VALUES, MORALS AND ETHICS

Medical schools and doctors are committed to learn and treat patients according to socially acceptable moral values. As clinicians, it is important we know what is meant by the terms “values morals and ethics” and to be aware of the dangers of INDOCTRINATION.

  1. What are values?

Values are internalized principles that individuals hold, which can order their lives

  1. What elements do values encompass?
    1. ATTITUDES
    2. BELIEFS
    3. BEHAVIOUR

Morals
VALUES can also be called MORALS so these terms can be interchanged.  Both  refer to the individualized principles held by individuals that guide HOW  we act, and what we OUGHT to do.

So what then are Ethics?

ETHICS
Ethics is therefore the RATIONALISATION of WHY we OUGHT to behave in a particular manner and involves an analysis of what we mean by the terms GOOD, BAD etc. It involves analysing WHY one action is RIGHT and another is WRONG.

ETHICS AS A SCIENCE?
For this reason, Ethics has been called a SCIENCE:

  1. “…a normative science of the conduct of human beings living in societies – a science which judges this conduct to be right or wrong, to be good or bad, or in some other way” [William Little, 1971, pp. 1-2].
  2. ETHICS, MORALS, VALUES are NOT technically the same, but we do tend to use the terms interchangeably – so just be aware the there are differences. 
  3. The differences can be summarised as: MORALS and VALUES refer to principles that guide our actions,
  4. ETHICS explains why we hold those principles. 

WHY WE ARE CONCERNED:
We are concerned with Values and Ethics because we are clinicians. And the importance of values in the medical curriculum has been acknowledged for a long time. The influential Wiltshire Report [1993] refers specifically to values in “Values and the Medical Curriculum” for the following reasons:

Medical colleges ARE PLACES WHERE doctors LEARN…..

  1. Skills
  2. Processes
  3. Content
  4. Values

 

REMEMBER!!

Medical Schools can never be VALUE-FREE. Clinicians can never be VALUE-FREE. So this is why it is important to promote SHARED values in an educational context.

 

SHARED VALUES
Although each of us has a unique world view,  there have to be some shared values (societal norms, professional codes of ethics) otherwise it would be impossible for any members of society to agree on any standards of behavior. 
As doctors, we believe in:

  1. Effective learning and teaching
  2. Quality and continuous improvement
  3. Respect and recognition for people
  4. Participation and consultation
  5. Professional and responsive services
  6. Equity and social justice
  7. Accountability for our actions and outcomes
  8. Effective and efficient management within available resources.

 

What is Indoctrination?
Indoctrination is NOT to be confused with conditioning, use of brute force, or use of threats. Indoctrination involves WILLINGNESS. An indoctrinated person is one who says and acts in a particular way because they WANT to.

ETYMOLOGY

  1. Indoctrination means to instill or imbue with doctrines
  2. A doctrine comes from Latin word “doctrina” simply meaning “teaching
  3. During Middle Ages, doctrina came to mean the Church doctrines or dogma
  4. Indoctrinating still just meant teaching but came to mean teaching anything that was not proven fact
  5. Finally, adopted pejorative meaning of teaching in a biased, unethical way.  

IDENTIFICATION
There are 4 elements involved in Indoctrination:

  1. The content to be told
  2. The methods used
  3. The outcomes for the patients
  4. The intention of the doctor

Not all 4 have to be present but often are

INTENTIONS
Although all 4 elements are important, INTENT alone can be sufficient:
“A person indoctrinates Patients if they treat with the intention that the patients believe Clinicians regardless of the evidence”.
And the test to ascertain if anyone is indoctrinated is: They WANT to believe Clinicians despite any contrary evidence presented! 

CODES OF ETHICS
Two Famous Codes

  1. Code of Hammurabi (Babylonia 1792-1750 BC):  Law Code
  2. Corpus Hippocratus:  Medical Ethics – The Hippocratic Oath

QUESTION: What is a Code of Professional Ethics? 
ANSWER:  Guidelines that tell members of a professional body HOW  we  OUGHT to behave in order to satisfy our ethical judgments.

QUESTION:  What is a Professional Body?
ANSWER: A group of professionals who through their professional association can support, encourage, enhance and maintain standards.

QUESTION:  What can a Code of Ethics include?
ANSWER:

  1. Prescriptions
  2. Sanctions
  3. Relationships

QUESTION: Why do we have a Code of Ethics?
ANSWER:  It means we, as a professional body, are ACCOUNTABLE.

QUESTION: How can we use a Code of Ethics?
ANSWERS:

  1. It should give REASONABLE people (the reasonable person test) a REASON to do what they believe to be RIGHT 
  2. It should give a reasonable person a reason NOT to do what they believe to be WRONG
  3. It can help define or re-define the nature of the situation we are faced with

QUESTION: Are members bound by BTR Code of Ethics?
ANSWER: Yes, because sanctions can be applied for serious breaches. Periodically, members names are removed from roll for misconduct. These instances are recorded in the BTR newsletter.