The Directors of two of Australia's leading centres on medical ethics are gravely concerned that a new draft code of conduct for doctors put forward by the Australian Medical Council, and that would be backed up by the force of law, is flawed.
The draft code is likely to be adopted by the proposed new National Medical Board in setting standards for, and in regulating, medical practice, including the assessment of complaints and allegations of unprofessional conduct against doctors.
In an article in the current edition of the Medical Journal of Australia,
Professor Paul Komesaroff, Director of Monash University's Centre for Ethics in Medicine and Society, and Associate Professor Ian Kerridge, Director of Sydney University's Centre for Values, Ethics and the Law in medicine, say that the draft code, a set of quasi-legal rules assembled from a collection of other codes and guidelines from around the world, might appear benign.
However, the Code was likely to be counterproductive for four main reasons:
— it was very unclear how standards could be enforced;
— the Code was based on a single concept of ethics, lacking a sufficient appreciation of our multicultural diversity;
— it contributed to an insidious, creeping authoritarianism; and, lastly,
— the code would suggest that good practice involved following the same rules in all circumstances rather than responding to individual circumstances and needs.
The authors used the example of providing end-of-life care to illustrate this last point.
"End-of-life care requires exquisite sensitivity on the clinician's part and the capacity to deal with rapidly shifting physical, psychological and emotional issues.
"In end-of-life care, good practice does not involve following rules, no matter now carefully crafted those rules appear to be," they said.
It required openness and flexibility rather than a set of injunctions.
The authors said, "Codes of conduct can either expand the ability of individuals to make their own decisions and maximise their opportunities for ethical action, or they can claim authority beyond their capacity and encourage the belief that good practice simply involves following a formula and applying the rules.
"We fear that the Code is not be a progressive step and suggest that the whole process that gave rise to this draft should be rigorously reconsidered."