| This edition of O&G
addresses some of the challenging ethical issues, in particular,
with the interface between ‘Ethics and Religion’.
As members of the medical profession, we enjoy many privileges,
not the least of which is the trust and respect of the general
community.
It is of paramount importance that, as doctors, we value
that trust and respect. We should strive to practise ethically,
acting in the best interests of our patients and the profession,
taking time to consider some of the more complex ethical issues
which impact on our practices.
Recently, there has been a great deal of publicity and comment,
on both sides of the Tasman, with regard to a small number
of practitioners whose medical practice has not conformed
with the standards of ethical practice, which both we and
the general public accept. The amount of attention and the
outcry which accompanies identification of underperforming
practitioners, or those who have been found to have violated
the doctor-patient relationship, is indicative of how important
the high ethical practice standards of doctors is to the community.
On 26 March 2008, an Intergovernmental Agreement for a National
Registration and Accreditation Scheme for the Health Professions
was signed by the Commonwealth of Australia and the eight
jurisdictions.
The scheme will initially apply to nine health professional
groups which are registered in all jurisdictions,including
medicine, physiotherapy, nursing and midwifery, pharmacy and
dental care. The five objectives to be set out in legislation
are to facilitate workforce mobility and high quality training
and assessment of international medical graduates, in order
to promote access to health services, to develop a flexible
and sustainable workforce and to ‘provide for the protection
of the public byensuring that only practitioners who are suitably
trained and qualified to practice in a competent and ethical
manner are registered’.
Profession-specific national boards will be established,
whose members will be appointed by Government the Ministerial
Council, who in turn will establish local committees whose
membership will also be appointed by the Ministerial Council
and which will replace the current medical boards. The projected
timeframe for implementation of the new system is July 2010.
Clearly, it will be an enormous task to establish the model,
which will include the adoption of common legislation across
all jurisdictions.
It is difficult to predict what the impact will be on practitioners.
However, it is expected that documented involvement with Continuing
Professional Development will be a registration requirement
and it is expected that there will be legislative provisions
for mandatory reporting by medical practitioners of their
colleagues in instances of serious misconduct, similar to
that which are being considered this month by the New South
Wales Government. In the New South Wales legislation, mandatory
reporting will be limited to three areas of serious misconduct:
1. Sexual abuse in the practice of medicine.
2. Being intoxicated by drugs or alcohol while practising
medicine.
3. Engaging in conduct while practising medicine that is a
flagrant departure from the accepted standards of professional
practice or competence and risks harm to another person.
I am aware that the introduction of mandatory reporting is
confronting for many practitioners, however, there can be
no debate that we have a responsibility to take action when
we consider a colleague to be engaged in unethical conduct
of a serious nature. It is incumbent upon all medical professionals
to persuade an impaired practitioner, whose professional performance
is of concern, to seek appropriate professional help. If that
is not acted upon voluntarily by the impaired professional,
it is the duty of his/her colleagues to report the impairment
to the appropriate authority. However, I am acutely aware
that practitioners find it very difficult to take action when
they realise that a long-time colleague has engaged in, or
is engaging in, what could be considered to be serious misconduct.
I think the adoption of mandatory reporting may provide a
clear and unambiguous pathway, acknowledging that reporting
misconduct does not come without significant difficulty.
Many national and international bodies have developed codes
of ethics which have their origins in history, including the
Hippocratic Oath, attributed to Hippocrates in the 4th century
BC. Codes of ethical practice are developed to provide clear
guidance on the many issues which medical practitioners must
consider. The RANZCOG Code of Ethics was revised in 2006 by
the College Bioethics Working Group and renamed the RANZCOG
Code of Ethical Practice, which is designed to complement
the Recommendations on Ethical Issues in Obstetrics and Gynaecology,
issued by the FIGO Committee for the Ethical Aspects of Human
Reproduction and Women’s Health.
The RANZCOG Code of Ethical Practice is clear and concise:
‘The principles set out in this document are intended
to aid Trainees, Members, Fellows and Diplomates in maintaining
a high level of ethical conduct. Members are morally obliged
to comply with this Code of Ethical Practice.’
At the March Council meeting, the RANZCOG Council endorsed
the Terms of Reference and the Regulations, which will apply
to the Standards and Complaints Committee (SCC). The SCC will
undertake the following function:
‘The promotion of accepted standards of practice and
ethics by
members of the College through the consideration and adjudication
of conduct that may breach the RANZCOG Code of Ethical Practice
or related College objectives. Such considerations may include
matters received through complaints from College members in
regards to the personal and/or professional conduct of other
members, but does not
include complaints received from members of the public in
respect to the personal and/or professional conduct of College
members’.
The SCC will not consider matters which are more appropriately
dealt with by other bodies such as the medical boards, but
matters which had previously been considered by the complaints
committee, which ceased to exist with the adoption of the
new constitution.
The many initiatives and reviews being undertaken by the
current Government are significantly impacting on the work
of the College at all levels. It is essential that we are
represented in as many discussions as possible and respond
to the many requests for information and input. At present,
this includes the maternity reform agenda; provision of ultrasound
services and accreditation of providers; workforce planning;
and development of consistent assessment processes for overseas
trained medical practitioners to name a few. I recognise that
it is of paramount importance that, amongst all this activity,
we do not lose sight of the fact that our key responsibilities
are to train and assess the next generation of specialists,
to represent and support our members and to ensure that we
fulfill our vision to ‘pursue excellence in healthcare
to women throughout their lives’.
As part of our vision, the RANZCOG 2008 Australian Indigenous
Women’s Health Meeting is being held in Darwin from
14 to 16 August. I am optimistic that the meeting will result
in the development of some practical and effective ways that
we can make a much overdue contribution to improving the health
of Aboriginal women and their babies. I encourage you to register
and make a contribution to this meeting.
l
Dr Christine Tippett,
President |
