From Guardianship to Complicity: A Boundary Perspective on Professional Misconduct

Ethics and Law.

Acquittal by the GMC is not necessarily an end to a doctor's case T he General Medical Council has recently come under serious scrutiny, especially after the publication of the...

Regulation of healthcare and medical imaging in Australia: A narrative review of the evolution, function and impact on professional behaviours

Professionalism in Psychiatryby GabbardGlen O., M.D., RobertsLaura Weiss, M.D., Crisp-HanHolly, M.D., BallValdesha, M.D., HobdayGabrielle, M.D., and RachalFunmilayo, M.D. Washington, DC, American Psychiatric Publishing, 2012, 218 pp., $60.00 (paper).

Background: Contemporary long-term trends in the all-cause mortality of heart failure (HF) in diabetic patients, when systematically compared with non-diabetic patients who received pharmacological management, are scarce. Methods: We performed a meta-analysis of HF trials that reported the all-cause mortality of patients with HF and diabetes from 1997-2017, in order to pool all of the available trial evidence on contemporary trends and changes in all-cause mortality. Findings: Fifteen studies met the inclusion criteria, and a total of 53,377 patients with HF, of whom 17,547 (32.89%) had diabetes, were analyzed. In total, and weighted by the follow-up period, the all-cause mortality in the diabetes group was significantly higher than that of non-diabetic patients (P <0.01). The odds ratio (OR) of the all-cause mortality in the diabetes group was 1.32 (95% confidence interval (CI), 1.14-1.53, P <0.01; RD=0.06, lower limit: 0.02, upper limit: 0.09, P <0.01) between 1997 and 2017, which was higher than that in the non-diabetes group; however, the OR was 1.19 (95% CI, 0.92 to 1.54, P=0.18), and the RD=0.03 (P=0.19) in the period from 2007 to 2017. We observed a decrease in the absolute risk difference between the two groups. Interpretation: This meta-analysis suggested that there was a downward trend in the all-cause mortality rate of HF, although it was significantly higher in patients with diabetes than in those without diabetes; and the RD gradually declined from 8% (1997-2006) to 5% (2007-2017). It is a long-term and arduous task to reduce the OR and RD between the groups of patients in the future. Funding: This study received no financial support. Declaration of Interest: The authors declare that there are no conflicts of interest. Ethical Approval: This study involved a post hoc analysis that does not involve ethics.

The concept of pro bono has been established in a variety of countries and has developed a distinctive discourse. Aspects of this discourse have also begun to impact other areas of the law, such as mitigation in professional misconduct. However, problems can arise if aspects of one discourse are imported into others. Using the Singapore law of professional misconduct as a case study, this article utilizes concepts from discourse analysis to understand how discourse regarding lawyers can be removed from its original context and inserted into another. The article identifies two examples of pro bono discourse in the mitigation of professional misconduct, that of distinguishing law-related public service from other charitable acts and distinguishing genuine pro bono services from self-serving commercial activity. The article investigates the coherence of this pro bono discourse in the field of professional misconduct and concludes that some pro bono discourse fits its new context while others do not. The article argues for an increased awareness of how lawyer discourse potentially impacts professional regulation.

Medical profession is essentially self-regulated, since historical times. The physicians convinced society that science-based medicine was superior to alternative therapies and that their profession represented a trustworthy moral enterprise. We constructed information from Pubmed/Medline, Google database and text books to provide an overview. Complexity of the knowledge base and skills required, especially as technology advanced, would make regulation by non-professionals difficult. The major obstacles for credible self-regulation are providing assurance that those in practice maintain their competence; taking appropriate action once a problem with an individual practitioner has been identified and regulating conflict of interest. Conflict is inherent in a profession in which individuals are expected to be altruistic, while, as human beings, still pursue their own interests. Self-regulation of the medical profession is complex, and involves multilaminar, clairvoyant oversight aimed at guaranteeing the competence of the practicing physician. The privilege of self-regulation of medical profession has gradually made way to establishment of licensing laws worldwide. Standards were considered to be weak, variable and inconsistently applied, and physicians were further accused of using collegiality as a means of shielding poorly performing peers. Identifying problem physicians and taking appropriate disciplinary action against them can be a complex situation and can tarnish the reputation of the entire medical profession. When the society becomes dissatisfied with the performance of the profession; changes the terms of the social contract and reclaim some of these powers, the medical profession's rights to self-regulation tends to decline. The principal regulatory body may have a majority of lay members, which would mean that the profession is no longer self-regulating. Profession must accept greater accountability and should not hesitate to act on professional misconduct. Self-regulation is a privilege that can be maintained only with public consent and trust. The present generation of doctors needs to adapt and accept the changing scenario and develop a scientific approach to achieve the lost glory.

Gifts are often given as tokens of gratitude by grateful patients to district nurses. However, there are circumstances where the Nursing and Midwifery Council (NMC), as the professional regulator, and the courts, have held that accepting gifts, large or small, from vulnerable adults is dishonest and amounts to professional misconduct and even theft. Richard Griffith discusses the circumstances where a district nurse who accepts a gift can face a fitness-to-practise investigation and an allegation of theft.

Medical experts, the law and professional regulation

Processes and problems of the creation of networking society and network-based economy are described in this theoretical article. Networking processes and the network-based new development tendencies in various sectors of economy and social life in the context of contemporary global changes are defined as an especially important field of the scientific research and studies. The main aspects of the networking and network-based development tendencies are analysed. The complexity and systematics of the networking processes and the networking society creation under conditions of globalisation and contemporary changes in various areas of social and economic life are analysed.The main attention is focused on the idea that networking processes and the creation of networking society and network-based economy could be perceived as one of the most important priorities of the modernisation of contemporary social and economic systems, as well as of social, economic, political development, science, and technological progress in general.The creation of networking society and network-based economy is assessed as the most important assumption and the main way to solve most of the social, economic, technological, even security, defence and ecological problems worldwide, as well as in various countries or regions in general and in various countries or regions in the space of the European Union.The processes of the creation of networking society and network-based economy express the essential qualitative changes in all areas of social, economic, political life, science, and technological progress, and interaction with nature. The processes of the creation of networking society and network-based economy deeply influence the content of globalisation and internationalisation processes and the effect on a situation in the modern world.The processes of the creation of networking society and network-based economy must be analysed in complexity. This analysis should be orientated towards the systematically examined and assessed changes and development processes.It is particularly important that the processes of the creation of networking society and network-based economy are taking place on a global scale and could be defined as the processes belonging to the category of global processes and changes: it also means that the complex interaction between the processes of global changes and the processes of the creation of networking society and network-based economy is a very important factor of the positive development in the societal life in the general context of globalisation.Problem is that the networking society and the network-based economy creation processes and other processes of global changes are usually analysed separately: the factor of the complex interaction between different global processes and the processes of the creation of networking society and network-based economy is often ignored. It means, that a complex analysis of the processes of various types, as well as an evaluation of the factors of interaction between different processes could be defined as a perspective way to solve some actual theoretical and practical problems of the development of contemporary economy and of the creation of networking society and network-based economy in general, especially in the context of globalisation.The complex analysis and the multidimensional evaluation of the general processes of global changes and of the specific processes of networking society and the network-based economy creation as a perspective theoretical approach in research on societal changes in the context of globalisation is defined and described in this theoretical article.The variety and the main phenomena and regularities of the global changes are identified, their impact on real processes of networking society and network-based economy creation is characterised. The main principles of the networking society and the network-based economy creation in the context of global changes are formulated.The main idea of the complex analysis and of the evaluation of the factors of interaction between different processes of global changes and the processes of networking society and network-based economy creation could be briefly described as follows: the complex analysis and evaluation of these factors includes two aspects – first, all these processes should be defined and analysed as the global changes in general, secondly, the processes of the creation of networking society and networks based economy should be identified as an specific and especially important priority of contemporary social, economic, organizational and technological changes in the global space. This idea is described in details in the article.

The past decade witnessed a series of high-profile inquiries that cast a noxious miasma over the medical profession and provoked demands for strict regulation. Somehow, a balance must be struck whereby the public can be confident that doctors practise competently, with due regard to ethical and technical standards, yet the regulations are not so overwhelming as to represent a sword of Damocles permanently hanging over doctors' heads. This article explores the current regulatory framework, exclusion from the workplace, serious professional misconduct and seriously deficient performance. The General Medical Council deals with a large number of regulatory cases each year, of which a small proportion are appealed. As well as providing valuable insight into judicial thought, case law in this area is helpful in understanding the balance between social policy and medical regulation.

In recent times, the Bar, the Bench, and the general public have been alarmed by the increasing and expansive dimension of misconduct of legal practitioners in Nigeria. This paper takes a critical look at the emerging cases of professional misconduct among lawyers in Nigeria. It sets out with an introductory part that gives an overview of what is considered professional misconduct by a lawyer in Nigeria. The main body of the paper dwells on the statutory regulation of the legal profession with a focus on ethics in legal practice. Some recent cases of professional misconduct of legal practitioners are reviewed leading to the interrogation of the rationale for establishing a case of professional misconduct of a lawyer in Nigeria pointing to the need for a more pragmatic approach. The paper concludes with the position that while the need for a lawyer to remain a light bearer, a leader worthy in learning and character because of the nobility of his calling is inviolate, the thin line between a lawyer’s professional and private life should be identified and respected to contain the expansive cases of misconduct. The point is made that the law which holds every act of a legal practitioner to a standard even where such an act was not done in a professional capacity deserves reformation. Recommendations are proffered to suggest ways of reducing cases of misconduct of lawyers without lowering the standards at the Bar.

Reviewed by: Medicine, Money, and Morals: Physicians’ Conflicts of Interest Peter E. Dans Marc A. Rodwin. Medicine, Money, and Morals: Physicians’ Conflicts of Interest. Oxford: Oxford University Press, 1993. xvii + 411 pp. Ill. $25.00. This book’s provocative and alliterative title promises more than it delivers. It does not tackle the broad subject of conflict of interest, but focuses on recent approaches to regulating physicians’ financial conflicts. Written by a lawyer/health policy analyst, the first fifty pages are more interesting than the remaining two hundred, whose tone is dry, legalistic, and hortatory. “Morals,” used interchangeably with “ethics” and “ethos,” is never defined. Treatment of the various codes of ethics is highly selective and fragmentary. In the case of the Hippocratic oath and corpus, Rodwin cites one scholar’s reflections on its underlying ethos rather than quoting it at length or discussing the changing attitudes toward its moral strictures. Nor does the section on the AMA’s code of ethics consider the fact that the original 1847 version was rooted in the norms of ethics and etiquette set forth in Percival’s code of the gentleman, and that major revisions in 1950 and 1980 resulted in less specificity as our moral and cultural pluralism was confronted. [End Page 159] Taking as his touchstone Shaw’s Doctor’s Dilemma (published in the early 1900s), Rodwin asserts that financial “conflict of interest was hardly mentioned in professional or popular writing about medicine in the United States until the late 1960s” (p. 2). Forgotten are the many critics within the profession, such as E. A. Codman and A. J. Cronin. In 1937, the latter’s very popular novel The Citadel explored the issue of fee-splitting and other aspects of physicians as moneymakers; so did The Last Angry Man, also made into a popular motion picture in the 1950s. Nor does Rodwin give sufficient credit to medicine, which as a profession has been very prone to hang its dirty linen publicly, providing almost daily fodder for the media. The opening chapters give some context, mainly through the eyes of politicians and policy makers, but the tremendous impact of Medicare and Medicaid—well-meaning reforms that poured enormous sums of money into the health care sector—is understated. Along with societal and technological changes, these programs catalyzed the transformation of a highly individualistic cottage industry, principally dedicated to caring for specific patients, into a vast jobs-creating and product-oriented enterprise increasingly run by nonphysicians for profit, with patients representing market share. As Arnold Relman points out in the introduction, physicians and even nonprofit institutions became more entrepreneurial. As the health-care sector prospered, warnings (beginning in the early seventies) about rising costs were largely ignored. Finally, an alliance of business, government, and labor has forced hospitals and physicians to cut costs, replacing incentives to “do everything” with equally problematic incentives to minimize care. Rodwin also fails to consider the influence of the “me” decade, whose shibboleth was “Look out for number one.” If money has become, in the words of a New Yorker cartoon, “life’s report card,” it should not be a revelation that some physicians—like some classmates who went into business, finance, and the law— put a premium on it. That 20,000 physicians put their self-interest above their patients in a drug company-sponsored program is clearly reprehensible, but why not mention that there are more than 600,000 licensed physicians? The solutions that Rodwin puts forward to resolve financial conflicts of interest are extremely theoretical and are likely to be ill suited to the set of problems being created by the radical transformation in the health-care landscape. Thus, while this book provides a good starting point, interested readers might wish to consult Edmund Pellegrino’s authoritative but uncited writings on the physician as double and triple agent for the views of a philosopher/practitioner, as they wait for the dust to settle. Peter E. Dans Johns Hopkins University Copyright © 1996 The Johns Hopkins University Press

Conflicts of interest in biomedical research can endanger the independent judgement of researchers and, in a worst‐case scenario, can result in harm to humans, animals or the environment, or avoidable damage to scientifically validated truths. Highly publicized cases of scientists who have downplayed the risk of passive smoking—while receiving funding from the tobacco industry—or researchers who have questioned anthropogenic global climate change—yet are supported by the coal or oil industries—(LaDou et al , 2007) have attracted persistent, and often appropriate, criticism. A conflict of interest occurs when someone in a position of trust—for example, an academic researcher, lawyer or physician—has competing private and professional interests that make it more difficult to fulfil his or her professional duties without bias. However, a conflict of interest in itself is not necessarily bad, as long as the ‘right’ interests prevail. Nevertheless, conflicts of interest can create an impression of impropriety that, in the long run, might undermine the credibility of an individual or even an entire profession. At a time when policy‐makers, politicians and the public increasingly rely on scientific advice about controversial issues—for example, human embryonic stem cells, genetically modified crops or global climate change—conflicts of interest diminish the public's trust in the independence and unbiased judgement of academic scientists. To maintain trust, researchers must remain visibly trustworthy, which requires a careful and explicit management of conflicts of interest. Amidst growing concerns about the rising prevalence of conflicts of interest (Bekelman et al , 2003) and the attendant risks, various commentators and scientists have proposed several measures to handle conflicts of interest, which range from injunctions for more systematic disclosures to outright bans (Kaiser, 2005). > …a conflict of interest in itself is not necessarily bad, as long as the ‘right’ interests prevail Yet, research funding from private benefactors—who often pursue their own …

The article begins by addressing central definitional and taxonomical issues for crowdlending (also known as peer-to-peer lending) as an evolving species of debt-based crowdfunding within the FinTech industry. It considers the regulatory tension between facilitating growth of the crowdlending industry and the need for regulatory intervention to ensure adequate investor protection. Regulatory lag is evident in uncertainties surrounding the application of existing EU regulatory instruments for credit institutions not written with crowdlending in mind. The regulatory vacuum at EU level enables regulatory arbitrage and a race to the bottom by platform operators. Accordingly the case is made for a proportionate European directive for crowdlending based on a prudential licensing and passporting framework covering matters such as minimum capitalisation, due diligence, disclosure rules, conflicts of interest, client money rules, protection for investors against bad debts and platform collapse, as well protection for the economy as a whole against potential systemic risk.