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Ethics 4 All

Ethics-for-AllAs a junior doctor, the choices you have to make both personally and professionally may not always be straightforward. Having a professional ethical framework can provide a steer through more difficult situations, says Dr Graham Howarth

Usually, you will find enough detail in the text of the law to tell you how you should act – or more pertinently in many cases, how you should not act. But there will be many other situations in your professional and personal lives where there is no such certainty – or, at least, some room for doubt. Ethics is largely about what happens in between those areas where the law has provided us with clarity and definition. However, many ethical principles are also enshrined in legislation, and in violating them you would be acting both unlawfully and unethically.

As well as law and ethics, our values define how we act – for example, fairness, decency, kindness, tolerance and responsibility. Striving to act ethically and professionally at all times will help you to strike the right balance between a caring, supportive and patient-centred approach, and the need to make a living.

Professionalism – A doctor’s duty of care is an important professional and ethical responsibility, but in general the expectation is one of reasonableness, not of perfection. This applies to standards as well as to specific acts and omissions. The ethical principle of treating others as one would wish to be treated ourselves is a useful starting point.

Morality and decency – Behaviour which might be the norm in some walks of life can be viewed seriously by the regulator. The question for the HPCSA – and for the public – is whether you can be relied upon to be upstanding, honourable and trustworthy. The level of decency and morality displayed in your personal life, and in broader aspects of your professional and business dealings, is a pointer to how you might behave in relation to patients in your care. When it comes to morality and decency there are no half measures for the healthcare professional.

When it comes to morality and decency there are no half measures for the healthcare professional

Honesty – Honesty is a central pillar of a doctor’s integrity. Your professional reputation can often survive an honest mistake or lapse in judgment if the response is open, honest and transparent. It is far more difficult for personal integrity to survive a minor transgression if this is then compounded by serial acts of dishonesty committed in a desperate, but misguided, attempt to recover the situation. At times of great stress, it is not always easy to think clearly and sensibly. Many acts of dishonesty are committed as a panic reaction.

Respect – Respect for patients might seem to be just common sense, rather than an ethical principle. Respect for another individual is not a single concept, but a combination of the principles of autonomy, fidelity and veracity, along with an intention to do no harm. When dealing with clinical situations, respect for the patient is rarely isolated from all the other ethical principles when it comes to managing your patients’ needs.

Patient autonomy and consent – Consent is about effective communication and a trusting relationship between a patient and doctor. It relies on a total respect for patient autonomy as far as the patient’s capacity will allow. It requires information to be shared so that a patient feels able to make a decision for their own benefit, according to their own codes and values. Patients who feel respected and involved in decisions about their care and treatment will, in turn, have greater respect and trust for their doctors.

Patient autonomy and their absolute right to confidentiality must be ensured in almost all but the most exceptional circumstances

Confidentiality – Patient autonomy and their absolute right to confidentiality must be ensured in almost all but the most exceptional circumstances. Patients have the ethical and legal right to expect this from you. They also have the expectation that you will retain that information safely for their access.

Competence – Being a professional requires competence, as well as a great deal of critical self-analysis and evaluation. You need to recognise when your own competence in a given situation is compromised. You must also be able to recognise suboptimal performance in others and be prepared to take action if patient safety is compromised.

Relating to colleagues – Conflicts arising from a breakdown in the relationship between professional colleagues should be contained in a manner which:

  • Avoids placing patients at risk
  • Maintains the continuity and quality of patient care
  • Avoids bringing the profession into disrepute
  • Maintains public confidence in the profession
  • Treats professional colleagues as we would wish to be treated ourselves.

Personal conduct – The public expectation of personal conduct is much higher if the person has a professional career and, particularly, if they are a doctor. You always need to ask yourself: “Would a reasonable person, knowing the facts, think that I am acting appropriately?”

To read this article in full, see the November edition of the Medical Chronicle.