Bringing Ethics into Focus Part 1: Ethics and Professional Responsibilities

1. Bringing Ethics into Focus Part 1: Ethics and Professional Responsibilities

2. Case Study Dr. Jacqueline Singer is an ophthalmic surgeon specializing in stitchless cataract surgery. Dr. Samuel Pargen, another ophthalmic surgeon, claims to own the procedure used in such surgery. He has a patent on this procedure and is suing Dr. Singer and others who have performed this surgery without paying him royalties. Patents of procedures used to be very rare, but as the number of complex ophthalmic devices has multiplied, the medical techniques used in conjunction with the equipment have increasingly been patented as the directions for using the devices. However, the AAO says it knows of no doctor who has paid another royalties for a technique. Dr. Joan Armice, Chair of the AAO’s Committee on Professional Responsibilities wondered, “How can anyone claim to own the way one turns one’s knife when performing surgery?” The Committee fears that patents of this sort will restrict access to treatment, obstruct peer review of new techniques, and add to the cost of care. Dr. Pargen responds, “How can the AAO take the position that a patent on pure technique is unethical, while a combined method and device patent is not?”

3. Are Professional Ethics Different? • Are the responsibilities that an individual has as a professional different from those she has as a private individual? • In what does this difference consist? • Source? • Force? • Nature?

4. Sources of Professional Responsibilities • The ultimate source of an individual’s professional responsibilities is their choice to join the profession. Engaging in the profession is understood to indicate agreement with the rules governing it. • It is these rules, typically organized in a code of ethics, which serve as the determinate source of professional responsibilities.

5. Codes of Ethics • Professional codes of ethics come in all shapes and sizes. • Sometimes they are unwritten, part of the “common understanding” of the profession; sometimes they are vaguely or imprecisely written; sometimes they are written in very specific detail. • Sometimes they enunciate purely moral principles; frequently they are a mixture of principles, rules of etiquette, and economic considerations (rules against competition, etc.). • Sometimes they make explicit reference to broader ethical perspectives and practices (usually for purposes of justification); sometimes they don’t. http://www.aaopt.org/about/governance/index.asp http://www.aaopt.org/about/governance/standards/index.asp

6. Nature of Professional Responsibilities • One of the things that most clearly distinguishes most professional codes of ethics from more fundamental moral systems is the predominance of the mixed form. • The mixed character of many professional codes of ethics perhaps encourages the common opinion that conformity with the code is all that is morally required of a professional.

7. Force of Professional Responsibilities • What is the force of a professional code of ethics? • Typically, such a code is understood to be both established and constrained by two internal factors: • The contingent nature of the individual’s commitment to the code; • The limited character of the individual’s participation in the profession. • A code of professional ethics can also be supplemented or limited by its consistency or inconsistency with broader ethical perspectives and practices.

8. Are Professional Ethics Different? • Are the responsibilities that an individual has as a professional different from those she has as a private individual? • There certainly are differences in the source, nature and force of professional ethics, but one thing remains consistent: the obligation on the practitioner to critically evaluate the rules in light of their own broader moral perspective.

9. Putting Your Principles into Action • If you’ve satisfactorily established the moral claims of the code of conduct in effect in your profession you still need to apply it (and other moral considerations) to the issues that you confront in your professional life. There is no procedure that can be specified that guarantees success in this, but there are some specific strategies that can increase your confidence in your ethical decision making.

10. Guidelines for Ethical Decision Making in Professional Practice • Determine the facts in the situation. • Define the stakeholders. • Assess stakeholder motivation. • Formulate possible responses to the situation. • Evaluate proposed responses. • Seek additional assistance if appropriate (codes of ethics, broader moral perspectives, colleagues or mentors, etc.). • Select the best response. • Implement the selected response. • Monitor and assess the outcome to assist in future decision making.