Ethics: The "Set" of Professionalism
These seven ethical tenets form the front line interaction in patient care. By demonstrating a solid knowledge and understanding of ethics, both practitioner and patient are served well by honouring the encounter and strengthening the patient’s trust.
Autonomy provides that a patient is free to make decisions that affect their needs: free from deceit, duress, constraint or coercion, and they are to be an informed participant in making those decisions. Autonomy provides a respect for personal freedom for both the patient and practitioner alike, that ennobles and professionalizes the clinical encounter.
In health care, inherent to the principle of autonomy is the concept of informed consent. Patients have the right to be properly informed of their condition, and the benefits and risks of the procedures that will be used to assess and treat them, in order to facilitate their decision, and their care.
Beneficence describes the principle of doing good; as much good as possible to benefit another.
It is a very strong concept of a positive action to remove or prevent the patient’s problem and strives to promote the very best. Beneficence is not served by partially withholding goods or services in order to prolong or extend the services provided for increased financial gain.
Non- malfeasance means one should never do any harm or inflict damage to another.
In health care, non-malfeasance is embodied in the principle of Primum Non Nocere and is found in the Hippocratic Oath as “physician - do no harm”. Some patient’s problems have solutions that may not be worth the treatment when the risk-benefit ratio is considered. Autonomy, veracity, beneficence also apply to this type of decision making.
Justice addresses the concepts of fairness and entitlement.
Fairness is difficult to measure objectively but encompasses the distribution of goods and services; who receives benefits and to what degree. As well, all patients are to be treated on a fair and equal basis irrespective of ethnicity, social status or any other type of social and personal uniqueness.
Justice is not served by using one’s position of authority to engage a patient on the basis of financial benefit versus the prudent management of the patient’s condition or problem.
Veracity refers to the comprehensive, accurate and objective communication of information, and binds the practitioner and patient in an association of truth.
This obligation, based on the respect owed to the patient, is closely linked with fidelity (to fulfill an agreement and keep a promise) and prohibits deceit. This ethical tenet particularly guards trust. We can’t expect a patient to trust a practitioner if they are not told the whole truth. It’s that simple.
Confidentiality further guards the professional’s trustworthiness. While patients surrender some privacy by granting to their professional personal and privileged information, they do not surrender control over how that information is used.
Confidentiality binds the professional not to divulge that privileged information to another party, unless of course permission has been given by the patient. The trust bond becomes severely weakened if the patient fears unauthorized disclosure, thus impairing the ability of the professional to fully serve the patient.
Paternalism is the principle empowering the professional to act on behalf of the patient when the patient is not able to choose or act for him or herself, as a parent makes choices for a child.
Linked with both autonomy and veracity, paternalism gives authority to the practitioner in helping the patient to make a decision, always acting within the confines of a fiduciary relationship; that being, placing the needs of the client above their own personal needs, and the needs of others.
While practicing in an ethical manner is not optional, the law, through legislation and regulations, can only go so far in setting out what the minimum standards are, in terms of what is strictly forbidden in the professional office setting. While the law does not establish precise optimal performance, professionalism demands that professionals strive for and maintain excellence in the both the ‘set’ and the ‘setting’.
Optimal behavior is particularly demonstrated in the virtues.
Virtues: The "Setting" of Professionalism
The concept of the virtues is rooted in history but now re-emerging. Professionalism obligates the professional to consider that the foundational ethical tenets, the set, be embodied in an appropriate setting, codified as virtues, or character traits.
A virtue is defined as a part of our character that is socially valuable, so that our character consists of a set of traits or virtues, which affect our thinking, words and deeds. The following seven virtues form the underlying basis for interaction with patients. These are the setting on which the set, the ethics, rests.
Professionals are accountable on four levels: to individual patients, colleagues, governing bodies and society at large. An important part of this accountability is accepting one’s duty to serve, sometimes with personal inconvenience, and sometimes with risks when advocating for the best possible outcome; for example to a patient in a financial hardship situation.
Compassion is a trait that combines an active regard for another’s welfare by modeling an awareness and a response of sympathy and tenderness for a patient’s misfortune or suffering.
Closely allied with compassion is respect, this being the essence of humanism, another central concept of professionalism. Individuals have immutable rights and therefore are worthy of respect for their individuality. Compassion and respect are virtues which follow from the ethical tenets of both autonomy and justice.
Excellence entails conscientious effort: an effort to exceed the ordinary expectations of the patient; an effort to continually pursue being a life-long learner, and an effort to give back to the profession.
Fortitude deals with a firm courage and perseverance despite discomfort, misfortune and even suffering when pursuing a professional task.
In health care, history is rich with examples of caregivers and researchers who placed themselves in situations of risk when dealing with unknown threats and diseases. Think of health care providers who have chosen to serve the sick and less fortunate in war torn countries and destitute regions. These motivated caregivers exemplify fortitude.
Integrity is the consistent regard for the highest standards of both professional and personal behavior; being a ‘whole’ person, and not given to a dual character that contrasts one’s personal behaviors with professional duties. It speaks of consistency in being fair, straightforward, speaking the truth, and in being faithful to finish the job.
The concept of integrity comes from the mathematical term ‘integer’, meaning whole number. Because professionals are held to higher standards, inappropriate behavior during time spent away from the clinic has an effect on both patients and colleagues.
Prudence refers to acting thoughtfully and discretely. A prudent professional is in the moment, mindful of the task at hand, taking care to always think about the implications to the patient and those close to the patient.
Prudence embraces temperance, the ability to demonstrate discernment and self control, and is linked with the virtue of compassion and the ethical tenets of veracity and confidentiality.
Fidelity is a strong concept referring to loyalty and trust, going beyond just being true to one’s word. The professional expresses fidelity by favoring the patient’s interests over all others, which is another way to define fiduciary.
While the law cannot force one to practice virtuously, it is the virtues that constitute the most powerful expression of one’s professionalism, allowing the ethical tenets, the set, to honor and ennoble the professional – patient encounter.
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