Ethics in occupational health

Abstract

Ethics, or moral philosophy, is an attempt to define principles that govern how people should behave in society. Healthcare is practised within communities and must reflect the cultural and ethical values of society as a whole. Professional codes of ethics are not unique to healthcare, but from as early as the 5th century BC ethical behaviour has been acknowledged as a cornerstone of good medical practice. The relationship between a health professional and a patient is one where power lies predominantly with the health professional and the various biomedical ethical codes seek, among other things, to redress that balance. Underpinning all of biomedical ethics are four main principles or shared moral beliefs first articulated by Beauchamp and Childress in the 1970s:1 Respect for autonomy of the individual. Non-malfeasance (do no harm). Beneficence (do good). Justice (fairness and equality).In some situations the principles can be opposing and each health professional must decide on the right course of action in those circumstances and be accountable for their decision. Material is available to help deal with such dilemmas and in the UK both the General Medical Council (GMC)2 and the British Medical Association (BMA)3 produce comprehensive guidance. Cultural and societal differences can lead to varied views on what is ethically acceptable and global guidance issued by bodies such as the World Medical Association4 is particularly useful as people become more mobile internationally. The issues in occupational health (OH) may differ from those in other branches of healthcare but the same four principles apply. A therapeutic relationship is uncommon in OH and blanket use of the term ‘patient’ in describing ethical duties may therefore be unhelpful since it may lead healthcare professionals and/or those to whom they are rendering services to believe that ethical guidance does not apply to much of their work. Internationally the term ‘worker’ is used much more widely in ethical guidance and this is the terminology that will be used throughout this chapter, whether or not a therapeutic relationship exists. In practice, the ethical challenges and reasoning that should be applied are essentially the same, whether the relationship is a therapeutic one or not, since the power predominantly lies with the OH professional. A worker is far more likely to divulge confidential information to a member of the OH team than to a lay person and management is far more likely to accept guidance on health matters from an OH professional than from someone without a healthcare qualification. OH practitioners enjoy the authority and the status of their core professions—they must therefore apply the same ethical principles as their peers in other specialties. Ethical guidance in OH has tended to be produced at national level, by and for individual professional groups within the discipline.5,6 This has its benefits but does not reflect well the multidisciplinary nature of most OH teams or the increasing globalization of the workforce. The International Commission on Occupational Health (ICOH) has produced a code of ethics7 that applies to all OH professionals and which is particularly helpful for those with international responsibilities. There is sometimes confusion between acting ethically and acting lawfully. They are not the same. Laws sometimes allow health professionals to opt out on ethical or moral grounds (e.g. termination of pregnancy). Where that is not the case practitioners should reflect carefully, consult with appropriate colleagues and follow their conscience in full knowledge of any potential consequences for themselves of breaking the law. Simple legal compliance does not guarantee ethical behaviour and acting ethically may be unlawful. The hallmark of a professional is taking responsibility for one’s own actions and acting with probity—that may be difficult but the application of sound ethical analysis can ease the process.