Professional Codes in Health Care

Ethical codes address the areas of personal integrity, dedication, and principled behavior.1 Health care professionals cherish and hold sacred the obligations that come from the study and subsequent entrance into a learned profession. The prescribed principles and standards of behavior codify and reinforce the significance of being a part of a special group of people who are committed to the same values and goals.

Three things demonstrate how codes can be effective in shaping professional behavior.2 First, when professional schools of health care screen applicants for admission to educational programs, integrity and character are an important criteria for acceptance. Admissions committees strive to select candidates who are the best qualified academically as well as candidates of good character. Virtues and virtue ethics, derived from the writings of Plato and Aristotle, are simply praiseworthy traits of human character. A virtue is a character trait; the assumption is that if a person is virtuous he or she will act virtuously. Thus, part of the selection process often focuses on identifying virtue in the character of applicants and explains why letters of recommendation are often part of the admissions process in health care professions.

Secondly, each entering student is assumed to have the character traits needed to be a true professional and the willingness to uphold the established values. Educational institutions actively seek to indoctrinate students to the goals of the profession and expected professional behaviors. Learning what is expected of that profession reinforces character traits in the developing professional. This often is accomplished by introducing students to the institution’s code of conduct, by familiarizing them with the profession’s code of ethics and professional conduct, and by faculty serving as positive role models. The now common practice of holding a White Coat Ceremony at the beginning of medical or dental school is a method of establishing expected professional duties and behaviors in a public and demonstrative manner.

Third, after entering professional practice, it becomes the obligation of the newly trained individuals to help regulate their profession. Members of the profession who become aware of code of ethics violations have a duty to intervene in a substantive way. This is an important duty and must be carefully considered; the reputation of the profession and the well-being of the public ultimately rest on a willingness to engage in meaningful self-policing of the profession.

Professional groups and the public have sometimes questioned the value of codes of ethics. Do codes of ethics really make a difference in the way health care providers interact with and treat patients and colleagues? If a member of a profession has seen evidence of colleagues acting unethically and those colleagues have not been dealt with, that question is legitimate. It would be the same for a member of the public who has had a poor experience with a health care professional or health care system. The patient may assume that he or she was treated in a manner inconsistent with the standards of behavior in the profession (even though the professional may have behaved appropriately). Sometimes the act may be inappropriate behavior by the professional; conversely, the frustration of the patient may lead him or she to believe unethical behavior occurred even when it has not. A bad outcome from treatment does not necessarily indicate unethical conduct.

The degree to which codes are effective remains a difficult question to answer completely. However, because health professions invest so much effort in the development and propagation of codes of ethics and standards of professional behavior, an assumption that the professions find them to be extremely valuable is reasonable. When violations of the code occur, the profession is empowered to take action to resolve the problem. Although codes alone do not guarantee that everyone will behave with integrity, they do provide guidance and standards by which professionals can be judged. A code of ethics does serve as a tool in the function of self-regulation.

Codes serve as a touchstone by which all members of a profession can judge the acceptable parameters of behavior. This is why being a professional person is a privilege and carries both benefits and burdens – responsibilities that must be met to uphold the elements of a true profession.