If I had
to sit an exam with a two-point short-answer question “what is professional
integrity?” I would probably write:
“Professional
integrity is professional ethics in action”
Here is
my explanation.
“Integrity”
is a person’s public front: the decisions, actions and behaviours of an
individual that others can see. The
chosen behaviour and action allows those around them to make an informed
decision about how much they might “trust” that person. What shapes, or drives, the person’s
behaviour is the ethical principles to which they subscribe.
Now, a
“profession” is a socially recognised label, for example, lawyer, doctor,
dentist, teacher, dietitian. This means
any “profession”, any one of these socially recognised labels, comes with it an
assumed level of “integrity”.
“The socially
recognised label for a “profession” comes with an already attached public trust
in professional integrity.”
This
assumed “professional integrity” is the privilege of choosing to be a
professional as a purposely-selected vocation to serve the public and act in
the interests of the individual in front of you. A “professional” therefore has a higher
expectation of self, and, in a way, the “expectation of self” is to recognise
the public’s assumed trust associated with the label. People who choose a
“profession”, and maybe this is particularly true of health professionals, are
driven by a desire to help others, believe in social equity, and recognise the
trust they are afforded by the public.
So,
“professional integrity” is still about others’ perception of you, and how much
they “trust” what your intentions are, what drives you to give the instruction
and information you do. Therefore, an
individual practitioner relies on [perception of] “trust” to be effective in
their chosen profession. Once that
“trust” is lost, it follows the service is no longer effective.
“Professional
integrity” is central to the credibility of a profession, and the effectiveness
of the service provided by an individual practitioner.”
Any
professional association, such as the Academy
of Nutrition & Dietetics (AND), or, our Australian equivalent, the Dietitians Association of Australia (DAA),
act for and on behalf of the profession.
A professional association is the “public voice of the profession”,
reflecting the collective professional integrity of the individual
practitioners. What the association does
and says, and the way in which they conduct their business reflects what [the
majority of] the profession wants and stands for.
“The association’s
“professional integrity” IS the
profession’s integrity, and, at the level of service delivery, IS the individual practitioner’s
integrity.”
Here it
is: if the individual practitioner has chosen a particular vocation knowing they
enter the profession with the expected higher level of self-professional
integrity, it seems reasonable the public assumption, and the professional’s
assumption, extends to the professional association. What the American group, Dietitians for Professional Integrity
(DFPI) is asking of the AND is to protect the dietetic profession’s integrity
by recognising the conflict of interest that exists with the AND’s financial
ties with the food industry.
Having
corporate funding is not against the law, and the AND, like the DAA,
rationalise their corporate relations by referencing their “corporate
sponsorship policy”. DFPI, as members and non-members of their association,
have worked many years trying to support their association to change from the
inside. Now they take this request public to encourage their
association to remember the principle of “integrity” on which the
profession is based. The reason for taking
the issue public is twofold 1) to be clear to the public the AND’s reliance on
corporate funding is not what dietitians want or support and 2) to use public
pressure to hold the AND to account – there is no other avenue available to
hold the association to account for a slip in professional ethics.
It is
reasonable to suggest it hypocritical the association who can hold an
individual to account for a slip in their professional ethics cannot themselves
be as easily held to account for their own slip in professional ethics. In playground speak: they get to tell us what
to do, but they really can do whatever they want. There is an imbalance of power here too: the
association has the power to hold an individual to account but there is no real
accountability for the association – accountability of the association relies
on the association having a “higher expectation of self” which includes
acknowledging this higher position of power.
Even if
we put “professional integrity” as a reason to limit corporate involvement in
the association to the side for a moment, there is a more obvious reason for a
professional association to NOT have corporate sponsorship. This reason is evidence. There is more than enough evidence for a
professional association, especially one who is an advocate for health, to
recognise the damage these ties have to professional integrity. It is not against the law to have corporate
funds, but it is certainly within “professional ethics”. Again, is it hypocritical an association who
promotes their profession as “evidence-based” is not in fact operating to the
evidence?
What I am
saying here is “professional integrity” is more than just “following the law”,
it is more than just following policy and procedure. Professional integrity is making an active
commitment to the “profession” and the profession’s ethics to put the patient
first. If an individual has a high expectation of self, then the association
who represents them should have an even higher expectation of its collective self.
There is
simply a fundamental philosophical difference between [health] professions, and
any company/corporation: a company has financial gain as the driver for
behaviour; a profession has the patient and the patient’s interest as the
driver for behaviour. Commercial interest and professional interest cannot
exist together because of the difference in the dominant driver of
behaviour. Even with the best of
intentions, once money is the driver, it is difficult to be absolute in defence
the acquisition of funds from commercial enterprise does not affect the
“patient first” expectation of professions.
Professions
have been around long enough to recognise “what is ethical” is, to some extent,
subjective. This is why “professions”
have “standards of professional practice”, supported by professional
registration and accreditation programs.
And an individual practitioner can be held to account to these professional
standards by “the law”.
Here is
the bit I would say to students is “examinable”. For the non-students – this is the “list of
professional ethics principles” I would want to see in action to make the
decision an individual (and their association) has unquestionable professional
integrity…..
Professional
integrity is professional ethics in action.
Professional ethics is a set of principles outlined by professional
practice guidelines, accreditation and credentialing programs, and then the law
is the recognised scaffolding to hold practitioners to account [if they move
outside these expectations].
Professional
ethics means a practitioner:
The links here are specific to Australian dietitians
1.
Recognises the
public trust in their title and credential and reward this public trust by expecting
a higher level of self in professional conduct
4.
Conduct
business within the law, but to subscribe to the higher elements of good governance
(transparent, fair and just, accountable, democratic, participatory and
responsive)
5.
Respect the complexity
of conflicts of interest and recognise the role of adequate disclosure of
interest
Extending
this to professional associations to demonstrate their professional integrity
by complying with 1 to 5 plus three more:
The links here are specific to Australia
8.
The terms of
good governance are adhered to, and in a collegial and solution-focussed
approach to problem-solving
Ok, I
made that last one (#8) up – but for those of you who have followed my posts on
“dietitian-only discussion groups” would know #8 trumps all others, and means
the association is operating to the law and has a [publicly] demonstrated high
level of professional ethics that extends to all arms and operations of the
association.
PS #7 is
a close 2nd in the “weighting of importance” in the integrity of an
association.
@MDPStudy
Want more on professional ethics
and professional integrity?
The
Global Mail, October 2013
The Royal Australasian College of Physicians produces an
internationally respected set of ethics guidelines for health professionals.
But the college executive has taken a new edition down from its website and
quietly disbanded the committee who authored it. Why? In the meantime, The
Global Mail has posted a copy of the draft guidelines here.
Australian
Prescriber 2013 36: Supplement 2
This
supplement is likely to be of interest to anyone involved in the development of
clinical guidelines and clinical research, including:
- Health
professionals, trainees and students who use guidelines as a basis for their
decision making
- Policy makers and
others working to improve the quality of health care
- People involved in
university, college and hospital education
Excerpt: Around
the world it is commonly assumed that clinical practice guidelines, systematic
reviews and the scientific literature are dependable and credible sources of
information about the efficacy and effectiveness of therapeutic products.
Health practitioners and consumers expect that these are reliable sources of
up-to-date information about treatment options, and policy makers rely on them
to guide important healthcare decisions.
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