Reader 5 Professional Ethics Reader
Three main contexts – personal, professional and organizational – social good in the larger society
Personal
ethics can be informed – Family values, religion, and conscience
Professional
ethics – (revolved from medical profession) ethical stance as code of
conduct
Organizational
ethics – closely related to organizational culture – ethos
Case study one – a short summary
Robert Francis the QC – produced the last year report
Strafford hospital 2005 and 2008
When as
many as 1,200 patients died of preventable causes
His second inquiry (fourth into the hospital and trust); he
had to untangle the relationship between hospital management, the health
authority which it says he had answered and agencies that monitored standards.
It says he asked fundamental questions about the long term impact of marketization
had on the NHS. His inquiry is dissection
of how the health service works.
The witnesses (senior staff/leadership of different organizations
within the NHS and other parties/agencies) will deal largely with local and
specific. In the reader 5 it says, ‘we know what went wrong. What has to be
established is why it was not stopped’ Why did the whole chain of accountability,
given how vast and long it is and the different organisation and authorities
involved, as mentioned in the reader 5, fail to realise that so many vulnerable
people were at risk? The two health secretaries also needed convince us they
didn’t deny a public inquiry out of fear what might be uncovered
The NHS Confederation – 698 auditing standards and 89
different auditing bodies, which suggest regulations maybe part of the problem
rather than a solution – a deeper cultural problem. Patients also struggled to
get their voices heard since the abolition of community health councils.
Thinking points
At whose door do
ethical principles lay - personal professional, organizational, societal? Where
do the limits for responsibility lie? Are there any overlaps? Where are there
tensions? How would these be resolved?
At a glance I think it is an example of the ripple effect
and the ethical principles lay within all four in some form, although I would have
liked, to have had a breakdown of 1,200 patients that died, before laying
judgement on the different ethical principles involved and to have a clearer overall
picture.
I would like to know if the preventable causes were
scattered across the trust or if they lay in a particular illness, age group,
area or domain. Had the earlier cases become more like needles in a haystack,
so senior leadership or organizations were less likely to pick up on them; did
the impact of dropping community health councils where patients could raise
their concerns make the needle even less likely to be spotted. Who is
responsible for even one preventable death? How does this get flagged up? Do
the people within these organisations, which do audits, have the necessary
skills? Is this about training as well
as ethical principles? Because of the
vast amount of different organisations involved did they think one of the other
organizations would be dealing with it? Were the deaths indirectly overlooked
without knowing? What were the pressures, wellbeing and fatigue of the
frontline staff? What could be done to prevent this from happening? What could
we learn from it?
Mistakes are often made because this is how we learn, but in
a hospital mistakes have severe consequences just like in some child cruelty
cases that have been reported on the news. This does make me think of the red beams within a practice and whose job is it, as I
mentioned very briefly on my blog in module one. When should some of the red beams in a practice become more of an orange/amber beam and have a traffic light approach? Allowing
for controlled flexibility of ethical principles and also for different skills,
experience and knowledge within a practice to be accessed and used, but not
exploited and that includes both parties; also allowing for an element of
creativity to be spread within a practice to improve overall performance.
In addition if I go back to the case and compare elements of
it to my practice, if I consider a child who may be underachieving or may not
be making a particular level for their age. This could either be flagged up by
the Teacher, Teacher Assistant/Learning Support Assistant or parent; this would
lead to the SENCO getting involved and possibly other organizations and people.
This would also be picked up after the teacher had logged/recorded their attainment
levels on a database, as it would become a different colour, making it easier for
it to be seen by senior members, Ofsted etc… Other factors may also come into
play such as illness, disability etc… so all of the ethical principles come
into play in some form, although the person at the top may have more control of
the funding to allow for more resources or support to be given.
History of ethics - to be continued...
