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APP-006 Code of Ethics and Ethical Management

This document outlines the Code of Ethics and Ethical Management policy for Vital Signs Medical Center in Dammam, Saudi Arabia. It establishes organizational values of concern for individuals, quality service, service to the community, integrity, fairness, accountability, respect for employees, and stewardship. The code of ethics calls on the medical center to consider ethical implications of decisions, act as a responsible business, make difficult choices with civility, act responsibly with the rights and obligations of its role, and continually develop best practices to provide quality services.

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0% found this document useful (0 votes)
47 views50 pages

APP-006 Code of Ethics and Ethical Management

This document outlines the Code of Ethics and Ethical Management policy for Vital Signs Medical Center in Dammam, Saudi Arabia. It establishes organizational values of concern for individuals, quality service, service to the community, integrity, fairness, accountability, respect for employees, and stewardship. The code of ethics calls on the medical center to consider ethical implications of decisions, act as a responsible business, make difficult choices with civility, act responsibly with the rights and obligations of its role, and continually develop best practices to provide quality services.

Uploaded by

john
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ADMINISTRATIVE POLICY AND PROCEDURES (APP)

VITAL SIGNS MEDICAL CENTER


3756 Imam Mohammed Bin Saud Street,
Al Faisaliyah, Dammam, Ash Sharqiyah
Kingdom of Saudi Arabia, 32272
+966 013 8899997 | [email protected]

POLICY NAME Code of Ethics and Ethical Management POLICY NO. APP - 006

Issued October 2021 Revised - Version Number 1st Edition

Effective November 2021 Due for Review November 2023 Department Administration

APPLIES TO: Vital Signs Medical Center

I. PREAMBLE:

§ Vital Signs Medical Center Code of Ethics is concerned not only with what is right and what is good, but
also with our obligation to others. The purpose of this Code is to contribute to a culture of ethical behavior
in the health care field. It is intended for Vital Signs Medical Center.

§ This Code articulates a set of values and behaviors that Vital Signs Medical Series believes is an
appropriate standard of conduct for the organization and its leadership. Vital Signs Medical Center
believes it should be held accountable to its customers, their members, and to the public. This Code
provides a guide for the way business should be conducted at Vital Signs Medical Center.

§ This Code is not a tool of certification, nor does it contain sanctions to be imposed for not meeting the
standards contained in the Code. Its primary sanction lies in the organizational and personal conscience
of the medical facility and its members.

§ In addition, this Code is an educational tool, designed to inspire individuals to act in a way that assures good
care, sound community relationships, and helps establish and reinforce public confidence in the entire
long-term healthcare field.

§ Vital Signs Medical Center believes that its customers (patients/ families) and their companies have a right
to expect the Code's ideals to be mentioned in our positions and policies. Further, Vital Signs Medical
Center customers and their members have the right to expect the hospital's leaders to act in accordance
with the values and standards of the code.

§ Framework established the ethical management.

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II. ORGANIZATIONAL VALUE:
The following organizational values are the foundation of Vital Signs Medical Center’s Code of Ethics:

A. Concern for Individuals in Need:

Vital Signs Medical Center recognizes that a growing number of people in Dammam and eastern region
need health care services. Many of these people have multiple needs: physical, emotional, spiritual, social,
and economic. Vital Signs Medical Center strives not only to support its customers (patients / families) and
their companies, but also to be an advocate for all people who need health care services and supportive
environments.

B. Quality Service:

People in need of health care deserve quality services. Vital Signs Medical Center is committed to providing
its constituents with quality products and services, which in turn will assist providers in serving their patients
well. Vital Signs Medical Center advocates for quality care, including appropriate standards and their
implementation.

C. Service to the Community:

Vital Signs Medical Center and its members perceive themselves to be good neighbors, contributing to the
overall good of the community. Vital Signs Medical Center supports this community service ideal and strives
to mirror it in its values, ideals, and policies.

D. Integrity and Honesty:

Honesty is the glue of social relationships, both personal and corporate. Vital Signs Medical Center is
committed to honesty and integrity in all its internal and external activities. To be honest is to be forthright
and open. It requires individuals and organization to actively provide complete and truthful information when
making decisions or when influencing others to make responsible decisions.

E. Fairness:

Vital Signs Medical Center believes that in establishing policies, advocating for the long-term care
community, developing employment practices, pricing products and services, seeking grants or business
opportunities, and in resolving disputes, the association and its members and staff must do what is fair and
just. To be just is to do what is right and proper - free of prejudice to achieve a balance of conflicting needs,
rights and demands. Concepts of fairness must apply to dealing with/acknowledging conflicts of interest
and, when appropriate, competing interests.

F. Accountability:

Vital Signs Medical Center, as a service organization, understands that it is accountable to its constituent
members and, by extension, to those whom they serve. Vital Signs Medical Center also understands that
the medical facility, its customers (patients/ families) and their companies are accountable to the public at
large. Vital Signs Medical Center recognizes that the facility, its customers, and their members must comply
with all laws and regulations that govern their operation.

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G. Respect for Employees:

People are the heart of organizations. Vital Signs Medical Center and its constituencies are committed to
enhancing the individual well-being and positive social interaction of all who are employed by the institution.
Vital Signs Medical Center, its customers and their members are committed to providing a safe and
supportive work environment for their employees. Vital Signs Medical Center and its members also
recognize their responsibility to provide employees fair compensation and to deal with employees fairly.

H. Stewardship:

Vital Signs Medical Center recognizes that it occupies a privileged position as one of the voices of health
care fields in the Kingdom of Saudi Arabia. Many individuals and organizations support patients on
individual basis under special circumstances. Such commitment and role demand that Vital Signs Medical
Center uses its relations & resources - financial, social, and moral - to comply with patient support prudently

III. CODE OF ETHICS FOR VITAL SIGNS MEDICAL CENTER:


The Code of Ethics for Vital Signs Medical Center is intended to direct people's actions toward a desired end. It
is not intended as a set of policies or procedures for Vital Signs Medical Center, but is an attempt to embody all
the aspirations, values, and beliefs.

A. Moral Responsibility:

As an organization with a moral responsibility, Vital Signs Medical Center reflects on the ethical implications
of its choices, but Vital Signs Medical Center also recognizes that in many instances respected values may
be in conflict. Such conflicts do not excuse Vital Signs Medical Center from recognizing differing
perspectives or from making difficult decisions. Vital Signs Medical Center itself accountable for its
decisions and the way in which they are made.

B. Good Business Practice:

As a health care organization, Vital Signs Medical Center manifests a commitment to the values and
behaviors, which mark good business practice. Individuals in leadership have a responsibility to act
responsibly and fairly to its customers and to their members.

C. Making Difficult Choices:

Society often is faced with decisions that are divisive. Similarly, Vital Signs Medical Center has and will
continue to be faced with difficult choices. Vital Signs Medical Center affirms that it is proper to forcefully
present one's views but that it is also vital that we do so with civility and openness to other perspectives. In
its entire decision-making, Vital Signs Medical Center will adhere to the spirit and to the processes of its
constitution and bylaws.

D. Acting Responsibly:

Individuals and organizations vested with powers to affect the life of Vital Signs Medical Center have both
the right and the responsibility to exercise their powers in the best interest of Vital Signs Medical Center and

VITAL SIGNS MEDICAL CENTER


APP – 006
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the entire field of health care. The staff, in turn, will exercise diligence both in providing truthful information
for decision makers and in fulfilling responsibilities in accord with the will of the members.

E. Obligations to Provide Quality Services:

Because the field of health care is in a state of flux, Vital Signs Medical Center must constantly learn from
the field and continually develop best practice models for use in the field. Vital Signs Medical Center will
forward standards and techniques to assist providers in meeting their obligations to provide high quality
care and services.

F. Dealing with Conflicting Values:

Vital Signs Medical Center recognizes that its constituency involves families, volunteers, employees, and
suppliers, as well as individual facilities. While in many instances the interests of all constituencies are
aligned, at times they are not. It is vital that any ambiguity and tension that arise from differing views and
conflicting values be faced with forthrightness and sensitivity, recognizing that, at times, the interests of
important, albeit secondary, constituencies must not only be heard, but they may be so compelling as to be
controlling. In some instances, persons of good will differ about choices to be made. Vital Signs Medical
Center is committed to facing difficult issues and differing perspectives with honesty, forthrightness, and
civility.

G. Use of Information:

Vital Signs Medical Center recognizes that information can be used to confuse, obfuscate, and bolster a
particular perspective. Vital Signs Medical Center is committed to gathering and distributing relevant
information to the best of its ability and to making it part of a fair and open decision­ making process.

H. Responsible Advocacy:

Vital Signs Medical Center has a special responsibility in advocacy. Vital Signs Medical Center must
promote good practice within the field of health care through promotion of education, training, research, and
the identification of best practice models. Vital Signs Medical Center also must promote the development of
ethically based practice by its behavior and through its various publications and other educational vehicles.
Vital Signs Medical Center believes that the policies and agenda must reflect willingness to self-regulate.
While Vital Signs Medical Center will support and help develop reasonable regulations that are fair and
promote quality and cost efficiency, Vital Signs Medical Center believes that quality must be internal to an
organization and be motivated through strong leadership and clear vision. As an advocate for people in need
of health care, Vital Signs Medical Center will promote reimbursement policies, which make possible the
provision of quality care to all individuals, including the economically disadvantaged. Similarly, Vital Signs
Medical Center will promote stewardship in the field so that both public and private resources will be used
wisely and efficiently.

I. Potential Conflicts of Interest:

All individuals within the Vital Signs Medical Center leadership, both staff and volunteer, will be sensitive to
potential conflicts and duality of interest. In areas that are questionable, leaders will declare such and

VITAL SIGNS MEDICAL CENTER


APP – 006
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subject themselves to the judgment of their peers as to the appropriateness of their participation in the
decision at hand.

J. Respect for Others:

Respect for the dignity of others is a key element in all-ethical behavior. Vital Signs Medical Center
recognizes the right to privacy and the importance of confidentiality. Vital Signs Medical Center will be
scrupulous in safeguarding these principles in the use of information - whether about individuals or about
organizations.

K. Fairness in Competition:

Entrepreneurship and healthy competitiveness are part of Saudi cultural values. However, fairness and
decency are values of high moral order. Especially at a time when there are difficult societal decisions
affecting the lives of all citizens, Vital Signs Medical Center recognizes the importance of joining together
with other organizations with similar values and concern for people needing health care services.

IV. HOW THE CODE APPLIES TO HEALTHCARE AND LONG-TERM CARE PROVIDERS:

The health care and the long-term care field’s deal with issues of great human drama: frailty, dependency,
suffering, and death - and the multiple costs they entail. With the role of caring for frail and vulnerable individuals
comes special responsibility:

• Concern for emotional physical, social, and spiritual well-being of patients and their families.

• Recognition that family and friends are integral to the care process.

• Recognition that the corporate ethic of the facility and its policies and procedures should be made explicit
and available for patients and families. These include appropriateness of medical interventions; clinical
decision-making processes; dispute resolution processes; grounds for transfer to other parts of the facility
or out of the facility; decisions about hospitalization; provision of nutrition and hydration; do not resuscitate
orders; the dying process.

• Recognition that residents, as well as long term care employees, have responsibilities to one another, to
promote the common good and to treat each other with the respect they expect for themselves.

A. Responsibility for Quality:

The primary responsibility for quality care lies with the facility and all who are part of it. However, government
must play a role in protecting both vulnerable individuals and payment structures. While regulatory
structures must be reasonable, humane, and cost effective, facilities, not government, must develop internal
structures that assure quality, and they must engage in decision-making that is grounded in sound ethical
principles.

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APP – 006
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B. Commitment to Quality and Patient Autonomy:

Member facilities are committed to the provision of quality services. All health care & long-term care services
should be provided in a safe environment, though a degree of risk is inevitable if patient autonomy is to be
respected and enhanced.

C. The Costs of Care:

Providing health care & long-term care services bring with it costs to individuals: economic, psychological,
and opportunity costs. Formal health care & long-term care also involve monetary exchanges. Facility
members of Vital Signs Medical Center affiliates are committed to stewardship of resources, both private
and public. Member facilities are committed to efficiency in the provision of quality care, accurately bills for
services and ensure that financial incentives and payment arrangements do not compromise patient care.

D. Obligation to the Poor:

Vital Signs Medical Center its customers and their members affirm that society has the obligation to provide
quality health care and long-term care services for people who do not have the personal resources for
decent care. Providers also have an obligation to provide cost-effective, quality services that are accessible
to the greater proportion of society.

E. Support for Employees:

Vital Signs Medical Center, its affiliates and their member facilities also affirm that competent,
compassionate, and dedicated employees are key to the provision of high-quality services. Member
facilities are committed to treating all employees with dignity and to providing safe and supportive working
conditions. Member facilities affirm that people are entitled to decent wages and working conditions.

V. CONTENT:

This APP describes the ethical management and framework in Vital Signs Medical Center.

VI. POLICY STATEMENT:

Vital Signs Medical Center management establishes a framework for ethical management that ensures that
patient care is provided within business, financial, ethical, and legal norms and that protects patients and their
rights with compliance with the national or international ethical norms.

VII. PURPOSE:
No. Procedures Responsible Person

The Vital Signs Medical Center management is committed to create a


Administration &
1 well-established ethical management and legal norm that protects
Management
patients and their rights.

VITAL SIGNS MEDICAL CENTER


APP – 006
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No. Procedures Responsible Person
Develop the medical facility's framework for ethical conduct in
2
compliance with the national or international ethical norms.
Ensures nondiscrimination in employment practices and provision of
3 patient care in the context of the cultural and regulatory norms of the
country.
Establishes a mechanism by which health care providers and other
4
staff may raise ethical concerns without fear of retribution.
Creates marketing strategy to promote hospital prestige and scope Admin Manager
5
of services Marketing Section
Establishes a systematic guideline for accepting patients, Administration &
6
transfer, and discharge procedures Management
Administration &
7 Discloses ownership.
Management
8 Portrays honestly the hospital scope of services. Heads of Dept.
9 Establishes accurate, precise, and reasonable bill prices Accounts Department

Admin Director
10 Discloses and resolves conflicts when financial incentives and
Accounts Manager
payment arrangements compromise patient care.
Supports ethical decision making in clinical care and non- clinical Medical Director
11
services. Ethical Committee
Medical Director
12 Supports those confronted by ethical dilemmas in patient care
Ethical Committee
13 Provides an effective and timely resolution to ethical conflicts that arise
Identifying and addressing ethical concerns is readily available and
Ethical Committee
14 includes ethics resources and training for health care providers and other
staff.

VIII. ATTACHMENTS:

A. Ethics Framework Overview


B. Terms of Reference: Ethics Committee

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APP – 006
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IX. DISTRIBUTION:

1. All Departments (Medical and Non-Medical)


2. Nursing Department
3. QI Department
4. CEO / Medical Director’s Office
5. Vital Signs Medical Center Policy and Procedures

VITAL SIGNS MEDICAL CENTER


APP – 006
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X. APPROVAL SHEET:
Prepared by:

Name: John P. Anastacio, MAN, RM, RN Designation: Medical Site Services Supervisor

Signature: Date: 03-Oct- 2021

Reviewed by:

Name: Dr. Hamood Abdullah Alkuhlani Designation: Medical Coordinator

Signature: Date: (DD)-Oct- 2021

Reviewed by:

Name: Ms. Amjaad Aljlaoud Designation: Administrative Director

Signature: Date: (DD)-Oct- 2021

Name: Mr. Ibrahim Bakhit Designation: Clinical Support Manager

Signature: Date: (DD)-Oct- 2021

Approved & Authorized by:

Name: Engr. Khalid Turki Alotaibi Designation: Chief Executive Officer (CEO)

Signature: Date: (DD)-Oct- 2021

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APP – 006
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XI. REPLACEMENT:

XII. REVISION:

VERSION HISTORY
VERSION APPROVED BY REVISION DATE DESCRIPTION OF CHANGE AUTHOR
1 Edition
st
Engr. K. Alotaibi 03-Oct-2021 - John Anastacio

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APP – 006
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ETHICS FRAMEWORK
OVERVIEW

Departed from its value of providing high quality care services with
integrity, vital signs medical center is committed to uphold the highest
ethical standards. Therefore, to help stakeholder to comply with the
commitment and to support ethical decisions, vital signs medical center
has developed this written ethics framework and make it available to
the management, all staff, physicians, volunteers, patients, families,
and the public.

This framework is a step-by-step guidance on ethical decision making,


including identifying stakeholders, getting the facts, and applying
classic ethical approaches. This document is not intended and should
not be considered a substitute to the professional's code of conduct
and the ethics guide of medical profession (issued by the Saudi council
for health specialties) by which all health care providers should abide
to. Indeed, vital signs medical center endorses and support all the
existing laws and regulations of the kingdom of Saudi Arabia related to
the medical ethics and to medical profession in general.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 1 of 36
Goal of the Ethics Framework:

§ Develop a common approach to enhance and guide ethical decision­ making and practice
that applies to both clinical and organizational ethical issues at Vital Signs Medical Center.

Objectives:

§ Increase awareness and understanding of the ethical dimensions of healthcare


provision and administration.

§ Enables staff, physicians, learners, and Management to identify ethical dilemmas and
issues related in their work and roles.

§ Help staff, physicians, learners, and Management to analyze, deliberate and resolve
ethical dilemmas and issues.

§ Encourage staff, physicians, learners, and Management to align their decisions and
actions with relevant values, duties, and principles.

§ Educate staff, physicians, learners, and Management about local ethics resources so
they can seek additional support when needed.

When to use the Ethics Framework:

While many decisions health care workers make daily have some ethical dimension, not every
decision requires application of this framework; this is because Vital Signs Medical Center
has pathways, policies, systems, and procedures that support us to do the right thing.
However, in some situations, knowing or doing the right thing is unclear or difficult. These
situations represent ethical dilemmas, which is framework is designed to address. Anyone
who identifies an ethical dilemma is encouraged to apply this ethical framework to address
the issues with appropriate stakeholders.

Signs of an ethical dilemma may include:


§ The "yuck factor”: an intuition that something isn’t right; a feeling of moral angst or
distress.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 2 of 36
§ Knowing the “right” thing to do in a situation but encountering organizational or
personal barriers.

§ Wondering what a good person or professional ought to do each situation.

§ Encountering a situation where two equally important values seem to conflict (e.g.,
between telling the whole truth and preserving confidentiality).

§ Conflict between members of a team around a challenging situation, often stemming


from differing professional roles, beliefs, or worldviews.

§ Moral ambiguity: a situation characterized by uncertainty about the right thing to do


either because it is novel, or it has unique features that make standards of practice
difficult to apply.

Overview:

Part 1: introduces the role of ethics in healthcare and defines key terms such as “clinical
ethics” and “organizational ethics”.

Part 2: provides a conceptual foundation for this framework, including a primer on Key ethical
principles, duties, and values relevant to both clinical and organizational ethical decision-
making.

Part 3: describes the ethical decision-making process for Vital Signs Medical Center staff,
learners, Management, and physicians to follow when addressing an ethical dilemma,
including tailored worksheets to guide clinical and organizational ethical decision-making.

Part 4: contains a list of ethics resources available to support clinical and organizational
ethics at Vital Signs Medical Center.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 3 of 36
Part 1: The Role of Ethics in Healthcare:

Good organizational governance flows from the integration of effective ethical decision­
making, supportive systems and processes, and an enabling environment and culture. The
relationship between these interdependent features of ethics within organizations is seen
(Figure 1).

OUTCOMES:
Demonstration of values
DECISIONS AND and behaviors, actions, and
ACTIONS communications

SUPPORTING
SYSTEMS AND STRUCTURES:
Policies, procedures,
DECISIONS pathways, and system
makes it easy to do the right
thing.

ROOTS
CULTURE AND
Shared beliefs, habits, and
ENVIRONMENT expectations encourage
ethical reflection and
decision-making.

FIGURE 1

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 4 of 36
Ethical Decisions and Actions:

Ethics is a part of daily life because thoughts and actions are ultimately grounded in individual
identities and collective values. Healthcare organizations and providers have moral
obligations stemming from their role in enhancing health to support the life goals of people in.
Their community, however, this primary role is balanced by man other ethical aspects of
healthcare (see Figure 2).

In trying to balance these multiple roles and obligations, administrators, support staff,
learners, and health ca re professionals may encounter ethical conflict, uncertainty, or
distress in their everyday working lives. In many situations, enacting one’s ethical duties and
responsibilities is clear and easy. In other situations, knowing or doing the right thing may be
fraught with. Uncertainties and risks, every situation brings unique factors, with both internal
and external influences, that because interpretive differences in terms of how best to weigh
different ethical values. This framework is intended to assist Vital Signs Medical Center to
systematically address ethical dilemmas, situations in which knowing or doing the right thing
is unclear or difficult.

Ethical System and Processes:

Vital Signs Medical Center systems and processes - drive decision-making. Systems and
processes (such as policies, procedures, pathways, guidelines, IT infrastructure, reporting
mechanisms, etc.) Can lead to ethical dilemmas (such as "silos", inequitable policies or lack
of procedural standards leading to uneven quality of care). But systems and processes can
also prevent and resolve ethical dilemmas and make it easier to do the right thing (such as
transparent and inclusive resource allocation processes, codes of conduct that are uniformly
enforced and guidelines that enhance patient and family centered care). While this framework
designed to support decision-making related to specific ethical decisions or issues, it is
crucial to think about how organizational systems and process might be contributing to an
ethical dilemma and identify positive steps to improve them. For example, this framework
aligns very well with VSMC Change and Quality Improvement Model (Define: Plan, Do, Study,
Act), and may be particularly useful in supporting the Definition and Planning phases of an
ethically charged change.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 5 of 36
FIGURE 2

Ethical Culture and Environment:

It is important that a Vital Signs Medical Center staff, physicians, Management, and learners
are empowered to "do the right thing" and integrate ethics into their daily practice. An
organization that ultimately serves the public good, our decision-making processes must be
transparent and perceived as just. Evidence is dear that organizations that integrate ethics
into everyday decision-making through fair processes and systems provide higher quality
service, and demonstrate improved employee morale, enhanced productivity, better customer

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 6 of 36
service, higher employee retention and lower job burnout. At Vital Signs Medical Center, we
function as a values-based organization, thus the ethical basis of decisions must be
articulated. Cultivating an ethical culture whereas encouraged to engage in ethical reflection
and questioning is crucial to nurture systems and processes that result in ethical decisions
and actions.

Key Terms:
Ethics the systematic examination of facts, beliefs, standards, and values in determining the
rightness or wrongness of decisions and actions, Consideration of contextual factors,
appropriate guidelines and the perspectives of all relevant stakeholders is integral to ethics.
Ethics involves expanding our notion of the good from what is good for me, to consider "the
greater good" (e.g., my profession, my family, my community, etc.). Ethics is not merely opinion
or gut reaction, but involve reasoned deliberation to address the question: "What is the best
thing to do, all things considered?"

Ethical Decision Making: disciplined reflection on how to make decision about what should
be done in a particular situation. Ethical decision-making usually involves four related
questions:

§ What should we do? ( What options are good or right in this context )?

§ Why should we do it? ( Exploring the values and reasons that support each option ).

§ How should we do it? ( What plan of action best aligns with these values and reasons?).

§ Who should do it? ( Who is responsible from making the final decision and enacting and
communicating it?).

Issues clinical Ethics (or patient-specific ethics): ethical issues and dilemmas that arise
in the care or treatment of individual and identified patients. In addressing clinical ethics
issues, health care professionals should consider the specific duties they must identify
patients, such as those related to confidentiality, disclosure, and consent etc.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 7 of 36
Some examples of clinical ethics issues include - whether to withdraw or withhold
treatments for the patient at end of life, conflict between a team and family regarding the
perceived safety or treatment plan for the patient; conflict between members of healthcare
team regarding whether to offer a fragile patient an innovative therapy; uncertainty regarding
whether a patient with a severe eating disorder is competent to refuse treatment. Health care
workers should be alert to any organizational contributors to a clinical ethics issues or
dilemmas.

Organizational Ethics (or issue-focused ethics): organization's efforts to define its own
core values and mission, identify areas in which important values come into conflict, seek the
best possible resolution of these conflicts, and manage its own performance to ensure that it
acts in accord with espoused values. "Organizational ethics addresses the ethical dimensions
of decisions affecting groups of patients, as well as non-patient related issues such as human
resource issues, policies and processes, and resource allocation decisions. Examples of
organizational ethics issues include: the development of a policy to support organ donation
after cardiac death; the disclosure of a health risk to a cohort of affected patients; the review
of a perceived conflict of interest of one of the top management members; the identification
of reasonable criteria to inform resource allocation decisions; or the realignment of staff roles
to support a new patient care process (such as access to best care plans)

Plans - strongly beliefs, ideals, principles, or standards that inform ethical decisions or
actions. This includes the Vital Signs Medical Center “High Five Guiding Principles”
(Delivering high quality patient care, supporting physicians and nurses, creating excellent
workplaces for our employees, taking leadership role in our communities, and ensuring fiscal
responsibility).

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 8 of 36
Part 2: Foundations for Ethics in Healthcare:

Common Ethical Values, Principles and Duties:

Certain ethical concepts apply across a healthcare organization, to both clinical and
organizational ethical issues, creating a common foundation for ethical decision-making.
These common foundations include:

§ Mission, Vision and Values : These are the foundations for building ethical actions,
systems, and culture.

Vital Signs Medical Center MISSION:

§ Providing patient-centered healthcare with excellence in quality, convenient


services, cost-effective and accessible; and making our local communities healthier
by assuring that each patient receives individual, personal attention and by building
up a long-term, partnering relationships built on trust and mutual respects.

§ We are committed to continuously educating ourselves and incorporating the best


of technology to provide excellent care.

§ We believe in the Islamic ethical practice in our relationship with patients,


employees, the services provide, merchants and competitors.

Vital Signs Medical Center VISION:

We work to be trusted by patients, a valued partner in the community, and creators of positive
change by creating a medical place where:

§ People choose to come for healthcare.

§ Physicians want to practice.

§ Employees want to work.

We believe that providing high quality, accessible healthcare is our reason for being. We seek
to be a model for other community health centers.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 9 of 36
Vital Signs Medical Center VALUES:

“High five guiding principles”

Delivering high quality patient care: we treat all patients based on


firm principles
“Safety” and “Honesty”.

Supporting physician and nurses: we will be creative and open to


new ideas and opportunities.
“Inclusions” and “Innovative”

Creating excellent workplaces for our employees: we will act with concern for the
well - being of every person.
“Teamwork” and “Compassion”

Taking a leadership role to our communities: “Respect” and “Dignity”


”Excellence” and “Efficiency”

Ensuring Fiscal Responsibility : We will treat every person with


dignity and courtesy.
“Integrity” & “Trustworthiness”
“Legal” & “Ethical Compliance

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 10 of 36
§ Legislation:

Vital Signs Medical Center conducts its clinical practice, business in compliance with the
spirit and letter of laws regulating the administration of business and the provision of
healthcare. Where there is uncertainty about the application or relevance of law in a
particular circumstances, appropriate legal consultation and review is sought.

§ Relationships, Teamwork’s, and Communications:

The Relationship Centered Care model acknowledges and values interactions with and
between staff, patients, family members, students, volunteers, and others. Everyone,
whatever their job, has a leadership role in developing a healthy relationship and promoting
positive experiences. All those involved in and affected by ethical decision-making should
be encouraged to express their points of view, ask questions, and raise concerns, within
the appropriate limits of privacy and confidentiality. The perspectives of all stakeholders
should be sought and considered with respect. To avoid misunderstanding or confusion,
team members should make their communications direct, with respect and consistent, and
must verify the information to avoid conflicts: silence should not be assumed to indicate
agreement. Disagreements between team members should not be aired in front of the
patients/ families or parties external to the conflict. Vital Signs Medical Center Values-
Based Code of Conduct identifies that a core competency of all employees and physicians
is to engage in respectful communication and teamwork in daily practice.

§ Veracity and Fidelity:


It is commonly agreed that we have a duty of veracity, i.e., a duty to tell the truth and not to
lie to or deceive others, a related duty is one of fidelity, which means the keeping of
promises, both implicit and explicit. These duties should support relationships between
healthcare providers and patients/clients, as well as between managers and staff. A duty
of truthfulness is part of the respect we owe to those in our care and our employ. It’s implicit
in our dealings with all persons that we will honor our responsibility to keep our promises.
Lying fails to show respect for persons and their autonomy, violates implicit contracts, and
threatens relationships based on trust.

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§ Utility or the “Greater God”:
The principle of utility is about making the best use of available resources, trying to provide
the greatest good for the greater number. This requires thinking about the possible
consequences or outcomes of our actions and decisions and working towards maximizing
good consequences or outcomes while mitigating possible negative consequences
especially vulnerable parties like patients.

§ Justice:

The principle of justice demands that people be treated fairly and without prejudice, equals
ought to be treated equally, but unequal treatment is justified considering morally relevant
differences, such as those pertaining to needs (e.g., when critically ill patients are treated
first because the risk of harm or impending death is greater than those with less acute
illnesses) or likelihood of benefits (e.g., published evidence of effectiveness). Justice is
also about promoting equity. Often by providing resources for improvement especially the
most vulnerable members of the society (the poorest or sickest).

§ Organizational Justice:

Fairness in the workplace, especially that the ethical basis of decision-making process and
all means in which allocation decision are made.

Organizational Justice if Grounded in Three Principles:

Procedural Justice: The perceived fairness of decision-making processes. Fairness


entails those decision-making processes meaningfully include all relevant stakeholders;
that accountability for decisions is clear at the outset; the decisions are made based on
valid reasons (e.g., evidence, principles, and arguments) that "fair-minded" people can
agree are relevant under the circumstances; and those decisions are communicated
transparently and promptly.

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Relational Justice: The perceived quality of the interactions among individuals involved
in or affected by the decisions. Quality interactions entails that the different opinions are
valued and encouraged; everyone is responsible for communicating respectfully and all
interactions are supported by Vital Signs Medical Center Code of Conduct.

Distributive Justice: The perceived fairness of decision outcomes. Fairness of outcomes


is consistent with reasonable and defined criteria; recognition and rewards are distributed
equitably; and outcomes of decisions are evaluated and improved.

§ Confidentiality and Privacy:

Healthcare workers and Vital Signs Medical Center as an organization are obliged to keep
the information about their patients confidential and to only access confidential information
that is required for the performance of their duties. This obligation is evaluated and
improved. Confidentiality provides a foundation for trust in the therapeutic relationship.
Without an understanding that their disclosures will be kept secret, patient may withhold
relevant personal information, and thus may be denied important treatments. Additionally,
patients and their legal guardian have the right to control the use of dissemination of
personal information. At times, law and policy offer clear guidance to healthcare workers
regarding acceptable exceptions to confidentiality at other times, workers best judgment
must be used in consultation with appropriate resources:

Reasonable exceptions to the duty of confidentiality include the following situations /


conditions:

a. The duty to protect children by reporting disclosures and / or suspicions of child


abuse.

b. The need to ensure the safety of clients who are a danger to themselves or others.

c. The legal subpoena of client records to a court of law.

Managers and colleagues also owe a duty to staff to honor their privacy by not disclosing
or discussing confidential information.

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§ Virtue and Reflective Practice:

Virtue ethics is concerned with the characteristics and qualities of being an ethical person,
A good practitioner is one who has the necessary knowledge, judgment, and technical skills
to be competent; but who also displays moral excellence by demonstrating certain virtues
(such as kindness, empathy, tact, and courtesy) derived from a sense of "ought” rather than
"must”. Individuals should be encouraged to reflect on the kind of person or professional
they wish to be and what is required of them when ethical issues are identified.

In addition, self-reflection on how one's cultural/personal/religious values and professional


training influence one's motives and behavior is essential to the critical analysis of ethical
dilemmas.

§ Respect for Diversity and Contacts:

Culture is not simply understood as ethnicity but rather the idea that all of us 'have culture'
and that we live in communities in which there are shared systems of meaning and
understandings of the person in society, Narratives or stories can be extremely valuable to
provide a better understanding of the persons involved in ethical dilemmas and their
contexts. Attending to context also requires attending to oppression the basis of race,
class, gender, and ability, among other factors and, the effects of oppression on health
status and health care. Case-based approaches to ethical analysis support this idea that
"moral problems must be resolved within concrete circumstances, in all their interpretive
complexity, by appeal to relevant historical and cultural traditions, with reference to critical
institutional and professional norms and virtues."

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§ Clinical Ethics: Principles, Values and Duties:
Healthcare providers are bound to practice conscientiously, in accordance with their own
Code of Ethics and practice standards as set out by Saudi Council for Health Specialties.
The following principles and values are featured among others in the ethics of the medical
profession guide issued and the Saudi Council for Health Specialties and are relevant to
many patient-specific clinical ethical dilemmas.

§ Therapeutic Relationship (Fiduciary Duty):


The therapeutic relationship is the foundational principle of ethical patient care. Good
therapeutic relationships sure founded on mutual trust and respect between providers and
recipients of care. When care providers lose this sense of mutuality, they become mere
technical experts and the human quality in the relationship is lost. When persons receiving
care lose this sense of mutuality, they experience a perceived or real loss of control and
increased vulnerability because persons receiving care are often weakened by their illness
and may feel powerless in the health care environment, the primary responsibility for
creating a trusting and respectful relationships rest with the care providers. The special
obligation health care professionals must safeguard the interests of their patients is
sometimes referred to as “fiduciary duty”.

§ Patient and Family Centered Care (Respect for Patient Autonomy):


Capable patients have a right to autonomy or self-determination; that is, to not have
treatments imposed upon them. The needs, values, and preferences of the person receiving
care should be the primary consideration in the provision of qualifies health care.
Sensitivity to and understanding of the needs and preferences of patients, is the
cornerstone of a good therapeutic relationship. These needs and preferences are diverse
and can be influenced! by a range of factors including cultural, Religious, and
socioeconomic backgrounds, Patient­ and Family-Centered Care at Vital Signs Medical
Center entails the commitment to communicate effectively with patients, along with family
members and friends who have been designated by the patient, to collaborate with them in
planning and implementing treatment, and to respond to their needs and concerns. Patients

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have a right to confidentiality; thus, it should be up to them whether they choose to involve
their family members or others in health care decision-making.

Patient- and Family-Centered care does not mean that patients or members of their families
have a right to demand treatments that fall outside standards of practice. Treatment plans
are negotiated between patients / families and healthcare care professionals, balancing the
principles described below.

§ Informed Consent:
Health care providers have a responsibility to ensure that capable patients have an
opportunity to be involved in decisions regarding their care. Patients are empowered to make
treatment decisions by being informed about their diagnosis and prognosis, reason able
options, the harms and benefits of each option, and the consequences of not having
treatment. Patients should be provided with the necessary support, time, and opportunity to
participate fully in discussions regarding care. Capable patients may also choose to
designate someone else to make decisions on their behalf.

A patient legal guardian makes decisions for a patient who lacks capacity to consent. The role
of the patient legal guardian is to protect the autonomy, rights, and interests of the patient; to
speak for the patient when he/she can’t speak. The patient legal guardian is responsible to
make decisions in accordance with the known preferences, wishes, values, beliefs, and goals
of the patient. The capable patient or legal guardian has the right to refuse, or withdraw
consent to any care treatment, including lifesaving or life-sustaining treatment.

§ Beneficence and Best Interest:


The primary goal of health care is to provide benefit and prevent harm to person receiving
care. The capable patient generally has the right to determine what constitutes benefit or
quality of life to him/her in each situation, including physical, psychological, spiritual, social,
or other considerations. When a patient is not capable to make his/her own decisions, and no
applicable wishes relevant to the circumstances are known, health care decisions should be

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made in the patient’s best interests. Best interests are determined through joint decision
making between legal and health care professionals. Best interests incorporate several
considerations, including whether treatment options meet the following criteria.

a. Support the patient’s known wishes, beliefs, goals, and values.

b. Improve the patient’s condition well-being.

c. Prevent the patient’s condition or well-being from deteriorating.

d. Cause pain or suffering to the patient.

e. Entail risks harm that outweigh the potential benefits.

§ Conscientious Objection:
Healthcare providers should not be expected or required to participate in procedures that
are contrary to their professional judgment or against deeply held personal values and
beliefs. Healthcare providers should proactively identify situations that are likely to conflict
with their strongly held personal values and beliefs and speak to their manager proactively
about how to balance their personal and professional obligations in these situations. While
healthcare providers should be supported to exercise conscientious objection where they
are asked to participate in procedures or practices that conflict with their own moral values
or professional judgment, doing so should never pull the patient receiving care at risk of
harm, abandonment, or disparagement. Appropriate referrals or transfer to another
practitioner willing to provide the care (where possible) should be facilitated to mitigate risk
to the patient.

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Part 3: The Ethical Decision - Making Process:
Values permeate everything we do in a health care setting and sometimes these values come
into conflict; when they do, it is imperative to recognize that one is experiencing an ethical
dilemma. Ethical conflicts or dilemmas are usually best resolved through direct engagement
with the parties involved. Often there will not be an answer that pleases everyone and so it is
our responsibility to ensure that our processes for decision-making are fair and legitimate.
This tool is designed to help you think through difficult decisions-when ethics is a factor-and
develop justifiable reasons for your chokes in a rigorous, transparent, and fair manner.

This process is captured in the acronym ISSUES:

1. I dentify issue and decision-making process.


2. S tudy the facts.
3. S elect reasonable options.
4. U nderstand values and duties.
5. E valuate and justify options.
6. S ustain and review the plan.

When we encounter ethical dilemmas our first instinct may be to find a quick fix; however, our
desire for resolution may cause us to misidentify the key issues or overlook. Important facts,
values, or stakeholder voices. Ethical decision-making starts with a strong foundation based on
a clear understanding of the nature of the problem and all relevant facts and perspectives,
before deciding on options, weighing those options, and making the decisions seen in Figure 3.

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Ethical Decision – Making ISSUES

Sustain and Review the Issues

Select reasonable Understand values Evaluates and


options and duties justify options

Study the facts

Identify issue and decision making process

FIGURE 3

All Staff, physicians, learners and Management and Administrative members are
encouraged to use this process methodology to initiate a review process for an ethically-
troubling situation. Two worksheets have been develop to help individuals and teams put
this process into action. The Organizational Ethics Worksheet has been designed to help
address any ethical issue that arises from a system or situation that is not patient-specific.
The Clinical Ethics Worksheet is tailored for use healthcare professionals and teams to
address patient-specific ethical dilemmas.

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§ Guidelines for Using the Ethical Framework with Groups:
Creating a forum where stakeholders have the opportunity to engage in a collaborative
discussion about a particular dilemma or situation in an open and non-threatening
environment is often the most efficient way to address an ethical issue.

1. It is important to define at the outset of a meeting certain aspects of the process, to


increase transparency, participation and satisfaction, including:

ü Ground rules (i.e., everyone gets to speak uninterrupted, confidentiality of


discussion, respectful interactions, etc.).

ü Roles for the meeting (i.e., chair, time-keeper, recorder).

ü Objectives and outcomes (i.e., the generation and analysis of reasonable options;
documentation and communication plan for the decision).

ü The decision-making process (i.e., how stakeholders’ feedback will be used and
who is ultimately responsible for making the decision).

2. The appropriate worksheet (Organizational or Clinical) may be distributed to all


participants to help keep the process on track, it should be worked through one
section at a time, recognizing that ethical decision-making is not always linear. You
may have to go back and revisit earlier steps in the process as additional questions
arise or facts emerge.

3. Keep a copy of this toolkit handy, to provide a quick reference for key terms and
concepts.

4. At the end of the meeting, summarize each section of the worksheet briefly. Define a
clear plan for documenting and communicating any decisions made and assign
specific individuals to accomplish next steps. As required, a follow­ up meeting should
be scheduled to review outcomes and address systems issues identified.

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Organizational Ethics ISSUES
PROCESS TIPS

1. IDENTIFY: the Ethical Issue and Decision-making Process:


§ Engage in reflective practice and consider your “gut reaction” to the situation. What
preconceptions and judgements might you bring to the situation? What are your
loyalties and institutions? Where do these come from?

§ State the conflict or dilemma as you currently see it. Try to articulate the issue in
one sentence. If you can’t, it may be better to break the problem down into two
questions or issues and tackle them one at a time. Example of ethics question:
“Given (state uncertainty or conflict about values). What decisions or actions are
ethically justifiable?

§ Determine best process for decision-making: How urgent is the situation? How can
stakeholder’s best be engaged? Who ultimately has decision-making authority?
Stakeholders deserve to know and understand how and why a decision that affects
them was made. It is important to remember that transparency is not just about the
transmission of information; it is also about keeping people engaged constructively
in the process. In the rare cases where confidentially is ethically necessary, the
process should still be made as transparent as possible while identifying the
confidentially constraints explicitly.

2. STUDY the Facts:


In any complex situation, different parties will have different views of tine facts of the
situation. Ideally, all stakeholders should have a chance to present their views to one
another in a respectful, open environment, considering both the context of the
situation and the evidence.

Stakeholder Perspective: all stakeholders should have an opportunity to voice their


views about the issue (staff, community, patients, etc.).

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Evidence: include risks and benefits to the organization and patients; impact of
situation on quality or services; best practices, etc.

Contextual Features: internal and external directives and partnerships legal


considerations past cases; cultural or environmental issues (i.e. staff morale); public
opinion.

Resource Implications: human and financial.

3. SELECT Reasonable Options:

Always look for more than two options, try brainstorming options without evaluating at
first, or start by describing your “ideal solution” and work backwards to options that
sure more realistic given the context.

4. UNDERSTAND Values and Duties:

ü Which values are in conflict? Where values may be compromised, what can you do
to minimize the negative impact?

ü Are there professional or legal obligations or standards to consider?

ü Consider how various options reflect or support the duties, principles and values
described in Part 2.

5. EVALUATE and Justify Options:


For each option consider:
ü What are possible harms to various stakeholders?

ü What are the probable benefits to various stakeholders?

ü What will be the impact on staff our mission and quality of care?

ü Which duties, principles and values support this option?

ü What if everyone in these circumstances did this? (Does this set a good
example? Are we making it easier or harder for others to do the right thing?).
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ü Does it meet organizational justice requirements, procedural justice,
distributive justice, and relational justice?

ü Does your solution answer the question you described above?

ü Choose the option with the best consequences overall and closest alignment
with key duties, principles and values.

ü Clearly state reasons for the decision, Remember that you are not aiming at "the
perfect" choice, but a good and defensible choice under the circumstances.

ü Anticipate how you might answer criticisms.

6. SUSTAIN and Review the Plan:

Accepting responsibility for an ethical choice means ensuring that the decision made
is enacted by articulating a clear plan of action, communicating it to stakeholders
appropriately and addressing systems that might have contributed to the problem. It
also means accepting the possibility that you might be wrong or that you may need to
revise your decision in light of new information or changing circumstances. In reviewing
the plan consider:

ü How well did the decision-making process work?


ü Was the decision carried out?
ü Was the result satisfactory?
ü Does this situation point to a systems problem (e.g., Policy gap)?
ü What lessons were learned from the situation?
ü How will the team respond to similar situations in the future?
ü Are there opportunities to appeal or modify the decision based on new
information?
ü Have new questions emerged? (If so, do they require similar deliberation?)
ü Is there a formal evaluation plan in place to monitor progress, good practices,
and opportunities for improvement?

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ORGANIZATIONAL ETHICS WORKSHEET
ISSUES

This worksheet is designed to help people engage in rigorous ethical decision-making


regarding organizational issues. Ethical decision-making is not linear; you may have to revisit
earlier steps in the process as additional questions arise or facts emerge.

1. IDENTIFY Issue and Decision-Making Process:


ü Engage in reflective practice: what is your gut reaction?

ü State the question or dilemma as you currently see it: "Given [state uncertainty or
conflict about values], what decisions or actions are ethically justifiable?"

ü Determine best process for decision-making and key stakeholders.

2. STUDY the Facts :


ü The perspectives of all stakeholders should be considered, as well as the context
of the situation and relevant evidence.

Stakeholder Perspectives: Evidence:


Staff, patients, community, partners, Risks, benefits, impact on quality or
etc. services, and best practices

Resource Implications: Contextual Features:


Internal and External Directives, legal
Human and Financial
consideration, past cases, cultural
issues

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3. SELECT Reasonable Options :
ü What are the realistic options? (Look for more than two).

Alt 1

Alt 2

Alt 3

4. UNDERSTAND Values and Duties :


ü What principles, duties and values are relevant to the options (See part 2 of Ethical
Framework)

ü What are the relevant legal requirements, professional standards and policies?

ü Are key values, duties, principles or standards in conflict?

Vital Signs Medical Center Mission, Vision and Values, Legislation,


Vital Signs Medical Center Policies, Utility and Justice, Veracity,
Confidentiality and Privacy, Relationships and Teamwork, Virtues,
Respect for Diversity

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5. EVALUATE and Justify Options :

ü What are the possible harms / benefits to various stakeholders of various options?

ü Choose the option with best consequences and alignment with duties, principles,
and values.

ü State clear reasons for your choice, anticipate questions and criticisms.

Alt 1

Alt 2

Alt 3

6. SUSTAIN and Review Plan :

ü Identify how best to implement, communicate and document the decision to meet
Organizational Justice principles (procedural justice, distributive justice, relational
justice).

ü Reflect on the decision and the process. What lessons could be learned for future
cases?

ü Does this situation point to a systems or organizational cultural problem (e.g., policy
gap)?

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CLINICAL ETHICS ISSUES
PROCESS TIPS

1. IDENTIFY the Ethical Issue and Decision-Making Process:

ü Engage in reflective practice and consider your "gut reaction" to the situation:
What preconceptions and judgments might you bring to the situation?
What are your loyalties and intuitions?
Where do these come from?

ü State the conflict or dilemma as you currently see it:


Try to articulate the issue in one sentence. If you can't it may be better to break the
problem down into two questions or issues and tackle them one at a time.
Example of ethics question: "Given [state uncertainty or conflict about values],
what decisions or actions are ethically justifiable"?

ü Identify stakeholders: Who will be impacted by the decisions made? Who ultimately
has decision-making authority? In clinical ethics the key stakeholder is the patient
affected by treatment decisions and his/her family; how can they be engaged in the
process?

ü Determine best process for decision-making: How urgent is the situation? How can
stakeholder’s best be engaged? Stakeholders deserve to know and understand how
and why a decision that affects them was made. It is important to remember that
transparency is not just about the transmission of information; it is also about
keeping people engaged constructively in the process. In rare cases where
confidentiality is ethically necessary, the process should be still made as
transparent as possible while identifying the confidentiality constraints explicitly.

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2. STUDY the Facts:
In any complex situation, different parties will have different views of the facts of the
situation. Ideally, all stakeholders should have a chance to present their views to
one another in a respectful, open environment, considering both the context of the
situation and the evidence:

A. Clinical Issues:
ü What are the patient’s medical history/ diagnosis / prognosis?

ü Is the problem Acute? Chronic? Critical? Emergent? Reversible?

ü What are the goals of treatment? What are the probabilities d success?

ü What are the risks and side effects of treatment?

ü What is the standard of practice? What does the evidence say?

B. Patient and Family Preferences:

ü What has the patient expressed about preferences for treatment? What are
the patient's long and short term goals?

ü Is the patient capable of making treatment decisions? What is the evidence


of incapacity?

ü If the patient is not capable, who is the patient's Substitute Decision Maker
(SDM)? Is the SDM making decisions appropriately, based on patient wishes
and best interests?

ü If the patient is now incapable, is there any information regarding what the
patient might have wanted given the current circumstance? What kind of
values did he or she have? How did he or she live her life? What kind of
person was the patient? What kind of values did he or she have? Have did he
or she live her life? What seemed most important to him or her?

ü What are the family’s needs and wishes?

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C. Quality of Life:
ü What are the prospects, with or without treatment, for a return to the patient’s
normal life?

ü Does the patient seems to find his or her daily life satisfying?

ü What gives him or her pleasure and meaning?

ü What suffering or burdens might the patient experience from the treatments
proposed?

ü How can the patient be made most comfortable? How can the patients
psycho-social and spiritual needs be the best met?

D. Contextual Features:
ü Who is the patient's family? What are the perceived family dynamics?

ü Who speaks for the family? Is there conflict amongst family members? Are
there cultural, religious or social factors that might influence treatment
decisions?

ü What is the relationship between the patient/family and team?

ü Are there team issues that might influence decisions?

ü Are there organizational or systems issues complicating the situation?

3. SELECT Reasonable Options:


ü Always look for more than two. Try brainstorming options without evaluating at
first or start by describing your ideal solution and work back ward to options that
are more realistic given the context.

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4. UNDERSTAND Values and Duties:
ü Which values are in conflict? Where values may be compromised, what can you
do to minimize the negative impact?

ü Are there professional obligations or standards to consider?

ü Consider how various options reflect or support the duties, principles and values
described in Part 2.

5. EVALUATE and Justify Options:


For each option consider:

ü What are the possible harms to the patient? To other stakeholders?

ü What are the probable benefits to the patient? To other stakeholders?

ü Which duties, principles and values support this option?

ü What if everyone in these circumstances did this? (Does this set a good example?
Are we making it easier or harder for others to do the right thing)?

ü Does your solution answer the question you described above?

ü Choose the option with the best consequences overall and closest alignment with
key duties, principles and values. Clearly state reasons for the decision. Remember
that you are aiming at “the perfect” choice, but a good and defensible choice under
the circumstances.

ü Anticipate how you might answer criticisms.

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6. SUSTAIN and Review the Plan:

Accepting responsibility for an ethical choice means ensuring that the decision
made is enacted by articulating a clear plan of action and communicating it to
stakeholders appropriately. It also means accepting the possibility that you might
be wrong or that you may need to revise your decision in light of new information or
changing circumstances. In reviewing time plan consider:

ü How well did the decision-making process work?

ü Was the decision carried out?

ü Was the result satisfactorily?

ü Does this situation point to a systems problem (e.g., policy gap)?

ü What lessons were learned from the situation?

ü How will the team respond to similar situations in the future?

ü Are there opportunities to appeal or modify the decision based on new


information?

ü Have new questions emerged? (If so? do they require similar deliberation?).

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CLINICAL ETHICS WORKSHEET
ISSUES

This worksheet is designed to help people engage in rigorous ethical decision-making for
specific patient cases. Ethical decision-making is not linear; you may have to revisit earlier
steps in the process as additional questions arise or facts emerge.

1. IDENTIFY issue and decision - making process:


ü Engage in reflective practice: what is your gut reaction?

ü State the conflict or dilemma as you currently see it. "Given (state uncertainly or
conflict about values), what decisions or actions are ethically justifiable?

ü Determine best process for decision-making and key stakeholders.

2. STUDY the Facts:

ü Not only the medical facts are important, bad also the patient's goals, wishes and
perception of quality of life, as well as the information about their family, background
and organizational issues,

Clinical Issues: Patient and Family Preferences:


History, Diagnosis, Prognosis, Options Long and short term goals, wishes values .

Quality of Life: Contextual Features:


Patient’s view of QoL, benefit, suffering Family, cultural and religious belief,
organizational issues.

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3. SELECT Reasonable Options:

ü What are the realistic alternatives, care plans or treatment options? (Look for more
than two).

Alt 1

Alt 2

Alt 3

4. UNDERSTAND Values and Duties:


ü What principles, duties and values are relevant to the options (See Part 2 of Ethical
Framework)?

ü What are the relevant legal requirements and/or professional standards?

ü Are key values, duties, principles or standards in conflict?

Informed Consent: Beneficence and Best Interest, Utility and Justice,


Patient and Family Centered care, Therapeutic Relationship, Veracity,
Vital Signs Medical Center Mission, Vision and Values, Confidentiality
and Privacy.

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5. EVALUATE and Justify Options:

ü Consider the possible harms and benefits of each option for the patient and other
key stakeholders.

ü Choose the option with best consequences and alignment with duties, principles
and values.

ü State clear reasons for your choice; anticipate questions and criticisms.

Alt 1

Alt 2

Alt 3

6. SUSTAIN and Review the Plan:

ü Identify how best to implement, communicate and document the decision to patient
and key stakeholders.

ü Reflect on the decision and the process. What lessons could be learned for future
cases?

ü Does this situation point to a systems problem (e.g., policy gap)?

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Part 4: Ethics Resources at Vital Signs Medical Center:

Clinical Ethics Resources


Vital Signs Medical Center Clinical Ethics program is uses a “Hub and Spoke” structure
to deliver Clinical Ethics Services, including ethics policy review, ethics consolation and
ethics educations. This approach strengthens staff capacity in clinical ethics by providing
decentralized resources coordinated by a centralized core of ethics leadership. The Hub of
Clinical Ethics at Vital Signs Medical Center is comprised of the Ethical Committee Chairs.
The spokes are head of the Departments, Medical Director, Quality Director and Quality
Department staff. The Central Hub supports and collaborates with ethics Spokes throughout
the organization, to integrate ethical awareness and practices across the organization.

Organizational Ethics Resources


Organizational Ethics resources at Vital Signs Medical Center are decentralized, Staff,
physicians, learners, and Administration encountering an ethical dilemma are encouraged to
consult with a range of ethics-related resources across the organization appropriate to tine
specific issue. Some of these resources are seen in Figure 4.

Saudi Council
for Health
Specialties
Office

Medical Center
Ethical
Legal
Committee Representative

Ethical
Issues

Human
Q.I.
Resources
Member
Consultant

Reference: VS-APP-00145-06 APP - 006


FIGURE 4 ATTACHMENT A
Page 35 of 36
REFERENCES:

1. Global Health Ethics Key Issues, World Health Organization, 2015.


2. HHS Ethics Frame Work, 2010.
3. National Center for Ethics in Health Care, US Department of Veterans Affairs.
4. Code of Ethics for Healthcare Practitioners, Saudi Commission for Health Specialties,
Riyadh, 2014.

Reference: VS-APP-00145-06 APP - 006


ATTACHMENT A
Page 36 of 36
TERMS OF REFERENCE

ETHICS COMMITTEE

1.0 PURPOSE:

1.1 The Ethics Committee promotes a systematic approach to ethical decision


making that is consistent with the medical center’s mission and values,
ethical code of behavior, laws and regulations, and patient’s preferences
and culture of Saudi Arabia.

2.0 TEAM CATEGORY:


[ X ] Standing [ ] Ad Hoc [ ] Task Force

[ X ] Medical Affairs [ X ] Administration

3.0 REPORTING RELATIONSHIP:


3.1 The Chair of the Committee reports to the CEO.

4.0 FREQUENCY OF MEETING:


4.1 The Committee shall meet when required.

5.0 DUTIES AND RESPONSIBILITIES:


5.1 Provides organizational guidance and oversight to ensure compliance with
the code of ethics.

5.2 Recommends new or revise policies and guidelines regarding ethical issues.

5.3 Provides an ethics consult service to clinicians, patients, and families.

5.4 Conducts case reviews with respect to ethical issues.

Reference: VS-APP-00150-06 APP - 006


ATTACHMENT B
Page 1 of 4
5.5 Identify ethical issues within the medical center and make recommendation
for change.

5.6 Provides direction regarding education related to ethical issues.

5.7 Serves as a resource for the medical, nursing, and allied staff, patients, or
families, in dealing with ethical questions related to treatment, medication,
sterilization, termination of pregnancy, emergency cases, DNR application,
and care vulnerable patients.

6.0 MEMBERSHIP:

Medical Director/CEO/General Manager Chairman


Quality Improvement Director: Member
Administrative Manager Member
Clinical Support Manager Member
Legal Advisor Member

7.0 QUOROM AND COURSE OF ACTION:


7.1 The Ethics Committee convenes at a quorum consisting of 50% of the total
number of members plus the Chairman.

8.0 MEETING MINUTES:


8.1 Written agenda will be circulated to committee members one week before
the scheduled meeting if required.

8.2 All minutes, records, and reports of the Committee will be maintained and
available to members of the Ethics.

8.3 Minutes are distributed via electronic mail to CEO/Medical Director, Q.I.
Director, and committee members.

Reference: VS-APP-00150-06 APP - 006


ATTACHMENT B
Page 2 of 4
9.0 REVIEW AND EVALUATION:
9.1 The committee evaluated the committee’s function annually and forwards it
to the CEO.

10.0 REVISION:
10.1 This Terms of Reference will be reviewed every two (2 years) and revised as
needed.

Reviewed by:

Prepared By:

Name: John P. Anastacio, MAN, RM, RN Designation: Medical Site Services Supervisor

Signature: Date: 03-Oct-2021

Approved By:

Name: Engr. Khalid Turki Al Otaibi Designation: Chief Executive Officer (CEO)

Signature: Date:

Reference: VS-APP-00150-06 APP - 006


ATTACHMENT B
Page 3 of 4
ATTACHMENT:

CURRENT MEMBERS

General Manager / Medical Director:


Chairman
Dr. Fayhan Mohammed Al Otaibi

Chief Executive Officer:


Member
Engr. Khalid Turki Al Otaibi

Clinical Support Manager:


Member
Mr. Ibrahim Bakhit

Administrative Manager:
Member
Ms. Amjaad Aljloud

Medical Coordinator:
Member
Dr. Hamood Abdullah Alkuhlani

Legal Advisor:
Member

Reference: VS-APP-00150-06 APP - 006


ATTACHMENT B
Page 4 of 4

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