Professionalism and ethics by mikesanye


									Professionalism and ethics


   Recent expressions of concern re the
    professional status of medical practitioners
    (NB Such concerns are not new!)
   The possible origins of these concerns
   The responses on behalf of the profession
   What this might all mean for regulators


   Professionalism and ethics, and the
    connection between them
   The influences that may be at work
   The responses from sections of the
   What might be learned


   What is a profession?
   What do we mean by ethics?
   What do we mean by “professional
   And what is “medical professionalism”?

          What is a profession?

   Historical notions of a life time
    commitment to service
   In modern times there is no agreed
   For the medical profession, I suggest that
    the defining quality is putting the patient’s
    interests ahead of personal interests

             What is “ethics”?
   “How we choose to live our lives after
    considering all the issues”
   “Ethics searches for reasons for acting or
    refraining from acting, for approving or not
    approving conduct, for believing or denying
    something about virtuous or vicious conduct or
    good or evil rules”

NB. Simple definitions encourage community input to
  ethical debate.

           What do we mean by
           “professional ethics”?
   Are professional ethical codes designed to
    entrench professional status and privilege?
   Or are they designed to foster conduct
    which will best serve the community?
   And how does a profession answer these
   Or how does a profession engage with the
    community they purport to serve?

What is “medical professionalism”?

   “Professionalism is the basis of medicine’s contract
    with society. It demands placing the interests of
    patients above those of the physician, setting and
    maintaining standards of competence and integrity and
    providing expert advice to society on matters of
    health” (1)
   Medical “professionalism is a set of values, behaviours
    and relationships that underpin the trust the public has
    in doctors”. (2)
     1. A physicians’ charter. Lancet 2002; 359: 520-522.

     2. Medical professionalism in a changing world. Royal College of
    Physicians, December 2005
              What really lies behind
               the recent papers?
     “Today, at the dawn of a new century, genuine
      medical professionalism is in peril. Increasingly,
      physicians encounter perverse financial incentives,
      fierce market competition, and the erosion of patients’
      trust, yet most physicians are ill-equipped to deal with
      these threats”.(1)
     “Physicians today are experiencing frustration as
      changes in the health care delivery systems in virtually
      all industrialised countries threaten the very nature
      and values of medical professionalism”. (2)
    (1) Wynia et al NEJM 1999;341: 1612-1616.
    (2) A Physicians’ Charter

              What really lies behind
             the recent papers? (cont)
   “the exercise of medical professionalism is
    hampered by the political and cultural
    environment of health, which many doctors
    consider disabling” and (at the end of its
    summary) “…our collective and abiding wish is
    to put medical professionalism back onto the
    political map of health in the UK”.*
    *Royal College of Physicians. Medical professionalism in a changing world.

      Why is the “sky falling in”?

   A “cottage industry” no longer
   Rising health care costs
   The need for government to use health
    budgets wisely
   Changing community expectations
   Fragmentation of the profession
   Diminished community respect ?
          The weaknesses of the
             responses so far
     (to a profession seeing itself under siege?)

   A one sided contract
   No or very little attempt to negotiate with,
    or consult with, the community
   “Our collective and abiding wish is to put
    medical professionalism back onto the
    political map of health in the UK”.*
    * Royal College of Physicians

        The real issues to debate
   What purpose does a code of ethics serve?
   Should a code of ethics be aspirational or should it be a
    set of standards below which failure would lead to
    disciplinary action?
   If is it agreed that a code be aspirational, who should
    prepare the code and what should be the core
    aspirational values/principles/ ethical qualities in it?
   Should the regulator set the ethical standards? If so,
    how would community expectations be included?
   Should codes of ethics be enforced? Should they have
    penalties attached?
   If so by whom should they be enforced and by what
Can professionalism be taught?

   Changes to undergraduate and post graduate
    curricula in a number of countries suggest we
    believe this to be the case.
   “Character formation cannot be avoided by
    medical educators. Students enter medical
    school with their characters partly formed. Yet
    they are still malleable as they assume roles and
    models on the way to their formation as
    physicians” (Pellegrino 2002)

       The changing balance of
     application of ethical principles
   The central ethical principle which seemed to be
    lived out by my mentors was beneficence.
   In one generation this has been overshadowed
    by the principle of patient autonomy and
   We are now moving into an era where justice
    will become the dominant influence, because of
    the evident need to use finite resources wisely.

  Some ideas you might wish to
1. What is the role of a code of ethics?
 2. Should a code of ethics be aspirational vs “lowest
common denominator”?
 3. Should a code of ethics be prepared by the
profession at large (with community and regulator input)
or by the regulator?
 4. Should the regulator have informal or formal
mechanisms for community consultation and
 5. Do you agree that justice is becoming a more
important ethical principle and if so who should take
responsibility to show leadership in this issue?

   WMA Declaration of Geneva 2006
  “At the time of being admitted as a member of the medical profession:
   I solemnly pledge to consecrate my life to the service of humanity;
   I will give to my teachers the respect and gratitude that is their due;
   I will practise my profession with conscience and dignity;
   The health of my patient will be my first consideration;
   I will respect the secrets confided in me, even after the patient has died;
   I will maintain, by all means in my power, the honour and noble traditions of the
    medical profession;
   My colleagues will be my sisters and brothers;
   I will not permit considerations of age, disease or disability, creed, ethnic origin,
    gender, nationality, political affiliation, race, sexual orientation, social standing or any
    other factor to intervene between my duty and my patient;
   I will maintain the utmost respect for human life;
   I will not use my medical knowledge to violate human rights and civil liberties, even
    under threat;
   I make these promises solemnly, freely and upon my honour”.

WMA Declaration of Geneva 2006
 What a pity the authors failed to add:
“Despite my patient being my first
 consideration, I will also seek to use
 resources wisely and to play a constructive
 part in the health care system my country
 chooses to establish”!

Thank you for your attention


To top