Ethics is defined as a set of moral principles which clarify what is morally right and what is morally wrong and also has been described as the science of morals and rules of conduct recognized in human life.(1)
Health professional ethics is concerned with moral principles, values and standards of conduct related to health care services(2). Adherence to professional ethics is the commitment of health professionals to treat their client without discrimination based on race, age, color, religion, ethnicity, national or social origin, sex, handicap and source of payment or other status(3). Other ethical concerns related to health care delivery in clinical setting are professional integrity, confidentiality, respect, compassionate, equality and equity (2, 4, 5).
Researches revealed that factors like lack of proper information among patients on health service provision, weak supervision and poor complaint mechanism contributes for the health professions poor adherence to ethics in developing countries(6, 7).
Health care providers need an awareness of professional ethics more than ever before. Because adherence to professional ethics by health care workers is one of the most critical aspects of quality health service delivery as it involves the way service providers interact with service users(4, 5, 8). Unethical behaviors among health professionals affects the accessibility of quality health services as it creates conflict in the relationship between health workers and health service users(3, 9).
In other words, non-adherence to professional ethics by health workers do not only affect the quality of services citizens receive but also erodes the reputation of health professionals and all other officials in the health system. Such a negative perception may further hinder the people’s access to public health services(3, 10). Health care should be safe, effective, patient-centered, timely, efficient and equitable. These requisites of quality care are not only synergistic with ethics, but ethical concepts and reasoning are the foundation behind most current definitions of healthcare quality(4, 8). A patient centered approach to healthcare means providing a respectful patient’s preferences and values through a shared decision make process. Such an approach is based on the ethical principles of autonomy and self-determination and is delineated in most healthcare organizations’ ethical standards of practice, an informed consent policy(3, 11).
Encouraging health professionals to behave more empathically and less formally with their patients’ needs identification of potential factors affecting their behavior in the health care setting. Therefore the primary objective of this study is to assess adherence of professional ethics among health professionals and identify factors associated with health professional ethics in hospitals found in Bale zone.
The patient has the right to self-determination, to make free decisions and the physician will inform the patient about the consequences of his/her decisions(2, 8, 20). Despite this most health care providers don’t provide informed consent for their patient. For instance one cross sectional study conducted among Iranian midwives shows that 87% of the pregnant mothers never received any information about the type of the childbirth, the advantages/disadvantages of different childbirth methods, their rights during pregnancy and childbirth after delivery.(25)
Providing the best possible care to the patients in the most ethical manner may find it difficult to balance the right to information with the need to avoid information overload(11). One challenge is how much information is adequate and how should complex medical information be communicated to patients who may be frightened or feeling ill, and may have trouble assessing risks, benefits and alternatives. Even, not all patients want a great deal of information. Some may prefer to trust their health provider to do what is best for them(12, 21). It is also common for health care professionals to clash with the family of the patients for whom they care over treatment decisions(22).
Confidentiality is also both an ethical and a legal issue. Keeping information about a patient confidential is a way of showing respect for the person’s autonomy. Because there is wide agreement that people have the right to control who has access to their information about them(11, 21, 24). In another way, the ability to provide high quality medical care depends on patients feeling free to communicate fully and truthfully with their caregivers. Furthermore, individuals could face stigmatization and discrimination if certain medical information, such as about sexually transmitted diseases or mental illness, is not carefully protected(12, 14). Therefore, all identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind, must be kept confidential, even after death(11, 26). A cross sectional study conducted among Nepalese nurses and a doctor shows that only 2.5 % doctors and 11.6 % nurses agreed that adhering to confidentiality of patients is important(27).
Therefore, medical ethics must be understood as an essential branch of general ethics, offers a valuable framework in which to define the norms for medical care(28). Thus, medical ethics is concerned with promoting health and medicine and clarifying norms for improving relationships between patients and health professionals(2, 12). Because, the statements of medical ethics require the health professional to do what is best for the patient and place the patient's interests before their interests. Above all, the purpose of medical ethics is to protect and defend human dignity and patients’ rights(13, 14). Despite this a report in Tanzania health facilities shows that 1 of 4 people in need of health services in these areas are routinely asked to give bribes(5).
Just like other public servants in Ethiopia, health workers are also bound by the legal and and ethical requirements. Basically, the act and codes of Ethics urge all health workers to avoid unethical practices in their working environment (29).Despite the presence of the act and codes of Ethics, incidents of failure to observe professional ethics continue and are particularly pronounced in Ethiopia calling for an end to these malpractices. The government, on its part, has been vainly promising to address the problem through imposition of tough measures against anyone found misbehaving(3, 29).
A Score Card Report on 45 Health Facilities in Tanzania reveals factors like unavailable or non-functional hospital ethics committee, weak supervision and poor management exacerbates poor adherence to professional ethics(5).
The problem of substance use has been common among health professionals due to their proximity to those drugs. It highly affects the medical practice and patient’s safety. A study conducted in Jimma University among medical interns shows that 48.4% of them used substance in their life time(32, 33). Another study in western Amhara region shows that Professionals who drank alcohol were more likely to be dissatisfied by their job(34).
Health professionals that are more knowledgeable and have favorable attitude tend to have good ethical practice. A study conducted among doctors in Addis Ababa showed that knowledgeable medical doctors were more likely to have good practice of code of ethics and having good practice of code of ethics among medical doctors with favorable attitude were 7.404 times the odds of those with unfavorable attitude towards code of ethics(18).
For years, unethical behavior among health workers in Ethiopia has been reported and discussed by various stakeholders including the media, members of parliament, community leaders as well as institutions.
Generally Non-adherence to professional ethics among health workers, not only affect the whole process of accessibility and provision of quality health services to citizens, but also tarnishes the reputation of health professionals and all other officials in the health system. This situation must not be tolerated any further and must be eliminated at all costs.