The use of the word ‘profession’ has expanded so far beyond its original meaning It is not uncommon to find the term ‘professional’ misused to describe sportsmen, tradesmen, and even politicians Common understanding that ‘professionals’ are doctors, lawyers and teachers A fundamental distinction between a profession and any other occupation, is that individuals engaged in a profession have an ethical obligation to whomever they offer their services. In other words, a profession is required to have a Code of Ethics
Optometry ranks amongst the leading healthcare professions Various national Codes of Ethics exist for the Optometry profession Tracked back to one of the original sources of medical ethics in the Western world: The famous oath of Hippocrates Original oath do not form part of medicine and healthcare today and it includes statements that would not concord with modern practice: Pledge to remain chaste and religious and never to procure abortion
Hippocrates oath has been transposed through history It was incorporated into the Declaration of Geneva (1948) following the Second World War. The following year, in response to Nazi War crimes, the World Medical Association adopted the International Code of Medical Ethics This has formed the basis of ethics of a number of healthcare professions.
The ethical codes contain guiding principles Help practitioners in their decisions and in practicing in accordance with a set of standards that are expected of a healthcare practitioner The four major ethical principles in healthcare are: Beneficence Non-maleficience Respect for autonomy Justice
Beneficence Striving to do good and to do the best for every patient The practitioner has a duty of care to every patient The objective to do good so that every patient leaves the practice in a better state than when they entered, and not in a worse condition Non-maleficience Directly traceable to the Hippocratic oath “above all to do no harm” i.e. this is about the avoidance of harm Requires balancing risks and benefits of treatment and making decisions that will optimize the benefits and minimize the risks of harm
Respect for autonomy Requires a practitioner to respect the choices and decisions that a patient makes about his/her own health Involves keeping the patients informed of their condition, treatment choices and options so that decisions made are based on pertinent facts Justice Entails being fair to all patients in a way that transgresses legal justice Includes deciding how much time is spent on a patient, how many and what types of resources are devoted to treatment of that patient and how this compares to the time and resources distributed to other patients
In addition to the four ethical principles the following ethical principles have been included to form the ethical principles that should guide optometric practice : Principles of confidentiality Protection of the vulnerable Collegiality
Principles of confidentiality Non-disclosure of patient details and health records To respect the privacy and preserve the dignity of each patient Traced directly to the Hippocratic oath: “Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one”
Protection of the vulnerable Standing up for the rights of those who may be unable to speak or act for themselves Children, the frail elderly, and patients who are unable to make decisions for themselves These patients may require a degree of protection that extends beyond the usual duty of care Collegiality Calls for support of colleagues and fellow practitioners and professionals Mutual respect & understanding for fellow optometrists, for other professionals and for their respective roles in the health care team This is the only ethical principle that does not apply to patients but to the way practitioners treat one another
The ethical principles may appear simple to follow and understand Yet for each one of them, situations may arise, that will make it difficult to apply these principles These principles are essential tools for ethical practice, but if applied too rigidly they can be problematic No principle can be applied absolutely
Beneficience dilemma: How good is good enough? Should a practitioner become so completely selfless that they commit their entire life and all available time to helping patients at the expense of a private life and duties to family? The difficulty with beneficience is that it is limitless and every practitioner needs to decide how far they want to take this principle
Non- Maleficence dilemma: Not limitless but may be limiting No practitioner will ever set out to harm a patient Certain practice methods will incur a risk of harm For example: Contact tonometry and the prescription of a contact lens can result in unwanted side effects To apply this principle would require a practitioner to abandon all practice methods with the potential of harm, no matter how minimal the harm or how small the risk
Respect for Autonomy dilemma: A legally blind patient who refuses to wear glasses and is still continuing to drive Is it ethical to respect this patient’s autonomy?? Can the optometrist always respect the choice of a patient whose behavior may be unreasonable and potentially dangerous?
Justice Dilemma: How to decide the basis of this fairness and how time and resources should be distributed? All patients should be given half an hour of an optometrists' time but this may prove to be too inflexible Some patients may need less time and some may need considerably more time
Collegiality dilemmas: It is easy to practice with those who have similar interests and outlooks Difficult when working with fellow optometrists who have different perspectives, opinions, attitudes, and behaviors If the colleague is practicing ethically, personal differences should be put aside Collegiality also has no place for prejudice or professional jealousy If a colleague is behaving in a manner that may be inappropriate for a professional, collegiality cannot be used as an excuse to protect what is wrong. Help should be offered but in some cases a colleague may need to be reported.
Confidentiality Can be compromised when a patient discloses to a practitioner something that may have serious ramifications for the patient and potentially for others For ex: it can be difficult for an optometrist to decide whether or not to keep confidential the details of a patient who admits to having AIDS but asks the optometrist to keep this secret from his (the patient’s) wife.
Protection of the vulnerable dilemmas: Must decide how far this protection can extend Should the parent of a child patient who appears with multiple bruising be reported even though the matter has nothing to do with eye care? Reporting such a matter to social services may result in innocent parents having to defend themselves against charges of child abuse. Not reporting, may leave vulnerable child open to further risk of harm.
There are circumstances that cause principles to conflict i.e. applying one principle will almost certainly require disregarding of another principle The practitioner is faced with an ethical dilemma Example: A case of an overweight diabetic who presents to the optometrist with early signs of diabetic retinopathy The patient is a smoker and refuses to stop smoking Beneficience requires the practitioner to do his/her best. In this case the best is to do whatever possible to alter the patient’s lifestyle If the patient continues to smoke, then the practitioner is obligated to respect the autonomy of this patient The autonomy of the patient and respect for his choices presides over a more active application of beneficence
Unlike laws and regulations, the principles of ethics are flexible and their application depends on each individual practitioner Each optometrist has: The responsibility of developing their own personal ethical standards The expectation of possessing the self-discipline to practice in accordance with these standards It is these responsibilities and expectations that are the hallmarks of a profession
The optometric profession has long recognized its ethical responsibilities to patients, colleagues, other health care professionals, and the public. The American Optometric Association (AOA) has historically provided statements of ethical aspirations and standards of expected professional behavior. The Code of Ethics and The Optometric Oath are the current documents guiding the ethical behavior of AOA members. These documents are frequently expanded on through policy resolutions adopted by the House of Delegates http://www.aoa.org/x4877.xml
It shall be the ideal, resolve, and duty of all optometrists: TO KEEP their patients' eye, vision, and general health paramount at all times; TO RESPECT the rights and dignity of patients regarding their health care decisions; TO ADVISE their patients whenever consultation with, or referral to another optometrist or other health professional is appropriate; TO ENSURE confidentiality and privacy of patients' protected health and other personal information; TO STRIVE to ensure that all persons have access to eye, vision, and general health care; TO ADVANCE their professional knowledge and proficiency to maintain and expand competence to benefit their patients; TO MAINTAIN their practices in accordance with professional health care standards; TO PROMOTE ethical and cordial relationships with all members of the health care community; TO RECOGNIZE their obligation to protect the health and welfare of society; and TO CONDUCT themselves as exemplary citizens and professionals with honesty, integrity, fairness, kindness and compassion http://www.aoa.org/x4878.xml
With full deliberation I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously, and to the fullest scope of my competence. I will uphold and honorably promote by example and action the highest standards, ethics and ideals of my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted me. I will provide professional care for those who seek my services, with concern, with compassion and with due regard for their human rights and dignity. I will place the treatment of those who seek my care above personal gain and strive to see that none shall lack for proper care. I will hold as privileged and inviolable all information entrusted to me in confidence by my patients. I will advise my patients fully and honestly of all which may serve to restore, maintain or enhance their vision and general health. I will strive continuously to broaden my knowledge and skills so that my patients may benefit from all new and efficacious means to enhance the care of human vision. I will share information cordially and unselfishly with my fellow optometrists and other professionals for the benefit of patients and the advancement of human knowledge and welfare. I will do my utmost to serve my community, my country and humankind as a citizen as well as an optometrist. I hereby commit myself to be steadfast in the performance of this my solemn oath and obligation http://www.aoa.org/x4881.xml
Astigmatism A condition in which the cornea's curvature is asymmetrical (the eye is shaped like a football or egg instead of a baseball); light rays are focused at two points on the retina rather than one, resulting in blurred vision. Additional symptoms include distorted vision, eyestrain, shadows on letters, squinting and double vision Anisometropia A condition where the eyes have a significantly different refractive power from each other, so the prescription required for good vision will be different for each eye. Amblyopia - Also called lazy eye. Undeveloped central vision in one eye that leads to the use of the other eye as the dominant eye. Strabismus is the leading cause, followed by anisometropia. There are no symptoms. The patient may be found squinting and closing one eye to see; there may be unrecognized blurred vision in one eye and vision loss. http://www.opted.org/files/public/Eyes_Have_it_Career_Guide_-_FINAL_02_10.pdf
Refraction The test performed during an eye exam to determine the eyeglass lens powers needed for optimum visual acuity. An automated refraction uses an instrument that does not require the patient to respond. A manifest refraction is the manual way to determine the best lenses, by placing various lenses in front of the patient's eyes and asking, "Which is better, lens A or lens B?“ Strabismus A misalignment of the eyes The eyes don't point at the same object together. Crossed eyes (esotropia) are one type of strabismus; "wall-eyes" (exotropia) are another. The exact cause is unknown, but appears to be a problem with the eye muscles. Strabismus can affect depth perception. http://www.opted.org/files/public/Eyes_Have_it_Career_Guide_-_FINAL_02_10.pdf
Intraocular pressure (IOP) Eye pressure, as determined by the amount of aqueous humor filling it. High IOP (ocular hypertension) can be a sign of glaucoma intraocular lens (IOL) Artificial lens that a cataract surgeon places in a patient's eye after removing the eye's natural lens. Like a contact lens, it has a built-in refractive power tailored specifically to the patient's visual condition. http://www.opted.org/files/public/Eyes_Have_it_Career_Guide_-_FINAL_02_10.pdf
Low vision Also called partial sight. Sight that cannot be satisfactorily corrected with glasses, contacts, or surgery. Low vision usually results from an eye disease such as glaucoma or macular degeneration. Age-related macular degeneration (AMD) Disorder characterized by changes in the eye's macula that result in the gradual loss of central vision. The exact cause is unknown, but appears to be related to a genetic predisposition, smoking and several other risk factors. Central vision may be blurred, distorted or shadowy before vision loss occurs. http://www.opted.org/files/public/Eyes_Have_it_Career_Guide_-_FINAL_02_10.pdf