An Issue of Ethics: Spring 2005
By Cidalia Paiva
The early Greek philosopher Socrates once wrote that “knowledge was
virtue.” He believed that if we knew right from wrong we would choose
right. Though a brilliant philosopher and founding forefather of
western thought, history has proven that on this one at least, Socrates
By Cidalia Paiva
The early Greek philosopher Socrates once wrote that “knowledge was virtue.” He believed that if we knew right from wrong we would choose right. Though a brilliant philosopher and founding forefather of western thought, history has proven that on this one at least, Socrates was wrong.
Unfortunately, the sheer fact of knowing what the ethically right thing to do is does not necessarily mean that we will act or behave ethically. From the pulpit to the courts we are told on a daily basis what the right thing to do is. Our parents tell us, society tells us, our peers tell us and the laws reinforce these messages. Yet we do not always behave ethically. Why?
Most of us are pretty clear about the laws, rules and regulations that form the list of injunctions and prohibitions that tell us what it is that we must not do in order to “do no harm.” The RHPA, Massage Therapy Act, bylaws of our regulatory authorities, Codes of Ethics and Standards of Practice documents make it extremely difficult for us not to know what the bottom line is in terms of professional expectations. The bottom line, of course, referring to those behaviours we must abstain from in order to meet the requirements of professional practice.
From the inception of our education in our training institutions ethics curriculum all too often largely consists of “laundry lists” of behaviours that we must abstain from. Despite the fact that we share a relatively similar educational experience for some of us “laundry list ethics” simply doesn’t work. For some of us, sincere compliance can only occur when we have internalized the demands that are being made of us and can fulfill these expectations from a place of personal commitment.
In order to make this commitment we need to ask a further question – why? Why should we keep the bottom line? If we could get away with dating our patients or falsifying a patient’s documentation in order to procure benefits for them and us (after all we might very well reason it will be coming out of the pockets of those rich insurance companies).
We certainly know what is required of us but not why we should meet this requirement.
It is precisely this type of question which “laundry list ethics” cannot answer because it requires a deeper understanding and analysis of who we are as health care professionals and why we do what we do.
Why should we be keepers “of the bottom line” if we could never be discovered and would never suffer any consequences. Ultimately there can only be one compelling answer to this question – because we promised to do so, because by entering the field of massage therapy and becoming a health care professional we have implicitly committed ourselves to do just that.
We have, in effect, said to society: if you provide us with the privilege of serving clients we will serve their best interests to the best of our ability. We will do this with the knowledge, skills and most importantly integrity that are part of this promise. As health professionals we promise that you can trust us to do this because we are people of integrity.
Being a professional, however, requires so much more of us. We have not simply promised to do “no harm” we have also promised to “do good” and to actually benefit others.
As health care professionals we must be just as diligently committed to the performance of positive duties as we are to negative duties.
What exactly do fulfilling positive duties entail? Let me give you a practical and mundane example from everyday life. Imagine that you and I are walking down the street and I have a candy bar wrapper in my hand that I need to discard. I likely will not just throw it on the ground (especially if there is a no littering sign near by and a policeman watching) because I do not wish to harm the environment or break the law. If, however, we are walking down the very same street and I see litter, there is no law which states that I must pick up this litter. Yet clearly I may choose to pick up this litter in order to beautify the street by helping to keep it clean. My action of picking up the litter is a positive good or benefit I choose to confer over and above what is required of me.
The minimum requirements of laws are certainly important but they are not everything and some might even say ethically speaking perhaps that they are not even the most important things.
As health professionals we need to provide our clients with the best possible care we can provide. To keep this commitment we must remain true to our positive ideals as well as to rules and regulations.
The ethical value systems we have pledged ourselves to form our ideals and speak to the highest measure of practice, to the top line or bar as opposed to the bottom line.
What are these values?
Some of these include respect, caring and compassion. No one can legally demand that we be caring and compassionate but we can and must expect this of ourselves.
Ethical life and behaving in an ethically responsible manner will always require more than committing ourselves to negative duties or laundry lists of “thou shall nots” in order to prevent harm. We must also commit ourselves to positively benefiting others.
This sometimes means walking the extra mile and spending those additional few minutes with that elderly patient, creating a sliding scale perhaps for that client who has lost his job, making that home visit to that patient who has been diagnosed with a terminal illness and wishes to continue with massage therapy but cannot come into the office any longer.
We need to believe that we are more than just “not bad people” who refrain from doing harm; we need to believe that we are in fact “good people” who do “good” and who contribute to the quality of life around us. We give what we can give because we realize and appreciate that what makes life rich and fulfilling is not the harm we abstain from doing but the good we actually do when we extend ourselves to support, enrich and touch the lives of others. Why is this case? Because as human beings we need to exercise our hearts and spirits as much as our bodies and minds.
We need to remember that we do not heal others with knowledge or skill alone, we heal with intent. When a positive intent is manifested, healing occurs. We need to do this for our clients and for ourselves because as Catholic Theologian John Powel once wrote: “people do not care how much you know, until they know how much you care.”
The professional promise is above all a commitment to our ideals. It is a commitment made with sincerity to others and to ourselves, because we are people of integrity who do care.