Ethics covers both what ought to be done and what must be done in a kind, considerate, and respectful way [1]. Generally, the study of morality and ethical principles that are accepted in daily life, known as ethics, aims to establish what is ethically good and wrong in human behavior. Medical ethics analyses ideas, assumptions, beliefs, attitudes, emotions, reasoning, and arguments behind medico-moral making decisions [2]. The professionalism of the medical staff is a crucial component of the ethical framework that governs healthcare [3]. Healthcare ethics mirror local legislation while economic and societal factors can influence ethical behavior. Medical professionals are mandated to act in patients' best interests, which strengthens the impact of assessing their mental and physical health conditions during healthcare provision in both the public and private sectors. This is stated in the Geneva Declaration of the World Medical Association and the International Code of Medical Ethics [4].
The ethical behavior of healthcare workers has been a subject of significant public concern. This is often reflected in complaints about unethical behavior and a rise in legal action against healthcare professionals. Informed consent, non-disclosure and deceptions, patient confidentiality, death determination, doctor-patient interaction, sexual contact between professionals and clients, drug company gifts, and research/publishing misconduct are common ethical dilemmas, especially for physicians. Bioethics, the burgeoning area of medical ethics, addresses such ethical concerns [5, 6]. In addition to endangering doctor-patient relationships, failing to follow healthcare ethics and handling situations inadequately might result in subpar service provision as well as perhaps sparking violent and abusive incidents. Complex ethical problems have emerged as a result of medical advancements and an atmosphere in the healthcare sector that is increasingly demanding. These together have increased the burden on healthcare professionals [7]. The rise in public awareness of unethical behavior among healthcare workers (HCWs) may contribute to the growing number of complaints against them [8].
Evidence of unethical behavior seen by medical students, residents, physicians, and nurses in a variety of contexts have been reported [9–11]. Healthcare practitioners, nurses and those who work in other paramedical fields are required to understand ethical concepts and use them in their clinical practice after finishing their education [12, 13]. Unfortunately, undergraduate and postgraduate medical programs have been neglected to educate ethics for many years [14]. As a consequence, many healthcare workers are not putting ethical principles into practice regularly, which has led to a major gap in the quality of patient care. Moreover, a lack of understanding and application of biomedical ethics have resulted in legal actions being taken against medical personnel [15]. In this regard, Pakistan is not an exception, where accusations of ethical misconduct and an increase in lawsuits against healthcare practitioners have been seen in recent years. Although the Pakistan Medical and Dental Council has a unique code of medical ethics that addresses the issues faced by Pakistani medical professionals in their particular social and cultural context, there are virtually no bioethics teaching curricula for undergraduate and graduate training programs respectively [16, 17].
Healthcare ethics and ethical standards have become more and more popular over the last several years as a specialty within medicine. Yet, there is still a need for growth in healthcare professionals' education, understanding, comprehension and awareness of the fundamentals of healthcare ethics [18]. Moreover, medical students often disregard and emphasize instruction on medical ethics during their first clinical practice. Through the hidden curriculum, seniors influence the future ethical practices of medical students, junior doctors and other coworkers [19]. Also, nurses are well-versed in the practical application of ethics and the hidden curriculum. This raises the question of whether Pakistani healthcare professionals understand and apply bioethical principles. Due to powerful sociocultural pressures that regulate healthcare organization practices and medical ethics, the topic of the hidden curriculum is very relevant in Pakistani culture [20, 21]. Pakistan is a developing country classified under the D category of the Eastern Mediterranean Region according to the regional classification system established by the World Health Organization (WHO) [22]. Pakistan faces significant economic, political and geopolitical challenges, where government allocates very little money to healthcare (less than 2% of total spending). Moreover, there is a lack of policies on numerous health concerns, unorganized planning, and corruption in the medical administration, which hinder the healthcare system [23]. The lack of patient’s legal protection, excessive working hours and low pay scales, a lack of professional evaluation of practitioners, and the lack of mandatory registration of medical and nursing practitioners have all been cited as contributing factors to ethical violations in the Pakistani healthcare system [24].
Physicians and nurses are the key pillars of healthcare delivery; however, they differ in education, professional responsibilities, and perceived medical norms and conduct [25]. The social context of bioethics instruction must be considered; the first step in creating an ethics curriculum for our country's unique social, cultural, and religious setup may be to assess healthcare professionals' fundamental perception, insights and awareness about medical ethics, including all medical technicians, dispensers and other HCWs also. Even though the ethical principles of health care are universally accepted in many countries, individual nations are free to make modifications, frames, and specific interpretations that are in line with their preexisting philosophical and spiritual perspectives, as well as the ethical principles that govern the practice of health care within their respective health systems [26].
In resource-constrained countries like Pakistan, there hasn't been much research evaluating all healthcare professionals (physician or non-physician) deep understanding and awareness regarding healthcare ethics across healthcare facilities (BHU, RHC, THQ, DHQ) and private hospitals. To address this gap, the proposed research would aim to explicate the level of bioethicsinsights and awareness among healthcare professionals (doctors, nurses, LHVs, medical tech/dispensers and other medical personnel) working in both public as well as private hospitals in Haripur district, Pakistan, as well as its relationship with sociodemographic factors, training and teaching of medical ethics, ethics in healthcare practice, and specific issues in medical ethics. This research would be crucial for keeping an eye on ethical practices and moral behavior and improving patient outcomes. The findings of this research will also enable us to emphasize how crucial it is for all medical professionals to be taught bioethics.
Methodology.