Ethical Foundations of Client-Centered Care in Family Planning

Abstract

Biomedical ethics provides the foundation for a model of client-centered care that can assure the good quality of family planning and other reproductive health services in developed and developing countries. Client concerns mirror the four ethical principles of autonomy, justice, beneficence, and nonmaleficence. Autonomy reflects clients' desire for full information and respect from providers so that they can exercise their right to make their own informed decisions. Justice, for clients, means fair treatment and ready access to services, regardless of one's socioeconomic status, education, ethnic group, or residence. Beneficence means that providers possess the technical competence and understanding needed to act in the best interest of their clients, as clients expect. Nonmaleficence translates into client concerns about safety--that no harm will come to them as a result of seeking services. Putting these ethical principles into practice requires changing providers' attitudes from paternalistic to client centered. Assessments of client satisfaction can help family planning programs identify and respond to client values and even raise client expectations about the care they should receive. Managers also can contribute to good quality care by meeting providers' professional needs for training, supervision, supplies, record keeping, and so on. Family planning programs around the world are focusing on these ethical concerns to emphasize respect for client values, appropriate decision making, broader access to services, and basic safety issues. Although they use a variety of techniques, all these quality assurance and improvement initiatives share an ethically based, client-centered philosophy.

Postpartum psychosis

“…The management of women at risk raises ethical questions on the role of the patient and her family in the decision‐making process. Ethical principles of patient‐centred care provide the foundation for the doctor–patient relationship: autonomy, justice, beneficence and nonmaleficence . The clinician should avoid paternalistic attitude, exploring and considering the values and the expectations of the patient and leaving the final informed decision to the woman.…”

“…Ethical principles of patient-centred care provide the foundation for the doctor-patient relationship: autonomy, justice, beneficence and nonmaleficence. 23 The clinician should avoid paternalistic attitude, exploring and considering the values and the expectations of the patient and leaving the final informed decision to the woman. If the woman wishes, family members can be involved in the decision making process.…”

From power to safety and respect the changing meaning of empowerment in women’s reproductive health care in the U.S.

“…Thomas 20 names this "dignity and respect" seeing it reflected in feminist centers' dedication to serve all women regardless of their income status. Both Kols et al 21 and Sherwin 22 consider information provision as an ethical issue as well. "Respect for autonomy" requires that a client be provided full and correct information and be respected in her decision-making ability and the decisions.…”

“…"Respect for autonomy" requires that a client be provided full and correct information and be respected in her decision-making ability and the decisions. Being treated with respect also includes courtesy, confidentiality, and privacy 23 , providing women with non-oppressive options and the opportunity to develop the skills that are necessary for making informed decisions. (in 1974 and 1978) by women closely following Roe v. Wade decision to legalize abortion in the U.S., to provide low cost abortion care in their communities.…”

“…"Being informed" was an indicator of "humane care", of being "treated with dignity", supporting the "ethics of care" models where provision of information is an ethical issue. 31 Kols et al 32 state that being treated with respect requires that a client be provided with full and correct information, courtesy, confidentiality, and privacy. Women in this study discussed information, courtesy, and privacy within the domain of humane care (respect).…”