3.6 Ethical practice and accountability: the role and function of professional bodies
The UK's medical profession is regulated by the General Medical Council (GMC). One of the main ways in which the GMC, and other regulatory bodies, influences its members is through its code of ethics. This sets out broad principles, rather than detailed guidance, for how practitioners should behave in specific circumstances. This is necessary because a practitioner retains individual accountability and ultimate responsibility for decisions taken during professional practice. Not all breaches of an ethical code result in disciplinary action being taken against the practitioner. However, the most fundamental breaches can lead to a disciplinary hearing, in which the professional conduct committee can remove the practitioner's licence to practise. In this way, a code of ethics can be a deterrent: that is, practitioners follow its principles because otherwise they could be ‘struck off’.
A code of ethics is only one way of encouraging and promoting ethical practice. The functions of a regulatory body go much further than disseminating codes of ethics. Regulatory bodies need to set and enforce educational standards, keep a register of members, and have in place processes for practitioners whose performance is below par and rehabilitative procedures for those whose performance is marred by ill health. Many of these broader aspects of ethical practice can only be co-ordinated at a collective level if they are to protect users adequately, which is the key function of professional self-regulation. Box 4 summarises some of the main responsibilities of regulatory bodies.
Box 4 Functions of regulatory bodies
Determine educational requirements for safe and competent practice at pre- and post-registration levels.
Encourage research and professional development.
Set standards through codes of ethics and codes of practice.
Maintain and make available a register of members so that the public can distinguish regulated practitioners from unregulated practitioners.
Maintain professional disciplinary procedures so that unethical practitioners can be held accountable for their actions.
Have a complaints mechanism so that users' grievances can be heard and any appropriate reparation made.
Install mechanisms for dealing with practitioners who are unfit to practise through ill health.
Provide information to members of the profession, including information about the standards of care they should expect.
Provide information to members of the public and promote user self-awareness.
Professionals have a special ethical responsibility to other people. Being a professional involves rights (respect from others and considerable freedom over what to do and how to do it) but also responsibilities (to act in the user's best interests at all times, and to surrender personal values if they conflict with providing optimum care). However, health professionals work mostly in an unsupervised context because another advantage of working in a professional capacity is relative autonomy over their work. This means it is extremely important for individual practitioners to be motivated and taught how to act responsibly and professionally in their dealings with service users. Equally, ‘good’ professionals may hold very different moral views. What then is the role of professional ethics and how does it relate to personal morality?
In essence, professional ethics refers to the ethos, rules and principles underpinning professional practice. In joining a professional body and assuming a professional title, a practitioner expressly agrees to be bound by the rules of that profession. Professional codes of ethics set down many general rules about how practitioners are expected to behave. This is an important aspect of professional self-regulation because it means there is a recognised standard against which professional practice can be measured, and an explicit statement about the level of commitment and behaviour the public is entitled to expect. A code of ethics represents the ethos of any given profession. Stone (2002) describes a code of ethics as a synthesis of minimal legal requirements and statements of ethical ideals, backed up with professional statements that represent the shared political and economic ideals of that particular group.
Currently, the only CAM professions that are statutorily regulated in the UK are osteopathy and chiropractic. Each profession has established a body with very similar functions to the GMC. As with the GMC, the General Osteopathic Council and the General Chiropractic Council have the right to remove or suspend practitioners from their registers. However, the usefulness of any regulatory body depends on the extent to which it is willing to exercise its range of regulatory powers. A professional body which is consistently soft on its members, and allows little scope for lay input, will fall short of its duty to protect the public.