VALUES, MORALS AND ETHICS: SOME DEFINITIONS AND EXPLANATIONS

WHY BE AWARE?
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.
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DEFINITIONS
1. What are values? Values are internalized principles that individuals hold, which can order their lives 2. What elements do values encompass?

ATTITUDES BELIEFS BEHAVIOUR

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MORALS
VALUES can also be called MORALS so these terms can be interchanged. Both refer to the individualised principles held by individuals that guide HOW we act, and what we OUGHT to do. 4 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.
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ETHICS AS A SCIENCE?
For this reason, Ethics has been called a SCIENCE: 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].
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JUST REMEMBER:
ETHICS, MORALS, VALUES are NOT technically the same, but we we do tend to use the terms interchangeably so just be aware the there are differences. The differences can be summarised as: MORALS and VALUES refer to principles that guide our actions, ETHICS explains why we hold those principles.
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WHY BE CONCERNED?
Not everyone will always agree to what the terms right, wrong good or bad, appropriate or inappropriate mean. WHY??? And to return to an earlier question - why should we be concerned?
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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:
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Medical colleges ARE PLACES WHERE doctors LEARN..

skills processes content and VALUES
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REMEMBER!! Medical Schools can never be VALUE-FREE Clinicians can never be VALUEFREE So this is why it is important to promote SHARED values in an educational context.
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SHARED VALUES
Although each of us has a unique world view, there have to be some 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 behaviour.
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As doctors, we believe in:

Effective learning and teaching Quality and continuous improvement Respect and recognition for people Participation and consultation Professional and responsive services Equity and social justice Accountability for our actions and outcomes Effective and efficient management within available resources.
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TO FINISH
A quote from Jean-Jacques Rousseau is pertinent here: Men (sic) always love what is good or what they find good: it is in judging what is it good that they go wrong.

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PART 2: INDOCTRINATION.

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INDOCTRINATION
Is a problem that can occur in an open as well as a closed society In an open society, it is due to the fact that there are often no agreed absolutes i.e. right or wrong, truths or falsehoods Often occurs when a clinicians presents material that may not be acceptable to some families They may accuse the doctor of indoctrinating rather than treating their patients. 16

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
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ETYMOLOGY
Indoctrination means to instill or imbue with doctrines A doctrine comes from Latin word doctrina simply meaning teaching During Middle Ages, doctrina came to mean the Church doctrines or dogma Indoctrinating still just meant teaching but came to mean teaching anything that was not proven fact Finally, adopted pejorative meaning of teaching in a biased, unethical way.
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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
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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!
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PART 3: CODES OF PROFESSIONAL ETHICS

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CODES OF ETHICS
1. Two Famous Codes a) Code of Hammurabi (Babylonia 1792-1750 BC): Law Code b) Corpus Hippocratus: Medical Ethics The Hippocratic Oath
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PROFESSIONAL ETHICS
1. 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.
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2. QUESTION: What is a Professional Body? ANSWER: A group of professionals who through their professional association can support, encourage, enhance and maintain standards. 3. QUESTION: What can a Code of Ethics include? ANSWER: Prescriptions Sanctions Relationships 4. QUESTION: Why do we have a Code of Ethics? ANSWER: It means we, as a professional body, are ACCOUNTABLE. 24

USES
b) It should give a 5. QUESTION: How can reasonable person we use a Code of Ethics a reason NOT to do what they ANSWERS: believe to be a) It should give WRONG REASONABLE people (the reasonable person test) a REASON to do c) It can help define or re-define the what they believe to be nature of the RIGHT situation we are faced with
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6. 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. 7. QUESTIONS: Any Criticisms of our Code??
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SUMMARY
a) There can be sanctions if Code is broken b) A Code of Ethics is concerned with getting members to behave in certain ways that have been determined to be morally desirable or appropriate by those members c) Codes of Ethics increase the likelihood that people will behave in certain ways by bringing to mind their actions 27

SUMMARY CONTINUED
d) Code itself can never force a member to behave in a particular way - but SANCTIONS can prevent their continued membership of profession. Even if member works against Code, it does not prevent Code from being valid. e) Codes of Ethics can fulfill the role of PUBLICALLY expressing a professions commitment to some moral or ethical standard or set of behaviours f) A Code of Ethics should NOT just include guidelines on HOW members ought to behave but include the reasons WHY. 28

AND TO FINISHTHE MOST ETHICAL PROFESSIONS?

A recent survey asked to rank from highest to lowest which professions they regarded as being the MOST ethical down to the LEAST ethical. What would you list as your top 5 and your bottom 5?
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HOW DID YOU FARE?

MOST ETHICAL

1. Doctors 2. Nurses 3. Pharmacists 4. Teachers 5. Dentists

LEAST ETHICAL 19. Union Leaders 20. Advertisers 21. Estate Agents 22. Journalists 23. Car Salesmen

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THANK YOU!
THANKYOU all so much for being so incredibly enthusiastic and committed and to this lecture. I have enjoyed every lecture and I know people are getting late, I do hope you have enjoyed thinking about me and this lecture.

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