Making ethical, respectful healthcare possible in Kashmir

BY: DR. FIAZ MAQBOOL FAZILI

When patients in Kashmir, or anywhere else, seek healthcare, they and their families expect healthcare professionals to act in their best interests and treat them with dignity and respect while adhering to their profession’s rules, regulations, laws and ethical standards. Patients want healthcare professionals to treat them as individuals and involve them in making decisions to meet their own needs, preferences, beliefs and wishes regarding their care and treatments.

Ethics involves applying moral principles to healthcare, and ethical decision-making is critical in healthcare practice. Understanding how to navigate these principles is essential for those working in the sector. It often requires them to balance respect for patient autonomy with beneficence. Defining autonomy, according to the British Medical Association (BMA), autonomy is usually described as a rather capable adult, making sound decisions about their own medical care. Autonomy also requires healthcare professionals to request competence, consent, or informed agreement before testing and treatment is carried out. . Respecting and protecting the rights of patients and their families is fundamental to healthcare delivery. These rights should be clearly displayed in bold at hospital entrances and other prominent locations, in both English and the local language most widely understood by the community.

For ensuring respectful and fair healthcare services, the significance of ethical healthcare is fundamental in today’s complex medical environment, ensuring services are delivered with integrity, fairness, and respect. It involves upholding moral principles in medical decisions, safeguarding patient autonomy, promoting justice, and adhering to professional standards. For patients, ethical healthcare guarantees their rights and dignity are upheld, fostering trust in healthcare providers. This trust leads to better health outcomes as patients feel empowered in their care. Healthcare professionals also benefit by maintaining credibility and building strong patient relationships through transparent communication and informed consent.

Society as a whole gains from ethical healthcare practices, which promote fairness in resource distribution and address disparities in access. Vulnerable populations receive necessary support, contributing to a more equitable healthcare system. Respecting patients’ rights to make informed decisions about their treatment, upholds patient autonomy. Beneficence and non-maleficence for balancing treatment benefits against potential harm. Confidentiality must be maintained by protecting patient privacy and sensitive information. Ensuring equity and justice through fair access to healthcare for all individuals. Respecting patient choices in healthcare planning honouring patients’ wishes regarding medical interventions even when there is no hope during end-of-life care. By prioritizing these principles, healthcare systems can improve patient outcomes and foster a compassionate, just environment.Patient autonomy is a cornerstone of ethical healthcare, allowing individuals to make informed decisions about their treatment. However, autonomy may be influenced by factors such as mental capacity, resource availability, and legal frameworks.

 Challenges in ensuring autonomy include assessing patient Capacity on accessibility and affordability. How uncomfortable it is to inform a patient that a treatment exists but may be financially out of reach. The high cost could make it seem unattainable, forcing a compromise in their care plan. Before discussing options, a doctor should discreetly assess the patient’s ability to pay or access financial support to avoid unnecessary distress. “Evaluating a patient’s ability to understand medical choices, using standardized tools respecting diverse values while ensuring decisions align with ethical and legal standards. Balancing autonomy and beneficence addressing conflicts when patients refuse beneficial treatments or request harmful interventions.Strategies to uphold autonomy include shared decision-making, clear communication, and involving substitute decision-makers when necessary.

 Promoting fairness and equity in healthcare access ensures all individuals have equal opportunities to achieve optimal health, regardless of socioeconomic status, race, or other factors. Since state Medical services work under strains of material, manpower , motivation (burnouts) and barriers to access include financial constraints, geographic limitations, and systemic biases. Organizational solutions to enhance fairness include policy reforms implementing anti-discrimination laws and equitable resource allocation, low cost with wide impact on community outreach providing education and services to underserved populations. Our healthcare delivery system needs to work on strategic operations for affordable care models thereby reducing financial burdens through subsidies or universal healthcare initiatives. Addressing these disparities fosters a more inclusive healthcare system.

 Empowering patients through informed consent has been a mandatory standard since times memorial. Informed consent ensures patients understand their medical options, risks, and benefits before making decisions. Using plain language and visual aids to explain treatments its risks ,benefits and alternatives (plan of care ) through a clear communication and language which patient ,or his/her guardians understand best and document it where patient or ,or his/her guardians sign the plan of care (preferably a preprinted Plan of care form has been designed by JCI ) puts patient in personalised care plan of voluntary participation ensuring decisions are free from coercion. The consent doesn’t start or stop her but has to be ongoing consent as a plan of care is implemented. At times the new situations arise and you may deviate from an original plan of care explained to the patient ,the first consent is not to be taken as blanket approval allowing patients to withdraw consent at any time. Challenges such as health literacy gaps and cultural differences can hinder informed consent, solutions include patient education programs and culturally sensitive communication strategies.

Protecting patient privacy and confidentiality is vital in maintaining trust between patients and providers. Measures to safeguard data are not restricted to secure it through electronic records instead of vulnerable leaks in traditional manual records using encryption and access controls but staff training educating healthcare workers on privacy protocols and adhering to regulations like HIPAA means legal compliance. Breaches of confidentiality can erode trust and lead to legal consequences, emphasizing the need for robust privacy practices. Ensuring non-discriminatory care Healthcare must be free from bias based on race, gender, religion, or other factors. Strategies to prevent discrimination include cultural competency training helping care providers understand diverse patient needs. Enforcing strict guidelines against discriminatory practices having anti-bias policies implemented in time and spirit. Patient advocacy is vital supporting marginalized groups in accessing care.Examples include accommodating transgender patients’ healthcare needs and addressing racial disparities in treatment outcomes.

 Ethical research and innovation are part of healthcare’s commitment to advancement and updates on evidence based best clinical protocols. Medical advancements must prioritize patient welfare. Ethical research involves informed participation ensuring participants understand risks and benefits, transparency on conflict of interest disclosing funding sources and potential conflicts of interest. Adhering to guidelines like the Declaration of Helsinki to overcome the regulatory oversight. Balancing innovation with ethical considerations ensures progress without compromising patient rights. Transparency and accountability in healthcare operations /organisation culture strengthens trust. Sharing treatment costs and outcomes with patients or relatives or legal guardians through  open unbiased communication. Regularly assessing and improving care standards are going as per ser accepted hospital  or departmental protocol’s by a Quality Monitoring professional or department has improved standards of healthcare delivery. Patient  satisfaction is the single most KPI_ key performance indicator to say,” Is your hospital doing good.or not ,plus rooms of improvement and strengths ?. Incorporating customised  patient feedback forms encouraging input to address concerns and enhance services and dispels sycophancy of people who feed Chief and HODs ,”All is well.” Accountability mechanisms, such as audits and patient surveys, help maintain high ethical standards.

 Commitment to Ethical Excellence-Achieving ethical healthcare requires collaboration among providers, patients, and policymakers. Recommendations include Patient-Centred Care tailoring services to individual needs and preferences. Professional Training: Ongoing Staff education in ethics and cultural competence.Policy Advocacy: Supporting laws that promote equity and access.By upholding ethical principles, healthcare systems can deliver respectful, fair, and high-quality care for all.

The author is a healthcare policy analyst and a certified expert in healthcare quality control and standards improvement.