Concept of Medical Ethics and Professional Ethical Standards of Physicians

Leadership Role: Nurses use leadership skills in many situations while performing their duties.

In the hospital, nurses proactively help patients to meet their basic needs when they request or perform treatment and care tasks with doctors for patients. Many times when patients obstruct the implementation, nurses need to promote their leadership role by persuading and explaining to them to cooperate in the treatment process to quickly recover.

In the community, nurses help single patients, families, or communities to change health-related behaviors. Nurses need to use sub-law documents, campaigns, health-oriented public service projects, support projects, etc. to fulfill their leadership role well [4],[81].

Research role: Nursing research is to contribute to the scientific basis for nursing practice. Through research projects to determine the results of nursing care and provide practical scientific evidence from which to learn from experience and improve the quality of care.

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1.2. Concept of medical ethics and professional ethical standards of nurses

1.2.1. Concept of medical ethics, some characteristics of medical ethics

1.2.1.1. Concept of medical ethics [15],[16]

Concept of ethics: according to the Vietnamese Dictionary (Social Sciences Publishing House): "Ethics are rules based on the economic and political regimes that are set forth to regulate the relationship between people, between individuals and society, in order to protect the economic and political regimes" . According to the Vietnamese Encyclopedia: "Ethics is one of the earliest forms of social consciousness, including social norms that regulate human behavior in relation to the whole society. According to the World Medical Association: " Ethics is a category that refers to

to doctrine - careful, systematic reflection and analysis of past, present or future decisions of conscience and behavior" [19]. Factors governing morality: political regime, law; customs, ethnicity; religion; age; gender; occupation; education;...

Medical ethics: is a concept within the category of ethics. Medical ethics is a branch of ethics that deals with ethical issues in medical practice. Medical ethics are rules or standards that medical practitioners must comply with in their professional practice.

Medical ethics includes rules that are specific to the profession and includes legal regulations in professional practice. Therefore, the category of medical ethics has both common attributes for all medical practitioners in the world and specific regulations depending on the laws of each country.

Section 7-Part III of the Hospital Management Regulations clearly states: "Medical ethics is a noble quality of a medical worker, expressed in a high sense of responsibility, dedicated service, wholehearted love and care for the sick, considering their pain as their own pain, as President Ho Chi Minh taught: "A good doctor must be like a mother" , must be honest, united, overcome difficulties, study and strive to fulfill their duties, wholeheartedly build Vietnamese medicine. Medical ethics must be demonstrated through socially recognized ethical standards and principles" [15],[16].

1.2.1.2. Principles of medical ethics

The principles of medical ethics include respecting the patient's right to self-determination, being compassionate, not doing harm, and treating the patient/patient's family fairly [15].

Respecting the patient's right to self-determination means respecting the patient's dignity, maintaining the patient's confidentiality, and respecting the patient's/the patient's family's right to choose care measures after the patient has been provided with full information related to their illness [15].

Compassion is defined as understanding and caring for a person's suffering, which is essential to the practice of medicine. Compassion is always doing good to the sick. Patients respond better to treatment if they receive sympathy, care, and appropriate treatment rather than just concern about their illness [15].

Do no harm: In the medical profession, the application of almost any care measure can pose a risk of harm to the patient. Therefore, the nurse's responsibility is to consider to ensure that the least harm is caused to the patient [15].

Fairness is not discriminating against class, religion, ethnicity, etc. when caring for the sick [15].

1.2.1.3. Some documents regulating medical ethics in the world

Through many stages of development in the history of medicine, the concepts and regulations of medical ethics have been adjusted and gradually perfected. International and national health organizations have successively approved and promulgated regulations on ethics in medical practice and community health care [15],[16].

The first international document to regulate the ethics of biomedical research was the Nuremberg Charter. It was issued in 1947, after the trial of Nazi doctors. It set out 10 principles for research conducted on human subjects.

From this charter to the Helsinki Declaration of 1964, then to the WHO guidelines of 1982, 2002..., regulations and guidelines for implementing ethics in research have been gradually adjusted and perfected. These documents

clearly states specific principles when conducting a human experimental study, what needs to be done before, during and after the trials to ensure benefits for the research subjects [15],[16].

Ethical documents in clinical practice

The first document promulgating regulations for medical practitioners was the Geneva Declaration issued at the second meeting of the World Medical Association in Switzerland in 1948, which was last supplemented at the World Medical Association's council meeting in Sweden in 2005 and promulgated in 2006 [15],[16],[87].

Human rights were accepted and declared by the United Nations General Assembly in October 1948, mentioning: "Everyone has the right to a life adequate for the health and well-being of himself and his family; including: food, clothing, housing and medical services and social services, and the right to protection in the event of unemployment, sickness, disability, old age..." [148].

In 1998, the General Medical Council issued guidelines on obtaining patient consent. Patient consent makes treatment more effective because of the patient's active cooperation. The guidelines also clarify the circumstances in which consent from a guardian is sought and there are some special circumstances in which patient consent is not required [15],[16],[87].

In 2000, the General Medical Council issued guidelines on confidentiality and information provision: “Patients have the right to know about the health care services available to them; have the right to know about the medical condition that is causing them pain” [15],[16],[87].

In 2005, the World Medical Association declared the rights of patients: “Patients have the right to self-determination, to make their own decisions, to receive information about themselves and to be informed about their health, including accurate medical information about their condition” [157].

1.2.1.4. The formation and development of ethical standards in the nursing profession When nursing was not officially recognized as a field

In public health care, the ethical standards of nurses are applied as well as the ethical standards of physicians in general. Professional nursing began to form in the 19th century in England as a school by Florence Nightingale (May 12, 1820 - August 13, 1910).

Nightingale's research results were the first milestone in the field of nursing although Nightingale's school was formed a long time ago. For the first 30-40 years of Nightingale's school, future nurses were trained by medical staff (HCWs) because there was not enough professionalism to teach nurses. Due to the great influence of the medical characteristics at that time, the early nurse educators focused on teaching techniques rather than teaching the art and science of nursing like Nightingale [101].

The International Confederation of Nurses (ICN), a pioneer in developing a code of conduct for nurses, was founded in 1899. In 1990, the first book on nursing ethics, Nursing Ethics: For Hospital and Private Use, was published. The book was written by American nursing leader Isabel Hampton Robb [101].

Historically, the main principles of nursing ethics have been determined based on the actual work of nurses. Isabel Hampton Robb's 1990 book on nursing work described the work of nurses quite accurately and interestingly through the names of the chapters, such as Chapter 4: The Probationer; Chapter 7: Uniform; Chapter 8: Night Duty and Chapter 12: The Care of the Patient (Nurse-Doctor, Nurse-Nurse, Nurse-Community Relationships) [101].

By the 1960s, nursing ethics had become more unusual in its focus on submissive regulation, as most nurses were women and most physicians were men. The requirement for nurses to be submissive to the orders and directions of physicians remained in place until the 1960s, and this is reflected in the 1965 ICN Nursing Code of Ethics.

By 1973, the ICN code focused on reflecting nursing response to shift changes and coordination from health care workers to patients…This code has been maintained to this day [101].

The development and promulgation of professional rules with the aim of providing professional health care services. One thing that nurses must remember is that medical ethics will be difficult to demonstrate, even useless without the necessary professional rules. Therefore, each nurse as well as managers and policy makers must have activities to improve medical ethics and nursing rules. Benner emphasized when talking about the role of nurses in the work: "Each of us and each nursing organization must breathe life into the rules through the actions of each individual and the collective" (Rowler & Benner, 2001, p.437) [101].

1.2.2. Ethical standards of nursing in the world

1.2.2.1. International Council of Nurses (ICN) Code of Ethics [123]

ICN is an association of 130 national nursing associations, with over 13 million nurses. Founded in 1899, ICN is the first and largest international organization for the health care profession. The International Code of Ethics for Nurses was first adopted by ICN in 1953. This code has been revised and updated several times. The most recent version was revised and completed in 2012 [123].

The latest code confirms that nursing care is respectful and does not discriminate on the basis of age, colour, creed, culture, disability or medical condition, gender, nationality, political, ethnic or social status.

1) Nursing and people

- The main professional function of the nurse is to provide nursing care on demand.

- In providing CSNB services, the service provider is developed in an environment where human rights, customer values and spiritual beliefs of each individual, family and community are respected.

- Nurses ensure that each individual patient receives timely and complete information on care and treatment appropriate to their own customs, practices and culture, based on the satisfaction of the patient/family.

- Nurses keep patients' personal information confidential and only share information with colleagues when absolutely necessary.

- Nurses share recommendations with the community; support and cooperate with the community in community health care activities, especially with vulnerable populations.

- The nurse ensures fairness in the allocation of resources, access to health services, and other social and economic services.

- The DDV supports values such as: respect, understanding, compassion, trust and integrity.

2) Nursing and practice

- Nurses have personal responsibility for nursing practice and maintain competence through continuous learning.

- Nurses maintain personal health standards to ensure the ability to provide care.

- The nurse recognizes the individual's abilities and limitations, accepts support and delegates responsibility when needed.

- Nurses must maintain standards of personal conduct at all times through good professional performance to contribute to increasing community confidence.

- Nurses must ensure the use of appropriate techniques and scientific advances, safety, and respect for human values when providing services.

- The DDV strives to promote and maintain a culture of practice, promoting ethical behavior and open dialogue.

3) Nursing and professional

- Nurses have a key role in defining and implementing accepted standards in clinical practice, management, research and training.

- Nurses are proactive in developing professional knowledge based on foundational research to support evidence-based practices.

- The DDV is proactive in developing and maintaining the foundation of professional values.

- Nursing activities: through professional organizations, participate in the process of creating a positive practice environment and maintaining medical safety for society as well as achieving economic efficiency in care.

- Practical nursing aimed at maintaining and protecting the natural environment and understanding the impact of nature on health.

- The nurse contributes opinions on expertise, ethics, challenges in professional practice and monitoring of ethical violations.

4) Nurses and colleagues

- Nurses maintain collaboration and respect for relationships with colleagues in the care and other areas.