3.5 The principles underlying ethical practice
Box 3 describes four principles that are central to an understanding of acting ethically.
Box 3 The principles of acting ethically
Ethics is not solely about rare dramatic conflicts. It concerns all aspects of the therapeutic encounter, including the practitioner's competence, boundaries between the practitioner and patient, the patient's right to make decisions based on informed choices, respect for the patient's culture and values, and confidentiality. The fact that CAM rarely involves life or death decisions does not mean that there are fewer ethical issues in CAM therapeutic relationships [than in conventional health care relationships]. Any interaction with a patient (including a potential patient or a former patient) can give rise to ethical tensions.
Ethical awareness is an ongoing process requiring active deliberation. Therapists can learn, through a process of reflection, how to apply a range of ethical theories to assist their decision-making and, indeed, have a moral duty to do so. Even though there may be no ‘right answer’ to a given dilemma, therapists have a moral responsibility to consider their options in the light of existing ethical theories, and to be sure that their decisions are ethically defensible and will stand up to external scrutiny. Since practitioners make most of their ethical decisions behind closed doors, practitioners must regulate their own conduct.
Acting ethically requires a practitioner to be aware of all relevant professional codes and to know about any particular laws governing his or her sphere of practice, since these are additional mechanisms for regulating the individual therapist's conduct. The rules contained in codes of ethics represent standards of conduct which society expects professionals to follow. These may impose more onerous duties on health professionals than those which apply to ordinary members of the public, but to be a professional is a privilege, which confers both rights and responsibilities. The shortcomings of both ethical codes and law as a means of regulating the professional relationship make it all the more important that practitioners are aware of their ethical responsibilities, and become habituated to making good moral choices.
Health care ethics involves benefiting patients and not causing them harm. Acting ethically requires practitioners to be aware of professional developments and research underpinning their therapy to ensure competence. It will rarely be ethical for practitioners to work in complete isolation from their professional colleagues and with little regard for developments in their field. In order to provide patients with a range of options, therapists should be aware of developments in health and social care generally.
So far this extract has considered some of the principles underpinning the ethical decisions of individual practitioners. This is important because most health care encounters are between an individual practitioner and an individual user. Clearly, there also needs to be consensus within a profession about what constitutes acceptable professional standards. If not, individual practitioners could take arbitrary and inconsistent decisions, with different practitioners adopting very different notions of what they consider ethical. Stone (2002) highlights that individual practitioners must act within the norms of their profession, as well as work within the law. This is important if the ethical principle respect for justice is to be met. The next section shows how professional bodies set relevant professional standards, and provide mechanisms for what happens when things go wrong.