Chapter Six Professional Gatekeeping as a Function of Role Fidelity
Elements of a Profession Being professional vs. being a member of a profession Historical criteria for a profession Specialized body of knowledge Education standards Practice standards Self-regulating Fiduciary relationship with those served
Professional Codes of Ethics An important tool for self-regulation found in most health care specialties HOWEVER An all encompassing code of ethics, which covers every conceivable ethical problem, does not exist
Professional Codes of Ethics (continued) Review the professional code of ethics for your specialty (many are found in index) Review the Duty to Lie case What advice does the code give you that relates to the case? If it is not in the code, where would you get the answer?
Disparagement of Professional Colleagues Disparagement Review the therapist article on ill-advised CPR found in the chapter Identify four examples where the therapist disparaged other health professionals Assuming the therapist was right, what was the downside to his article?
Gaming the System Definition? Gaming the system for patient benefit Does intent make the difference? Ethical principles that are sacrificed
Gaming the System (continued) Negative Consequences: Lying undermines a practitioner’s credibility Lying undermines the credibility of all health professionals In a world of finite resources, does gaming for one patient take from another patient?
Conflict of Interest Fiduciary relationship One of the elements associated with a profession Conflict of interest Basic principles involved Conflicts of interest where patient-interests are served Does intent make the difference?
Conflict of Interest (continued) A young man signed up for a genetic research protocol. Following a severe reaction he died. The physician researcher was well respected and qualified The protocol had been approved
Conflict of Interest (continued) Would it make a difference to you to know that the physician had a financial interest in the genetics company that supplied the material used in the injection?
Sexual Misconduct Sexual relations between practitioners and patients Basic principles involved Effects on therapeutic relationship Review the chapter case What is appropriate?
Scope of Practice Scope of practice Basic principles involved Problem of role evolution, for example, nursing Legislated practice acts General elements Legal sanctions
Impaired Colleagues Basic problem Basic principles involved Rationale for a duty to act: Protection of patients Protection of specialty Protection of colleague Protection of institution
Steps in Problem Solving Problem sensing – gather and review facts Formulate and state problem List solutions of initial credibility Evaluate consequences to individuals involved Evaluate solutions in regard to basic principles
Steps in Problem Solving (continued) Select solution Prepare a defense Use this format to resolve the “You and Ben” problem
Whistle-Blowing Definition Downside What principles are involved? Making the decision Elements to consider Process
Institutional Ethics Committee Genesis of need Membership Common functions: Policy and procedure development Educational role Case consultation Retrospective case review Decision making not function of IEC
Key Concepts Key elements of a profession Codes of ethics as important statements of self-regulation Problems associated with disparagement of colleagues
Key Concepts (continued) Problems associated with sexual misconduct with patients Problems associated with conflicts of interests Functions of institutional ethics committee
Key Concepts (continued) Gaming the system Intent does not eliminate the harm Guidelines for whistle-blowing Requirements for role fidelity