For a few reasons, I’ve been thinking a bit over the last few months about professionalism and professional codes.\u00a0 In fact, that’s the topic that’s attracted most of my attention here since… oooh, ages ago.\u00a0 I find the idea of a code of professional ethics troubling in many ways, but also fascinating.\u00a0 And one of the fascinating questions has to do with what they’re for.<\/p>\n
They can’t be meant as a particularly useful tool for solving deep moral dilemmas: they’re much too blunt for that, often presuppose too much, and tend to bend to suit the law.\u00a0 To think that because the relevant professional code enjoins x<\/em> it follows that x<\/em> is permissible or right smacks of a simple appeal to authority, and this flies in the face of what it is to be a moral agent in the first place.\u00a0 But what a professional code of ethics may do is to provide a certain kind of Bolam<\/em>esque legal defence: if your having done\u00a0\u03c6 attracts a claim that it’s negligent or unreasonable or something like that, being able to point out that your professional body endorses \u03c6-ing will help you out.\u00a0 But professional ethics, and what counts as professional discipline, stretches way beyond that.\u00a0 For example, instances of workplace bullying can be matters of great professional and ethical import, but it’s not at all obvious that the law should be involved.<\/p>\n There’s a range of reasons why someone’s behaviour might be of professional ethical concern.\u00a0 Perhaps the most obvious is a concern for public protection.\u00a0 If someone has been found to have behaved in a way that endangers third parties, then the profession may well want to intervene.\u00a0 For example: if an HCP knew herself to be a carrier of a transmissible disease but did nothing about it, this would quite plausibly be a matter for professional concern, irrespective<\/em> of what the law says, or whether anyone had been harmed.\u00a0 The same would apply if we discovered that a surgeon was unable to function without a large brandy to settle his nerves.\u00a0 But we’d want to make sure that the professional concern was for the right thing.\u00a0 It would be inappropriate to sanction someone merely for being a carrier, or for being alcohol dependent.\u00a0 (Along these lines, it seems defensible to me not to have suspended Martin Royle, a surgeon who falsified prescriptions<\/a><\/span> in order to satisfy his addiction to painkillers.\u00a0 It’s better to treat an addiction than to punish it.)<\/p>\n A second reason is for the sake of collegiality.\u00a0 For example, there’s nothing illegal about being\u00a0 a racist, and there probably shouldn’t be; but it is at the very best distasteful.\u00a0 Imagine you discover that your colleague is an abiding racist.\u00a0 It is not hard to see how this knowledge might have implications for your professional interactions – especially (but not only) if you’re a member of one of the groups to which your colleague has a demeaning attitude.\u00a0 (Indeed, the same might be true if he had used<\/em> to be a racist, but had changed his attitudes.\u00a0 I suspect that that’s the sort of thing that might have a fairly long half-life.)\u00a0 Now imagine that your colleague is a frequent attendee at rallies, held in support of racist policies, that are often associated with threatening behaviour: he doesn’t just dislike some people, but is visibly hostile to them.\u00a0 That, it seems to me, might be a matter of professional concern, because it will predictably make the working environment much more difficult.\u00a0 It would be harder to trust this colleague (again, especially but not only if you happen to be a member of one of the groups he hates).\u00a0 That might be sufficient to raise worries about whether he’s a fit person to do the job in question.\u00a0 Again, though, there’d have to be a proviso: there is a difference between one’s professional abilities and one’s personal attitudes, and between how one behaves in and out of work.\u00a0 A surgeon is a surgeon for all that.\u00a0 So there is a genuine problem here concerning what to do.\u00a0 But a genuine problem means that there is a cause for concern.<\/p>\n (Indirectly, this second concern might have something to do with public safety, too.\u00a0 A surgical team in which people are uncomfortable working along side each other may be one in which patient outcomes are affected.\u00a0 But that would be a further matter, and would not have to collapse into the safety point.\u00a0 Imagine that the profession is accountancy: it might still be that members of the group would simply be intolerably uncomfortable working alongside their racist colleague, although the audit will still be done perfectly well.\u00a0 The same will apply in any profession.)<\/p>\n But there’s another factor, which is the status of the profession.\u00a0 To what extent are professional ethics codes and bodies that judge professionalism in the business of protecting themselves and their high social status?\u00a0 A couple of recent cases raises that question.<\/p>\n One that hit the headlines was that of Lavinia Woodward.\u00a0 She was the medical student who stabbed her partner but who was reported as having escaped a custodial sentence because of the damage that that would do to her career.\u00a0 (The always-excellent Secret Barrister has a rather more thoughtful take<\/a><\/span> on the case than did some members of the Fourth Estate.)\u00a0 As Daniel Sokol points out<\/a><\/span>, “Ms Woodward may not be permitted to enter the profession. Once the criminal proceedings are over, investigations and disciplinary hearings await her”.\u00a0 This will come as a surprise to virtually noone, but it does prompt the question of why that should be.\u00a0 She was found to have broken the criminal law; she was treated in accordance with the criminal law.\u00a0 Assume, arguendo<\/em>, that whatever the sentence imposed – custodial or not – it would have been just.\u00a0 What further business is it of anyone else?<\/p>\n There may be a perfectly good answer to be had to this question: that’s the danger of rhetorical questions.\u00a0 But if she has served her time, and there’s no indication that she’s any more of a danger to her patients than is any other tolerably competent medic… well, what’s the problem?\u00a0 The concern might be collegiality-based, but would future colleagues remember her?\u00a0 I had to google her name for the sake of this post, and the case was only a couple of months ago.\u00a0 Might it be simply that the profession would simply want to make a show of dissociating itself from certain kinds of people?\u00a0 I’m wary of wandering from a real life case into the realms of speculation – but a lot of professions have some version of a rule against bringing the profession into disrepute.\u00a0 That seems best explained in terms not of protecting patients or collegiality, but maintaining status.\u00a0 In other words, public opinion becomes important in settling someone’s fate.\u00a0 Whether that’s necessarily just is… well, it’s not an easy question to answer.<\/p>\n And then there’s this.<\/p>\n Last autumn, one Theresa Okondunjokanma was jailed for 18 months for fraud<\/a><\/span>.\u00a0 I have no particular problems with that: if it’s what the law demands, and on the assumption that the law is just and justly applied, then all seems to be in order.\u00a0 Now, Okondunjokanma was a nurse; and it’s reasonable to suspect that a spell in chokey would be the sort of thing that would put a dent in one’s career progress.\u00a0 It might even be the kind of thing that puts an end to your career: if potential future employers have to choose between you and someone who is perfectly matched CV-wise but who lacks the criminal conviction, then that might well serve as a tie-breaker.\u00a0 Further, if you go long enough out of work, you might get to the point where your skills are significantly out of date.\u00a0 This, it seems to me, is unfortunate.\u00a0 (It’s just one of the many arguments against being enthusiastic to send people to prison – but that belongs on another blog.)\u00a0 But unfortunate does not mean unjust.<\/p>\n Yet Okondunjokanma has also been struck off<\/a><\/span> the nursing register.\u00a0 The charge and the ruling by the NMC can be found here<\/a><\/span>.\u00a0 What is interesting is some of the phrasing: notably, in the charge, that her fitness to practise was impaired by reason of her fraud conviction.\u00a0 Why should that be?<\/p>\n Grace Hansen, representing the NMC, argued that<\/p>\n Ms Hansen submitted that fitness to practise is a matter for the panel having regard to the public interest in upholding public confidence in the profession and in the NMC as a regulator. She submitted that defrauding public money is a serious matter and there is a high public interest in this case.<\/p>\n Ms Hansen submitted that Ms Okondunjokanma has demonstrated serious and persistent dishonesty and the panel may surmise that this demonstration of dishonesty in her personal life may indicate that she would act dishonestly in her professional life. She submitted that she has breached one of the fundamental tenets of the profession in not acting with honesty and integrity. […]<\/p><\/blockquote>\n<\/div>\n<\/div>\n<\/div>\n Nurses occupy a position of privilege and trust in society and are expected at all times to be professional and to maintain professional boundaries. Patients and their families must be able to trust nurses with their lives and the lives of their loved ones. To justify that trust, nurses must be honest and open and act with integrity. They must make sure that their conduct at all times justifies both their patients\u2019 and the public\u2019s trust in the profession.<\/p><\/blockquote>\n This was accepted by the NMC.\u00a0 But there is something curious about it all.<\/p>\n Why is there a public interest matter here?\u00a0 I mean, there’s a public interest to be served in nurses being competent and trustworthy qua<\/em> nurses – but does benefit fraud fall under that?\u00a0 It’s not obvious that it does: it’s quite possible for there to be a big difference between the way one behaves in different areas of life; no evidence seems to have been produced that Okondunjokanma actually had been dishonest during office hours, or in a way that had any inherent link to her job.\u00a0 Indeed, the case against her is an invitation to speculate.\u00a0 The idea that people may not be able to trust a fraudster with the life of their loved ones is… well, it’s a bit of a stretch, isn’t it?<\/p>\n It’s more of a stretch when we compare what happened to her with what happened to Royle, the surgeon whom I mentioned above.\u00a0 His fraud was directly medically relevant.\u00a0 More, he was also found to have performed sub-standard procedures, and to have continued to perform them even after restrictions were placed on his practise.\u00a0 This is also a serious matter of direct clinical concern.\u00a0 It may be that his treatment was unduly lenient.\u00a0 But that doesn’t mean that Okondunjokanma’s was not unduly harsh.<\/p>\n One wonders what, really, the NMC was hoping to achieve by striking off the register someone who’s crime was not professionally related, and who might have had all the reason in the world not to seek further registration for the sake of jobs she’d be less likely to get in the future anyway.<\/p>\n<\/div>\n<\/div>\n<\/div>\n <\/p>\n","protected":false},"excerpt":{"rendered":" For a few reasons, I’ve been thinking a bit over the last few months about professionalism and professional codes.\u00a0 In fact, that’s the topic that’s attracted most of my attention here since… oooh, ages ago.\u00a0 I find the idea of a code of professional ethics troubling in many ways, but also fascinating.\u00a0 And one of […]<\/p>\n