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Trust and regulation: Lessons from the Shipman Inquiry. Aneez Esmail University of Manchester. ‘When a doctor goes wrong he is the first of criminals. He has nerve and he has knowledge’. Conan Doyle A. The Speckled Band London, 1891. The Professional Response. What of the future?.

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trust and regulation lessons from the shipman inquiry

Trust and regulation:Lessons from the Shipman Inquiry

Aneez Esmail

University of Manchester

slide3

‘When a doctor goes wrong he is the first of criminals. He has nerve and he has knowledge’

Conan Doyle A. The Speckled BandLondon,1891

the need for regulation
The need for regulation
  • Who controls the ethics, behaviour , training and qualifications of the medical profession.
  • Is self-regulation sufficient?
    • Professional self regulation relies on the notion that trustworthiness is enhanced by the self respect accompanying ownership of professional standards
internal morality vs external morality
Internal morality vs External morality
  • The stories we tell can restrict our thinking about solutions
  • Internal morality is denigrated with external controls being championed as the solution
  • External controls need a functioning internal morality to interpret them
trust
Trust?
  • Both external and internal morality are important
  • External controls are a blunt instrument
  • Complex regulations can disempower
    • If people accept they cannot be trusted, there is a risk that they will become less trustworthy and obey the letter of the law only
slide9

“…. This inquiry is about power: the power of the medical profession and the patients lack of it. This is the framework in which events of the past must be placed. Changes in the future must have as their aim the equalisation of this power imbalance, by dismantling the power of the profession and strengthening patients’ rights. Only then will we be confident of claiming ‘never again’”

Bunkle P. Side-stepping Cartwright. In Coney S ed, Unfinished business. Auckland. Women Health Action, 1993:54. (Quoted in Paul C, Internal and external morality of medicine: lessons from New Zealand. BMJ 2000;320:499-503.

slide10

The situation which is confronting Medicine today is a contest of two forces in Medicine itself. One holds that the most important thing is the maintenance of our vested historical interest, our private property, our monopoly of health distribution. The other contends that the function of Medicine is greater than the maintenance of the doctor’s position, that the security of the people’s health is our primary duty, and that our human rights are above professional privileges…

Norman Bethune in The Wounds (1930’s)