1. Professional Ethics for Healthcare Practice Lawrence Siegel, MA, CSE, AASECT Sage Institute for Family Development www.sageinstitute.org

2. MORALS Internal to oneself; based upon values, beliefs and individual interpretation Concerned with motives – why do I do what I do? Serves the interest of the individual “Enforced” by feelings of personal integrity ETHICS External to oneself; established rules and regulations for profession Concerned with actions – what did the person do? Serves the interest of the profession (therefore, the public at large) Enforced by professional practice boards

3. 3 Approaches to Interpreting Ethics: Deontological Teleological Principalism

4. Deontological From the Greek word meaning “duty. This approach is founded in the belief that human beings have duties and obligations to one. This approach looks to the intention of the action, not the consequences, Emphasizes the dignity of human beings

5. Teleological From the Greek word meaning “end”. “Right” consists of actions that have good outcomes, “Wrong” consists of actions that have bad outcomes (there is no agreement on how to determine what is a good outcome versus a bad outcome) Usually referred to as Utilitarian in that what makes an action good or bad is how much good it brings (Usefulness determined by the amount of happiness that it brings) Rule Utilitarianism seek the greatest good for all and appeals to public agreement as a basis for the greatest good. Action Utilitarianism tries to determine the action that will bring about the greatest good, doing the least harm to a single individual

6. Principlism Emerging theory that attempts to resolve conflict with ethical issues by applying one or more ethical principles in concert

7. Key Ethical Principles Autonomy Beneficence Non-maleficent Veracity Justice Paternalism (as it relates to patient dignity) Fidelity Respect for others

8. Autonomy Autonomy is personal freedom and the right to choose what will happen to one’s own self. Example: Informed consent

9. Beneficence This principle states that the actions that one takes should promote good. Example: ___________

10. Non-Malfeasance One should do not harm

11. Veracity Concerns truth telling and incorporates the concept that people should always tell the truth

12. Justice Concerns the issue of all people being treated fairly and equally (really put to the test when there is competition for resources or benefits; or something is in short supply)

13. Paternalism Allows others to assist in making decisions when they do not have enough information or expertise Can be seen as negative when the entire decision making process has been removed from the patient

14. Fidelity Keeping one’s promises and commitments; integrity

15. Respect for Others Incorporates all of the principles and is the most well regarded. Respect acknowledges the right of individuals to make decisions for themselves and live by those decisions. Respect transcends cultural difference, religious beliefs, gender issues, and racial concerns.

16. Ethical Relativism Global ethics Situational ethics Real?

17. Codes of Ethics for Various Professions

18. Principles of Medical Ethics I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

19. Principles of Medical Ethics VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. IX. A physician shall support access to medical care for all people. Adopted by the American Medical Association (“…not laws, but standards of conduct which define the essentials of honorable behavior for the physician.”)

20. American Board of Internal Medicine “Project Professionalism” (1995 Report) According to the report, professionalism requires that one strive for excellence in the following areas which should be modeled by mentors and teachers and become part of the attitudes, behaviors, and skills integral to patient care: Altruism: A physician is obligated to attend to the best interest of patients, rather than self-interest. Accountability: Physicians are accountable to their patients, to society on issues of public health, and to their profession. Excellence: Physicians are obligated to make a commitment to life-long learning. Duty: A physician should be available and responsive when "on call," accepting a commitment to service within the profession and the community. Honor and integrity: Physicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession. Respect for others: A physician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.

21. “Wear cotton on your feet before you step into the life of another.” -- Father Reuben Westin, Oglala Sioux Tribe

22. The Judgment Box LEGAL UNETHICAL LEGAL ETHICAL ILLEGAL ETHICAL ILLEGAL UNETHICAL

23. Professionalism: I Know it When I Don’t See it…

24. Professionalism What does it mean to be a member of a profession? 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 will act 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. From ETHICS IN MEDICINE University of Washington School of Medicine Albert R. Jonsen, PhD, Professor and Chair, Medical History and Ethics, 1998

25. Professionalism The marks of a profession are: competence in a specialized body of knowledge and skill; an acknowledgment of specific duties and responsibilities toward the individuals it serves and toward society; the right to train, admit, discipline and dismiss its members for failure to sustain competence or observe the duties and responsibilities. From ETHICS IN MEDICINE University of Washington School of Medicine Albert R. Jonsen, PhD, Professor and Chair, Medical History and Ethics, 1998

26. Professional Ethics and Personal Values If one is to choose to be a member of a profession, he or she has a professional obligation to (1) abide their personal values if they are in conflict with their profession’s, and (2) recognize that their professional ethics must take precedence. If a profession adopts a “conscience clause,” it must be seen as a concession to, not an obligation to, the individual, and both must agree to insure professional obligations remain of paramount importance. CEOS Earth Observation Handbook

27. Ethical Obligations to Maintain Boundaries 1.Legal Boundaries 2.Professional Boundaries Scope of Practice 3.Personal Boundaries Transference Countertransference  Feel good about the work, don’t work to feel good! Self-disclosure Ethical Judgment Calls www.haekyungleeanddancers.org/photo.htm

28. Ethical Obligation to Understand “Scope of Practice” Issues What is a “massage therapist?” Are these earned titles, job descriptions, or self- proclaimed? What specific skill sets define the parameters of professional practice? Artist: Robert Taverner, used here with permission from the artist’s Dad! With love & gratitude to Bill Taverner.

29. Ethical Obligation to Continuing Education & Training Conferences, Workshops, Seminars, ListServes, etc. ▫Both attending and presenting! ▫“To teach is to learn twice” (Josef Joubert) Supervision and Mentor Relationships Networking and Collegial Relationships

30. Ethical Obligation to Advocacy “When even one American - who has done nothing wrong - is forced by fear to shut his mind and close his mouth, then all Americans are in peril.” -- Harry S. Truman

31. Ethical Obligation to be Culturally Competent Understanding “culture” and striving for respect, tolerance and inclusion Race and Ethnicity Sexual Orientation Gender http://skyscraper.fortunecity.com/terabyte/966/gallery/novg/culture.jp g

32. Ethical Obligation to Be Accountable Professionally ▫ What are “Best Practices?” ▫ Do we use empirically-based treatment? Personally ▫ Titles, certifications, licenses are contractual agreements ▫ Represents part of a professional group, therefore, the public may assume certain standards ▫ Relationship is three-way between individual, group & public ▫ Representation also includes personal behavior

33. Ethical Obligation to Practice Self-Care and Prevent Burn-Out “Walk the Walk”-- We all could use reminders to live like health educators! Practice physical, mental, relational, occupational, environmental and spiritual health-promoting behaviors! Diet, exercise, stress management, counseling p.r.n. Recognize and address “two-hatter” issues Remember: your job is you, you are not your job! Dual relationships and mixing roles Mix it up at work! Cross-training has multiple rewards Always expand your repertoire! Train in new areas LIVE, LOVE and LAUGH…OFTEN!

34. Some Ethical Issues in Massage Sex and Dating Bartering Dual relationships “no pain, no gain” Draping Supplements, aromatherapy Reflexology Training vs exposure