Informed consent requires that a patient agrees to a certain procedure while Autonomy provides that the patient has the sole responsibility to decide. These are very ideal and in theory their practicability is simple. But is it?
At the wake of limited resources, the patient may not completely have the final say as to what happens to them. They may not have as many options to choose from, as the resources may not be as plenty. Further in developing countries, consent and autonomy is further complicated by the paternalistic relations that exists between the provider and the patients. The patients are less informed on their care and their conditions and interpret illness in a society and cultural context thus resulting into lesser accurate information on their well-being.
Healthcare providers in developing countries therefore have to create a balance between respect for autonomy and informed consent with the need to adequately educate the patient on the preferred care they choose. With the limited resources, the doctor often will choose the diagnostic procedure and have a big say on the prognosis treatment and rehabilitation of the patient. Consent to this end is thus used with overall call on doctors since Hippocratic times to do no harm.
The principle of “doing no harm” is the underlying ethical principle in the limited resources system and heavy patient load clinical atmospheres. The doctors who are often the more informed party have to constantly recall the Hippocratic oath section stating “…I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing”
The healthcare provider has to often balance between the available resources, the huge patient numbers with different needs and in this situations he/she has to do good at all times. Students in medicine in the whole of the healthcare profession seeking an elective in low resources settings must in similar way be prepared to do no harm. They must practice within their scope, they must appreciate their skills deficit and must at all times only perform a procedure that they are certain of their competence to and safeguard the safety of patient as a principle superior to hands on experience and clinical exposure.
This principle is rather a common phenomenon and often seen as a direct inferred principle to any practice of medicine. The premise from which it progresses is that all actions of the provider must be such that it benefits the patient.
While beneficence to the patient is relative and its interpretation different to various providers, in developing countries, this is seen as extending beyond the clinical care of the patient. It involves a proper provision of information on the need to seek the professional health services as well as advice on the measures that are essential for prevention of further harm arising from the condition. Healthcare providers take an active role in preventive care and health promotion.
Students intending to undertake an elective in a developing must therefore be prepared to undertake deliberate efforts both in learning and for benefit of patients to educate the patients on care. Further they should be ready to participate in CMEs and other sessions so arranged within the hospital of placement.
While discussions revolving around ethics elucidate heated debates, understanding the centrality of the patients in them is a sure way to ensure the open view of ethics. Learning ethics and their application best happens in atmospheres where the ethical dilemmas often arise and where their application is not a direct sweep of the written standard.
A placement abroad and especially in a developing country is a unique exposure to learn through practice of the ethics in healthcare practice. These are opportunities that healthcare students should keenly consider.
About the Author
Richard Kariuki, BSC Hons Health Services Management and the Lead Placement Advisor at Elective Africa, a healthcare placements organizer to Africa.