MANAGEMENT OF CLINICAL CASES

APPENDIX 3. DEONTOLOGY
Valeria Serra
 Management of Clinical Cases

APPENDIX 3. DEONTOLOGY

Professional deontology and information to the patient: in this chapter we will conceptualise
general aspects in which the exercise of professional hearing care should be ethically
sustained, whether its activity is developed in public or private fields. Also these ethical
principles must take into consideration the treatment of information to the patient.

1. GENERAL CONCEPTS ETHICS AND DEONTOLOGY

Ethics is a part of Philosophy and deals with good in general and moral of human actions
and Deontology is the set of principles and ethical rules which must inspire and guide the
professional behaviour. Deontology is expressed through the duties and professional
obligations contained in the Codes of Ethics or Deontological Codes of the different
professions, in our case the ones related to health.

The principles and criteria of such disciplines are involved in the regulation and guidance of
the relationship: patient-professional because such human relationship is not a relationship
between “equals", in it there is a marked difference in height with predominance of technical-
scientific of the professional that will reflect in the moral duties towards the patient softened
or weakened such inequality to place in the hands of the patient control tools that limit the
power of the professional.

Deontology: is the set of duties to which the professional is bound, usually contained in the
Code of Ethics.

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 Management of Clinical Cases

These equal and ethical principles for all medical and paramedical branches will be
mentioned in the paragraph 4.2.1. and their correlates.

2. THE RIGHT TO HEALTH

As we mentioned in section 4.1, the World Health Organization (WHO) gave already in 1946
a definition of health with positive sense excluding the idea of "absence of disease" and
including the mental and social health to refer it as “state of complete physical, mental and
social well-being”.

Within this framework, the "right to health" is inserted in its two aspects: on the one hand, its
recognition as a subjective right, closely linked to the dignity and integrity of the human
person and, on the other hand, an objective mandate aimed at triggering public in its role as
intermediary for the realisation of the constitutional mandates.

The right to health is ascribed to the right to life and to physical and mental integrity that
every person has, it is the substrate that is indispensable for the exercise of other rights, for
the realisation of values in life and the personal project of every human being.

The delicate nature of the right that is at stake in the professional relationship of the health-
patient (which is the preservation of health, essential component of the right to life) reveals
once again that few professional activities require so many ethical considerations as the
exercise of competence in a health profession (both public and private professional
practice).

2.1. PRINCIPLES OF ETHICS IN PUBLIC AND PRIVATE HEALTH CARE PRACTICE

Three fundamental ethical principles inherent to the professional practice are recognised by
bioethicists, philosophers and legal experts, depending on the interests of the people and
based primarily on the respect and protection of fundamental rights, these principles are: the
principle of beneficence, the principle of autonomy and the principle of confidentiality.

2.1.1. Principle of Beneficence

The principle of beneficence has two aspects, one of affirmative action and other negative or
of abstention, this way: it is the duty of the professional to act for the benefit of the
patient or to contribute positively to the well-being of the same. The other aspect means to
refrain from any physical or psychological harm to the patient (also known as the

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 Management of Clinical Cases

principle of non-maleficence).

2.1.2. Principle of autonomy (right of the patient)

Understood this principle as the patient's right to have respect for their decisions, it
means that each performance must be consciously accepted by the patient. This
should allow to be aware and informed about the scan, the diagnostic technique or therapy
which will be object, knowing the benefits, potential risks and possible alternatives.

2.1.3. Principle of Confidentiality

The principle of confidentiality connects directly with the right to privacy and the privacy
of the patient as a very personal right.

3. INFORMED CONSENT

It is the counterpart of the duty to report and it consists of the right in every person, as an
autonomous moral agent, to receive the necessary information in order to have an opinion.
Informed consent is the most evident demonstration of the principle of autonomy.

The professional relationship or technician of health-patient evolved historically from an

authoritarian model (prehelenic and primitive cultures) to a paternalistic model (Greek
culture: where the curator had the role of father-protector and the patient was the son that
had to obey) to subsequently achieve since the mid-20th century the so-called autonomic
model--where the relationship has tended to be egalitarian, and in which the decisions of the
patient require respect.

The professional relationship of the health-patient does not end with the fulfilment of the
obligation to report, it requires that the patient-recipient has a participatory and collaborative
function.

Part of the source of the information requires: the responsibility of giving a clear, founded
and full opinion, and by the receiver: to receive information, understand it completely,
elaborate it intellectually and as a consequence: give a consenting (or not) opinion.

We don’t know that health relationships have tended to overcrowding and depersonalisation
with deterioration of a model based on trust, being that the most widespread modality to
grant health benefits is the activity of large hospitals or clinics or any health care institution
and this has prevented to presuppose opinion and hierarchy of values in relations occurring
virtually "between strangers".

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Against this progressive complexity of the social realities, legal and ethical standards come
to regulate and advertise the behaviours between the parties in the professional-patient
relationship.