The need for everyday ethics in clinical practice with people who are substance dependent

David A Silkoff1

1 Centre for Health Equity, Melbourne School of Population and Global Health, 207 Bouverie Street, The University of Melbourne, Victoria 3010, dsilkoff@student.unimelb.edu.au

This paper argues for a richer understanding of how ethical challenges are embedded within the everyday practice of practitioners within the field of substance misuse. This will benefit both thinking regarding ethics and clinical practice. I describe my own experiences of ethical and legal grey areas in routine clinical practice as an experienced clinician in the field. Examples include decisions such as what to do in respect to prescribing a medication for opioid dependence when any beneficial impact appears negligible; and addressing hazardous mixing of prescribed and non-prescribed drugs.

To assess whether research in ethics could assist with these challenges. I conducted a systematic review of 20 high ranking journals in bioethics, using the terms drug dependen* OR substance dependen* OR alcohol*; and of 20 high ranking substance misuse journals using the terms ethic* OR moral*. I also examined textbooks in the field of ethics in substance use work.

Within published research, representation of clinicians’ everyday ethical challenges was almost absent. Most work concerning ethics and substance use concentrates on research ethics, or applying ethical theory to specific interventions or policy. Studies using empirical data at all were a minority. Textbooks concentrate on applying ethical principles to hypothetical situations. I will argue that to help with ethical reflection within practice, research should focus on the everyday work and experiences of practitioners. Ethical challenges may benefit from a detailed empirical approach to everyday ethics within the substance use field. This will also broaden the currently narrow study of ethics within a complicated area of healthcare.


Biography

David Silkoff is a PhD student in the Centre for Health Equity at the University of Melbourne. He is studying the everyday ethics of practitioners working with people who have problematic substance use. David is also a nurse practitioner in the Alcohol and Other Drug sector, and he prescribes pharmacotherapy within this field. His interest in ethics within daily practice grows from his own experience of ethical challenges, and exploring possible frameworks to assist with these.

More than words: The ethical implications of language in alcohol-related health warning label discourses

Emma Muhlack1, Jaklin Eliott2, Annette Braunack-Mayer3, Drew Carter4

1 School of Public Health, University of Adelaide, Adelaide, South Australia, 5005
2 School of Public Health, University of Adelaide, Adelaide, South Australia, 5005
3 School of Public Health, University of Adelaide, Adelaide, South Australia, 5005
4 School of Public Health, University of Adelaide, Adelaide, South Australia, 5005

For many researchers outside the field of bioethics, ethical considerations in research consist of meeting institutional requirements for proposed research. However, the fundamental assumptions of reported research are also valid targets for ethical evaluation. In this study, we show how problematic ethical arguments underpinning scholarship can be identified through examination of language used in reporting research.

We reviewed academic literature (106 publications), advocacy group statements, and industry bodies, and identified justificatory language referring to mandatory warning labels on alcoholic beverages. We then examined this language to identify and clarify themes and any relationships between them.

We found that the academic literature most often drew from three nested arguments, collectively consistent with the tenets of liberalism dominant in developed democracies, namely: that warning labels would (1) inform, thereby (2) change drinking behaviour and (3) ultimately reduce alcohol-related social and economic burdens on society. This is contrasted with both literature from industry bodies, focussed solely on the informative nature of warning labels, and advocacy literature, with a more sophisticated argument in support of labels as part of a comprehensive suite of interventions.

The assumptions evident in the academic literature, and some industry literature, clearly assumed a justification at odds with known mechanisms of change to health-affecting behaviours (information on risk often fails to reduce risky behaviour). By contrast, the arguments proposed by health advocate organisations were supported by data, and acknowledged various social and economic influences upon consumers’ decision-making regarding alcohol consumption. Whilst it is important to ensure that the mechanics of research are ethically sound, it is equally important to understand underlying assumptions and biases and how they might have an effect on the design and reporting of research.


Biography

With a background in philosophy and communications, Emma joined the School of Population Health as a PhD candidate in January 2015.

Her research considers the ethical issues around the implementation of cancer warning labels in connection with the ARC Linkage Project “Public and ethical responses to mandated alcohol warning labels about increased long-term risk of cancer” (LP120200175).

“Off-field” behaviour

Prof. Tony Eyers1

1Macquarie University

Most professional sports, in response to high-profile players having behaved badly in their private lives, have introduced codes of conduct that apply to off-field behaviour, and their regulatory bodies have shown their preparedness to penalise those that transgress them.

In August 2014 the Australian ABC, through its Four Corners program, reported that, A highly paid neurosurgeon who indulged his cocaine addiction, paid thousands of dollars for sex and was directly linked to the death of two prostitutes avoided detection and continued to practise at a private Sydney hospital.” 

While this was an extreme case, the co-regulatory process of professional oversight in NSW is regularly notified of various forms of “off-field behaviour” by healthcare practitioners.  While the primary purpose of the regulatory process is to protect the public, the question is begged as to what it means to be “a fit and proper person” to practice as a healthcare professional.  There is, no doubt, further interest in seeking to preserve the good name of the healthcare professions in the public eye.  The legislation underpinning the co-regulatory process does not specifically address the issue of “off-field behaviour” by healthcare professionals.

Examples of the “off-field behaviours” to which I refer include, but are not restricted to; charges relating to drink-driving offences, notifications of doctors and medical students found in possession of prohibited substances (often when attending concerts or patronising night clubs), incidents of Intimate Partner Violence, and “problem” gambling.

This presentation will open this theme for discussion.  It will seek to identify the principles which should guide the regulatory bodies, in NSW and Australia-wide, in responding rationally and consistently to these behaviours.  A broader discussion should also involve healthcare professionals themselves and their professional colleges and associations, universities, and providers of healthcare indemnity.


Biography

Tony Eyers is a general surgeon. He is Professor of Ethics in Surgery and Medicine in the Faculty of Medicine and Health Sciences at Macquarie University in Sydney. He is also a member of the Medical Council of NSW, and is currently chairperson of the Council’s Health Committee.

The ethics of sharing: Nealth social worker concerns about recording in shared records

Isobel R. Cairns1

1 The University of Auckland, Private Bag 92019, Auckland 1142, isobelrosecairns@gmail.com

Health social workers come across across a variety of sensitive information in the course of their work, and some information – such as details of abuse or trauma, alcohol or drug dependence, or mental health problems – is particularly sensitive. They may be reluctant to record this information in shared health records where it can be accessed by multiple health providers. Yet, comprehensive records are important to ensure appropriate and beneficial care is provided to a client. Do health social workers face a tension between protecting their client’s privacy and ensuring good care?

This qualitative empirical ethics study aimed to investigate these concerns. The presentation will draw on eleven interviews with health social workers across New Zealand’s North Island. Participants reported that keeping records had some ethical complications, but they all promoted the sharing of details that were necessary and relevant to a client’s healthcare. This core principle guided good recording practice, as well as principles of epistemic accuracy and avoiding perjorative judgements. Residual moral concerns indicate that there are occasionally genuinely conflicting obligations when recording sensitive information.

This research received funding from New Zealand’s Office of the Privacy Commissioner’s Privacy Good Research Fund.


Biography

Isobel Cairns holds a Bachelor of Arts with Honours in Philosophy and a Graduate Diploma in Psychology from Victoria University of Wellington. She completed her Masters of Public Health at The University of Auckland in 2016.

About the Association

The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

It encourages open discussion and debate on a range of bioethical issues, providing a place where people can ask difficult questions about ideas and practices associated with health and illness, biomedical research and human values.

The AABHL seeks to foster a distinctive Australasian voice in bioethics, and provide opportunities for international engagement through its membership, journal and conferences.

Members come from all the contributing humanities, social science and science disciplines that make up contemporary bioethics.

Many members have cross-disciplinary interests and all seek to broaden the dialogues in which all members of the wider community ultimately have an interest.

The AABHL is a supportive, creative and challenging community that provides a rich source of continuing academic refreshment and renewal.

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