Drawing on an analysis of complaint files that we conducted for the Irish Medical Council, this paper offers three possible explanations for the gap between the ubiquity of official commitments to taking patients’ complaints seriously and medical professional regulators’ dismissal—as not warranting an inquiry—of the vast majority of complaints submitted by members of the public. One explanation points to the “regulatory illiteracy” of many complainants, where the remit and threshold of seriousness of regulators is poorly understood by the general (...) public. Another points to possible processes of “institutional epistemic injustice” that unjustly undermine the credibility of certain complainants, such as those with low levels of formal education. A third explanation highlights the marginalization of the general public from “symbolic power” to define what matters in medical professional regulation. The paper is offered in a spirit of ideas in progress and raising questions rather than definitive insights into the regulatory process. (shrink)

In this article, we will consider how the regulation of populations is not just a feature of prisons, but of all institutions and organisations that control members though hierarchies, divisions and norms. While nurses and other allied health professionals are considered to be predominantly self‐regulatory, practice is guided by a code of conduct and codes of ethics that act as rules that serve to uphold the safety of the patient, whether they are a sick person in a hospital bed (...) or an inmate in a prison. The codes of conduct espouse a number of rules that to a certain extent govern the behaviour of individual and groups of practitioners through reciprocal rewards and punishments. Supervision is one method of monitoring the effectiveness of the codes of conduct and ethics while regulating both the minimum standard of individual practice and of training organisations. It is posited that one of the possible effects of clinical supervision is to make the person effectively self‐regulatory as, an autonomous practitioner. We take the view that professional autonomy is a highly problematic concept requiring closer examination. (shrink)

In their 2018 article in the Cambridge Quarterly of Healthcare Ethics, Little, Lipworth, and Kerridge unpack the concept of corruption and clarify the mechanisms that foster corruption and allow it to persist, noting that organizations are “corruptogenic.” To address the “so-what” question, I draw on research about trust and trustworthiness, emphasizing that a person’s well-being and sense of security require trust to be present at both the individual and organizational levels—which is not possible in an environment where corruption and misconduct (...) prevail. I highlight similarities in Little et al.’s framing of corruption to the persistent problem of scientific misconduct in research and publishing. I acknowledge the challenges in stemming corruption in science and medicine and conclude with a discussion about the need to reinvigorate a web of stakeholders to actively engage in professional regulation. (shrink)

Social work students in England now have to register with the General Social Care Council and ?sign up to? the codes of practice. These specify that social workers must not ?behave in a way, in work or outside work, which would call into question [their] suitability to work in social care services'. This paper describes a small and ongoing piece of doctoral research into social work students' perceptions of professional regulation. The policy context for social work regulation (...) is outlined, including the implications for social work educators and students. The paper discusses the ethical and methodological issues which arose when planning the study. In conclusion, regulation has benefits for service users and professionals, but its implementation involves difficult ethical decisions. When students' suitability is called into question, there are implications for their personal and professional identities: exploring these implications will be the focus of the next stage of the research. (shrink)

This book describes in detail the important issues in these professions, accountability, standards of conduct, and the framework of the disciplinary process, ...

This article asserts that graduate study should include preparation for participation in the process of self-regulation to assure the responsible conduct of research in the scientific community. This article outlines the various ways in which doctoral study can incorporate such preparation. These suggested ways include the inculcation of general attitudes and values about professional self-regulation, various ways doctoral study can be configured so that future scientists are prepared to participate in the deterrence, detection and sanctioning of scientific (...) wrongdoing. The stages of doctoral study in the United States and their relevance to preparation for self-regulations are also discussed. Recommendations regarding an extended role for faculty advisors, graduate assistantships, coursework and departmental policies and activities are also advanced. (shrink)

Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because (...) of tensions between two or more of four doctor roles: the patient’s advocate, a steward of societal interests, a member of a profession and a private individual. Results 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Conclusions Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. (shrink)

ABSTRACT In discussions of the regulation of teaching, there are a number of issues which arise concerning how teachers understand the professional expectations upon them and the role that such standards play in supporting and maintaining the ethical dimensions of teachers’ practice. Arguably, teachers’ professional standards evolve to meet the needs of the societies in which they exist. Consequently, they provide a locus for analysis of the desires, aspirations and philosophical perspectives of the social and educational systems (...) to which they belong. Durkheim’s ideas about professional ethics provide a means of making sense of the complex and varied landscape of teacher regulation. They provide a way of seeing teacher professional standards as not constrained by neoliberal conceptions of regulation in which the fear of sanction may limit imaginative engagement with the profession. Instead, even within highly managerial systems, we begin to see professional standards as a prompt to engaged and ethical action for the greater good. In this sense, Durkheim’s work facilitates a way of seeing professional standards as having the capacity to magnify teachers’ innate potential for positive social impact regardless of the context in which they work. (shrink)

ABSTRACTProfessional associations, once the bodies responsible for professional self-regulation, have lost regulatory power. Some have entered into co-regulatory arrangements with state or independ...

This paper argues that more attention should be paid to the civic functions of ethical discourse about the professions and to the moral virtues inherent in their practice and traditions. The ability of professional ethics to articulate civic ideals and virtues is discussed in relation to three issues. First, should professional ethics aim to enlighten ethical understanding or to motivate ethical conduct? Second, how should professional ethics define the professional's moral responsibilities in the face of ethical (...) dilemmas — should the professional attempt to resolve the dilemma ethically or to change the social conditions that create the dilemma in the first place? The third issue discussed in the paper is whether professional ethics should be based on the model of regulation and rational self-interest or on the model of virtue and a fundamental personal commitment to the ideal of a certain form of life? In order for work in professional ethics to attain intellectual credibility among a non-philosophical audience, it must develop a coherent and convincing position on each of these issues. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, there is (...) a significant tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

Systematically improving patient safety is of the utmost importance, but it is also an extremely complex and challenging task. This illuminating study evaluates the role of professionalism, regulation and law in seeking to improve safety, arguing that the 'medical dominance' model is ill-suited to this aim, which instead requires a patient-centred vision of professionalism. It brings together literatures on professions, regulation and trust, while examining the different legal mechanisms for responding to patient safety events. Oliver Quick includes an (...) examination in areas of law which have received little attention in this context, such as health and safety law, and coronial law, and contends in particular that the active involvement of patients in their own treatment is fundamental to ensuring their safety. (shrink)

In vitro fertilization is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures. As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. (...) One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act. (shrink)

In vitro fertilization is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures. As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. (...) One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act. (shrink)

This article investigates the uneasy process of integrating midwifery’s alternative, women-centered model of childbirth care within the medically-dominated healthcare system in Canada. It analyses the impure processes of rhetorical identification and differentiation that characterized the debate about how to regulate midwifery in Ontario by examining a selection of submissions from diverse health care groups with vested interest in the debate’s outcome. In divergent ways, these groups strategically appeal to the value of the “public interest” in order to advance professional (...) concerns. The study considers the implications of this rhetorical process for re-defining midwifery’s distinctive professional identity in relation to other health professions, to the state, and to the women for whom midwives care. Likewise, it suggests the relevance of rhetorical analysis for understanding the discursive formation and re-formation of health models, values, and professions in Western culture. (shrink)

The World Medical Association (WMA), the global representation of the medical profession, first adopted the International Code of Medical Ethics (ICoME) in 1949 to outline the professional duties of physicians to patients, other physicians and health professionals, themselves and society as a whole. The ICoME recently underwent a major 4-year revision process, culminating in its unanimous adoption by the WMA General Assembly in October 2022 in Berlin. This article describes and discusses the ICoME, its revision process, the controversial and (...) uncontroversial issues, and the broad consensus achieved among WMA constituent members, representing over 10 million physicians worldwide. The authors analyse the ICoME, including its response to contemporary changes and challenges like ethical plurality and globalisation, in light of ethical theories and approaches, reaching the conclusion that the document is a good example of international ethical professional self-regulation. (shrink)

In Professional Ethics and Civic Morals , Emile Durkheim outlined the core of his theory of morality and social rights which was to dominate his work throughout the course of his life. In Durkheim's view, sociology is a science of morals which are objective social facts, and these moral regulations form the basis of individual rights and obligations. This book is crucial to an understanding of Durkheim's sociology because it contains his much-neglected theory of the state as a moral (...) institution, and it provides an understanding of his critique of anomie and egoistic individualism. The growing interest in cultural revolution and moral regulation make this edition of Durkheim's classic work especially timely. The new preface by Bryan Turner sets the book in its intellectual and historical context, and illustrates the relevance of this work to present day debates on the state, society, and moral regulation. (shrink)

Regulation and governance of medical research is frequently criticised by researchers. In this paper, we draw on Everett Hughes’ concepts of professional licence and professional mandate, and on contemporary sociological theory on risk regulation, to explain the emergence of research governance and the kinds of criticism it receives. We offer explanations for researcher criticism of the rules and practices of research governance, suggesting that these are perceived as interference in their mandate. We argue that, in spite (...) of their complaints, researchers benefit from the institutions of governance and regulation, in particular by the ways in which regulation secures the social licence for research. While it is difficult to answer questions such as: “Is medical research over-regulated?” and “Does the regulation of medical research successfully protect patients or promote ethical conduct?”, a close analysis of the social functions of research governance and its relationship to risk, trust, and confidence permits us to pose these questions in a more illuminating way. (shrink)

Many important regulatory decisions are taken by professionals employing limited and conflicting evidence. We conduct an experiment in a merger regulation setting, identifying the role of different standards of proof, volumes of evidence, cost of error and professional or lay decision making. The experiment was conducted on current practitioners from 11 different jurisdictions, in addition to student subjects. Legal standards of proof significantly affect decisions. There are specific differences because of professional judgment, including in how error costs (...) and volume of evidence are taken into account. We narrow the range of explanations for why professional decision making matters. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have (...) tended to focus on a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses (...) that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

Given the significance of teachers’ professional success in the adequacy of education, exploring the determinants of this variable appears crucial. To address this need, this inquiry inspected the role of well-being and emotion regulation in Chinese EFL teachers’ professional success. For this purpose, 357 Chinese EFL teachers were selected to answer three pre-designed questionnaires. Structural equation modeling using Smart-PLS was implemented to analyze teacher participants’ responses. The structural model revealed a strong, favorable connection between well-being, emotion (...) class='Hi'>regulation, and professional success. The model also demonstrated that both well-being and emotion regulation were highly influential in Chinese EFL teachers’ professional success. The potential implications for EFL teachers, teacher educators, and educational authorities are further discussed. (shrink)

Zusammenfassung Um die Öffnung der Bundesliga gegenüber Investoren möglichst wettbewerbsneutral zu gestalten und den Einfluss von externen Geldgebern auf einen Profi-Fußballclub zu beschränken, wurde die sogenannte 50-plus-1-Regel in die Satzung des DFB aufgenommen. In diesem Beitrag wird umfassend analysiert, welche Konstellationen mit beherrschendem Einfluss nicht von dieser Regelung erfasst werden. Ziel dieser Analyse ist der anschließende Vorschlag eines alternativen Konzeptes, welches die vorgebrachten Zielsetzungen konsequent realisieren könnte. Zur Durchführung der Regulation werden außerdem konkrete Handlungsempfehlungen ausgesprochen. Die Vorteilhaftigkeit des vorgeschlagenen (...) Konzeptes wird aus sportökonomischer und rechtlicher Perspektive gewürdigt. (shrink)

Objectives: To analyse legislation and medical professional positions concerning the doctor’s role in assisted dying in western Europe, and to discuss their implications for doctors.Method: This paper is based on country-specific reports by experts from European countries where assisted dying is legalised , or openly practiced , or where it is illegal .Results: Laws on assisted dying in The Netherlands and Belgium are restricted to doctors. In principle, assisted suicide is not illegal in either Germany or Switzerland, but a (...) doctor’s participation in Germany would violate the code of professional medical conduct and might contravene of a doctor’s legal duty to save life. The Assisted Dying for the Terminally Ill Bill proposed in the UK in 2005 focused on doctors, whereas the Proposal on Assisted Dying of the Norwegian Penal Code Commission minority in 2002 did not.Professional medical organisations in all these countries except The Netherlands maintain the position that medical assistance in dying conflicts with the basic role of doctors. However, in Belgium and Switzerland, and for a time in the UK, these organisations dropped their opposition to new legislation. Today, they regard the issue as primarily a matter for society and politics. This “neutral” stance differs from the official position of the Royal Dutch Medical Association which has played a key role in developing the Dutch practice of euthanasia as a “medical end-of-life decision” since the 1970s.Conclusion: A society moving towards an open approach to assisted dying should carefully identify tasks to assign exclusively to medical doctors, and distinguish those possibly better performed by other professions. (shrink)

Professional Responsibility: New Horizons of Praxis addresses the manifold and complex challenges inherent in professional responsibility. Since the beginning of the 20th Century, professions have been accorded a conjoined mandate - political and moral responsibility - to serve the interests of individual's and society. The quality of professional work, how professionals understand and live out their responsibilities in practice, is a matter of pervasive concern since increasingly they have such a prominent presence in most people's lives. Until (...) the late 1960's, professionals' roles and responsibilities were rarely questioned, but such trust has since given way to collective scepticism concerning their commitment and willingness to live up to their moral and societal obligations. Abuse of power and privilege by some professionals has contributed to decline in trust by publics, the concept of 'good work' is increasingly challenged, and politicians and policy-makers have sought to regulate and hold professions to account. It is timely, therefore, to investigate critically conflicting discourses and practices on what counts as professional responsibility, to question how professionals understand and are prepared for a life of professional responsibility, and what acting with integrity and authority looks like in practice. One of the distinctive features of this book is the combination of normative and empirical dimensions that are used to dissect this question. The authors indicate from a diversity of disciplinary perspectives how professional responsibility includes particular thoughts and warranted actions yet remains multifaceted and inarticulate"-- Provided by publisher. (shrink)

This article points out how far-reaching the changes in our public life would actually have to be if we wanted to avoid paternalism altogether. For example, the widespread view that only a physician with training at a recognized institution should be allowed to perform surgery or that only an educated lawyer may provide legal council is clearly paternalistic. In fact, many professional regulations, not just in medicine and law, but also in engineering and many other areas of expertise, have (...) a strongly paternalistic function. Moreover, this problem is located in a sphere that is neither clearly private, nor seems to be part of a state-legislated public sphere. Professional organizations are neither governments, nor necessarily democratic, but they are often state-certified and produce binding regulations for issues of public interest. The author bites the bullet and accepts professional paternalism, while insisting that special care should be placed on how to design an appropriate professional code of conduct. (shrink)

Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional ethics, one should notice (...) that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)

The quest for a ``theory of nonhuman minds'''' to assessclaims about the moral status of animals is misguided. Misframedquestions about animal minds facilitate the appropriation ofanimal welfare by the animal user industry. When misframed, thesequestions shift the burden of proof unreasonably to animalwelfare regulators. An illustrative instance of misframing can befound in the US National Research Council''s 1998 publication thatreports professional efforts to define the psychologicalwell-being of nonhuman primates, a condition that the US 1985animal welfare act requires users of (...) primates to promote. Thereport claims that ``psychological well-being'''' is a hypotheticalconstruct whose validity can only be determined by a theory thatdefines its properties and links it to observed data. Thisconception is used to contest common knowledge about animalwelfare by treating psychological well-being as a mentalcondition whose properties are difficult to discover. Thisframework limits regulatory efforts to treat animal subjects lessoppressively and serves the interests of the user industry.A more liberatory framework can be constructed by recognizing thecontested nature of welfare norms, where competing conceptions ofanimal welfare have implications about norm-setting authority, asit does in other regulatory contexts, e.g., food safety. Properlyconceptualized welfare should include both the avoidance ofdistressful circumstances and the relationship between ananimal''s capacities to engage in enjoyable activities and itsopportunities to exercise these capacities. This conception ofanimal welfare avoids appropriation by scientific experts. (shrink)

The situational context within which an activity takes place, as well as the personality characteristics of individuals shape the types of strategies people choose in order to regulate their emotions, especially when confronted with challenging or undesirable situations. Taking self-regulation as the framework to study emotions in relation to learning and performing chamber music canon repertoire, this quasi-experimental and intra-individual study focused on the self-rated emotional states of a professional classical cellist during long-term sustained practice across 100-weeks. This (...) helped to develop greater awareness of different emotions and how they vary over artistic events. Data analysis included traditional psychometric measurements to test the internal consistency of the time series data as well as the relationship between variables. The study mapped the cellist’s flexible regulation of 17 different positive and negative emotions empirically linked to learning and achievement while practicing within the social context of performing music publicly at a high level. Findings arising from the study help with understandings of how to support musicians to maximize their artistic potential by reducing emotion dysregulation and strengthening the types of adaptive methods that enable them to manage their own emotions. (shrink)

In March 2021, the Spanish Congress approved the law regulating euthanasia, that regulates both euthanasia and physician-assisted suicide (PAS). In this article, we analyse the Spanish law regulating euthanasia and PAS, comparing it with the rest of the European laws on euthanasia and PAS (Netherlands, Belgium and Luxembourg). Identified strengths of the Spanish law, with respect to other norms, are that it is a law with many safeguards, which broadly recognises professionals’ right to conscientious objection and the specification that it (...) makes on the prior comprehensive care of the patient, including the approach to care dependency. Regarding its shortcomings, the law does not differentiate well between euthanasia and PAS; it barely assigns a role to the healthcare team as a whole (similar to other regulations); it does not clarify the functions of the different professionals involved; it does not detail the specific composition and duration of theevaluation commission; it has not been accompanied by a prior or simultaneous regulation of palliative care; and, lastly, the period of time to implement the law is too short. (shrink)