Nonmaleficencein Professional Life Thomas Donlin-Smith, Professor of Religious Studies
Nonmaleficence in Professional Life • “First, do no harm”
What counts as harm? • Example: paternalism • Motivated by benevolence yet experienced as harm. • Best safeguard against paternalism – client’s voluntary, informed, competent consent • Voluntariness. Avoiding “controlling influences.” • Information. Levels & comprehension issues. • Competence. Can be difficult to ascertain. Means competence for this decision (not in general).
Are some harms justifiable? • E.g., principle of veracity and the possibility of justifiable lies to and for clients. • What’s the harm in lies? • Much of professional life is based on trust and promises, either explicit or implicit. • False promises & broken promises may provide short term gain, but destroy trust. • Lies are ways of controlling & manipulating people, getting them to do things they would not otherwise do. Lies infringe on others’ autonomy. • The tendency to lie may be strengthened or diminished by the metaphor or model of relationship we are using.
Conditions for justifying lies • Is this lie a last resort? Exhaust all truthful alternatives. • Weigh & assess the moral principles & issues at stake. Who is being protected & who is being hurt & why? Does the good outweigh the bad (utility)? • “Publicity test” - what would others say? How does this look from the dupe’s perspective? • Does the dupe have a right to the truth? Or is there a special latitude with truth permitted in this professional relationship? • Slippery slope concerns.
Another type of harm in the professional-client relationship: privacy and confidentiality violations
Two basic rules • Privacy – obligation to minimize invasions of client’s personal information • Client’s right to know what info is gathered & why • Confidentiality – obligation to protect client information • Client’s right to proper safeguards and to know about these safeguards
Privacy & confidentiality are important because . . . • Deontologically: • They express basic respect. • A promise (at least implied) • Consequentially: • They maintain trust & encourage the full disclosure pros need in order to do their work • Virtue: • Don’t be a voyeuristic gossip!
Limits on confidentiality rules? • May break confidence only when there is a duty to do so. May only when must. • Begin by asking for waiver of confidentiality • Better to violate confidence for the sake of preventing harms than to do good • Better for the sake of preventing harms to third parties than for the client’s own protection
Considerations in confidentiality violations • Only as a last resort • Minimize the amount • Give the client a justification • Specific, legally required breeches of confidentiality: • Suspected child abuse • Bullet wounds • Selected communicable diseases • Threatened injury to third party
Temptations to harm • What factors lead to professional misconduct, lack of “due care,” in professional practice? • How to enforce moral standards to prevent or punish misconduct? • See Banks McDowell, “The Excuses That Make Professional Ethics Irrelevant”
Mike Martin on professional misconduct • Usually amounts to the triumph of private goods over public goods. • Religious ethics as antidote? • Two fundamental dangers in modern pro life: • conflict of interests of advising about & providing services • “hired gun” mentality that erodes personal responsibility