PROFESSIONAL ETHICS IN A SOCIAL WORK AND HEALTH CONTEXT David Anderson-Ford Chair: Brunel University Research Ethics Committee Brunel University 2009

PROFESSIONAL ETHICS IN A SOCIAL WORK AND HEALTH CONTEXT

David Anderson-FordChair: Brunel University Research Ethics

Committee

Brunel University 2009

Ethics is concerned with how men and women ought to live their lives

Morality concerns the process of deliberation about right and wrong.Moral Immoral

(Right) (Wrong)

Seedhouse D Ethical Issues in Health Care


Two Forms:

• Everyday Ethics• Technical Ethics:

i.e. the attempt to design a theory which is internally coherent and which enables a person to “act morally” (according to the particular theory) whatever the situation in life which confronts her/him.


Aspects of Technical Ethics1. Moral philosophy as a quest to understand

‘good’2. Moral philosophy based on either

consequences or dutiesConsequences (Teleology)

• Utilitarianism (JS Mill)• Consequentialism

Duties (Deontology)• Right/wrong• Duty/obligation – the Moral Imperative (Kant)

3. Moral philosophy as a process of deliberation – Aristotle


Principles of Ethics

Jacques Thiroux (1980) – 5 Principles:• The Value of Life

At all costs? Abortion; Euthanasia; killing in self-defence; war; capital punishment; suicide; moral dilemmas: e.g. ‘quality adjusted life years’ – quantity rather than quality.


• Goodness or RightnessDo no harm: - beneficence

- non-malfeasance- malfeasance

• Justice or FairnessDilemmas e.g. kidney transplants

• Truth-telling or Honesty – fraud/plagiarism• Individual Freedom

Respect for the autonomy of the individual


Human Rights Act 1998• Convention Rights

– Article 2: A right to life– Article 3: Inhuman or degrading treatment– Article 5: A right to liberty and security– Article 6: A right to a fair trial– Article 8: A right to respect for family life and

private life– Article 14: Prohibits discrimination NB: Any interference with convention rights

must be lawful, necessary and proportionate


LEGAL ASPECTS OF PROFESSIONAL

ACCOUNTABILITY

• Professional Negligence• Confidentiality• Consent


LIABILITY IN NEGLIGENCE

Based on concept of duty of care


3 ingredients• The defendant owed the claimant a duty of

care

• The defendant was in breach of that duty by negligent conduct – i.e. a failure to act with reasonable care (+ concept of foreseeability)

• The defendant’s negligent conduct caused damage to the claimant (concept of causation)


Bolam v Friern Barnet Hospital Management Committee (1957)

See now: Bolitho v City and Hackney Heath Authority

(1997)


THE STANDARD OF CARE

The test is the standard of the ordinary skilled [social worker/health professional] exercising and professing to have that special skill. A professional need not possess the highest expert skill…. It is sufficient if s/he exercises the ordinary skill of the ordinary competent person exercising that particular art….”


• “A [social worker/health professional] will not be negligent if s/he acted in accordance with the practice accepted by a responsible body of [health professionals] skilled in that particular art.”


VICARIOUS LIABILITY

The Local Authority/NHS Trust or employer has two forms of liability in negligence:

• Direct liability, i.e. the Local Authority/Trust itself is at fault.

• Vicarious liability (indirect liability), i.e. the Local Authority/Trust is responsible for the faults of others – mainly employees, providing they were acting in the course of employment.


COMPETENCE, CONSENT & COMPULSION

AUTONOMY v PATERNALISM


The Competent Adult/Child

The Nature of Consent

-Express

-Implied ('need to know' basis)


3 issues:

• Was the consent voluntarily given?

• Was the person giving consent appropriately informed beforehand? – issue of informed consent.

• Did the patient/client have capacity in law? -i.e. was the patient/client competent to give consent?


Children

Gillick v West Norfolk & Wisbech Area Health Authority

(1986) Children Act 1989 Test of 'Gillick competence' ? But see: Re R (1992) Re W (1992)


Incapacity: Adults/Children

• Meaning of 'incompetence? Lack of capacity/ ‘decisionally incapable’/intellectually challenged

• Mental Health Acts 1983/2007 • Test of Competence:

Re C (1993)1. Comprehension and retention of information2. Believing such information3. Weighing the information and balancing the risks.See now: B v An NHS Hospital Trust (2002)

Mental Capacity Act 2005


Documents

PROFESSIONAL ETHICS IN A SOCIAL WORK AND HEALTH CONTEXT David Anderson-Ford Chair: Brunel University Research Ethics Committee Brunel University 2009