Upskilling for Healthcare

According to the World Health Organization (WHO) ethics are an integral part of global health systems creating a foundation for expected health-related services and clinical outcomes. WHO states that “health ethics promotes the consideration of values in the prioritization and justification of actions by health professionals, researchers, and policymakers that may impact the health and wellbeing of patients, families, and communities”. Ethics and ethical standards can guide the moral compass, with consideration of the interdisciplinary nature of the healthcare space, by supporting:

- Public health
- Research
- Clinical care
- Policy
- Healthcare operations

Relative to the application of clinical services a physician, or other healthcare professional, commits to maintaining the highest ethical standards and approaches to deliver care and treatment designed to:

- Benefit the patient
- Avoid or minimize harm
- Respect individual values and preferences of each patient

The above is the baseline for ethical standards in care delivery but it should be recognized that deviations may present, within the parameters of a “common morality” (as quoted by Varkey 2020) within a community or the profession, which can be assuaged by societal differences that include:

- Cultures
- Spiritual beliefs
- Professional standards
- Ideals
- Societal norms

Ethical Principles Guiding Healthcare

A presumed ethical framework supports healthcare delivery, outcomes, and systems management by respecting four ethical principles:

- Beneficence: this is the ethical principle that maintains that all clinicians act in the best interests of each respective patient. It involves the provision of care to improve the patient’s health and wellbeing, avoiding steps that can harm the patient, and respecting the patient’s personal choices for their health care. Beneficence is essential for all health care professionals to demonstrate including physicians, nurses, and allied health professionals.,. Examples of beneficence can include direct care, advocacy, and assistance with support services in the greater community.
- Nonmaleficence: a core medical ethical principle that states that healthcare should be delivered to do no harm and that decisions should be made by considering the benefits and potential risks of all procedures and care plans. There are four key components of nonmaleficence:
  - Every action should be taken without intentional wrongdoing
  - All actions should have good intentions
  - All good intentions should outweigh potential bad effects
  - All actions should be the least harmful option available
- Autonomy: this core principle asserts that all people have invaluable and unconditional worth and are entitled to make rational decisions with moral choices based on their capacity for self-determination, with a sound mind. Autonomy, however, is a principle that may be overridden should a person lack capacity or be incompetent, to act autonomously. This could be applied to infants, young children, and those with mental and physical limitations that prevent them from making autonomous decisions. It should be noted that governmental policies determine appropriate assessment for incompetence.
- Justice: as a core health-related value, justice is viewed as fair, equitable, and appropriate treatment of all people. Conceptually, this is equitable access to care and health-related services based on availability, accessibility, and distribution. Applying this core value to all people is often complex and requires insight and awareness of available resources.

Applying Ethics in Healthcare Systems

In addition to applying ethics to actual care, treatment plans, accessibility, and equitable availability of resources, ethics is applicable to public health provision, treatment of staff, process, and other complex issues. Moral issues that include end-of-life planning and treatment, reproduction and reproductive rights, decisions pertaining to infectious disease, and addressing disparities, frequently generate ethical questions that are addressed through federal, state, and regional laws, as well as policies and procedures established by each organization and credentialing body.Ethical issues and questions that are frequently addressed involve moral principles and values relative to medicine and healthcare. Some pertinent issues of concern include:

- How do we respect patient autonomy and informed consent?
- How do we find the appropriate balance between beneficence and nonmaleficence when making treatment decisions and implementing patient protocol?
- How do we allocate limited resources and ensure justice in healthcare accessibility?
- How do we regulate assisted suicide and support end of life rights?
- How do we address abortion rights?
- How do we evaluate the risks and benefits of innovative medical technology and implementation?
- How do manage data and maintain compliance?

Addressing Current Societal Needs and Social Determinants of Health

There is tremendous emphasis on providers, clinicians, and allied health professionals to align and maintain clear ethical standards as defined by individual moral compass, but reinforced through payors, credentialing bodies, and healthcare organizations. Additionally, there are societal expectations for health plans, healthcare systems, and other service providers including vendors, suppliers, and independent entities, to provide services in adherence to ethical standards and compliance. The expectation of the highest quality of service delivery will ultimately impact patient care, decision making, wellbeing, and public health and safety.Addressing the broader implications of public health will cover the following aspects of functionality:

- Delivering care to minimize language and communication barriers
- Addressing systemic health inequities
- Provision of care and social support in underserved areas, ensuring that needs are met implementing innovative solutions to impact rural and isolated communities, Native American Tribal communities, and other communities with glaring disparities
- Balancing autonomy with understanding of treatment implications relative to culture, religion, and societal norms
- Recognition of historical injustices that helped shape ethical practices in global healthcare (Legacy of the Holocaust, genital mutilation, forced sterilization, etc.)
- Recognizing accessibility of immorally and illicitly acquired data and personal information that cannot be integrated into any decisions in a just environment

It is imperative to understand that providing ethical care to patients and the greater community includes insight and understanding of the social determinants of health (SDOH), the non-medical factors in a person’s life that has direct implications on health and wellbeing. SDOH factors include societal issues and challenges, as well as lifestyle choices, that shape the conditions faced in everyday life.

- Socioeconomic status
- Neighbor/built environment
- Access to healthcare
- Education
- Community context, social connection

For a collective, successful, equitable approach towards healthcare and development of healthy communities, ethical standards must be applied to all for best outcomes and maintenance of high-quality standards.