Ethics

Liana Al-Labadi, O.D.

http://www.journalofoptometry.org/10.3921/joptom.2008.5.pdf

 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


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

 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.

 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.

 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.


Ethics

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