Thursday, September 23, 2010
The greatest good.....for the greatest many;
What do we do when we have a moral dilemma? we examine our values and beliefs....where do these values and beliefs come from???? Values determine what we appreciate in life, what we reject and what we feel dispassionate about.
Take our current dilemma within Midwifery - do we? don't we accept the current determination? that is the question; now as I don't have a crystal ball, I have to judge by the facts; before I do I will explore two ethical theories that applies to our dilemma:
Deontology: which is duty bound based on a moral action regardless of their consequences; I like to think of the classic example is that we should not lie, however many people lie to save the feelings of the other person. However you are duty bound to tell the truth regardless of the consequences; for the good of a single person;
Telelogy - Utilitariansism - also known as consequentialism; actions can only be judged right and or good on the basis of the consequences they produce - therefore 'the greatest good for the greatess many' - therefore opposite to Deontology;
I always considered myself more deontology than utilitariansim.... however on this occasion I am the opposite;
A friend of mine gave me a classic analogy about the determination: it goes, " Dear Santa, thank you for the new red bike, but I really don't like red, and the wheels are two small, so no thanks I would rather go without my brand new bike" or the alternative response could be "thanks Santa for the new bike, yes I don't like red and the wheels are two small, but in the mean time I will ride the bike until l save some money paint it and put new wheels on"
I have always considered that the midwife provides continuity of midwifery care to "normal" "low risk" women.... once a complication arises then it is time to collaborate with our colleagues the obstetricians; this is done as professional to professional...... this is not recognised here in Australia.
I have circulated information far and wide about the issues at hand; the majority of feedback from midwives and some women has been to accept the the determination and the main reason being it is the first step to bigger better things; we can change something we have, not something we don't have;
There is much rhetoric about this subject; I fail to see how we are harming by accepting this, if the choice is this or nothing; yes I understand it is not perfect and I for one do not want to be beholding to an obstetrician. However I come back to the same point that this is very new to Australia, midwives are not as autonomous as our counterparts in the UK and NZ... so there has to be a period of trial or adjustment change is always difficult and does not come without a price......this is the first step to massive change... we have to keep working at it to get what we want....at the end of the day you can choose to accept this process or not.... you don't have to have a medicare provider number.... women still can choose an independent midwife.....and not claim a medicare rebate......
The facts remain the same:
Will not prevent private midwives being able to practice (they can still access insurance)
Will not prevent women being able to make choices –If you are having a homebirth and choose not to access Medicare you do not need a signed agreement with a doctor.
Only affects midwives seeking to access Medicare and midwives can choose not to do this.
Is not included in the NMBA Quality and Safety Exemption Framework supporting private midwives providing homebirth services
Does not re-define the ICM definition of a midwife – it does not define the role or scope of practice of midwives in Australia. It only defines how midwives can access Medicare if they choose to do so. Midwives can still work in public and/or private practice and access insurance and register as a midwife (under our current regulatory requirements that have an accepted definition and scope of practice of the midwife in Australia).
Does not mean that midwives must have a signed agreement with a doctor – this is only IF YOU CHOOSE TO ACCESS MEDICARE - Midwives can have
a. an individual signed agreement with a doctor
b. a referral of a woman to you
c. clinical privileging
d. an agreement signed by the medical director of a hospital.
Does not mean you need acknowledgment in writing - we have been told by the Minister’s advisors that a midwife writing in her own clinical notes that results etc have been sent to the hospital/doctor where they have a collaborative arrangement meets this requirement.