Identities, ethics and practice: a critical appraisal of interprofessional ethical practice MALCOLM COWBURN UNIVERSITY OF BRADFORD & HILARY PENGELLY SHEFFIELD HALLAM UNIVERSITY 10TH UK JOINT SOCIAL WORK EDUCATION CONFERENCE WITH THE 2ND UK SOCIAL WORK RESEARCH CONFERENCE HOMERTON COLLEGE, CAMBRIDGE 9TH-11TH JULY 2008

This paper considers: Ethical standpoints as sources of conflict for the interprofessional team The possibilities of a character- relationship approach to ethics The strengths of ethical interprofessional practice that is accountable, compassionate and consistent

Ethical standpoints Principle-based ◦ Kantian - categorical imperative ◦ Utilitarian - greatest benefit for greatest number Character-relationship-based (Banks, 2006) ◦ Virtue - good, honourable conduct descriptors, equity ◦ Care (relational) (Noddings, 1984, 2002)

Ethical standpoints: a source of ethical conflict or tension in interprofessional practice Professional codes of conduct and codes of ethics emphasise Kantian principles (Banks 2006) - respect for the individual Members of the interprofessional team may have different ethical standpoints ◦ Eg. interpretations of ‘respect for the individual’, or what is a ‘virtuous’ or ‘caring’ act may be contested

Ethical thinking in action: the ethics of care Banks (2006) and others (Kvale 1996; Pence 2006; Grimshaw 2006) have highlighted how principle based approaches to ethical conduct sometimes have to give way to ethical thinking that occurs reactively and reflectively in moments of practice. On these occasions considerations of what is 'virtuous' or what is 'caring' tend to guide professional practice in the moment.

A case study Cyril – white working class man aged 74. Due to be discharged from hospital following investigation of ‘prostate issues’ Home situation – Cyril has lived in a small cottage (which he owns) on the edge of what was formerly a mining community. The house has integral sanitation, electricity but no gas. There is no (running) hot water. Professional situation – joint home visit by Occupational therapist (OT), health visitor (HV), social worker (SW) and Cyril.

Ethical dilemma Cyril wants to return home immediately. OT & HV do not want to sanction his return to the cottage because of the absence of ‘on tap’ hot water. Cyril says he does not need ‘on tap’ hot water – he can easily boil a kettle if he needs hot water. OT & HV want SW to arrange respite care until either Cyril’s cottage has been renovated or until alternative accommodation can be found. SW does not consider this appropriate.

Issues to consider What are the areas of ethical conflict for members of the interprofessional team? How do they resolve this conflict? How do they ensure Cyril’s wishes are respected?

The possibilities of a character-relationship approach to ethics (Banks, 2006 Emphasis on virtue - good, honourable conduct descriptors, equity ◦ Care is relational (Noddings, 1984, 2002) ◦ Connectedness to ‘the other’ Focus on relationship between persons ◦ Holistic interconnectedness of all things ◦ Collective nature of identity

The strengths of ethical interprofessional practice A character-relationship approach to ethics that is: Accountable Compassionate Consistent can promote fairness, justice and equality (Gilligan et al, 1990)