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An issue of ethics: Fall 2003

Often, when people talk about ethics, they want to talk about how they feel about, for example, confidentiality or dating clients, and they want to know how you feel about the subject. 
According to this taken for granted belief, “doing ethics” is about discussing feelings and right and wrong in turn become a matter of what we feel.


September 22, 2009
By Cidalia Paiva

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Often, when people talk about ethics, they want to talk about how they feel about, for example, confidentiality or dating clients, and they want to know how you feel about the subject. 

According to this taken for granted belief, “doing ethics” is about discussing feelings and right and wrong in turn become a matter of what we feel.

Moreover, since my feelings cannot be more right or wrong than yours, all our opinions are equally valid and meaningful because they reflect our feelings on the subject in question. While it may be true that our feelings are equally valid, this interpretation of ethics is based on s serious misunderstanding and misinformed opinion

Ethics is a discipline of study with a prescribed knowledge base. The body of knowledge of ethics consists of concepts such as informed consent, respect for persons, confidentiality, ethical theory and decision making.

This body of knowledge is established and has been developed in medical ethics out of the work done in the last 25 years. 

When we use the term informed consent, for example, we cannot simply elect to reinvent this concept, to define it as we will or like because this is what we believe it ought to mean any more than we can decide to call Swedish Massage Shiatsu because we believe it is suitable or accurate to do so. 

We have a commonly agreed upon body of knowledge that defines Swedish Massage clearly within the context of massage therapy. Similarly we have a body of knowledge in ethics that tells us that concepts such as informed consent or respect for persons have a certain defined and commonly shared meaning and application. 

Beyond this, and significantly, ethics for health care professionals is a discipline of study which involves reflection, thought, and reasoning. “Doing ethics” requires looking at reasons for different positions presented to support or refute an argument, and assessing these utilizing critical thinking skills.

Similarly, the concept of professionalism is also little understood and often taken for granted in common everyday language. Many groups, if not all organized working groups, consider themselves professionals.

Some believe that merely thinking oneself to be a professional or calling oneself a professional is sufficient to warrant the title and ascription. However if this were accurate or true then by extrapolation all ways of making a living would be considered professions. Clearly in a health care setting, being a health care professional has a very specific meaning and context.

What is a profession in this sense? Sociologist, Abraham Flexner, defined professions as, “those forms of employment that require an uncommonly complex knowledge base used by persons committed to the direct benefit of human beings with minimal societal control placed on their practice and organized among themselves to ensure that they continue to provide these services.”

According to this definition, professionals are those expert groups of people we depend on to provide us with knowledge which we cannot easily acquire on our own. Therefore professionals usually require education within the university system and often beyond the level of a fourth year degree.

What is a profession in this sense? Sociologist, Abraham Flexner, defined professions as, “those forms of employment that require an uncommonly complex knowledge base used by persons committed to the direct benefit of human beings with minimal societal control placed on their practice and organized among themselves to ensure that they continue to provide these services.”

By this definition, professionals are expert groups of people we depend on to provide us with knowledge which we cannot easily acquire on our own. Therefore, professionals usually require education within the university system and often beyond the level of a fourth-year degree. 

Members of professions are also usually involved in research to ensure their expertise is continuously pursued and developed. However, the key and critical idea behind being a professional revolves around this fundamental point: Expert knowledge of the professional is used for the direct benefit of human beings. It is this crucial distinction which separates professions from occupations that are openly self serving.

The person who earns a living, for example, selling shoes, has an occupation. However, that occupation is not called a profession; it is called an occupation, even if he has expert knowledge that enables him to be extremely successful in selling shoes.

It is our expectation as a society that health professionals will be motivated by the desire to benefit their clients and we pass judgment on those health professionals who subordinate the goal of benefiting other to the pursuit of self interest.

The health care professional makes a commitment to utilize his or her expertise for the direct benefit of human beings. He or she professes that he or she has special knowledge and skills and that he or she will utilize this knowledge and skills in the patient’s interest not his or her own.

The deeper meaning of being a professional then entails a personal decision to involve oneself in a system of roles that are socially defined.

A professional commitment is a different commitment from a private decision. It is a public commitment to all potential users of the profession’s services. Thus it begins to involve other persons in a way that a purely private decision usually cannot.

Although personal preference is often a good thing or a good reason for doing something or not doing something, once a promise has been made, the action in question can no longer be a matter of personal preference. The individual who makes the promise has a duty to act and those to whom the promise is made have a right to what it is that person has promised. This is why professional issues are ethical issues. Professional issues relate directly to the profession’s ability to live up to the promise that it made to society.

A profession’s commitment to the public good is officially articulated in a given profession’s code of ethics and related guidelines for conduct.

In fact, the drafting of a code of ethics and its endorsement within a profession are two of the earliest signs that a profession is emerging from what was previously a domain for technicians or crafts persons.

Equally important to the growth of a profession is the development of a body of knowledge that includes both sophisticated clinical skills and a strong grounding in theory.

Professions combine practical skill and theoretical knowledge. The importance of practical skills has always been understood by massage therapy as a hands-on profession. The requirement of advanced theory-based knowledge, however, requires further refinement and development.

A good example of this in ethics would be efforts to teach ethical concepts such as informed consent as if an understanding of these concepts simply required retentive knowledge, that is the memorization of the straightforward legal requirements of informed consent.

We must continue to support the development of our theoretical knowledge base in order to facilitate the acquisition of critical thinking skills and independent judge that will enable our students to think and problem solve.

We must develop ethics curriculum that strengthen our students’ ability
to deal with the ambiguity, posed by the ethical issues and dilemmas that are a part of clinical practice. Ethics as theory centres on cognitive skills, skills of the intellect such as perception, clarity and argument.

Why do we need to study ethical theory? Certainly not to memorize a code of ethics as a “to do” list, but rather to help our students acquire a deeper, richer, more reflective understanding of the ethical quality of their  choices and actions and a deeper appreciation of the commitment
they will be called to make as health care professionals.

If we are to continue our emergence and evolution as health care professionals, the ethics curriculum taught in schools must also provide a theoretical understanding of the concepts health care professionals utilize.

We must learn the language and tools of ethics and begin to develop ethics curriculum that assists our profession in developing responsible thinking persons in a large and broad domain of professional life where in practice and in theory clinical skill and theoretical knowledge are integral parts of the professional experience.


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