Emergency Law and Ethics

Ethics

 

Introduction to the theme: professional codes of conduct or ethics codes

 

The subject area of ethics is broad, and even though we have quite a narrow interest in the area I will alert you to some of the features of the whole field.

 

In Part II I will insert sections from Codes to save you sourcing them whilst reading.

 

 

Ethics, Morality, Bioethics, Clinical Ethics and Social Morality

 

So, what is ethics? Notice that in this question I have not put the word ‘ethics’ in inverted commas. So I am not asking the question, “What is the meaning or the origin of the word ‘ethics’?”[1] Our first target is not the word itself; we will look into the word and its origins a bit later. Our first target is the activity or activities that are picked out or identified in the concept of ethics. I am assuming that whatever ethics is it is acted out or done by people.

 

How do we start?

 

What exactly does the term ‘ethics’ encompass? Or, put in another way, how do we specify the subject matter of ethics by identifying instances or examples of it?

 

Before we begin in a piecemeal way by providing examples, it might be tempting to try and put a definition forward: a definition of the word, ‘ethics’.

 

Tempting, yes. We can agree that it would be better to give a definition of ‘triangle’ as ‘a three-sided plane figure where the internal angles equal 180 degrees’, rather than pilling up examples of different kinds of triangles: the equilateral, isosceles, scalene and such. But not all nouns are so easily captured in a definition. ‘Ethics’ is abstract because it is an organising idea and not a concrete constituent in our world. The best way to start to understand abstract nouns that name concepts – justice, generosity, compassion, ego, velocity, brilliance etc., – is to see them in action and analyse them (look at their relationships to other ideas).

 

So with these points in mind, let’s turn to ethics again.

 

As I said, I am going to start with the assumption that we are interested in human behaviour or actions.

 

What does the list of activities that fall under the title of ethics look like? I hope that you will see the activities assembled here are closely related in subject matter.

 

(A) Ethics as a mundane part of everyday evaluative activity.

 

It is that part of our lives where the evaluation of human behaviour is our primary concern. A bit more narrowly, it is the evaluation of human behaviour that we undertake when our concern is with what is done by someone that has potential impacts on the interests of others. Ethics is a routine and mundane part of our lives because evaluation is an inevitable part of all of our lives.  The evaluation of the behaviour of people is deeper and more central to what we are as social beings than almost anything else.

 

Examples are probably unnecessary here, but I will introduce a few to show you how common evaluations of people are, and how ethical evaluation forms a sub-set.

 

 

  • Consider how you might characterise someone, a friend perhaps, as amiable, cheerful, courteous, dependable and tactful. That is just a smattering of the evaluative terms that we might use when describing someone found to be good company.

 

  • Or, and differently, we might describe another person as zany, witty, whimsical, playful, clever, humorous and jocular. Again it looks as thought we are evaluating them in terms of attributes that make them fun to be with.

 

  • However, imagine that instead of either of these sets of characteristics you said that a person was conceited, pompous and arrogant. These are evaluative terms too, but ones that point to aspects of someone that might count as reasons for avoiding them.

 

Finally, consider two very different kinds of evaluations:

 

  • Imagine that your evaluation of someone is like this: he is cruel, callous and malicious. In all likelihood this is not just a character you would avoid as a companion on a long journey, but someone to be avoided at all costs.

 

  • Imagine now the complete opposite: your evaluation is that someone is kind, compassionate, and loyal. That character would be a social asset rather than a liability.

 

Proper use of all of the evaluative terms found above, and others implicit in the examples, entails a sensitive judgment about the person in question based on accurate observations. None of these can be used lightly and some skill is involved in working out whether someone is shy and retiring or mutely resentful. It would be my guess that this part of the domain of evaluation is more tightly packed with terms that have fine grades of difference than any other non-scientific area we are involved with.

 

These evaluative terms relate to personality and character traits (the evaluative terms that are doing all the work here in the examples). These are the ones that get further classified as vices or virtues: vices being those traits that destroy or undermine cooperative endeavours, while virtues are the strengths of character (traits) that support and facilitate cooperation and coordination. So here under (A) we have ethics as the routine evaluation of people in terms of vices and virtues.

 

 

(B) Ethics is the name for a formal area of study found in philosophy departments in universities.

 

Theorizing is a well-known human activity, and when applied to ethics (that busy evaluative business in A above) it is a formal area of study. In academic programs ethics is also known as ‘moral philosophy’. Philosophising is just thinking that proceeds in a systematic and critical way, so philosophical ethics takes the activity and words of ethics evaluation as its subject matter and spins theories about them. It’s been going on in one form or another since Plato in the 4th century BCE and many of the modern theories of ethics can be found in his book, The Republic. The activity called philosophical ethics or moral philosophy is really talking and writing about the language and the activity of evaluation. It is explicitly theoretical; that is, it is an activity conducted at a very abstract level.

 

This formal study called ethics is conducted in topics run in places other than philosophy departments, but when it is you can expect to see qualifying adjectives coming into use: Christian ethics in theology departments, medical ethics in departments of medicine, nursing ethics in nursing schools, health care ethics in health sciences and business ethics in commerce and business schools, or legal ethics in law schools and so on.

 

As I mentioned above the philosophical subject called ‘ethics’ is also referred to as ‘moral philosophy’ and at the present moment these are treated as equivalent terms. The significance of the dual terminology will be explained in a moment.

 

 

(C) ‘Ethics’ is a name attached to what are seen as core values.

 

‘Ethics’ is often used as another name for core values. As such it is clearly not an activity in itself, but it is common to find people talking about espousing[2] values where what that means is living according to a set of identified values that constitute a tradition or a personal stance. And the espousing and/or living of values can quite clearly be an immensely important human activity.

 

    This point about espousing values is obvious enough but it has a depth that might be worth drawing attention to. Let’s say you accuse someone of being hypocritical. This involves the claim that they espouse or publicly acknowledge or endorse certain values but in their other action(s) they ignore or blatantly contravene the values they publicly endorse. So the deeper point is that you cannot judge a person’s values simply by what they say those values are.[3]

 

This area of core values is also where you expect to find the word ‘ethics’ preceded by a culturally locating adjective:

 

·         Christian ethics

·         Buddhist ethics

·         Islamic ethics

·         Confucian ethics

·         Secular or humanist ethics

·         Samurai ethics (or Bushido, the way of the warrior)

 

The relationship between values and ethics can be quite complicated; for example, how do you answer the question, ‘what part of Australian values are ethical, or what part of the Hebrew 10 Commandments are ethical?’

 

 

(D) Ethics as a personal basis for action.

 

This point is closely connected to the previous one on core values. It is not unusual to hear someone explaining that they either can or cannot go along with some policy or proposal because it accords with or deeply offends their personal sense of ethics. You come across this when people conscientiously object to something – war, conscription, or participation in some medical procedures like abortion or euthanasia – or when they feel compelled to act when some crisis occurs: ‘I won’t stand by while they are brutalised’ might be a reaction to the continued Israeli occupation and blockade of parts of Palestine.

 

Many people believe that maturity as a person entails being capable of exercising critical self-reflection. And because the reflection is critical you can arrive at some unflattering conclusions about our own behaviour.  The terms of that internal reflection – the ideas you use to evaluate yourself – represent your personal ethical standards or ideals.[4]

 

 

As a personal reflective exercise try to identify the standards you are prepared to judge yourself by. What ideals or self-imposed standards do you hold up as a measure for yourself?

 

(E) Ethics as the content of professional codes of conduct.

 

There is no doubt at all that ‘ethics’ is the most commonly chosen descriptive term for codes of conduct in professional life.

In a legal context the concerned is with you within your role as health professional, not with you in terms of your personal status as a citizen. In a parallel way ethics codes relate to you in your professional role but not necessarily in your personal life. So the sense of ethics as deeply held personal values needs to be clearly distinguished from the codes that provide directions for practice.

Remember, a professional evaluation of your conduct attaches only to the role you play.

 

Professional groups refer to their codes as ethics codes because those codes regulate some aspects of the interaction between members and their patients/clients and also between practitioners themselves.

 

 

What part of ethics does HLTH 1003 concentrate on?

This topic concentrates on category E.

 

 

The Terms Used

We will now turn to the question that I alluded to above: “what is the meaning of the word ‘ethics’?” What it means and where it comes from are intimately connected.

Ethics

 

This word comes into English directly from ancient Greek. Their word was ethikos and it originally referred to the study of both character traits (like courage, loyalty, justice, truthfulness, cruelty, indifference, kindness, prudence etc.,).

 

So ethikos = the study of character traits (exactly what we covered in category A above).

 

The rise and dominance of the Roman state (from c200 BCE) and the dominance of the Latin language throughout their empire ensured that another term would appear to translate the Greek word ‘ethics’. The Roman equivalent word gave rise to our ‘morality’.

 

Morality

The Latin language of the Romans had no direct term to translate ethikos. When Cicero translated the works of Aristotle (3 books on ethikos) the lawyer and philosopher chose the term moralis. This Latin term moralis is the origin of our words morals and morality. The Latin word related mainly to customs and conventions, or what we still mean by the word ‘mores’ (‘when in Rome do as the Romans do’ = follow Roman mores or local practices); so the words ‘morality’ and ‘morals’ have a much stronger association with customary practices than the Greek counterpart, ‘ethics’. But at least historically there is no reason to distinguish between ethics and morals (hence the philosophers’ interchangeable use: ethics = moral philosophy).

Are these words used in the same way now? I think the short answer is ‘no’.

 

Before you go on to consider my reasons for thinking that there is a modern difference of meaning, give some thought to how the two words function in your own thought.

 

 

How the terms diverge

First, there is no doubt at all that ‘ethics’ is the term of choice in modern discussions when we evaluate professional behavior. The production of professional codes is supposed to be action guiding. But how deep are these professional obligations supposed to go? When you state ethical principles in codes as guiding or obligatory you might still be a long way from the claim that codes demand personal conscientious adherence to values that you believe are defining of who you are.

Ethics statements in codes, like legal requirements in legislation, are an external benchmark, whereas someone’s moral life is considered a much murkier internal world (the phrase, ‘of dubious or questionable moral character’ is sometimes heard, as is another of those old gems, ‘exhibiting moral turpitude’; both are still found in judicial pronouncements).

Curiously, the legal practitioners’ code of conduct does use ‘of good character’ as a criterion for evaluation, and ‘moral character’ is clearly intended to be under the microscope.  The same is true of medical codes. Lawyers, as officers of the court, are held to account for what is sometimes called ‘infamous behaviour’, or less grandly, ‘scandalous behaviour’. Scandals are much loved by the media and often get described in terms of someone’s sexual morality. Somehow sexuality and moral turpitude get lumped together.

So, I would conclude that despite their common origin ‘ethics’ and ‘morals’ are not equivalent terms in modern everyday usage.

 

Bioethics

 

This term only came into circulation in 1971 and it refers to the collection of complex issues (what the press calls ‘dilemmas’) generated by the rapidly evolving biological sciences.

 

Bioethics is multi-professional and has a strong emphasis on the arguments that surround policy settings in the public arena. Debates that mirror or provoke public disagreement about euthanasia, IVF, genetic engineering, abortion and resource allocation are all examples of bioethical issues.

 

Clinical Ethics

 

Only some disciplines are concerned with hands-on patient care, and since the word ‘clinic’ comes from the Greek for ‘bed’, clinical ethics concentrates on the clinical encounter involved in the direct delivery of care to patients. But since delivery of care does not exist in a vacuum, legal and policy considerations inevitably come into play at direct care levels too, so no firm demarcations are possible.

 

 

Ethics and human nature

 

 

We have identified a number of practical and theoretical activities that all legitimately fall within the domain of ethics:

 

1.    Codes of conduct in professional life

2.    Another name for core values

3.    A formal area of study (moral philosophy)

4.    An unavoidable human activity (evaluation of human conduct)

5.    A personal sense of the quality of our own actions and those of others

 

But a curious person will want to ask, ‘why did we come up with all of these different forms of activity; what is it about humans that gave rise to them?’

 

The answer is that ethics or morality has a basis in human capacities and attitudes. Its origin will be found in very fundamental features of the human condition and:

 

Our capacity to suffer and to enjoy in two very distinct ways:

 

·         Physically (the body)

·         Psychologically (the mind)

 

Our characteristic ability to see this dual capacity for suffering and enjoyment as shared among our kind:

·         Sensitivity to the needs of others

This sensitivity to detailed aspects of the needs of others attunes us to the different ways in which human being may respond:

 

§ Pain

§ Agony

§ Distress

§ Fear or terror

§ Anxiety

§ Anguish

§ Grief, loss and sadness

§ Humiliation and indignity

§ Uncertainty as the basis for worry

   [You could continue this list………]

Sensitivity and insensitivity to these well-known human vulnerabilities can be described in terms of character traits.

§ Compassion – Malice

§ Empathy – Indifference

§ Kindness – Cruelty

§ Loyalty – Disloyalty

§ Humaneness – Callousness

§ Truthfulness – Dishonesty

§ Fairness – Biased behaviour

§ Gratefulness – Ingratitude

 

 

The roots of morality are to be found in the biological origins of human beings as a social species.

 

Social moralities

 

A social morality is a broad set of constraints designed to provide a framework for the functioning of groups. The point to a social morality is to assist with the problems of co-ordination and co-operation that are bound to occur among a group of people who are possibly strangers to one another. You can conclude that for most of human history modes of social coordination were in place, back to and before the creation of language.

 

Closer to modern times there were written, codified frameworks to help with control and coordination:

 

·         The early Babylonian code of Hammurabi (1728-1686 BCE) was inscribed on tablets of iron and carved on huge boundary stones that still exist. Hammurabi included images of himself sitting on a throne at the top a mountain receiving the law tablets straight from the hand of his Babylonian god.

 

·         The much later Hebrew Mosaic code (600 BCE) had a somewhat down- market version: tablets of clay given to Moses by his god Yahweh; (unlike the much earlier Babylonian code no tablets survive, but an oral tradition did finally find a written form).

 

·         The laws of the Germanic tribes, for example the Salian code, went from an oral to a written form.

 

 

These codes all prescribed[5] and proscribed[6] behavior. Their constraints and demands are stated as coming from an external source (from the king as an intermediary between the people and a god).

 

Here are some examples from the Hebrew source:

 

Mosaic Mitzvoth or Commandments: [Exodus 20: 1-17)]

 

·         Have no other gods but me

·       Create no idols in the shape of anything in the sky or on the earth and do not worship them

·         Do not take your god’s name in vain

 

(Violation of any of these 3 will bring dire punishment on you and your progeny down to the 4th generation)

 

·         Observe the Sabbath as a day of rest

 

·         Honour your father and mother

 

·         Do no murder (NB: The Hebrew word rautsach used in the original text means murder, not kill, so the translation in the majority of Bibles as do not kill is dangerously wrong)

 

·         Do not commit adultery

 

·         Do not steal

 

·         Do not bear false witness

 

·         Do not be envious of your neighbor’s possessions

 

 

From a different religious tradition, Christianity, he following summary points are taken from Luke and from Matthew:

·         Love your enemies

 

·         Do good to those who hate you

 

·         Bless those who curse you

 

·         Return cruelty with kindness

 

·         Be generous to those who rob you

 

·         Give to beggars

 

·         Do to others what you would have them do to you

 

·         Be compassionate

 

·         Neither judge nor condemn others

You might notice in passing that the tribal code of the Hebrews is much more like a modern legal code (with attendant lists of punishments) while the second list looks more like an aspirational code of personal values. That is not an accident since the most important code in the Mesopotamian world was the law code of Hammurabi. The Hebrew approach, and much later Islam, followed his legalistic model.  No state, least of all those that were officially Christian, ever instituted anything like the Sermon on the Mount as its social sanctioned morality.

 

PART II – Codes of Conduct (Ethics Codes)

 

I will begin with the global code that covers all who are employed under the SA state government  (inclusive of health professionals who will also have more stringent codes created by their associations.

  1. The SA Public Sector:

For the sake of our discussion we will not distinguish between codes of conduct and ethics codes.  I say this knowing that at page 344 your textbook says that they are different: ‘codes of conduct differ from codes of ethics, the latter relating to the ideals of the particular profession’.  In some instances that is true but in others it is not the case so ignore the distinction.

The SA public sector code of conduct referred to in the Public Sector Act 2009 (SA) cited immediately below provides the ethical framework for public sector employees but there also appears to be something titled, Code of Ethics for the South Australian Public Sector (2009). In its introduction this code of ethics says that it ‘builds upon…principles’ set out in the Act and aims to support the highest standards of ethical conduct. It is also states that: ‘This Code of Ethics is the Code of Conduct for the purposes of the Public Sector Act 2009. So you can see that despite what the textbook says the two forms of code can be taken as one for the biggest employer of health professionals in SA.

The relevant sections are 5, 14 and 15 of the Public Sector Act 2009 (SA).

For convenience sake here they are:

5(6)      Ethical behaviour and professional integrity

Public sector employees are to—

  • be honest;
  • promptly report and deal with improper conduct;
  • avoid conflicts of interest, nepotism and patronage;
  • treat the public and public sector employees with respect and courtesy;
  • make decisions and provide advice fairly and without bias, caprice, favouritism or self interest;
  • deal with agency information in accordance with law and agency requirements;
  • avoid conduct that will reflect adversely on the public sector;
  • accept responsibility for decisions and actions;
  • submit to appropriate scrutiny.

 

6           Public sector code of conduct

Public sector employees must observe the public sector code of conduct.

 

14          Functions of Commissioner

(1)    The Commissioner has the function of advancing the objects of this Act, and promoting observance of the public sector principles, in so far as they relate to public sector employment and for that purpose is to—

(a)    issue the public sector code of conduct (see section 15)

15        Public sector code of conduct

(1)    The public sector code of conduct may contain—

(a)    provisions directed towards advancement of the objects of this Act and observance of the public sector principles; and

 

(b)     provisions governing the conduct of public sector employees (within and outside their employment) that are expressed to be disciplinary provisions.

 

(2)    The code will be taken to allow a public sector employee to engage in a private capacity in conduct intended to influence public opinion on an issue, or promote an outcome in relation to an issue of public interest, except if—

(a)    it is reasonably foreseeable that the conduct may seriously prejudice the Government or a public sector agency in the conduct of its policies given the relative seniority of the employee, the extent to which the issue is relevant to the role or a previous role of the employee and the nature and circumstances of the conduct; or

(b)    the conduct involves—

(i)     disclosure of information in breach of intellectual property rights; or

(ii)     disclosure of information contrary to any law or to any lawful instruction or direction relating to a specific matter; or

(iii)    disclosure of information with a view to securing a pecuniary or other advantage for the employee or any other person; or

(iv)    disclosure of information of commercial value the disclosure of which would diminish its value or unfairly advantage a person in commercial dealings with the Government or a public sector agency; or

(c)     the conduct is disgraceful or improper conduct that reflects seriously and adversely on the public sector.

(3)    Subsection (2)(a) does not apply in respect of conduct engaged in by an employee in the employee’s capacity as a member of the governing body of a public sector representative organisation.

(4)    The Commissioner must keep the code under review and may vary the code, or revoke and substitute the code.

(5)    The code, and any variation of the code, must be published in accordance with the regulations.

(6)    The code, or a variation of the code, has effect from a date fixed by the Commissioner.

(7)    Sections 10 and 10A of the Subordinate Legislation Act 1978 apply to the code, or a variation of the code, as if it were a regulation within the meaning of that Act.

 

Turning to the Code of Ethics for the South Australian Public Sector we have:

 

 

Objectives of the Code

 

The Code of Ethics for the South Australian Public Sector has four objectives:

  • to guide and support public sector employees in all of their professional activities
  • to strengthen public confidence in the public sector
  • to earn respect from citizens, government and employees for the public sector as an institution which is critical to good government in South Australia and
  • to set out the standards of professional conduct expected of every public sector employee

 

And,

 

This Code therefore places more emphasis on guiding values and principles of behaviour and less on the punitive measures usually associated with Codes of Conduct of the past.

 

 

The guiding values and principles are stated as:

 

Values – overview

 

The following values are the foundation of ethical behaviour in the South Australian Public Sector:

 

  • democratic values
  • service, respect and courtesy
  • honesty and integrity
  • accountability
  • professional conduct standards

 

 

As I mentioned, you have this document available on but there is some point in drawing your attention to dot point three here: honesty and integrity.

 

The Code of Ethics offers no definition of what is meant by integrity but its predecessor did:

 

‘Integrity is about the intent or meaning behind your actions. As a public sector employee you are required to behave with integrity’.

 

After reading through the section on integrity you might conclude the following:

 

  • To act with integrity entails:

 

  • Genuine respect for the rule of law

 

  • A commitment to open and transparent decision-making, allowing for full accountability

 

  • Coordination of private and professional roles to maintain public trust in impartial governance of public affairs

 

  • Commit to resolving conflicts in the favour of public interest

 

  • Act impartially on the merits of each case (avoid bias)

 

  • Acknowledge fairness and equity in public actions

 

 

Clearly, what they are getting at here is integrity in the role of a public sector employee. Roles entail duties and duties are spelled out in terms of sets of obligations, so you can identify the public face of your professional role in this way.

 

So much for the overarching code that governs all public sector employees, but as you know there are roughly a dozen health professional groupings in the health system and each has its own form of ethics governance. In each of those groupings some members will operate in the private sector, others in the public sector. For our purposes we can ignore that, except to say in passing that those in the public sector will fall under more than one code.

 

  1. The Clinical World

 

Careful scrutiny of the interaction between clinicians and patients goes very far back in human history. There are precepts to guide doctors found in ancient Indian sources (the Sushruta Samhita), in ancient Chinese texts (Chinese writing on medicine was well established when the emperor Huang Ti, 2697-2598 BCE, produced a medical text) and in the west in the writings of Hippocrates of Cos (460 BC – 370 BCE). Cos is a small island on the Asia Minor coast that was part of the Ionian Greek diaspora).[7]

 

In Australia at the moment scrutiny of clinical practice (inclusive of research on humans and other animals) is at an all time high. So let’s take a modern Australian medical code as our example: Good Medical Practice: A Code of Conduct for Doctors in Australia (July 2009).

 

1.1       Purpose of the code

 

Good Medical Practice (Code) describes what is expected of all doctors registered to practise medicine in Australia. It sets out the principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community. The code was developed following wide consultation with the medical profession and the community. The code is addressed to doctors and is also intended to let the community know what they can expect from doctors. The application of the code will vary according to individual circumstances, but the principles should not be compromised.

 

 

1.3    What the code does not do

 

This code is not a substitute for the provisions of legislation and case law. If there is any conflict between this code and the law, the law takes precedence.

 

This code is not an exhaustive study of medical ethics or an ethics textbook. It does not address in detail the standards of practice within particular medical disciplines; these are found in the policies and guidelines issued by medical colleges and other professional bodies.

 

 

1.4    Professional values and qualities of doctors

 

While individual doctors have their own personal beliefs and values, there are certain professional values on which all doctors are expected to base their practice.

 

  • Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively.

 

  • They must be ethical and trustworthy.

 

  • Patients trust their doctors because they believe that, in addition to being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion.

 

  • Patients also rely on their doctors to protect their confidentiality.

 

  • Doctors have a responsibility to protect and promote the health of individuals and the community.

 

The central sections of the Code cover working with patients and working with other health care professionals. What you find there are quite specific aspects of clinical interactions (with the patient and with other professionals) subjected to an analysis that utilizes values without necessarily highlighting or dwelling on general or abstract values.

 

This is to be applauded. Let me just draw your attention to a one of these areas because you are already familiar with its treatment in law:

 

3.5    Informed consent

 

Informed consent is a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved… Good medical practice involves:

 

3.5.1 Providing information to patients in a way that they can understand before asking for their consent.

 

3.5.2  Obtaining informed consent or other valid authority before you undertake any examination, investigation or provide treatment (except in an emergency), or before involving patients in teaching or research.

 

3.5.3 Ensuring that your patients are informed about your fees and charges.

 

3.5.4 When referring a patient for investigation or treatment, advising the patient that there may be additional costs, which patients may wish to clarify before proceeding.

 

Informed consent, as described here, is a process that involves patients and clinicians in an ongoing way; it is seldom just an isolated event (although it can be when you line up for a flu shot, roll up your sleeve and stick your arm out at the person giving the injection). The items mentioned here are tasks to be performed.

 

To get at the values inherent in these tasks we can go straight to the Consent to Medical Treatment and Palliative Care Act 1995 (SA). You will recall that in the first set of lecture notes I printed the Objects section of that Act:

 

The clinical requirement to gain consent where possible is strictly in accord with the legal position. And the value that is expressed in the CMT&PC Act’s objectives and in the AMC Code is respect for individual people as self-determining in regard to their medical matters.

 

 

Nursing Codes

 

The Code of Ethics for Nurses in Australia (issued by the Australian Nursing and Midwifery Council in conjunction with the Royal College of Nursing and the Australian Nursing Federation) takes a very different approach to what you find in the AMC Code. It’s what writers would call strongly aspirational: it puts the values up front and then draws some conclusions for practice from them in its explanation sections.

 

 

Value Statement 1

Nurses value quality nursing care for all people

 

Value Statement 2

Nurses value respect and kindness for self and others

 

Value Statement 3

Nurses value the diversity of people

 

Value Statement 4

Nurses value access to quality nursing and health care for all people

 

Value Statement 5

Nurses value informed decision making

 

Value Statement 6

Nurses value a culture of safety in nursing and health care

 

Value Statement 7

Nurses value ethical management of information

 

Value Statement 8

Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing

 

 

As an example of how a value is spelled out, here is the explanation given for value statement 5:

 

Nurses value informed decision-making

 

Person (health consumer): Nurses value the legal and moral right of people, including children, to participate whenever possible in decision making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision-making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision-making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making processes.

 

 

Disability professionals

 

The Disability Professionals Australasia Code of Ethics is worthy of attention for at least two reasons. First, some of you may have chosen disability as a major theme in your health science studies, and second, this is brand new document that adopts another, somewhat different, approach to what is found in the older, medically oriented code.

 

 

Its preamble reads as follows:

 

The DPA Code of Ethics sets out the principles and ethical behaviours that reflect the skills, knowledge, attitudes and values which combine to influence the manner in which Disability Professionals meet the requirements of their role/s.

 

The Code applies to practice by all Disability Professionals who provide, facilitate, manage or develop services to people with a disability in Australasia. This includes but is not limited to Disability Professionals who may provide direct support, are allied health practitioners; are administrative and managerial practitioners as well as Disability Professionals who work in academic, research and other capacities.

 

This DPA Code of Ethics references the more detailed DPA Code of Practice[8] that expands on each of the principles to provide guidelines and some practical examples of ethical service provision by all Disability Professionals.

 

Disability Professionals have an obligation to familiarise themselves with this Code of Ethics, to identify ethical issues and to respond to them appropriately.

 

 

The principles are set out as follows:

 

 

Principle of Person Centered Practice

As a Disability Professional I will value all people and support a person centered approach in which the needs and desires of the person form the basis of the support and services provided to them.

 

 

Principle of supporting personal and professional development

As a Disability Professional I will value and promote the physical, intellectual, emotional, spiritual, and professional development of all people with a disability and all others who provide support and professional services directly or indirectly to them.

 

Principle of advocating for equal rights and social justice

As a Disability Professional I will advocate for people with a disability in all areas of human rights and social justice. Wherever possible I will engage directly with people with a disability in the advocacy process and foster and encourage the development of people with a disability to assume advocacy and leadership roles. I will support the rights of people with a disability as documented in the UN Convention on the Rights of Persons with Disabilities, 2006.

 

Principle of confidentiality, privacy and responsibility for personal information

As a Disability Professional I will safeguard and respect the confidentiality and privacy of people with a disability by adhering to current applicable privacy legislation.

 

Principle of professional competence

As a Disability Professional I recognise that ongoing training and professional development are necessary to ensure my currency of knowledge and skills to ensure high standards of professional practice within the profession. I will actively seek opportunities to further my professional development.

 

Principle of integrity, responsibility and accountability

As a Disability Professional I will act with integrity and a sense of responsibility at all times.

 

 

A couple of comments

 

The impression is overwhelming that this new code is premised on something deeper than the expressed principles. This deeper element or idea comes to the fore most prominently in principles 2 and 3:

 

  • Principle of supporting personal and professional development

 

  • Principle of advocating for equal rights and social justice

 

The idea is that of enabling, by strenuously supporting existing capacities, by enhancing others and by enabling the creation of capacities and powers through advocacy and political action.

 

This ethical basis reflects the situation of the clients. The special vulnerabilities of the clients dictate the professional behaviours deemed as ethically required.

 

A second point is about the final principle:

 

  • Principle of integrity, responsibility and accountability

 

This one will not be new to you, but again I want you to note the prominence of this notion of integrity in the way that codes aim to express values.

 

 

The third point relates to the information privacy principle:

 

  • Principle of confidentiality, privacy and responsibility for personal information

 

The notions of privacy and confidentiality are historically quite distinct, but both form part of the protection that is offered for a client’s information.

 

 

 

The SA Ambulance Service Code

 

SA Ambulance fall under the provisions of the SA Public Sector Code, and at the moment is not promulgating any separate and distinct ethics code.

 

 

 

 

 

 

 

 

 

[1] Using a word is different to referring to a word. When you tell me that your cat is prone to scratch strangers, so I should be careful when patting her, you could say, ‘careful, Millie scratches’. Her name is used to identify her. But if I ask, “why did you choose ‘Millie’ as a name for your cat?” I am not identifying her directly, but I’m referring directly to the name you gave her. Whenever you refer to (mention) a word or a name put it in inverted commas (or for a change you can use italics to do the same). When you refer to a concept or an idea do not use the commas, so ‘justice is a complicated idea’ does not refer to the word ‘justice’ whereas, “I think that ‘justice’ is word that comes from Latin” does.

[2] OED 4. trans. To associate or ally oneself with, to adopt, embrace (an opinion, doctrine, policy, course of action, mode of life, etc.); to take to oneself, make one’s own (a cause, a party).

[3] There is another problem here: some politicians publicly claim to represent values or cultural traditions that they patently do not understand.

[4] An interesting variant can be found in Japanese mythology where the great god Izanagi gives each of his children a mirror in which they are to examine themselves twice each day: when the mirror is dim, the soul is unclean, goes his proverb.

 

[5] OED prescribe: To make an authoritative ruling.

[6] OED proscribe: To declare authoritatively to be unacceptable or invalid; to prohibit, forbid, exclude; to condemn, discountenance.

 

[7] For those of you who may wish to look into the history I strongly recommend the following: Jurgen Thorwald, Science and Secrets of Early Medicine (1st ed, 1962) and the volumes by Henry Sigerist, A History of Medicine (3 vols) (1st ed, 1961).

[8] You will find this short document in your Guidelines folder.

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