Thank you to Jaimie Andrews for writing the third of our blog posts on ethics. This week we look at the various types of duties and what they mean in practice. Happy reading!
What is a duty?
“A duty is an obligation to do or refrain from doing something.” It’s basically the grown-up way to pinkie-promise something to someone by scribbling it down, saying it out loud or because… well, just because – you both just know. In other more adulting words, it’s the responsibility we hold with respect to another via a drawn-up or written, verbal or implicit contract. This responsibility to take or not take a certain action with regard to another person results in the other person being entitled to the results of action or inaction. Essentially, at least two parties need to be involved: one responsible for fulfilling the duty and one entitled to reap the rewards thereof.
A simple example of this is the duty we have to our clients to keep their time slot scheduled for their treatment on the agreed-upon regular basis (e.g. weekly), while the client is entitled to attend this scheduled time as predetermined. Similarly, should a client not be able to attend one of her/his scheduled sessions, s/he has the responsibility to inform the health care professional timeously, while the health care professional has the right to charge for the unattended session if not informed timeously as per specific contract.
Chinese finger puzzle (source unknown)
The Chinese finger puzzle is a clever toy to think of when trying to understand the bond formed between parties connected by an obligation: if the two trapped fingers/ parties do nothing, avoid or move away from one another without trying to solve the puzzle between them, they remain stuck and tied together; if they move towards each other and come together, however, they are freed to move separately again.
“Duties may be ethical, legal or both at once, and operate in the personal, social, professional or political spheres of our lives.” Natural duties are those responsibilities we inherently have to one another purely because we are fellow human beings belonging to the same family of the animal kingdom, e.g. to do good and not harm, try be impartial and reasonable to all, etc. These exists regardless of our chosen profession and its respective duties. Moral obligations are defined as those duties which are fundamentally part of one’s profession, e.g. healthcare workers’ duties to their patients’ confidentiality, informed consent, etc.
Institutional duties, however, are more specific to one’s place of practice and work as stipulated by the specific position’s contractual agreement, job description, etc. such as the difference between government and private. Legal duties are the official obligations required by the country’s general and industry-specific legislation. In the health sector’s case, The National Health Act (2003) and The Health Professions Act (1974). These Acts enable appropriate consequences for those who do not honour their duties (e.g. sanctions, fines, etc.) as “underlying these duties is a set of core ethical values and standards of good practice that are regarded as basic ethical principles.”
Our duties to our patients, specifically, are the following:
- Prioritise their best interests or well-being
- Honour their trust
- Navigate position of power appropriately
- Ensure accessibility and approachability
- Non-biased decision-making
- Full disclosure of potential bias, conflict of interest or dual loyalty
- Timeous treatment and support
- Carefully considered health plans
- Partnered problem-solving
- Professional conduct and teamwork
- Appropriate referral when necessary
One of the most important responsibilities of health-care workers is ensuring that they are adequately educated, trained, qualified and especially up to date with the most recent, evidence-based practice and certifications in the field of treatment required by their clients who maintain the right to such current care. Furthermore, healthcare workers are obligated to obtain sufficient experience in their field of practice under suitable conditions and fitting settings for such experience to benefit their clients best.
Our duty to respect our patients necessitates the following:
- Respect their privacy, confidentiality and dignity
- Considerate and appropriately professional interactions
- Uphold their rights, especially informed consent
Informed Consent includes the following:
- Provide the information requested by the patient(s)
- Communicate information appropriately for patient to understand best
- Advise patient as to the best practice recommended
- Ensure informed consent is attained at every point of treatment
- Permit patients to access their treatment records
Informed consent is the crucial pre-cursor to ensuring patients can and do participate in their own healthcare via decision-making, teaching and research with the health-care professional (team), as well as having the opportunity to refuse recommended treatment and/ or seek a second opinion elsewhere. Think back to the Chinese finger puzzle mentioned above: the patient and her/his health professional (team) must be working close together to solve the puzzle and move on therefrom. This candid collaboration can also help prevent potential conflicts of interest such as coercing or over-servicing patients.
Healthcare workers also have duties to their professional peers, specifically:
- Non-discriminative respect for all colleagues
- Supportive co-operation towards the patient’s best interests
- Appropriate advice, referral and receipt of both from colleagues
- Equal treatment of colleague’s referred patients
Beyond patients and professional peers, health-care workers have responsibilities to themselves. As we know and was stated earlier, they must “update their skills and knowledge of ethics, human rights and health law as provided for in accredited Continuing Professional Development programmes.” Furthermore, they are obligated to maintain a professional practice by ensuring the following:
- Treatment equipment and materials are in good condition
- Treatment environment kept hygienic
- Accurate and update patient records
- Safe and healthy patient treatment
- Confidential colleagues and staff on site
- Responsible allocation of scarce resources (not administering unnecessary services)
- Proper policy development (e.g. our most favourite POPI/A)
- Prevent, remedy and pre-empt by protecting patients from any and all violations of rights, misconduct, unethical behaviour, etc.
And, of course, when looking on a macro-environmental scale as we know all too well how healthcare professionals need to consider the environment itself by engaging in the following:
- Conserving and protecting natural resources
- Legal disposal of waste without harming natural environment
- Safely maximise use of materials before disposal
But, before we all lose whatever is left of our minds after this crazy time in history with all that our hearts are bursting to do to help others and the whole wide world around us, let us dutifully ‘do-tea’ – quietly alone to recharge and with others to reconnect – to fulfil the duty we have first and foremost: to take care of ourselves so that we may take care of others too. Here’s to fulfilling many ‘do-teas’ together again soon!
“I cannot do all the good that the world needs. But the world needs all the good that I can do”
– Jana Stanfield