Professional Roles and Responsibilities

By: Gabriele DeMori, Class of 2001

Dr. DeMori is a 2001 graduate of the WVU School of Medicine. He is pursuing residency training in Internal Medicine at the University of Florida. He was born in Venice, Italy but came to the United States as a young child and grew up in Wheeling, WV.

These are my thoughts on my own personal transformation from the first to the fourth year of medical school. Members of a profession claim maximal competence and knowledge in a specific area. This competence is achieved through specialized education, with long periods of apprenticeship, or internship as a transition to practice the profession.

The profession of the physician offers a service, which is of high significant social value. It also carries a fiduciary duty toward those he or she serves.

One of the most distinctive aspects of the medical profession is that it is given the right to control its own work; it has a legitimate, socially recognized autonomy, responsibilities and obligations.

In order to deserve this independence, a physician must meet standards of ethical, as well as of technical, competence. For this reason, professions have codes of ethics to delineate the ethical standards that members are expected to uphold, and to define a philosophical ground, which gives coherence and solidity to the practice.

Many times health professionals encounter in daily practice situations that raise moral issues. Morality is concerned with relations between people and how they ought to behave towards one another in order to live in peace and harmony. The goal of moral behavior is to protect important values cherished by society and its members: this could be, for example, quality of life, or freedom to choose a lifestyle. There are occasions where how to act morally is not obvious. These situations will raise questions that provoke a process of weighing the alternatives.

Ethics is that part of philosophy which deals with systematic approaches to these types of considerations. An “ethical issue“ is present when one can identify these types of considerations in a situation. An “ethical dilemma“ occurs when acting on one moral conviction means breaking another. In these instances of conflict, it is easy to see that sometimes our ideas or actions require careful analysis of all their subtleties and complexities.

Every human being, for example, is under moral obligation to respect others, to help them, to keep promises, to be truthful. The doctor has the further obligation to go beyond normal expectations in relationship with patients.

Professionalism binds the doctor to higher ideals and higher virtues because of the nature of the medical relationship. Higher standards of professional conduct require higher virtue and greater personal effort in character formation. The molding of one’s internal character leads one to choose certain directions. It is a way of being related to the world and to other people, and it expresses itself in chosen attitudes and patterns of behavior.

Having principles and sticking to them, risking unpopularity to do what’s right, having the courage of one’s convictions, being fair, being unselfish, being able to rebound from a failure are terms that have a lot to do with consciousness, intention, and good will, that is the expression of one’s character. Maturing and perfecting one’s character takes time and patience.

The awareness of the development of an ethical inner being depends upon a total and permanent commitment to be a certain type of person and to an ideal, full dedication to the good of others, and to help people who are in need. Consequently it leads one to develop or change certain attitudes: it brings up the discipline, the practice, and the effort to act in certain ways. Eventually the conduct becomes more natural. This development involves personal sacrifice, effort, resolution, work, and discipline.

The physician has a legitimate role and a moral responsibility towards the community at large. First, the nature of illness itself is a universal human phenomenon that makes medicine a special kind of human activity. The sick person is in a uniquely dependent, anxious, and vulnerable state. He may have to compromise his dignity, reveal intimacies, and trust the physician in a relationship in which he is in a dependent status. Moreover, the physician’s knowledge is not proprietary. It is acquired through the privilege of a medical education, and it is not intended for personal gain, prestige or power. By accepting this privilege, the doctor acknowledges publicly, with the Hippocratic oath, that he understands the responsibility of this moral commitment, that he promises to be competent, and to use this competence in the interest of the sick.

Physicians have ethical obligations that transcend self-interest, personal emergency, and even social, political, and economic forces. They are members of a moral community and have to be faithful to the moral binding forces of that community. They have to be constructive and appropriate in their actions.

With the oath, the physician binds himself publicly and voluntarily to competence as a moral obligation, not simply a legal one, and he places the wellbeing of those he is dedicated to help above his own personal gain. It leaves little room for incompetence, selfishness or even legitimate personal concerns like fatigue, lack of time, or demands by the family.

Unlike matters of sciences, where the scientific method will often reveal reproducible answers, the answers to questions regarding values are not reducible to exact formulas. Rarely does everyone agree with the answers. Health care ethics reside in the field of human values, morals, cultures, intense personal beliefs and faith that have been individually shaped by the events of our lives and the traditions of our people. In order to make better value decisions, physicians must move beyond their initial thoughts and feelings, and build a framework to objectively examine them.

Four essential values constitute the most significant parts of the ethical code for physicians.

1. Justice requires a balanced and fair distribution of benefits and burdens among persons and groups in a society.
2. Beneficence is defined as obligation to act in a positive way toward another person for the best possible consequence.
3. Nonmaleficence is to intentionally perform an action that will not harm others in any way and to act with prudence and care in order to prevent unintentional damage.
4. Autonomy is the duty to understand and respect the right of a patient to make autonomous and personal decisions about his mode of care. This concept also refers to the practice of the medical profession where competency, knowledge and expertise give the physician the right of relative independence in decision making according to professional obligations.

Doctors are aware of their role in the community, the professional obligation to their practice and to their personal responsibility toward the society in which they work and live. There could be occasions where their interest in public welfare can generate great benefit to many people. With these considerations, the compliance to the concepts expressed in the ethical guidelines has to become an intrinsic part of their way of life, a total profound personal commitment to the profession.

Recognized obligations and values of a professional physician that should become part of the behavior and skills integral to patient care can be summarized as follows:

• Commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge.
• Commitment to sustain the interest and welfare of patients.
• Commitment to be responsive to the health needs of society.

Further definitions of the required professional traits of the physician are here described:

Altruism:

Service to patients without self-interest. Welfare of the patient and the community must take precedence.

Accountability:

Accountability to patients to fulfill the physician-patient responsibility, to the profession for adhering to medicine’s time honored ethical precepts, and to the society for addressing the health needs of the public.

Excellence:

Conscientious effort to exceed ordinary expectations and to make a commitment to life long learning.

Duty:

Free acceptance of a commitment to service. It requires availability and responsibility, and the acceptance of inconveniences to meet the needs of patients. Moreover it requires seeking active roles in professional organizations and volunteering one’s skills and expertise for the welfare of the community.

Honor and Integrity:

Honest and uncompromised pursuit of high quality patient care. This is key for physicians to be trusted by patients and society as healers. The patient must trust the physician in order to submit to examination, reveal information, accept therapy, and feel confident of the care provided. Honor and integrity also imply fairness, truthfulness, keeping one’s word, meeting commitments, and being straightforward. They also require recognition of the possibility of conflict of interests, and avoidance of relationships that may allow personal gain to supersede the best interest of the patient.

Compassion:

Physicians must be sensitive and genuinely feel for the existential situation of the person who is bearing the burden of sickness.

Respect for others:

Respect for patients, their families, physicians, and professional colleagues is fundamental to enhance collegiality, and to show the understanding of the privilege to practice medicine.

Technical competence:

Patients must be assured that high standards of care will be delivered. The physician must be committed to lifelong learning and excellence in clinical practice.

Communication:

Physicians must treat everyone with respect, dignity, and fairness. Effective listening enhances respect and communication. The physician is challenged to be attentive, seek understanding and show respect despite cultural difference, medical illness, psychological state, or perceived social importance.

Justice:

Justice requires an equitable distribution of health care resources. Patients must be treated without bias or judgment, without regard to status or position.

Humility:

The socialization process of medicine may possibly allow arrogance, confidence, and disproportionate knowledge that may lead the physician to a position of authority and power. The trust of patients and society is enhanced when power is accompanied by humility.

Prudence:

Physicians must show practical wisdom and capacity of moral insight. They must find the right way to act with respect for all the others. Prudence implies capacity and disposition to select the right means and the right balance between means and good ends, between benefits and harms in the clinical interventions, and how to put the moral and technical issues in a proper relationship with each other.