|Year : 2021 | Volume
| Issue : 1 | Page : 6-9
Professionalism and bioethics
Mourouguessine Vimal1, Anandabaskar Nishanthi2
1 Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
2 Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
|Date of Submission||24-Apr-2019|
|Date of Decision||18-Feb-2020|
|Date of Acceptance||29-Nov-2020|
|Date of Web Publication||18-Jun-2021|
Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry - 605 107
Source of Support: None, Conflict of Interest: None
Professionalism is applied to any field which requires a specialized body of knowledge and skill and the highest standards of conduct directed at the general benefit of the society. The principles of bioethics have always been the key component in the practice of medical profession. The authors highlight the various aspects of professionalism and characteristics of a professional. Principles of bioethics have been the key component in the practice of medical profession. The authors discuss the various ethical dilemmas which could arise in the practice of medical profession where the principles of bioethics could be applied to ensure quality assurance of health-care services. In addition, the need for teaching professionalism and bioethics, as a part of the medical curriculum, had been insisted.
Keywords: Bioethics, doctor–patient relationship, ethical dilemmas, principles of ethics, professionalism
|How to cite this article:|
Vimal M, Nishanthi A. Professionalism and bioethics. CHRISMED J Health Res 2021;8:6-9
| Context|| |
The social contract between the doctors and the society includes codes of professional conduct which has evolved over years. With increasing demands and advanced technologies, these codes of professional conduct are redefined as per the changing scenario. The society expects a transparency in the medical practice and competency and altruism from the treating doctors. The society also expects doctors to be accountable for their patients, and patient's interest has to take precedence at every moment. The doctor has to understand that the basis of society's expectation relies on professionalism and its obligations. Knowledge and practice of bioethics are needed for the doctors to demonstrate professionalism in their work.
| Introduction|| |
“Professionalism: It's NOT the job you do, it's HOW you do the job” (Anonymous).
The concept of professionalism is broad and intriguing, and the society's perception of professionalism is changing over time., It has been difficult to explain it with a single definition because it encompasses a wide variety of attributes and differing perceptions depending on the profession involved.
The terms “profession” and “professionalism” are derived from the Latin word “Professio” which means “Oath of canonical obedience.” The word makes its first recorded occurrence in the Oxford English Dictionary in 1420, and it was initially used only in the religious sense. The next recorded occurrence is in 1747 where the word acquires its usage in the modern context. Traditionally, medicine, law, and clergy are regarded as the professional fields. However, in the recent context, the word “Profession” is applied to any field which requires a specialized body of knowledge and skill and highest standards of conduct directed at the general benefit of the society. It has the right to admit and train its members to sustain the competence and observe the responsibilities.
The normative definition of professionalism proposed by Swick is more elaborate and encompasses most of the attributes of professionalism. He has identified the following behaviors to consider oneself as a true medical professional. The doctor must place the interest and needs of the patients well above his personal interest. This is an important aspect of medical professionalism and professionalism in general. All professionals should adopt high ethical and moral standards.
Professionals should demonstrate humanistic values such as honesty, integrity, caring, altruism, respect for others, empathy, compassion, and trustworthiness. Professionals must take responsibility for their work and those of their colleagues. In other words, they must be accountable for their actions. Professionals must be competent and should have a desire to excel in their field. Because medicine is an ever-growing field, physicians must constantly keep updating their knowledge and sharpen their skills to keep them abreast of the advancements in their field so as to provide better services to the patients and society. Thus, lifelong learning is a fundamental aspect of professionalism.
Professionals should share their knowledge with others for the betterment of the society. They should work toward preserving the health of their patients and the society as a whole. They should have the skill of independent decision-making at times of ambiguity and uncertainty in their work. Reflection and deductive reasoning are hallmarks of professionalism. A good physician should be able to reflect upon the decisions taken by him/her, critically analyze it, and make conclusions, which will help him/her to take better decisions in future when he/she confronts a similar situation.
Newkirk (1982) defined professionalism as “the quality of an individual to overtly display characteristics that positively represent the standards of one's profession and a commitment to advancing the program or activity of the profession.” The term professionalism includes two different entities: the learned rational science and the emotional psychosocial beings. Brown in 1971 described the three fundamental elements of a profession which includes orientation of the service to the well-being of the society is the prime intention, usage of conceptual knowledge skillfully in the area of service, and maintaining autonomy in decision-making based on the expertise knowledge and reasoning out.
The authors feel that the most important aspect of professionalism is to serve the society and safeguard its interest and work for its well-being and betterment. Any professional should work for the well-being of the society that he/she serves and perform his/her duties toward the society. In other words, a professional should understand that he/she has a social contract with the community he/she serves and should cater to its needs.
| Characteristics of a Professional|| |
The following are considered as the characteristics of a professional: ethical – should follow the moral code of conduct, altruistic – should have obligation to the interest of others, selflessness, responsible – should be accountable to their own profession and to the society, and be able to respond, theoretical – should follow systematic and abstract principles in the professional action, intellectual – should be committed to the continuous development of professional knowledge and skills, respect for others – should respect the colleagues and subordinates, and honor and integrity – should follow fairness and truthfulness.
| Professionalism and Bioethics|| |
Bioethics is the study of morality and its implications in the field of biological sciences. The principles of bioethics have always been the key component in the practice of medical profession. A doctor should serve the interest of the patient, society, and other health professionals by applying his/her conceptual knowledge and skills.
There are many attributes of professionalism, each of which is related to bioethics either directly or indirectly. Professionals, especially medical professionals, have a fiduciary relationship with the society that they serve. They are entrusted to take the right decisions and act in the best interest of the patient and the society. They are expected to protect the needs of their patients over their personal benefits. This aspect of professionalism is ensured by the formulation of the code of ethics and enactment of laws to enforce punishments for those who deviate from it. Thus, the patients are protected and their welfare gets priority. Another important aspect of professionalism is to adhere to the moral and ethical standards formulated by the professional bodies. Thus, knowledge of bioethics helps us to enrich our knowledge regarding the ethical codes of conduct so that we could apply the same patient care for the betterment of the society.
Furthermore, many a times, a professional has to confront ethical dilemmas in his/her work. Clinicians face ethical problems in patient care. Medical researchers face various ethical issues in basic and clinical research. Thus, modern medical practice is associated with ethically challenging situations, where the physician is trusted upon to make the clinical judgments which are moral and ethical. These clinical decisions should also be in line with the code of medical ethics and laws pertaining to the ethical dilemma. A good professional is one who is competent enough to take the right decision which is ethically and clinically sound. Thus, knowledge and practice of bioethics are needed to demonstrate professionalism in our work.
In medical research, the researcher is expected to conduct good-quality research which would help advance the medical literature and identify newer modalities of treatment. While encouraging and contributing to the development of a new knowledge is a professional responsibility, a good professional should be aware of the ethical principles in doing research and follow the same. A conference held at Bethesda by the American Heart Association highlighted the need for an ethical conduct of research by the clinical researcher/practitioner. It gave recommendations to be followed by the health-care professionals while conducting a research. A clinical researcher should put the patients' interest at first above their own to maintain the trust between the patient and the doctor.
One of the attributes of professionalism is to constantly keep ourselves updated of the recent advances in our field. This is related to bioethics because if we are not up to date with our knowledge and skills, we would not be able to offer the best available treatment for the patient and it is unethical to do so. With the rapidly expanding medical knowledge, many new diagnostic entities, new modalities of investigation and treatment, and new drugs are available in the market at an exponential rate. Hence, updating the knowledge and skills is vital for the health-care professionals to ensure a cost-effective treatment and a quality assurance health care. Remaining competent and up to date will also sharpen the professionals' continued professional development.
Another aspect of professionalism is to have humanistic values like respect for persons which is the fundamental principle of bioethics. In other words, patients' autonomy should be respected by taking informed consent for medical procedures during patient care and in medical research.
Medical and professional ethics are based on the principles of beneficence (always act in the best interest of the patient and the society), non-maleficence (do no harm to the patient), autonomy (respect and protect the right of the patient to make his/her own choice of decision, and maintain privacy and confidentiality), and justice (all individuals in the society are treated fairly and the burdens and benefits of research should be distributed equitably).,
Physicians are encountered with ethical dilemmas in weighing these principles and conflicts arising among them. Various researchers have enumerated some of the examples of ethical dilemmas faced by medical practitioners., One of the situations of an ethical dilemma is when conflict arises between the two ethical principles of “beneficence” and “confidentiality.” Consider that a physician makes a diagnosis of acquired immunodeficiency syndrome in his/her patient and also the doctor is aware that the patient is going to get married the next week. What should the doctor do? Should he/she disclose the condition to the patient's fiancée (beneficence) or maintain the confidentiality of the information to safeguard his/her patient's trust on him/her? The doctor should exert his/her communication skills and discernment counseling here to seek the best personal and social outcome.
Another scenario may exist in which disclosing the medical information to the patient may cause psychological harm or worsen the patient illness such as in myocardial infarction or mental illness. In such scenarios, the therapeutic privilege of a doctor to temporarily withhold the medical information to the patient can be defended legally, but need to be reviewed when the patient's condition improves.
Let us consider another scenario, where there is a conflict arising between the duty of care toward patients and personal responsibilities. For example, consider the scenario when a surgeon is going to perform a lifesaving surgery on a critically ill patient the following day, and he/she comes to know that his/her father is ill and is admitted to a hospital in another city and is going to undergo an emergency surgery. What can the surgeon do? An ethical professional should weigh the principles of beneficence and nonmaleficence and justice in such scenario and should be able to perform his/her roles related to patient care and responsibilities.
Significant issues in the field of bioethics include the process of informed consent, genetic engineering and testing, refraining from life support treatment, euthanasia, doctor–patient relationship, relationship with the caregivers, confidentiality, and conflicts of interest. Ethical dilemmas in end-of-life situations are complex and challenging during decision-making. The physician has to consider the moral value of a life, futility of the treatment, the decision-making capacity of the patient, and the surrogate decisions when the patient lacks such capacity. In a writ petition filed by a journalist Pinki Virani for euthanasia of Aruna Shanbaug, a Mumbai nurse who spent 42 years in vegetative state following a sexual assault, the Supreme Court after assessing the patient's condition and testimonies from the health-care team, rejected the plea. However, in its landmark opinion, it permitted passive euthanasia in India. A living will can serve as an advance directive and a legal document, which records patient's future wishes regarding the medical treatment in the event of their decision-making capacity due to incapacitation.
The physician should consider the circumstances of individual patients, articulate the ethical principles, and make judicial decision which necessitates commitment to the welfare of the patients as well as the society. A physician has both moral and legal responsibilities and should be able to balance these obligations in decision-making.
The three fundamental principles of medical professionalism are patient's welfare, patient's autonomy, and social justice. The responsibility of a professional is to follow these fundamental principles of bioethics by updating his/her knowledge and skills in a competent manner. The importance of ethical conduct for physicians is further re-emphasized by the oath-taking ceremony conducted by various medical schools on the day of graduation. The students take the “Hippocratic oath,” formulated by the Greek physician Hippocrates, which is universally accepted as an ethical code of conduct for physicians. This oath is the earliest expression of medical ethics, which requires the physician to swear by the name of gods that he/she will uphold the best ethical standards in their medical profession. Furthermore, the oath has been modified by some researchers to suit the ethical demands of a modern medical practitioner, called the “modern Hippocratic oath.”, This is also widely practiced in various medical schools across the world.
Moreover, in 1999, the World Medical Association made teaching of bioethics mandatory to the medical graduates through a resolution. The Medical Council of India (MCI), in its document on “Vision 2015,” insisted on the need for incorporating medical ethics and professionalism as part of undergraduate curriculum. The Accreditation Council of Graduate Medical Education (ACGME) in the USA recognizes professionalism as a core competency of a medical graduate. As professionalism is a continuous and incremental process, the MCI has recommended a structured, longitudinal Attitude, Ethics and Communication (AETCOM) module which has 27 case-based modules transacted over a period of 139 h. This training will enable an Indian medical graduate to perform his/her roles ethically as a member of the health-care team and as a professional. Such trainings would aid in improving the ethical standards of medical practice.
| Conclusion|| |
A medical professional should be able to recognize the ethical dilemmas along with the professional expertise required in a particular situation and make a judicial decision in the context of patient and the society. In addition, it is evident that bioethics and professionalism are intricately related to each other, and an education in bioethics is important to reach the goal of professionalism. Thus, in order to sow the seeds of ethical conduct among medical practitioners, it is essential to train them on professionalism and bioethics, and these subjects should be included as mandatory aspects of medical curriculum both for undergraduate and postgraduate students. Furthermore, continuing medical education on these topics must be organized for practicing physicians, which provides them a common platform to discuss the various ethical issues and dilemmas faced by them and how they had tackled them. The need to train medical students in professionalism has been recognized by the ACGME in the USA and the MCI has recommended incorporation of AETCOM module in the curriculum to enable the medical students to perform their duties ethically as a member of the health-care team. Such early and repeated trainings on professionalism and bioethics for medical students would aid in improving the ethical standards of medical practice.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
van Mook WN, de Grave WS, Wass V, O'Sullivan H, Zwaveling JH, Schuwirth LW, et al
. Professionalism: Evolution of the concept. Eur J Intern Med 2009;20:e81-4.
Evetts J. Professionalism: Value and ideology. Curr Sociol 2013;61:778-96.
Timms O. Biomedical Ethics. 1st
ed. Haryana: Elsevier; 2016.
Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000;75:612-6.
Cascais AF. Bioethics: History, scope, object. Global Bioeth 1997;10:1-4, 9-24.
Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. (amended upto 8th
October 2016). New Delhi: Indian Medical Council; 2016. Available from: http://niti.gov.in/writereaddata/files/1.pdf
. [Last accessed on 2019 Feb 09].
Mackenzie CR. Ethics and professionalism 2016. Trans Am Clin Climatol Assoc 2017;128:75-82.
ACCF/AHA consensus conference report on professionalism and ethics. Presented in Bethesda, Maryland, June 2-3, 2004. Circulation 2004;110:2506-49.
Anshu., Singh T. Continuing professional development of doctors. Natl Med J India 2017;30:89-92.
del Carmen MG, Joffe S. Informed consent for medical treatment and research: A review. Oncologist 2005;10:636-41.
Gillon R. Medical ethics: Four principles plus attention to scope. BMJ 1994;309:184-8.
Taylor RM. Ethical principles and concepts in medicine. Handb Clin Neurol 2013;118:1-9.
Blightman K, Griffiths SE, Danbury C. Patient confidentiality: When can a breach be justified? Continuing Educat Anaesth Crit Care Pain 2014;14:52-6.
Downes T, Channer KS. Ethical problems in clinical practice. Postgrad Med J 2003;79:151-3.
Hulkower R. The history of the Hippocratic Oath: Outdated, inauthentic, and yet still relevant. Einstein J Biol Med 2016;25:41-4.