1. Ethics for Midwives

2. Ethical Theories
Ethical theories attempt to provide a system of principles and rules for resolving ethical dilemmas.
Ethical theories consist of fundamental beliefs about what is morally right or wrong and propose reasons for maintaining these beliefs.
Ethical theories provide the bases for professional codes of ethics.

3. DEONTOLOGY
Deontology is a theory of ethical decision making based on the discovery and confirmation of a set of morals or rules that govern the resolution of ethical dilemmas.
The source of duty is the concept of autonomy and rational will
Deontology attempts to determine what is right or wrong based on one's duty or obligation to act rather on the action's consequences.

4. There are many kinds of deontological theory e. g
There are many kinds of deontological theory e.g., The 'Golden Rule‘ "Do unto others as you'd have them do unto you.”
The most significant thing to understand about deontological moral systems is that their moral principles are completely separated from any consequences which following those principles might have.

5. Because it emphasizes duty or obligation to another person, Deontology is the acceptable theory for ethical decision making in health care
Any act in accord with one's duty or obligation is right.
Thus, if you have a moral duty not to lie, then lying is always wrong - even if that results in harm to others.

6. Limitations:
Duties or obligations may conflict, requiring decision about which duty or obligation takes precedence over another.
Questions commonly arise about the origin of a duty or obligation. Such as " who determined the duty?" Or " who identified the obligation?”
Deontology can be inflexible.
The problem with Deontology is that there is no consensus regarding a list of duties, or how to respond when two or more duties clash

7. Teleology
The word teleology comes from the Greek roots telos, which means end, and logos, which means science. Thus, teleology is the "science of ends.
Teleological moral systems are characterized primarily by a focus on the consequences which any action might have (consequentalist moral systems)
Thus, in order to make correct moral choices, we have to have some understanding of what will result from our choices.

8. The central aim is the premise of 'maximizing the greatest good for the greatest number'. The 'good' referred to can be expressed in a variety of ways and may refer to values or 'utility' such as happiness, being pain or symptom free or another life enhancing outcome.
In other words, judge an action by the total amount of happiness and unhappiness it creates
It is the consequences, not the acts, that are right or wrong (the ends justify the means)

9. Types of teleogical ethical theory
Ethical Egoism
an action is morally right if the consequences of the action are more favorable than unfavorable only to the moral agent performing the action.
Ethical Altruism
an action is morally right if the consequences of the action are more favorable than unfavorable to everyone except the moral agent.

10. Ethical Utilitarianis
an action is morally right if the consequences of the action are more favorable than unfavorable to everyone.

11. Application of Utilitarian Theory
You attempt to help an elderly man across the street. He gets across safely.
Conclusion
The Act was a good act.

12. Application of Utilitarian Theory
You attempt to help an elderly man across the street. You stumble as you go, he is knocked into the path of a car, and is hurt.
Conclusion
The Act was a bad act.

13. Limitations Requires definition of good
Requires computation of amount of good
Places public good over private good (ignore individual)
Possible harmful to minorities and individuals, sacrificed for the majority
Difficult to predict the consequences of an action
It is the consequences, not the acts, that are right or wrong (the ends justify the means)

14. Ethical Terms Values Morals
Concepts or ideals that give meaning to the life and provide frame work for decisions and action.
Morals
Standard of right and wrong learned by socialization and based on religious beliefs.
Ethical code
A written list of professions values plus standards of conduct.
Statement of etiquette
Describe expected professional behaviors established in ethical codes.

15. Laws Rights Ethical dilemma
Rules of social conduct designed to prevent the actions of infringing on the right of others.
Rights
Entitlements that one deserves according to just claims, legal guarantee, or moral law or principles.
Ethical dilemma
Situation requires a choice between two equally unfavorable alternatives (moral imperative).

16. Personal: to one self and patient. Public: to employer and society.
Accountability
Answerability for your practice and responsibility for your actions:
Personal: to one self and patient.
Public: to employer and society.
Privacy 
refers to freedom from intrusion and relates to all information and practice that is personal or sensitive in nature to an individual

17. Dignity
is concerned with how people feel, think and behave in relation to the worth or value of themselves and others.
To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals, being of equal value and worth irrespective of differences such as age, race, culture, gender, sexual orientation, social background, health or marital status, disability, religion or political conviction.”

18. Ethical Principles Autonomy
Right to make decisions a bout one's health care without intimidation or influence .
Never looking upon another.
Woman must have all the relevant information including treatment option in language she understand

19. Beneficence
Obligation to act in way which promote the well being of others.
Midwife is obligated to do only good that is to implement action that benefit women and their support persons .

20. Non-maleficence:
Do not harm and prevent the harm. Differs from beneficence in the sense that imposed fewer obligations.(deliberate harm, risk of harm and unintentional harm
In midwifery, intentional harm is always unacceptable.

21. Confidentiality
Safeguarding a person’s health information from public disclosure is the foundation of trust
Where the information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life.
Also related to truth telling. There is a balance between people having the information required to make an autonomous decision and being distressed by the truth.

22. For patient autonomy, dignity and liberty. Veracity
Respect
For patient autonomy, dignity and liberty.
Veracity
Obligation to tell the truth.
Means the duty to be honest and avoid deceiving or misleading the woman

23. This may cause conflict when the truth may harm the client by interfering with recovery or worsening the present condition
Avoiding truth is never justified when it is used to shield caregiver discomfort with bad news

24. Altruism
Protect the community & meet the health needs.
Paternalism
Protect the weak in the community
IX . Egoism:
The right to maximize personal benefits.

25. X. Fidelity
Obligation to loyal for woman, newborn , family, community government, employer, midwife herself and profession
midwife is obligated to be competent in performing midwifery skills and services required for safe and appropriate care through continuing education and follow code of ethics, institutional policy and laws.

26. Justice
Be fair equitable to all patients
Mandates that woman be treated without discrimination according to age, race, religion, socioeconomic status, weight, marital status
Make fair decision for allocation of resources based on individual needs. Everyone should have equal distribution of goods and services

27. The greatest good for the greatest number.
Utilitarianism
The greatest good for the greatest number.
Maximize benefice or minimize harms.
We have 2 approaches of moral theories: first focused upon consequences of actions (called consequence-based) and a second focused on moral duty (called duty based).
utilitarian midwife does according to the first in decision making.

28. What is a Code of Ethics
A code of ethics is a public declaration of the beliefs and values of a profession and the members of that profession. This code makes public the goals, values and morals of those who call themselves 'midwives' - a statement to the public about what the profession of midwifery defines as moral behavior for its practitioners.

29. Why to have a code?
A code of ethics acts as a specific, identifying feature for a particular professional group, both for the professionals themselves and for the general public.
In addition, the need for an explicit code has become more urgent in recent years, as an accelerated pace of social and technological change has produced situations that demand an ethical response.
the increased speed and frequency of global communications have made the development of a formal statement of shared beliefs and values vital as an agreed point of departure or common language for the profession worldwide

30. ICM International Code of Ethics for Midwives
 Aim
 To improve the standard of care provided to women, babies and families throughout the world through the development, education, and appropriate utilization of the professional midwife.
In keeping with its aim of women's health and focus on the midwife, the ICM sets forth the following code to guide the education, practice and research of the midwife.

31. This code acknowledges women as persons, seeks justice for all people and equity in access to health care, and is based on mutual relationships of respect, trust, and the dignity of all members of society.

32. ICM International Code of Ethics for Midwives
Midwifery Relationships
 Midwives respect a woman's informed right of choice and promote the woman's acceptance of responsibility for the outcomes of her choices.
Midwives work with women, supporting their right to participate actively in decisions about their care, and empowering women to speak for themselves on issues affecting the health of women and their families in their culture/society.  

33. Midwives, together with women, work with policy and funding agencies to define women's needs for health services and to ensure that resources are fairly allocated considering priorities and availability.
 Midwives support and sustain each other in their professional roles, and actively nurture their own and others' sense of self-worth.

34. Practice of Midwifery
Midwives provide care for women and childbearing families with respect for cultural diversity while also working to eliminate harmful practices within those same cultures.
 Midwives encourage realistic expectations of childbirth by women within their own society, with the minimum expectation that no women should be harmed by conception or childbearing.

35. knowledge to ensure safe birthing practices in all environments and cultures.  
Midwives respond to the psychological, physical, emotional and spiritual needs of women seeking health care, whatever their circumstances. 
 Midwives act as effective role models in health promotion for women throughout their life cycle, for families and for other health professionals. 

36. ICM International Code of Ethics for Midwives cont…
 The Professional Responsibilities of Midwives :
Midwives hold in confidence client information in order to protect the right to privacy, and use judgment in sharing this information.
 Midwives are responsible for their decisions and actions, and are accountable for the related outcomes in their care of women. 

37.  Midwives may refuse to participate in activities for which they hold deep moral opposition; however, the emphasis on individual conscience should not deprive women of essential health services. 
 Midwives participate in the development and implementation of health policies that promote the health of all women and childbearing families.

38. Advancement of Midwifery Knowledge and Practice 
Midwives ensure that the advancement of midwifery knowledge is based on activities that protect the rights of women as persons.
Midwives develop and share midwifery knowledge through a variety of processes, such as peer review and research. 
 Midwives participate in the formal education of midwifery students and midwives.

39. Bills of right for women & midwives
ICM calls for governments globally to recognize & support accessible and effective midwifery care as a basic human right of all women, babies and midwives. The issues for women around gender equity and access to education also extend to midwives as a woman-dominated profession. The Bill of Rights for Women and Midwives addresses those basic human rights of women and midwives that have been systematically denied

40. ICM believes women have a right to a midwife as the most appropriate care provider in most situations and midwives have a right to obtain adequate education, regulations to foster their practice and associations to forward their mission. the ICM believes that there should be recognition of the following as basic human rights for women and midwives across the globe;

41. Woman’s Rights
Every woman has the right to receive care in childbirth from an autonomous & competent midwife
Every newborn baby has the right to a healthy and well informed mother
Every woman has a right to be respected as a person of value and worth
Every woman has a right to security of her body

42. Every women has a right to be free from any form of discrimination
Every woman has a right to up-to-date health information
Every woman has a right to participate actively in decisions about her health care & to offer informed consent
Every woman has a right to privacy
Every woman has a right to choose the place where she gives birth

43. Midwives’ Rights
Every midwife has the right to a midwifery-specific education that will enable her to develop and maintain competency as a midwife
Every midwife has the right to practice on her own responsibility within the International Confederation of Midwives definition and scope of practice of a midwife

44. Every midwife has the right to be recognized, respected and supported as a health professional
Midwives have the right to access a strong midwifery association that can contribute to midwifery and maternity policy and services at a national level

45. Women’s and Midwives’ Rights
Midwives and women have the right to a system of regulation that will ensure a safe, competent and autonomous midwifery workforce for women and their babies.
Midwives and women have the right to national midwifery workforce planning to ensure sufficient midwives to meet the needs of women and babies

46. Women and midwives have the right to be respected by governments and government institutions for health and education
The midwifery profession has the right to be recognized as separate and distinct profession