MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES.

(MUHAS)

SCHOOL OF PUBLIC HEALTH AND SOCIAL SCIENCE.

DEPARTMENT OF PROFESSIONALISM AND ETHICS.

BACHELOR OF MEDICINE AND BACHELOR OF SURGERY(MBBS/MD).

PROFESSIONALISM AND ETHICS.

GROUP WORK. MD 4.

DISCUSS THE IMPORTANCE OF ELEMENTS OF PROFESSIONALISM,

PRINCIPLES OF PROFESSIONALISM, AND PROFESSIONAL CODES OF
CONDUCT AND HOW THEY CONTRIBUTE TO OVERALL SUCCESS IN SOLVING
ETHICAL DILEMMAS.

NAMES. REGISTRATION SIGNATURE.

NUMBER.
MAGDALENA JOSEPH MWANDA 2023-04-17685 M.J. MWANDA
DARWIN STEPHANO TWALELE 2024-04-18523 D.S.TWALELE
NAURAT NASSOR MAJID 2024-04-18680 N.N. MAJID
RUDOVICKO BOMBASTICK 2024-04-18416 R.B. KAMAZIGAWA
KAMAZIGAWA
KELNA BARAKA ALFRED 2024-04-18425 K.B. ALFRED
FRANK PAULO MWEZI 2024-04-18771 F.B. MWEZI
ISAKA MANOLI PHILIPO 2024-04-18401 I.K. PHILIPO
ALLEN HAPPYGOD KENYISON 2024-04-18402 A.H. KENYISON
ISAYA KIRAYO MARO 2024-04-18360 I.K. MARO
EDNAS KIRARYO MARO 2024-04-18834 E.K. MARO
MOHAMMAD SIBGHATULLAH 2024-04-18358 M.S. HAIDAR
HAIDAR
REBEKA ALPHONCE VINCENT 2024-04-18977 R.A. VINCENT
JAPHET KILAGO PASCHAL 2024-04-18656 J.K. PASCHAL
NORBETH IGNAS MASSAWE 2024-04-18843 N.I. MASSAWE
MASENGWE GREYSON JAMES 2024-04-18568 M.G. JAMES
 WHAT IS PROFESSIONALISM?

It refers to carrying out professional responsibilities and adhere to ethical principles by

demonstrating compassion, integrity, and respect for others; responsiveness to patient
needs that supersede self-interest; respect for patient privacy and autonomy;
accountability to patients, society, and the profession; and sensitivity and responsiveness
to a diverse patient population.

At present, the medical profession is confronted by an explosion of technology, changing

market forces, problems in health care delivery, bioterrorism, and globalization. As a
result, physicians find it increasingly difficult to meet their responsibilities to patients and
society. In these circumstances, reaffirming the fundamental and universal principles and
values of medical professionalism, which remain ideals to be pursued by all physicians,
becomes all the more important.

The medical profession everywhere is embedded in diverse cultures and national

traditions, but its members share the role of the healer, which has roots extending back to
Hippocrates. Indeed, the medical profession must contend with complicated political,
legal, and market forces. Moreover, there are wide variations in medical delivery and
practice through which any general principles may be expressed in both complex and
subtle ways.

ELEMENTS OF PROFESSIONALISM.
The elements of professionalism include altruism, accountability, responsibility,
excellence, duty, honesty, integrity, and respect for others.

1. Altruism.
Altruism is the unselfish regard for and devotion to the welfare of others and is a key element
of professionalism. Self-interest or the interests of other parties should not interfere with the
care of one’s patients and their families.

2. Accountability and responsibility.

Accountability and responsibility are required at many levels – individual patients, society
and the profession. First, there must be accountability to one’s patients and to their families.
There must also be accountability to society for addressing the health needs of the public and
to ensure that the public’s needs are addressed. One must also be accountable to the
profession to ensure that the ethical precepts of practice are upheld. Inherent in responsibility
is reliability in completing assigned duties or fulfilling commitments. There must also be a
willingness to accept responsibility for errors.

3. Excellence.
Excellence entails a conscientious effort to exceed ordinary expectations and to make a
commitment to life-long learning. Commitment to excellence is an acknowledged goal for all
physicians and students of medicine. A key to excellence is the pursuit of and commitment to
providing the highest quality of health care through lifelong learning, education, and
reflection. One must seek to learn from errors and aspire to excellence through self-
evaluation and acceptance of the critiques of others. “A professional is someone who can do
his best work when he doesn't feel like it.” Professionalism Reborn: Theory, Prophecy, and
Policy, Pg 213.

4. Duty.
Duty is the free acceptance of a commitment to service. This commitment entails being
available and responsive when “on call,” accepting inconvenience to meet the need of one’s
patients, enduring unavoidable risks to oneself when a patient’s welfare is at stake,
advocating the best possible care regardless of ability to pay, seeking active roles in
professional organizations, and volunteering one’s skills and expertise for the welfare of the
community. Professional behaviours: “I wouldn’t dream of now going into the NHS and
turning up in a pair of jeans and a t-shirt and treat somebody, it’s just not something you
would think of, even if I was stuck out in the wilds in the middle of nowhere, I would still
turn up in a uniform because I would want people to see me as a professional.” (FG15,
chiropody / podiatry student).

5. Honesty and integrity.

Honesty and integrity are the consistent regard for the highest standards of behavior and the
refusal to violate one’s personal and professional codes. Honesty and integrity imply being
fair, being truthful, keeping one’s word, meeting commitments, and being forthright in
interactions with patients, peers, and in all professional work, whether through
documentation, personal communication, presentations, research, or other aspects of
interaction. They require awareness of situations that may result in conflict of interest or that
result in personal gain at the expense of the best interest of the patient.

6. Respect for others.

Respect for others is the essence of humanism, and humanism is central to professionalism.
This respect extends to all spheres of contact, including but not limited to patients, families,
other physicians, and professional colleagues, including nurses, residents, fellows, and
medical students. One must treat all persons with respect and regard for their individual
worth and dignity. One must listen attentively and respond humanely to the concerns of
patients and family members. Appropriate empathy for and relief of pain, discomfort, and
anxiety should be part of the daily practice of medicine. One must be fair and
nondiscriminatory and be aware of emotional, personal, family, and cultural influences on
patient well- being and patients’ rights and choices of medical care. It is also a professional
obligation to respect appropriate patient confidentiality.

PRINCIPLES OF PROFESSIONALISM.

Principles of professionalism is a set of expected behaviors,conduct and ideals of a profession

.
The following are some of the principles of professionalism and their importances:

1. Beneficence.
This refers to positive acts which lead to welfare of others and a client.
IMPORTANCE OF BENEFICENCE.
 I. Beneficence helps to laid down trust foundation between patient and medical
officer thus enable easy communication.This is obtained as patient feel of much
value and worth due to being shown positive acts by medical officer.
II. Beneficence promotes both immediate and long term healing as it helps medical
officer to provide timely treatment and improve patient well being.
III. A beneficence physician uses both clinical and moral reasoning and judgement,
considers all relevant knowledge and circumstances, and makes decisions
carefully, in good conscience, and with due regard for principles of exemplary
medical care.
IV. Upholding the principle of beneficence in a way that causes the most good to be
done for the most people can also help ensure that the ethical principle of justice is
respected

2. Non maleficence.
This refers to refraining from any act or omission that may result into undesirable or
uncomfortable consquences inflicted upon a client.
IMPORTANCE OF NON-MALEFICENCE.
I. Non maleficence helps to ensure patient’s safety as it avoids doing harm and
provides patient centered care effectively .This is achieved as it directs a medical
professional to consider the benefits of all procedures and weigh them against the
potential risks and burdens on the patient.
II. A compassionate and non-maleficence physician recognizes suffering and
vulnerability, seeks to understand the unique circumstances of each patient and to
alleviate the patient’s suffering, and accompanies the suffering and vulnerable
patient.

3. Autonomy.
This refers to person's ability to take decision and actions independently. i.e, one has inherit
right to make decisions in accordance with his values.
IMPORTANCE OF AUTONOMY.
I. It enables provision of health care service that is sensitive to personal and cultural
differences which fosters more inclusive and equitable care.
II. It ensures that patients are well informed about their conditions and treatment
options, including any potential risks and hazards that might occur. I
III. It likely improves adherence of patients to the medical service provided as it
ensures that patients have a voice and opinions in their health care decisions but
also reinforces the principles of respect ,trust and collaboration between patients
and providers.

4. Privacy. (Confidentiality).
This principle is based on the concept that records, interests and affairs relating to the clients'
health condition are confided to the practitioner only. Confidentiality has been an established
duty of physicians at least since Hippocrates wrote:
“What I may see or hear in the course of treatment … in regard to the life of men …
I will keep to myself, holding such things to be shameful to be spoken about.”
IMPORTANCE OF CONFIDENTIALITY.
I. This helps to build trust between patient and medical practitioner as it preserves
individual dignity, prevents information misuse and protects autonomous decision
making by patient. Earning the trust and confidence of patients requires that
appropriate confidentiality safeguards be applied to disclosure of patient
 information. This commitment extends to discussions with persons acting on a
patient’s behalf when obtaining the patient’s own consent is not feasible.
‘Fulfilling the commitment to confidentiality is more pressing now than ever
before, given the widespread use of electronic information systems for compiling
patient data and an increasing availability of genetic information. Physicians
recognize, however, that their commitment to patient confidentiality must
occasionally yield to overriding considerations in the public interest (for example,
when patients endanger others)’’
II. This enables patients to reveal their symptoms easily as their privacy is
maintained. One feels much more comfortable to talk about his/her symptoms
when assured that the information provided will remain a secret between the
doctor and patient only
5. Justice.
This is based on the concept of fairness ,equitable and appropriate treatment in light of what
is due or owed to a person. It helps to bring about freedom, happiness, truth and equality in
health care centers.
IMPORTANCE OF JUSTICE
I. It helps to bring about freedom, happiness, truth and equality in health care
centers. A humble and justice physician acknowledges and is cautious not to
overstep the limits of their knowledge and skills or the limits of medicine, seeks
advice and support from colleagues in challenging circumstances, and recognizes
the patient’s knowledge of their own circumstances.
II. Promote the well-being of communities and populations by striving to improve
health outcomes and access to care, reduce health inequities and disparities in
care, and promote social accountability.

6. Integrity and competence.

Integrity refer to encompassing honesty, keeping one's word and consistently adhering to
principles of professionalism. Competence refers to developing and advancing one's
knowledge and skills. It enables to identify and eliminate root causes of systemic problems
that threaten patient safety. It forms foundation for patient's trust and fosters healthy
therapeutic relationships that promote healing.
IMPORTANCE OF INTEGRITY AND COMPETENCE.
I. It enables to identify and eliminate root causes of systemic problems that threaten
patient safety. A physician who acts with integrity demonstrates consistency in
their intentions and actions and acts in a truthful manner in accordance with
professional expectations, even in the face of adversity.
II. It forms foundation for patient’s trust and fosters healthy therapeutic relationships
that promote healing.
III. Contribute to the development and innovation in medicine through clinical
practice, research, teaching, mentorship, leadership, quality improvement,
administration, or advocacy on behalf of the profession or the public.
IV. Participate in establishing and maintaining professional standards and engage in
processes that support the institutions involved in the regulation of the profession.
V. Cultivate collaborative and respectful relationships with physicians and learners in
all areas of medicine and with other colleagues and partners in health care

PROFESSIONALISM CODES OF CONDUCT.

Codes of conducts refers to systematic collection of laws and statures in order to achieve
specific results in professionalism. In medical field there are also codes of conduct which
tend to guide professionals to bring positive results in medical field as other fields also
medical field is influenced by the following codes of conducts to guide medical professionals
to run their works. The following are codes of conducts that medical professional must follow
and bring positive results in medical field.

1. Respect and Equality in servicing.

Medical professionals must have an understanding all the sick or patients have different
statuses in different spheres of life like economic, religions and origin. Hence there must be
fair treatment and service to all the individuals who require services. Medical workers must
not treat people based on their economic statuses, colour, race, beliefs systems, or age. All the
individuals must be treated fairly with equality and respect to everyone not only those with
high life standards. As professionals we must be aware that all the lives of individuals are
equal in value. For example, some medical professionals are corrupt as result they never
follow this code of conduct and eventually only some lives become important to them
causing absence of equality and respect.

2. Openness in their activities.

Openness and transparency are very important in medical field meaning that every thing
medical field worker they want to do their must be transparency to their patients or
individuals who require service that is they must tell every thing and giving fully information
about what they want to perform. Nothing is done without the permission of the patient or
patient’s close relatives, the medical field workers must explain the effects of some medicines
to the patients or some fearful diseases the victims must become aware of their conditions
though medical professionals must find a good means to communicate to them and advise
them how to live in their conditions, For example most individuals are not aware of
medicines given by doctors and their side effect if misused.

3. Competence and skills improvement.

Every medical field worker must be very competent in their field this is because this field
mainly involve in direct contact of human lives it’s a code or principle that every medical
field worker must learn intensively about their field because the diseases and infections
increase everyday as result medical field individuals must invest their time in studying and
improving skills so that to become competent in their field due to eruption of diseases
everyday so that to tackle every kind of diseases. This is important because competence is the
key to excellence in what is done. Its a call to everyone to involve in learning in this field due
to the fact that experience through learning is a good doctor than only limited knowledge.

4. Good handling of confidential information.

It is a code of conduct that every professional must avoid sharing some secrets of victims or
patients to people from which the information may bring negative results to the victims.
Some of the secrets may endanger the life of the patients and even loss of hopes to the victim
some diseases and conditions must remain as the secrets to the victim and professional. The
proper handling of the information will bring hopes and beliefs and good relationship
between the victim and medical professionals.
The Principles of Ethics and Code of Professional Conduct, as known today are not new
phenomenon in Tanzania and the World in General. They have their roots in Greece, way
back in 500 B.C and traceable to the emergence of Hippocrates (460 B.C.) and his philosophy
in scientific approaches in medicine and principles on moral and ethical requirement of an
ideal physician. The principles, which were then summarized in the form of “Hippocratic
oath”, were the fundamental governance of the medical and dental professions. Ever since,
the principles have existed throughout history until when they were officially modified by the
Geneva Convention in 1948, which then formed the basis for diverse ethical approaches.

The Principles of Ethics and Code of Professional Conduct for medical and dental
practitioners in Tanzania are therefore epitomised and herein presented into five
cardinal principles namely:
1. Beneficence that requires practitioners to do good.
2. Non maleficence that requires practitioners not to do harm to their clients.
3. Autonomy that emphasises respect for the client’s informed choices and consent.
4. Justice which puts obligation on practitioners to act fairly.
5. Veracity and Fidelity which demands truthfulness and royalty in the practitioner’s
actions.

The importances of codes of ethics in medical professionalism.

1. Protection of clients and service users. Through good handling of confidential
informations and competence in skills it will help to protect patients from shame and
death due to good handling of secrets and to keep the secrets for patients.
2. Guidences to practitioners. About how to act and how to act and how to make
ethical decisions through codes of conduct tends to guide the professionals example
integrity an accountability are the guiding rules to be followed by medical
professionals.
3. Enhancement of professional status. Through existence of codes of ethics tend to
improve and enhance the status of professionals.
4. Creating and maintaining professional identity. Through the explicit statement of
the service ideal key ethical principles tends to measure the kinds of qualities
expected of people who belong to the profession and the kind of conduct required.

ETHICAL DILEMMAS.
Ethical dilemma refers when a profession sees herself as facing a choice between two
equally unwelcome alternatives, which may involve a conflict of ethical values, and it is not
velar which choice will be the right one. (According to Ethics and values in social works by
Sarah Banks, page 20 list 1.1).
General Solutions to ethical dilemmas using the element, principles and codes of
conduct of professionalism.
When it comes to ethical dilemmas in healthcare, a few critical solutions can help.

1. Communication is key.
If you feel uneasy about a situation, communicate with your supervisor or another trusted
individual.

2. Always remember the importance of informed consent.

Make sure that patients understand all of their options before making any decisions.

3. Always keep patient confidentiality in mind.

Even if you are uncomfortable with a particular situation, remember that it is not your place
to share any information about the patient without their consent.

4. Be transparent with patients.

This means being honest about risks and benefits and providing information in a way that is
easy to understand.

5. Involve patients in decision-making.

This can help ensure that decisions are made based on what is best for the patient rather
than what is easiest or most profitable for the provider.

6. Ensure you are up-to-date on the latest ethical guidelines.

Adhere to the code of ethics set forth by their professional organizations. This code of ethics
provides guidelines for how healthcare professionals should behave in various situations.

7. Try and reason with the parties involved in the dilemma.

This cannot be easy, as people’s ethical standards are often very different. However, if both
parties are willing to listen to each other and compromise, this can be an effective way to
solve the problem.

8. The Last resort is to go to a higher authority.

This could be a manager at work, a judge in a court of law, or even God if the dilemma is
religious. You can also consult with an ethical committee. These committees are usually made
up of experts in the field who can offer guidance on how to resolve the issue. They can also
provide information on resources that may be helpful in solving the problem.

The following of some of the examples of ethical dilemmas and showing how elements,
principles and codes of conduct of professionalism are used to solve them.

Scenario 1:
A patient, is brought to the emergency after being caught in a house fire with her two
children, who have both died. A patient herself has sustained burns which will be fatal in the
next few hours. The patient asks you, the doctor treating her, “how are children my children?”
You fear that knowing the truth will distress her.
Ethical dilemma, do you deceive her, for the short period of time she has left to live, and tell
her that her children are alive?

According to principles of professionalism,

Respect of autonomy we should not lie to patients, beneficence and non-maleficence holds
that lying may be crucial in easing the patient distress. Using three principles beneficence
and non-maleficence could appear at the first glance to outweigh the patient’s autonomy
and right to know the truth. It is suggested that lying to patient is justified only if a person
acting rationally, were present with alternatives, he or she would always choose being lied to
(Gert and Culver 1979).
(Medical ethics and sociology by Mosby Elsevier pg. 16-17).

Scenario 2:
Three days ago, Dr B saw miss X a 20 years student in her surgery, who has been feeling
unusual tired for over a month. Dr B had sent off a number of blood tests. When Dr B is
shopping in a local super market where she bumps into miss X’s mother, who asks what is
happening with her daughter. What should Dr B reply while she is not supposed to bleach
patient information?
According to confidentiality as a code of conduct, Dr B has to confirm that miss X an adult
patient has to tell her mother about the blood test results because Dr B does not know what
miss X would wish her mother to know. So, Dr B might reply that she does not discuss
patient’s information outside the surgery.
(Medical ethics and sociology by Mosby Elsevier pg. 18).

Scenario 3:
A young woman arrives at the emergency room following a car accident. The nurse on duty
soon discovers the woman is a Jehovah's Witness, and her faith forbids blood transfusions.
However, the woman has lost a significant amount of blood and requires a transfusion to
survive.
Solution: This scenario presents a conflict between respecting the patient's religious beliefs
and the element of beneficence (saving the patient's life). The nurse, in collaboration with the
doctor, should explore alternative options like bloodless medicine techniques or using blood
volume expanders. Open communication and respecting the patient's faith are crucial. If
possible, working with a religious leader or cultural mediator can help bridge the gap and find
a solution that respects both the patient's beliefs and medical needs.
Source: https://essaypro.com/blog/ethical-dilemmas.

References:
 Laura Weiss Roberts MD,MA , Daryn Reicherter MD. Professionalism and ethics in
medicine. 2st Edition. Stanford University School of Medicine. Stanford, CA, USA.
2015.
 Accreditation Council for Graduate Medical Education. ACGME Common Program
Requirements (Residency).
https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_202
2v3.pdf.
 ACP FOUNDATION, EUROPEAN FEDERATION OF INTERNAL MEDICINE.
 Principles of professionalism, adopted by Pg1.
 Andrew Papanikitas, BSc (Hons) MA MBBS DCH MRCGP DPMSA PhD. Medical
ethics and sociology. 2nd Edition. WSAL Course in Philosophy and Ethics, London,
UK.
 Dominic Wilkinson, MBBS BMedSci MBioeth DPhil FRACP FRCPCH, Jonathan
Herring and Julian Savulescu, BMedSci, MBBS, MA, PhD. Medical Ethics and Law,
3rd Edition. University of Oxford, Uk.
 Ethics and values in social work by Sarah Banks. Practical social work FOURTH
EDITION.