Anti-vaccine nurses and midwives 7

Kate Larvin is a direct-entry level registered midwife in Victoria:

Larvin 1 AHPRA rego

Larvin’s registration does not include endorsement to administer scheduled medications:

Larvin 1 AHPRA rego non endorsed for scheduled meds

Larvin notes her qualifications on her Facebook profile:

Larvin 1 midwife on Facebook profile

Larvin runs a business providing “holistic midwifery” services, which includes a number of non-evidence-based treatments:

Larvin 4 website treatments

On October 22 2015, Larvin thought it was appropriate to post anti-vaccination lies on the Light for Riley Facebook page, which is an educational memorial page set up to honour the memory of baby Riley Hughes who lost his life to whooping cough:

Larvin 2 midwife comment on LFR Oct 22 2015

Larvin 3 midwife comment on LFR Oct 22 2015

The following addenda contain excerpts from the Nursing and Midwifery Board of Australia’s codes and guidelines from which the reader may choose to include when they lodge a complaint.

Thanks for reading.

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Addendum 1

Code of professional conduct for midwives

Midwives practise competently in accordance with legislation, standards and professional practice

1 Midwives practise in a safe and competent manner.

Conduct statement 1

Midwives practise in a safe and competent manner

Explanation

1 Midwives are personally accountable to the woman and her infant(s); their employer and their profession for the provision of safe and competent midwifery care. It is the responsibility of each midwife to maintain the competence necessary for current practice. Maintenance of competence includes participation in ongoing professional development to maintain and improve knowledge, skills and attitudes relevant to practice in a clinical, management, education or research setting.

2 Midwives practise in a manner that recognises the woman’s right to receive accurate information; be protected against foreseeable risk of harm to themselves and their infant(s); and have freedom to make choices in relation to their care.

3 Midwives practise within the scope of midwifery, according to the International Confederation of Midwives Definition of the Midwife (2005).

6 Midwives make known to an appropriate person or authority any circumstance that may compromise professional standards, or any observation of questionable, unethical or unlawful practice, and intervene to safeguard the individual if the concern is unresolved.

2 Midwives practise in accordance with the standards of the profession and broader health system.

Conduct statement 2

Midwives practise in accordance with the standards of the profession and broader health system

Explanation

1 Midwives practise in partnership with the woman, and in accordance with the standards of the profession (e.g. the Board-approved National competency standards for the midwife), to provide safe and effective midwifery care.

2 Midwives practise in accordance with wider standards relating to safety and quality in midwifery care and accountability for a safe health system, such as those relating to health documentation and information management, incident reporting and participation in adverse event analysis and formal open disclosure procedures.

3 Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery.

Conduct statement 3

Midwives practise and conduct themselves in accordance with laws relevant to the profession and practice of midwifery

Explanation

1 Midwives are familiar with relevant laws and ensure they do not engage in practices prohibited by such laws or delegate to others activities prohibited by those laws.

2 Midwives practise in accordance with laws relevant to the midwife’s area of practice.

3 Midwives witnessing the unlawful conduct of colleagues and other co-workers, whether in midwifery practice, management, education or research, have both a responsibility and an obligation to report such conduct to an appropriate authority and take other action as necessary to safeguard people and the public interest.

6 Midwives who are employees support the responsible use of the resources of their employing organisations.

4 Midwives respect the dignity, culture, values and beliefs of each woman and her infant(s) in their care and the woman’s partner and family, and of colleagues.

5 Midwives treat personal information obtained in a professional capacity as private and confidential.

Conduct statement 5

Midwives treat personal information obtained in a professional capacity as private and confidential

Explanation

The treatment of personal information should be considered in conjunction with the Guidelines to the National Privacy Principles 2001, which support the Privacy Act 1988 (Cwth). Many jurisdictions also have legislation and policies relating to privacy and confidentiality of personal health information including midwifery care records.

1 Midwives have ethical and legal obligations to treat personal information obtained in a professional capacity as confidential. Midwives protect the privacy of each woman, her infant(s) and family by treating the information gained in the relationship as confidential, restricting its use to professional purposes only.

6 Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products.

Conduct statement 6

Midwives provide impartial, honest and accurate information in relation to midwifery care and health care products

Explanation

1 When midwives provide advice about any care or product, they fully explain the advantages and disadvantages of alternative products or care so individuals can make informed choices. Midwives refrain from engaging in exploitation, misinformation or misrepresentation with regard to health care products and midwifery care.

2 Midwives accurately represent the nature of the midwifery care they intend to provide.

3 Where specific care or a specific product is advised, midwives ensure their advice is based on adequate knowledge and not on commercial or other forms of gain. Midwives refrain from the deceptive endorsement of services or products.

Midwives practise within a woman-centred framework

7 Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman.

Conduct statement 7

Midwives focus on a woman’s health needs, her expectations and aspirations, supporting the informed decision making of each woman

Explanation

1 Midwives ensure the mother and her infant(s) are the primary focus of midwifery care.

2 Midwives support the health and wellbeing of each woman and her infant(s), promoting and preserving practices that contribute to the woman’s self-confidence and the wellbeing of the woman and her infant(s).

4 Midwives support informed decision making by advising the woman and, where the woman wishes, her partner, family, friends or health interpreter, of the nature and purpose of the midwifery care, and assist the woman to make informed decisions about that care.

6 Midwives advocate for the protection of the rights of each woman, her infant(s), partner, family and community in relation to midwifery care.

8 Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each woman and her infant(s).

Conduct statement 8

Midwives promote and preserve the trust and privilege inherent in the relationship between midwives and each women and her infant(s)

Explanation

1 Midwives promote and preserve the trust inherent in the woman-midwife partnership.

2 An inherent power imbalance exists within the relationship between each woman and midwives that may make the woman and her infant(s) in their care vulnerable and open to exploitation. Midwives actively preserve the dignity of people through practised kindness and by recognising the potential vulnerability and powerlessness of each woman being cared for by midwives. The power relativities between a woman and a midwife can be significant, particularly where the woman has limited knowledge, experiences fear or pain, needs assistance with personal care, or experiences an unfamiliar loss of self-determination. This vulnerability creates a power differential in the relationship between midwives and each woman in their care that must be recognised and managed.

9 Midwives maintain and build on the community’s trust and confidence in the midwifery profession.

Conduct statement 9

Midwives maintain and build on the community’s trust and confidence in the midwifery profession

Explanation

1 The conduct of midwives maintains and builds public trust and confidence in the profession at all times.

2 The unlawful and unethical actions of midwives in their personal lives risk adversely affecting both their own and the profession’s good reputation and standing in the eyes of the public. If the good standing of either individual midwives or the profession were to diminish, this might jeopardise the inherent trust between the midwifery profession and women, as well as the community more generally, necessary for effective relationships and the effective delivery of midwifery care.

3 Midwives consider the ethical interests of the midwifery profession when exercising their right to freedom of speech and participating in public, political and academic debate, including publication.

Midwives practise midwifery reflectively and ethically

10 Midwives practise midwifery reflectively and ethically.

Conduct statement 10                  

Midwives practise midwifery reflectively and ethically

Explanation

1 Midwives practise midwifery reflectively and ethically, practising in accordance with the Code of ethics for midwives in Australia, in order to learn from experience and contribute to personal

2 Midwives develop and maintain appropriate and current midwifery advice, support and care for each woman in their care and her infant(s) and family.

3 Midwives evaluate their conduct and competency according to the standards of the midwifery profession.

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Code of ethics for midwives

1 Midwives value quality midwifery care for each woman and her infant(s).

Value statement 1

Midwives value quality midwifery care for each woman and her infant(s)

Explanation

At the heart of valuing quality midwifery care is valuing each woman, the process of childbirth, the woman- midwife partnership, and the mother-baby relationship. This involves midwives assisting each woman during pregnancy, birth and the early postnatal period, providing support, advice and care according to individual needs. The woman-midwife partnership focuses on the health and midwifery needs of the woman, her infant(s) and her partner and family. Midwives have a responsibility not to interfere with the normal process of pregnancy and childbirth unless it is necessary for the safety of the women and infant(s). Quality midwifery care also necessitates midwives being accountable for the standard of care they provide; helping to raise the standard; and taking action when they consider, on reasonable grounds, the standard to be unacceptable. This includes a responsibility to question and report unethical behaviour or treatment.

2 Midwives value respect and kindness for self and others.

3 Midwives value the diversity of people.

4 Midwives value access to quality midwifery care for each woman and her infant(s).

5 Midwives value informed decision making.

Value statement 5

Midwives value informed decision making

Explanation

Midwives value people’s interests in making free and informed decisions. This includes each woman having the opportunity to verify the meaning and implication of information being given to her when making decisions about her maternity care and childbirth experience. Midwives also recognise that making decisions is sometimes constrained by circumstances beyond individual control and that there may be circumstances where informed decision making cannot always be fully realised

6 Midwives value a culture of safety in midwifery care.

Value statement 6

Midwives value a culture of safety in midwifery care

Explanation

Valuing a culture of safety involves midwives actively engaging in the development of shared knowledge and understanding of the importance of safety – physical, emotional, social and spiritual – as a crucial component of contemporary midwifery care. Midwives who value a culture of safety support reasonable measures, processes and reporting systems designed to reduce the incidence and impact of preventable adverse events in the provision of midwifery care. They also support the open disclosure to women of any adverse events affecting them or their infants during the course of their care

7 Midwives value ethical management of information.

Value statement 7

Midwives value ethical management of information

Explanation

The generation and management of information (including midwifery care records and other documents) are performed with professionalism and integrity. This requires the information being recorded to be accurate, non-judgemental and relevant to the midwifery care of the woman and her infant(s). All midwifery documentation is a record that cannot be changed or altered other than by the addition of further information. A notation in a record or a document used for midwifery care communication can have a powerful positive or negative impact on the quality of care received by a woman and her infant(s). These effects can be long-lasting, either through ensuring the provision of quality care, or through enshrining stigma, stereotyping and judgement in maternity care decision making and maternity care provision experienced by a woman and her infant(s).

The ethical management of information involves respecting people’s privacy and confidentiality without compromising health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. Personal information may only be shared with the consent of the individual or with lawful authorisation.

8 Midwives value a socially, economically and ecologically sustainable environment promoting health and wellbeing.

Value statement 8

Midwives value a socially, economically and ecologically sustainable environment, promoting health and wellbeing

Explanation

Midwives value strategies aimed at preventing, minimising and overcoming the harmful effects of economic, social or ecological factors on the health of each woman, her infant(s), family and community. Commitment to a healthy environment involves the conservation and efficient use of resources such as energy, water and fuel, as well as clinical and other materials.

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Addendum 2

Guidelines for advertising regulated health services

6.2 Prohibited advertising under the National Law

Section 133 of the National Law prohibits advertising that:

  • is false, misleading or deceptive or is likely to be so
  • offers a gift, discount or other inducement to attract a user of the health service without stating the terms and conditions of the offer
  • uses testimonials or purported testimonials
  • creates an unreasonable expectation of beneficial treatment, and/or
  • encourages the indiscriminate or unnecessary use of health services.

6.2.1 Misleading or deceptive advertising

Section 133 of the National Law states:

1 A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that –

a Is false, misleading or deceptive or is likely to be misleading or deceptive

Eg:

– mislead, either directly, or by implication, use of emphasis, comparison, contrast or omission

– only provide partial information which could be misleading

– imply that the regulated health services can be a substitute for public health vaccination or immunisation

– advertise the health benefits of a regulated health service when there is no proof that such benefits can be attained, and/or

– compare different regulated health professions or practitioners, in the same profession or across professions, in a way that may mislead or deceive.

6.2.2 Gifts and discounts

Section 133 of the National Law states:

1 A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that –

b Offers a gift, discount or other inducement to attract a person to use the service or the business, unless the advertisement also states the terms and conditions of the offer

Advertising may contravene the National Law when it:

– contains price information that is inexact

– contains price information that does not specify any terms and conditions or variables to an advertised price, or that could be considered misleading or deceptive

– states an instalment amount without stating the total cost (which is a condition of the offer), and/or

– does not state the terms and conditions of offers of gifts, discounts or other inducements.

6.2.3 Testimonials

Section 133 of the National Law states:

1 A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that –

c Uses testimonials or purported testimonials about the service or business

6.2.4 Unreasonable expectation of beneficial treatment

Section 133 of the National Law states:

1 A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that –

d Creates an unreasonable expectation of beneficial treatment

6.2.5 Encouraging indiscriminate or unnecessary use of health services

Section 133 of the National Law states:

1 A person must not advertise a regulated health service, or a business that provides a regulated health service, in a way that –

e Directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services

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Addendum 3

Social Media Policy

When using social media, health practitioners should remember that the National Law, their National Board’s code of ethics and professional conduct (the Code of conduct) and the Guidelines for advertising regulated health services (the Advertising guidelines) apply.

Registered health practitioners should only post information that is not in breach of these obligations by:

  • complying with professional obligations
  • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations)
  • presenting information in an unbiased, evidence-based context, and
  • not making unsubstantiated claims.

Additional information may be available from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that registered health practitioners must adhere to are set out in the National Boards’ respective Code of conduct and the Advertising guidelines.

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