Introduction
In Tanzania, physicians undergo five years of intensive university training, heavily funded by public funds, after which they take the “modified” Hippocratic Oath and receive a doctorate in medicine. Through democratic elections, citizens hold the government accountable for protecting their health. Citizens also pay taxes and share costs so that the government can provide quality health care. In addition, citizens have the opportunity to participate, at least in theory, in local government committees to plan and implement health programs. Finally, citizens make suggestions for improving medical services through any feedback mechanisms that can and should be available. To find approaches to solving the existing ethical dilemmas in the medical field of Tanzania, it is important to consider each of them.
Medical Strikes
Doctors’ strikes have caused serious concern in Tanzania, not only among citizens whose access to health services has been affected but also among members of parliament, activists, private hospitals, and various other stakeholders. The strikes have always been linked to two issues: 1) the working conditions of doctors, including infrastructure, the availability of medicines, equipment, and other medical supplies, and 2) the underpayment of wages and benefits. Underpayment has become a significant cause of strikes by doctors in many countries. The main ethical questions in this area concern whether inconclusive negotiations with the government justify a strike. In addition, can a doctor act in the interests of his patient in poor working conditions? The doctor does not have a direct service contract with citizens; they have only moral and ethical obligations toward patients. They are supposed to act in the interests of citizens seeking medical care as patients. In this case, we can say that the salaries of medical workers should be higher. Otherwise, such ethical issues will often arise, which can significantly slow down the medical sector in the country.
The Dilemma in Chemotherapy
Chemotherapy remains a vital palliative care modality in most countries, especially in Africa, despite research showing that chemotherapy does more harm than good to patients. Therein lies another crucial ethical dilemma. Is it worth subjecting a person to severe tests if treatment can aggravate his condition? Giving chemotherapy to patients approaching the end of life reduces life expectancy. A study by Exarchakou et al. (2022) found that in England, about 8.4% of lung cancer patients and 2.4% of breast cancer patients died within a month of starting chemotherapy. This indicates the seriousness of the dilemma and the fact that treatment and therapy should be carefully prescribed to people, taking into account the characteristics of each.
Ethics Committees
The severity of the contradictions between the qualitative changes in African medicine and the moral values ​​established in society has led to a complex of ethically ambiguous problems. According to Aboud et al. (2018), “Healthcare ethics committees (HECs) are common within US hospital-based institutions and assist clinicians, patients, families, and others with difficult ethical problems” (p. 75). The need to solve them requires the creation of new social mechanisms and structures for coordinating divergent interests in medical practice. In real life, this requirement was embodied in the emergence and development of the practice of ethics committees, representing a fundamentally new regulation of ethical conflicts in clinical practice and biomedical research. Ethical issues in the field of bioethics contributed to the formation of such committees in Tanzania. There is currently no universal model for organizing their activities.
Sexual Health Care in Tanzania
Tanzania is a country with numerous sexual health problems, including high levels of HIV/STIs, early onset of sexual activity, forced sex, sexual dysfunction, and teenage pregnancy. According to Rosser et al. (2020), “Tanzania has Multiple sexual and reproductive health challenges” (p. 2). Sexual health education is limited, and there are no courses to address the ethical aspects of sexual health. On this issue, several primary ethical issues can be identified. These include issues such as addressing sexual and intimate partner violence and the treatment of illegal or stigmatized vital populations. Also necessary are the treatment of couples in HIV serodiscordant, non-monogamous, and/or polygamous relationships and requests for and participation in illegal medical care. Treating women and children in the presence of their husbands and fathers requires the attention of psychological medical personnel. An essential part of the ethical issues in Tanzania, in addition to the above, is the fight against the sexual abuse of children. Ethical principles of autonomy, justice, beneficence, and non-infliction of evil deeds can be applied to resolve existing problems.
Workplace Distress
Distress in the workplace is a common ethical issue. This is due to several different deficiencies in the doctors’ workplace, leading to inadequate patient care and guilt on the part of the staff. The lack of well-educated staff, especially paramedical staff, and the insufficient number of nurses on duty in all work shifts lead to the exhaustion of nurses. With an acute staff shortage, nurses often work overtime against their will. This can sometimes lead to the nurse forgetting to give the patient the prescribed medicine and thus making the nurses feel guilty about not doing their job perfectly, even though this was their intention.
Lack of Outfit
Many ethical dilemmas arise from workplace stress as doctors have to work daily in conditions that can be life-threatening. For example, the chances of patients surviving and whether they receive good care or die depend on the available resources. Since protective equipment and equipment are often in short supply, and therefore, every day, doctors are at risk of serious infections, and they are more worried about their own lives. That nurse sometimes have to give preference to rich over poor patients applies to patients and nurses out of fear of losing their jobs and dare not protest about it. The importance of ethical dilemmas and stress in the workplace has been expressed in different ways by nurses. This is sometimes seen, such as when they formally try to demand change, such as when they speak their minds to management and doctors. In other cases, it is invisible, such as their thoughts about ethical dilemmas and workplace stresses, which they do not share with others but instead gnaw at their conscience and create internal existential anxieties. This ethical problem rests on insufficient funding, which makes it impossible to provide personnel with protective equipment.
Patient Privacy Dilemmas
Medical staff often face an ethical dilemma related to the difficulties in their daily work to protect patient confidentiality. According to Ramathuba & Ndou (2020), “Communities are aware of their needs and rights when visiting health services and institutions are overwhelmed to satisfy consumer demands” (p. 1). There was not enough room for nurses to meet with patients in private. Examinations, nursing, and conversations took place in front of other patients. Secrecy was also unnecessarily compromised by employees talking to strangers and even each other when it was not necessary, especially about HIV diagnoses. This ethical issue may have been caused by a lack of cooperation and knowledge about HIV-positive patients, which often violated patients’ rights.
The Lack of Motivation Dilemma
Employees are not always interested in developing themselves and their work skills, and some of them can be characterized as lazy and passive, which leads to a deterioration in quality. The reasons for this may be that the number of patients about the number of staff is too high, and the lack of resources leads to the staff losing motivation to work, which negatively affects morale. The quality of care may deteriorate due to the high workload, and staff may feel overwhelmed by the situation. Medical personnel is also frustrated by their lack of knowledge of the essential elements of patient care.
The Lack of Attention and Respect Dilemma
Ethical dilemmas often arise because the staff has inadequate respect for their work based on several factors. Supervisors can often be absent from the workplace and do not listen to or acknowledge doctors when they have problems. Often supervisors don’t care if medical staff talk or want to be listened to about something difficult in their job, such as lack of staff, too many patients, lack of resources, need for training, and need more qualified staff. Instead of being listened to about problems at work, they were looked down upon by their superiors and often criticized for poor performance. If something goes wrong, such as when a patient complains about their care, the fault lies with the nurse, not with a thorough investigation into what happened. Leadership has also been described as favoring sure nurses who receive benefits that others do not, such as training or promotions.
Conclusion
When considering the ethical dilemmas that arise in the work of medical personnel in Tanzania, it is essential to consider their causes. In many of the cases studied, the main problem is the lack of funding. However, there are also ethical issues, such as insufficient attention from the authorities, which can be solved in simple ways. Tanzania’s medical system requires attention as it needs to be modernized to eradicate existing problems and prevent new ones from emerging.
References
Aboud, M., Bukini, D., Waddell, R., Peterson, L., Joseph, R., Morris, B., Shayo, J., Williams, K., Merz, J. & Ulrich, C. (2018). Do Tanzanian hospitals need healthcare ethics committees? Report on the 2014 Dartmouth/Penn Research Ethics Training and Program Development for Tanzania (DPRET) workshop.South African Journal of Bioethics and Law. 11. 75.
Exarchakou, A., Kipourou, D. K., Belot, A., & Rachet, B. (2022). Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?British journal of cancer, 126(10), 1490–1498.
Ramathuba, D. U., & Ndou, H. (2020). Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa. Health SA Gesondheid (Online), 25, 1-9.
Rosser, B., Mgopa, L., Leshabari, S., Ross, M. W., Lukumay, G. G., Massawe, A., Mkonyi, E., Mohammed, I., Mushy, S., Mwakawanga, D., Trent, M., & Wadley, J. (2020). Legal and Ethical Considerations in the Delivery of Sexual Health Care in Tanzania. African journal of health, nursing and midwifery, 3(7), 84–102.