important to ethics because of the ethical domains of character and the way of life. Nursing work(Liaschenko 2002) can be analysed in a number of ways: as a physical transformation, as a social transaction, as information exchange work, and as identity. • .As a physical transformation of material reality - such as that designed to relieve, contain, or prevent symptoms - for example, nurses involved in wound care, help to change the body from one state to another. • As a social transaction - several examples come to mind Patients are distressed by a diagnosis and anxious about coping with treatment. Patients are worried about who will care for their children or spouses. Responding to this kind of distress is extra work, requires time and is not usually listed in any form of job description. It is a social transaction, not immediately visible but which contributes immensely to the quality of health care. In the absence of this social element, healthcare is inhumane, without compassion, even brutal. • Another form of social transaction in nursing work is the amount of information to be communicated between many different people 7 and departments - such as when transferring patients from one department to another, explaining to a physician what a patient has said about symptoms and treatment, clarifying orders, and talking with families. In the absence ofthis information exchange work, healthcare becomes chaotic, dangerous even impossible. • As identity - The development of organised nursing and the promotion of nursing education to an academic platform has raised the identity of the nurse to a more interesting, fulfilling and professional one. According to the UK Nursing and Midwifery Council's Code of Professional Conduct, published in April 2002, in caring for patients and clients, a registered nurse or midwife must: 1. Respect the patient or client as an individual, 2. Obtain consent before any treatment or care is given, 3. Protect confidential information, 4. Co-operate with others in the team, 5. Maintain professional knowledge and competence, 6. Be trustworthy, and 7. Act to identify and minimise risk to patients and clients. No one disputes that the work of nursing is indispensable for the well being of patients and to the day-to-day operations of health care delivery. It is precisely this indispensability that raises ethical questions. One ethical question that comes to mind is the right to strike. Looking back at my eleven years' experience as a council member of the Medical Association of Malta, I clearly remember the ethical dilemmas about the morality of striking - such that discussions used to focus on the ethical issues related to the special duty of doctors not to abandon patients. I am sure that the same dilemmas were experienced by nurses. 8 Other issues that come to mind are the role of the nurse as an educator, and as a researcher. Nurse educators are responsible for teaching students to observe the Code ?f Ethics and Standards of Nursing Practice (Morgan 2001). By attending carefully to their own behaviour, wise nursing faculty serve as helpful role models for students. This is readily apparent in patient care settings when instructors guide students in planning patient care or assist students with technical skills. As more nurses are indulging in a research career, maintaining ethical principles can ensure that nurses can protect patients who may be subjects of research, while retaining their dignity, respect and confidentiality. Today's seminar deals with the major ethical issues faced by nurses and midwives in their everyday practice. I am sure that this seminar will provide the right playing field to discuss, debate, analyse and hopefully reach a consensus on how to approach these issues. I would like to thank the Bioethics Consultative Committee and the staff at IRC for working hard in organizing this seminar. I would also like to thank you - participants for positively answering our call. It is indeed a satisfaction to experience your desire to actively participate in a seminar on ethics - which I believe should have a firm position in our daily professional lives. I wish you all a fruitful seminar. References Liaschenko, J. (2002), 'Thoughts on Nursing Work', Journal of Nursing Administration, vo1.32, no. 2, pp. 69-70. Morgan, J. (2001), 'Confidential Student Information in Nurse Education', Nurse Educator, vol. 26, no. 6, pp. 289-292. UKCC. (2002), Code of Professional Conduct, London. Royal College of Nursing. (1998), Research Ethics: Guidance for Nurses involved in Research or any Investigative Project Involving Human Subjects. London, RCN. 9 Ethical Issues In Practice For Nurses And Midwives: A Historical Perspective Professor John Rizzo Naudi I wish to welcome you all to this Seminar on Ethical Issues in Practice for Nurses and Midwives and thank the sponsors and organisers. This is the first occasion when nurses and midwives are meeting together as a profession to discuss and address this highly important area of health care practice