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General Ethical Principles
In terms of medical ethics, it is crucial for every healthcare practitioner to maintain general ethical principles throughout their professional practice. Ahmed et al. (2020) state that ethical principles are intended to shape the moral values and professional conduct of practitioners in order to prioritize the well-being of patients seeking medical or diagnostic interventions (p. 646). The four general principles of medical ethics aimed to regulate practitioners actions and behaviors are non-maleficence, beneficence, a patients right to autonomy, and justice (Ahmed et al., 2020). Ethical principles are the concepts of right and wrong professional conduct, including moral values and societal norms that aim to establish a favorable environment for practice, treatment, and beneficial patients health outcomes.
Non-maleficence
This ethical principle refers to the healthcare common rule to do no harm and mainly implies harm avoidance and prevention. The concept of non-maleficence is one of the key principles in the ethics employed in healthcare settings and employed in diverse ways throughout professional practice (Ahmed et al., 2020, p. 644). Considerations of this principle include physical and mental harm avoidance, patients privacy respect, and attention to patients preferences. Nonetheless, implementation of the concept of non-maleficence is not limited to health or emotional harm prevention. According to Ahmed et al. (2020), seeking cost-effectiveness of treatment is one of this principles purports. High costs of healthcare services may lead to patients economic harm and unjust financial burden. Thus, maintaining this principle involves considering any possible way to minimize or prevent any potential harm for patients.
Beneficence
The principle of beneficence implies that healthcare practitioners actions should be intended to achieve the best possible outcomes for patients. According to this concept, patients benefits in health and well-being are prioritized. Hence, healthcare professionals primary goal is to contribute to the patients welfare through therapeutic interventions that directly confer benefit to the patients (Ahmed et al., 2020, p. 645). In the fields of osteopathy, this principle plays a significant role since patients turn to osteopathic consultations and sessions in search of pain or tension relief and to treat somatic dysfunction. It is essential for an osteopath to help patients establish harmony in their bodies by providing the most appropriate and beneficial treatment.
Patients Autonomy
This principle emphasizes patients rights to have particular preferences, make decisions regarding their health, and choose preferable treatment. In conformity with the ethical principle of autonomy, patients are free to express their opinions, fears, and desires and reject or accept offered treatment (Ahmed et al., 2020). Moreover, the concept of autonomy implies practitioners moral obligation to respect and accept patients preferences, choices, as well as opinions, values, and beliefs that affect patients decision-making.
Justice
This principle of medical ethics initially addresses fairness and equity of the provided care. The concept of justice applies to a broad range of categories, such as fair distribution of resources, respect for patients rights, and compliance with laws, regulations, and legal procedures. Ahmed et al. (2020) claim that patients age, ethical background, social status, sexual and cultural preferences, legal capacity and disability may impact the principle of justice in healthcare settings (p. 65). Healthcare professionals should provide treatment with equity and equality, excluding the influence of mentioned factors. Inaccessibility and inequity of treatment result in physical or mental harm for patients; therefore, it is essential to promote equal access to healthcare following the ethical principle of justice.
Ethical Issues in Osteopathic Practice
Ethical dilemmas in healthcare settings occur when the current situation interferes with moral principles and potentially harms patients, practitioners, or society in general. Ambiguous and uncertain occasions in terms of medical ethics and moral dimension lacking clear right or wrong course of action happen in every field of medicine, including osteopathy. Osteopathic practitioners deal with ethical issues in their day-to-day practice by making decisions that potentially may affect them and their patients. According to Hudon et al. (2015), an ethical issue may be defined as any circumstances accompanied by an ethical tension during professional practice based on a conflict of beliefs, norms, or values. Other reasons include uncertainty as to appropriate ethical action to take; or distress arising from an inability to act in a way that met the professionals ethical standards (Hudon et al., 2015, p. 126). Substantial ethical issues may pose severe challenges for osteopaths, negatively affect care quality, undermine public confidence and trust, or create an unattractive professions image. In the currently developing and expanding scope of osteopathy, ethical dilemmas appear as a concerning issue that needs to be addressed to discover suggestions and acceptable solutions.
Nonetheless, it is vital to adequately identify which ethical issues are encountered by osteopathic practitioners prior to developing the solving strategies. In the diverse fields of manual therapy, Hudon et al. (2015) highlight three broad categories of ethical issues: patients rights and welfare issues , professional issues , and business and economic issues . Business and economic ethical issues are macro-level challenges, which should be considered from the organizational perspective and addressed via institutional, legislative, and political amendments and innovations. Professional ethical issues, in turn, mainly are in the area of responsibility of educational institutions.
Patients Rights and Welfare Issues
On the other hand, many ethical challenges within the patients rights and welfare category are directly related to patient-operator communication. Hudon et al. (2015) outline the category of patients rights and welfare issues addresses patients vulnerability and their right to be treated with care and respect (p. 127). Examples within this category include, but are not limited to, patients confidentiality violations and neglecting patients rights for autonomy, frequently accompanied by hierarchical patient-operator relationship, practitioners paternalistic behaviors, or patients forced consent. The osteopathic practice involves manual interventions and diverse body touches when applying various technics: inappropriate actions may be considered sexual misconduct. A consensual intimate relationship is also an objectionable ethical issue that counts as highly unprofessional and unmannerly behavior.
In my opinion, it is noteworthy to discuss violations of patients privacy and rights to autonomy. Confidentiality of patients data implies that information should be protected and not disclosed to third parties. Throughout professional practice, osteopaths make many medical records, which are defined as a kind of sensitive information: its disclosure may result in minor or severe harm for patients. Snelling and Quick (2022) claim that maintaining the confidentiality of patients information is critically important to the effective functioning of trusting therapeutic relationships (p. 29). However, ethical issues arise when patients information is requested for public interest disclosure. There are several occasions in which this action is legally permitted. Still, a lack of knowledge about corresponding laws and regulations may lead to ethical errors which can harm patients, practitioners, or the public (Snelling & Quick, 2022). Moreover, maintaining patients privacy is impossible while treating minors: their parents or caregivers are obligated to attend osteopathic sessions.
Unfortunately, there are many ethical issues related to the violation of patients autonomy. Such issues arise despite informed consent, which is defined as an ethical and legal requirement for any therapeutic process from examination to intervention (Daniels & Vogel, 2012, p. 93). Ethical issues may be caused by hierarchical patient-operator relationships and practitioners paternalistic behaviors. The study of Reed and Thomson (2021) suggests that patients experience disempowerment during the procedure of informed consent. They lack self-doubt and confidence, cannot comprehend and engage with proposed treatments fully , rely on the practitioners decisions, and hesitate to disagree (Reed & Thomson, 2021, p. 11). Thus, essentially, patients take no part in decision-making and frequently allow osteopaths to make choices about treatment regardless of patients unsaid wishes.
Another autonomy issue occurs when caring for minors-patients: parents, caregivers, or other representatives make decisions instead of patients themselves. Ahmed et al. (2020) argue that the understanding of best interests becomes highly difficult when& outcomes of therapies and preferences or values expressed by the responsible individuals on behalf of the incapacitated patients (p. 645). Osteopathic practitioners should be sufficiently educated and experienced to recognize these ethical dilemmas or even to prevent the emergence of such issues.
Resolving Ethical Issues
The moral dimension of the osteopathic field is multifaceted, while emerging ethical dilemmas may lack a prompt solution. Evidently, an osteopathic practitioner should maintain professional behaviors, boundaries, qualities, and values. Following International Osteopathic Association, manual osteopaths are expected to maintain the highest standards of professional and personal conduct, and should comply with all governmental jurisdictional rules and regulations (IOA, n.d.). Nevertheless, moral considerations are more profound, and resolving ethical issues requires a comprehensive approach based on the defined dilemma. Regarding patients rights and welfare issues, the primary solving strategy lies in a trustful operator-patient relationship and sufficient patients informing and education. Osteopaths should establish mutual respect and cooperate with patients, be honest and avoid misleading patients into unjustified treatment results (IOA, n.d.). Practitioners are obligated to provide patients with easy-to-understand treatment options while patients are expected to make choices independently.
Proposed information exchange may be part of the informed consent process: patients should be provided with broad knowledge about benefits, risks, disclosure of diagnosis, and treatment options.
Research by Daniels and Vogel (2012) reveals that patients prefer to conduct such information-filled discussions during the first consultation. It is crucial to let patients time to overthink, the opportunity to ask questions, share fears or concerns. It is equally important to educate patients in a strictly fair manner and provide only reliable information to avoid any misunderstandings resulting in ethical issues. Daniels and Vogel (2012) claim that verbal communication is a foundation for the information presented and a valuable tool for establishing fruitful patient-provider relationships. Thus, the main suggestion is to expand the informed consent process by providing patients with excess knowledge regarding treatment and empowering them for decision-making with respect to their autonomy.
Moreover, confidentiality and privacy policies are usually emphasized within the informed consent process. Osteopathic practitioners should explicitly explain the purposes of collecting information, methods of storage and protection, and under which circumstances it may be shared with third parties. It is justifiably turning to professional mentorship to seek guidance from more experienced practitioners to receive the best strategies and suggestions. Such a strategy may potentially improve novice professionals ethical reasoning, reflection, and decision-making skills.
References
Ahmed, A., Ali, H. S., & Mahmoud, M. A. (2020). Prioritizing well-being of patients through consideration of ethical principles in healthcare settings: Concepts and practices. Systematic Reviews in Pharmacy, 11(5), 643-648. Web.
Daniels, G., & Vogel, S. (2012). Consent in osteopathy: A cross sectional survey of patients information and process preferences. International Journal of Osteopathic Medicine, 15(3), 92-102. Web.
Hudon, A., Drolet, M. J., & Williams-Jones, B. (2015). Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review. Physiotherapy Canada, 67(2), 124-132. Web.
International Osteopathic Association. (n.d). Code of ethics. Web.
Reed, M. B., & Thomson, O. P. (2021). Who am I to disagree? A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine. International Journal of Osteopathic Medicine, 40, 4-13. Web.
Snelling, P., & Quick, O. (2022). Confidentiality and public interest disclosure: A framework to evaluate UK healthcare professional regulatory guidance. Medical Law International, 1-31. Web.
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