As a follow up on Strategies for resolving ethically ambiguous scenarios last month below is a reprint of a discussion piece by AHRECS senior consultant Colin Thomson
In the first column in this series, the circumstances in which the ethics of health professionals emerge were identified as being a member of a profession and the context of health care. This third column examines the subject of professional ethics in more depth, focussing on matters that are generic to any health profession.
What is a profession?
Although there is no agreed definition, the Australian Consumer and Competition Commission and the Australian Council of Professions have developed the following useful definition of this concept:
A disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others.
Inherent in this definition is the concept that the responsibility for the health and welfare and safety of the community shall take precedence over other considerations (i).
This identifies the elements that distinguish the ethical character of the professional-patient/client relationship from other relationships. These are the special knowledge and skill of professionals and the exercise of these in the interest of others.
Special Knowledge and Skill
Because professionals have special knowledge and skill, their relationships with patients and clients have been assumed to be unequal: the professional has knowledge that the patient does not. In non-professional relationships, such an inequality can place the uninformed at risk of being influenced, persuaded or exploited. In such relationships, no clear ethical obligations apply to such use of a superior position, and although society recognises the risks of being “conned”, it does not impose ethical obligations. When there is sufficient harm, common law principles that protect against fraud or statutory rules about fair trading can apply. By contrast, professionals are required to use their superior knowledge and skill in accordance with ethical obligations.
In the interest of others
The key ethical obligation of professionals is to use their knowledge and skill in the interests of, or in the health sphere, for the benefit of others, namely their patients or clients. Where professionals use the superior position that their superior knowledge and skill gives them, for their own benefit, they are exposed to professional sanctions. Using a professional relationship for sexual gratification or financial gain unrelated to expert services are gross examples of such conduct and can lead to loss of professional credentials.
From beneficence to respect
The emergence of medicine as a distinct body of knowledge and skill was closely followed by early expressions of the ethics of health professionals, notably by Thomas Percival. Although the obligation to use that knowledge and skill for the benefit of patients was recognised, the benefits of medicine were not then well established. As these benefits increased, this ethical obligation increasingly emphasised the patient’s benefit, an expression of the ethical principle of beneficence or to act for the benefit of others. When this becomes the dominant motivation in a relationship it can become paternalism, as expressed in the aphorism “doctor knows best”.
In the last four decades, as the result of a complex interaction of social factors, the prominence of beneficence has gradually been replaced by the ethical principle respect for autonomy. Although this can be described as a reaction to the undue emphasis on beneficence that became paternalism, the causes are more complex. Nonetheless, respecting a patient’s capacity and entitlement to make decisions about their healthcare has become central to professional ethics in health care.
Respect and beneficence: professional “distance”
The rise of respect for autonomy can present health professionals with another tension: that between respect for a patient’s views and the compassionate desire to achieve a patient’s maximum welfare. In non-professional personal relations, personal attachment and love freely allows such a desire to be expressed. By contrast, expressing compassion can be difficult for professionals because of the detachment and structure required by their relationships with patients. We are free to say we love our friends and family and that love explains our devotion, but professionals are not similarly free and need to express their commitment and compassion through an ethical structure that can feel impersonal.
(i) http://www.accc.gov.au/content/index.phtm/itemId/277772 (accessed 10 December 2009
Republished with permission of the Australian Hospital & Healthcare Bulletin, http://www.hospitalhealth.com.au/subscribe
This post may be cited as:
Thomson C. (2017, 14 July) Professional ethics Research Ethics Monthly. Retrieved from: https://ahrecs.com/human-research-ethics/professional-ethics