Medical Ethics and Professionalism – Extended Notes – Introduction

Medical Ethics and Professionalism – Extended Notes – Introduction

MEDICAL ETHICS AND

PROFESSIONALISM

• 1 INTRODUCTION

Sub-Enabling Outcomes (1)

• Describe basic concepts of ethics and professionalism in
• medical practice
• Utilize theories and principles of medical ethics in delivering
• health care services
• Demonstrate professional values in providing quality health
• care services
• Describe the relationship between clinician and society in
• providing quality health care servicesSub-Enabling Outcomes (2)
• Describe rights of patients and health care providers in the
• provision of health care services
• Manage ethical dilemmas in medical practice in improving
• provision of health care services
• Apply knowledge of medical laws in disclosing health
• information
• Apply principles of medical ethics in obtaining clients’

consent Integrated Method of Assessment

Continuous Assessment 40%

• Written 30%
• Assignments 10%
• End of Semester Examination 60%
• Written 60%BASIC CONCEPTS OF ETHICS AND

PROFESSIONALISM IN MEDICAL

PRACTICE

• 6 Learning Objectives
• By the end of this session, students are expected to be able to:
• Explain professionalism in clinical medicine practice
• Identify the characteristics of a profession
• Describe the code of ethics for medical profession
• Recognize the roles of professional associations and licensing bodies
• a)Explain professionalism in medical practice
• b) Explain the term ethics in medical practice
• c) Explain characteristics of a profession
• d) Describe medical code of ethics
• e) Explain the social role of a profession
• f) Explain the roles of professional associations and licensing bodies
• What does the term Profession mean?
• The words ‘profession’ and ‘professional’ come from the Latin word ‘
• professio’ which means a public declaration with the force of a
• promise.
• Professions are groups which declare in a public way that their
• members promise to work, operate and live in certain ways and that
• the group and the society may discipline those who fail to do so
• The profession presents itself to society as a social benefit and
• society accepts the profession, expecting it to serve some important
• social goal. 10Select this paragraph to edit
• The profession usually issues a code of ethics stating the standards by
• which its members can be judged.
• It is a vocation in which knowledge of some department of science or
• learning, or the practice of an art founded on it, is used in the service
• of others.
• Its members profess a commitment to competence, integrity, morality,
• humanity, and the promotion of the public good within their domain.
• These commitments form the basis of a social contract between a
• profession and society, which in return grants the profession
• autonomy in practice and the privilege of self regulation.
• Professions and their members are accountable to those served and
• to society.
• Medical professionalism differs from other professions in both
• content and motivation.
• 12• It is a service profession dedicated to patients, centering on the
• doctor-patient relationship.
• Medicine seeks the prevention of disease and injury, the promotion
• and maintenance of health, the relief of pain and suffering, the care
• and cure of those with illness, the avoidance of premature death, and
• the pursuit of a peaceful death.
• The true professionalism in medicine will always put in first place the
• well-being of the patient and the community as principal objective.
• Medicine is a moral endeavor which demands integrity, competence,
• and high ethical standards among other key attributes
• Medical professionalism embodies the relationship between
• medicine and society as it forms the basis of patient-physician trust
• It attempts to make tangible certain attitudes, behaviors, and
• characteristics that are desirable among the medical profession.
• Professionalism embodies the competence, skills and behaviours
• expected of a practitioner
• Characteristics of a Profession
• Body of knowledge
• Usually the knowledge is not easily understood by the public, and
• consequently the professions are given substantial control over its use.
• They acquire responsibility for its integrity, for its proper application, and for
• its expansion, which for medicine, means the support of science
• Professions have an obligation to transmit their knowledge by teaching it to
• future practitioners, the general public, and their patients.
• Service
• The knowledge is used in the service of others.
• Clinicians use their knowledge primarily to benefit individual patient.
• Altruism
• There is agreement that the trust placed in the professions and their
• privileged status are only justified by the expectation that they will be
• altruistic (Disinterested and selfless concern for the well-being of others)
• For clinicians this means consistently placing the interests of individual
• patients and society above their own.
• Professions must be devoted to the public good.
• Autonomy
• This is another important characteristic of a profession.
• Individually, clinicians are granted sufficient autonomy to act in the best
• interests of their patients.
• In the early days, autonomy was expressed in a paternalistic fashion, but

modern society, recognizing patient autonomy, now views the clinicianpatient relationship as a partnership.

• The profession is also granted collective autonomy through self-regulation.
• It has the privilege and obligation to set and maintain standards for
• education and training, entry into practice, and the standards of practice.
• It must guarantee the competence of its practitioners, and has an absolute
• obligation to discipline unprofessional, incompetent, or unethical conduct.
• This means that professionals have a particularly strict duty to assure that
• their decisions and actions serve the welfare of their patients or clients, even
• at some cost to themselves.
• Code of ethics
• Professions have codes of ethics which specify the obligations arising from
• their duty
• Professionalism requires that the practitioner strive for excellence in the
• following areas which should be modelled by mentors and teachers and

become part of the attitudes, behaviours, and skills integral to patient care:

• Altruism: Clinician is obligated to attend to the best interest of patients, rather than selfinterest.
• Accountability: Clinicians are accountable to their patients, to society on issues of public
• health, and to their profession.
• Excellence: Clinicians are obligated to make a commitment to life-long learning
• Duty: Clinicians should be available and responsive when ‘on call,’ accepting a
• commitment to service within the profession and the community.
• Honour and integrity: Clinicians should be committed to being fair, truthful and
• straightforward in their interactions with patients and the profession.
• Respect for others: A Clinician should demonstrate respect for patients and their
• families, other physicians and team members, medical students, residents and fellows
• These values should provide guidance for promoting professional behaviour and for
• making difficult ethical decisions.
• One of the principal attributes of professionalism is independent judgment
• about technical matters relevant to the expertise of the profession.
• The purpose of this independent judgment is to assure that general technical
• knowledge is appropriately applied to particular cases.

Code of Ethics for the Medical Profession

• Small Group Discussion

• discuss the ‘code of ethics for medical profession’
• Clinicians’ dual roles-as healer and professional-are linked by codes
• of ethics governing behaviour and are empowered by science
• Being part of a profession entails a societal contract.
• The profession is granted a monopoly over the use of a body of
• knowledge and the privilege of self-regulation and, in return,
• guarantees society professional competence, integrity and the
• provision of altruistic service.
• Societal attitudes to professionalism have changed from supportive
• to increasingly critical with health workers being criticized for
• pursuing their own financial interests, and failing to self-regulate in a
• way that guarantees competence.
• Professional values are also threatened by many other factors.
• The most important are the lack of or limited resources in the health
• care delivery, and dissatisfaction from the public on service provided.
• In order for professionalism to survive, health professionals must
• understand that service to the public is their role in the social
• contract.
• Professionals must meet the obligations necessary to sustain
• professionalism and ensure that healthcare systems support, rather
• than weakening, behaviour that is compatible with professionalism's
• values.
• The principal threats to professional status come from public mistrust
• of the profession as a whole
• Two major factors contribute to this mistrust :
• public perception that health profession has failed to self regulate in a way
• that can guarantee competence,
• and that it put its own interest above that of patients and the public.
• The profession presents itself to society as a social benefit and
• society accepts the profession, expecting it to serve some important
• social goal.
• The profession usually issues a code of ethics stating the standards by
• which its members can be judged.
• The fundamental principles of professionalism are stated as the
• primacy of patient welfare, patient autonomy and social justice.
• Professional responsibilities that follow from these principles are
• commitment
• to competence,
• honesty with patients,
• confidentiality,
• appropriate relationship with patients,
• improving quality of care,
• improving access to care,
• just distribution of limited resources,
• scientific knowledge,
• maintaining trust by managing conflicts of interests
• and to professional responsibilities.
• Individual clinician must consider the consequences of being seen to
• put self-interest above that of their patient.
• Altruism and ethical conduct must serve as the backbone against
• which medicine is practiced.
• Accountability: All health professionals are accountable to their
• patients and to their profession, accountable for patient care and selfregulation.
• Morality and integrity: The professions are expected to be moral,

ethical, and carry out their activities with integrity.

Professional Responsibility

• Any professional health worker has the following responsibilities
• Professional competence
• Honesty with patients
• Patient confidentiality
• Appropriate relations with patients
• Improve quality of care
• Improve access to care
• Just (fair) distribution of resources
• Scientific knowledge
• Manage conflicts of interest

Roles of Professional Associations and

Licensing Bodies

• Professional associations and licensing bodies are characteristics of
• all professions.
• They operate under government authority, which may be altered if society
• becomes dissatisfied with their performance
• The role of professional bodies in self-regulation is major, as is the
• expectation that they will advise the public as experts in their
• domain.
• The associations and licensing bodies have a primary role in
• guaranteeing the quality of healthcare services.
• Medical associations also have an obligation to protect the interests
• of their individual members.
• Function of professional associations is so important; they require
• the support of their members
• Each health worker is responsible for the actions of their
• associations.
• Professional associations and licensing bodies must not engage in
• activities which detract from the morality and integrity of the
• profession.
• Morality and virtue must be integral to the rules, processes and
• procedures by which Medicine governs and regulates itself
• Medicine's professional associations must be extremely wise in how
• they negotiate for their members.
• Any hint that the public good is being ignored during these
• negotiations can be damaging to the credibility of the profession and
• result in loss of the trust, which is so essential to the healing process.
• The privilege of self-regulation entails an absolute obligation to
• guarantee the competence of members.
• The setting and maintenance of standards is of overriding
• importance, and issues such as recertification and revalidation are,
• without question, now regarded as professional obligations
• The disciplining of unethical or incompetent practitioners must be
• rigorous, open, and have the support of every practicing clinician.
• Not only are individual clinicians expected to demonstrate morality

and virtue, but so are the institutions which represent them.

Key Points

• The principal objective of true professionalism in health is to put in
• first place the wellbeing of the patients and the community
• Medicine is a moral endeavour which demands integrity,
• competence, and high ethical standards among other key attributes.
• Medical professionalism embodies the relationship between
• medicine and society to make tangible certain attitudes, behaviours,
• and characteristics that are desirable among the medical profession.
• The fundamental principles of professionalism are the foundation of
• patient welfare; patient autonomy and social justice.
• The associations and licensing bodies have a primary role in
• guaranteeing the quality of healthcare services.
• Evaluation
• What is a profession?
• What are the characteristics of a profession?
• What are professional responsibilities?
• What are the roles of professional bodies?

References

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• 124:229–239.
• Ham, C. & Alberti, K.G. (2002). The Medical Profession, the Public, and the Government.

BMJ.324:838–842.

• Kultgen, J.H. (1988). Ethics and Professionalism. Philadelphia: University of Pennsylvania
• Press.
• Mechanic, D. (1996). Changing Medical Organization and the Erosion of Trust. Milbank Q.
• 74:171–189
• Moran, M. & Wood, B. (1993). States, Regulation and the Medical Profession.

Buckingham: Open University Press.

• Pellegrino, E.D. (1991). Trust and Distrust in Professional Ethics. In Pellegrino (ed.) Veatch
• R.M.,& Langen JP, (ed.). Ethics, Trust, and the Professions. Washington, DC: Georgetown
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Contemporary Practice. Soc Sci Med. 22:1175–1179. 3839Select this paragraph to edit