Professionalism

Hirna Ashara
MPT (Rehabilitation Science)

1
The concept of profession is an ancient one that has roots in Greek and Roman times.
The early origins of the word are reflected in its Latin precursor profiteor, which means “to profess a
belief.”
This root meaning suggests that professionals have historically been expected to have a sense of
“calling,” or vocation.
Although not everyone construes this calling as religious, society still expects professionals to exhibit
dedication to their work and clients.
The following preliminary definitions provide a starting point for discussion:
 A profession is an occupation that is viewed by society as a profession on the basis of its
characteristics, development, or power.
 Professionalism is the internalized conceptualization of expected professional obligations, attributes,
interactions, attitudes, values, and role behaviors in relation to individual patients and clients and
society as a whole.
 Professionalism may be collective (practiced by the profession as a whole) or individual.
 Individual professionalism refers to the internalized beliefs of an individual member of a profession
regarding professional obligations, attributes, interactions, attitudes, values, and role behaviors.
Individual professionalism might also be called “professional role concept.”

Characteristics of professions cited in the literature

Knowledge
Broad, theoretical, generalized, systematic knowledge
Unique body of knowledge
“Formal” knowledge—knowledge that is “embodied and applied in and through the professional”
Autonomy in professional decisions
Autonomy from client
Autonomy from organizations or external parties
Autonomy in selecting colleagues
Authority
Based on internal knowledge
Granted by society
Demonstrated by power and status in society
Demonstrated by monetary and symbolic awards
Education
Extensive
Skilled, technical, esoteric
High standards for admission
Responsibility, Accountability, and Ethics
Service orientation
Accountability and responsibility to society
Formal code of ethics that members enforce
Self-control of behavior through internalized professional ethic
Belief in self-regulation
Community interest more important than self-interest
Fiduciary relationship and trustworthiness central
Nature of work and decisions
Important or essential to clients
Complex
Not routine
Not programmed
Role and Identity
Internally based on a sense of calling
Formed and driven by the professional group
Extending beyond the specific work situation

2
Ethics in professional practice
Ethics is the science of conduct.
It considers the actions of human beings with reference to their rightness or wrongness.
The word "ethics" is derived from the Greek word ethos, which means "character".
Mackenzie defines ethics as ―the study of what is right or good in human conduct or ―the science of
the ideal involved in conduct.
It is a branch of philosophy, specially the moral philosophy that studies the evolution of concepts;
such as right or wrong behaviour. So, it is clear that ethics is the study which determines rightness or
wrongness of actions.

Types of professional ethics:

1. Meta ethics: (origin of ethical principle)
It deals with origin of ethical principles that govern the specification of right and wrong behaviour.
A major issue of debate in this category is whether ethical principles are eternal truths that evolved
from a spiritual world or simply created by the humans.
2. Descriptive ethics: (moral beliefs)
It refers to the study of moral beliefs of the people. It is a field of empirical research into what
people or societies consider right or wrong.
3. Normative ethics: (self moral conduct)
It is concerned with arriving at set of moral conduct rules against which behaviour are judged.
4. Applied ethics:
The ethical principles are designed or written for implementation in a specific situation.
a. Bio ethics: These are the ethical principles or codes for maintaining normal livelihood.
b. Medical ethics: The ethical principles or codes designed for a medical profession.
c. Computer ethics: The ethical principles or codes designed for a IT profession.
d. Engineering ethics: The ethical principles or codes designed for an engineering
profession.
e. Business ethics: The ethical principles or codes designed for a business operation
f. Legal ethics: The ethical principles or codes designed for maintaining a legal system.

Professional ethics are those values and principles that are introduced to an individual in a
professional organization. Each employee is meant to strictly follow these principles. They do not
have a choice. Also, this approach is imperative in professional settings as it brings a sense of
discipline in people as well as helps maintain decorum in offices. Some examples may include
confidentiality, fairness, transparency and proficiency. These ethics make employees responsible.
Features of professional ethics:
Openness
Transparency
privacy
Impartial
Practical and unbiased
Loyal
Co-operative
Objective oriented

3
Principles of practice in any profession
1. Practice reasonable, responsible, and transparent behavior …

… that consciously avoids harmful actions by embodying high ethical standards.

… by clearly articulating and widely disseminating your organization’s policies and guidelines.
… that guarantees equitable services for all constituencies.
… that is commensurate with professional association standards and principles.
… when resolving differences and addressing concerns.
… by nurturing sustainable relationships that are respectful and transcend transactions.

2. Act without bias …

… when advising, servicing, interviewing, or making employment decisions.

… when defining what constitutes employment.

3. Ensure equitable access …

… without stipulation or exception relative to contributions of financial support, gifts, affiliation, or in-
kind services.
… in the provision of services and opportunities without discriminating on the basis of race, gender,
gender identity, ethnicity, sexual orientation, religion, national origin, disability, age, economic status, or
veteran status.
… by proactively addressing inclusivity and diversity.

4. Comply with laws …

… associated with local, state, and federal entities, including but not limited to EEO compliance,
immigration, and affirmative action.
… in a timely and appropriate way if complaints of non-compliance occur.
… and respond to complaints of non-compliance in a timely and prudent manner.

5. Protect confidentiality of

… all personal information related to candidates and their interviews, and their engagement with
services, programs, and resources.
… student information related to professional plans.

Shared Decision Making

Shared decision making is a collaborative process that involves a person and their healthcare
professional working together to reach a joint decision about care.
It could be care the person needs straightaway or care in the future, for example, through advance
care planning.
It involves choosing tests and treatments based both on evidence and on the person’s individual
preferences, beliefs and values.

4
It means making sure the person understands the risks, benefits and possible consequences of
different options through discussion and information sharing.
This joint process empowers people to make decisions about the care that is right for them at that
time (with the options of choosing to have no treatment or not changing what they are currently
doing always included).
It promotes ways for healthcare professionals and people using services to work together to make
decisions about treatment and care.
It includes recommendations on training, communicating risks, benefits and consequences, using
decision aids, and how to embed shared decision making in organisational culture and practices.
The guideline does not cover unexpected emergencies in which immediate life-saving care is needed.
It also does not cover situations when, at the time a decision needs to be made, an adult does not
have mental capacity to make a decision about their healthcare.

Who is it for?
 Everybody who delivers healthcare services
 Commissioners of health and public health services
 Adults (aged 18 and over) using healthcare services, their families, carers and
advocates, and the public
It may also be relevant for:
 Social care practitioners
 Voluntary, community and social enterprise organisations
 People who use social care services

Privacy and Confidentiality

Privacy
Privacy is the right of an individual to control or influence the information that can be collected and
stored and by whom and to whom that information may be disclosed or shared.
Privacy refers to the right to be free from interference.
It is supposed to enable individuals to exert control over their own lives, which includes deciding who
should have access to personal information, and when and how this information will be disclosed.
It is the right of an individual or a group to be free from intrusion from others, and includes the right to
determine which information about them should be disclosed to others

Confidentiality
Confidentiality is the obligation of the researcher/research team/organization to the participant to
safeguard the entrusted information.
It includes the obligation to protect information from unauthorized access, use, disclosure, modification,
loss or theft.
The duty of confidentiality is the duty to maintain privacy of information concerning patients by not
divulging it to unauthorized persons.
In principle, the scope of the duty is broad and includes all information about patients obtained during
professional interactions with them.

5
In practice, this consists of any intimate and potentially sensitive information, including that concerning
the immediate care provided, additional health-related information, financial information, and other
potentially sensitive information.
Confidentiality refers to the duty to protect privileged information and to share entrusted information
responsibly.
It stems from the notion that a person’s wishes, decisions, and personal information should be treated
with respect.
The duty of confidentiality can apply to individuals, organizations, and institutions.
In fields like medicine, the law, and counseling, there are explicit, professional obligations to keep
personal information in confidence, because the trust is the foundation for meaningful professional
relationships.
As a general rule, health care providers have a responsibility to avoid disclosing personal and medical
information that has been entrusted to them without the patient’s consent.
In accordance with professional standards, when a patient’s private information is shared, there is the
expectation that health care providers will keep the information in confidence.
This might include details pertaining to a patient’s diagnosis, prognosis, history of illness, drug use, family
history, and sexual activity.
Reasons for respecting privacy and confidentiality:
a Individuals ‘own’ their information: it is essential to their personal integrity.
b For many people privacy is an essential aspect of their dignity; invading their privacy against their will is
a violation of their dignity.
c Respect for others requires protecting their privacy and the confidentiality of information about them.
d Patients are less likely to trust health care providers and confide in them if they think that the health
care providers will not keep the information confidential. This can have serious consequences for the
patients’ health and well-being and sometimes for the health of others (e.g. family members).

Duty of healthcare providers to protect the privacyof patients-

Health care providers have an ethical obligation to protect patient privacy to the greatest extent possible
in the circumstances.
For example, they should interview patients where they cannot be overheard; they should ask the
patient’s permission to examine him or her unclothed; and they should ensure that an unclothed patient
cannot be viewed by passers-by.
Duty of health care providers to maintain confidentiality
The duty of maintaining confidentiality (also known as ‘professional secrecy’) has been part of Western
medical ethics since Hippocrates (5th century B.C.E.).
The Hippocratic Oath states, ‘Whatever I see or hear, professionally or privately, which ought not to be
divulged, I will keep secret and tell no one’.
Justifiedbreaches of confidentiality include:
a Sharing information for patient care
In the hospital setting, many individuals need access to the patient’s chart in order to provide care;
however, each of these individuals is bound to maintain confidentiality to the greatest extent possible;
outside the hospital setting, family members may need patient information in order to provide care
and/or to protect themselves.
b Using interpreters
Where the health care provider does not speak the patient’s language, an interpreter will be needed who
will then have access to information about the patient; interpreters should be bound to observe
confidentiality.
c Teaching medical students
Observation and discussion of patients is a necessary part of medical education; students should be
informed of their obligation to maintain confidentiality.
d Mandatory reporting
Health care providers should be familiar with the laws about mandatory reporting of infectious diseases,
suspected child abuse and other conditions in the country where they practise; normally patients should
be informed that their information has to be reported to the appropriate authorities.

6
e Serious dangerto others
For example, in exceptional circumstances and generally as a last resort, health care providers may need
to inform other persons that the patient has threatened to harm them, whether by violence or by sexual
contact when the patient has an transmissible disease such as HIV.
f Genetic information
There is controversy regarding whether other individuals with the same genetic makeup (usually close
family members) have a right to a patient’s genetic information. Physicians should consult their national
regulations or guidelines when faced with this situation.
g With patient or guardian consent
This should generally be obtained for all breaches of confidentiality and renders the breach acceptable
ethically.

Special circumstances of research

Disclosure of personal health information obtained in the course of a research study requires the prior
consent of the research subject.
There is a great controversy regarding whether anonymized patient information requires consent for
disclosure; researchers should consult their national regulations or guidelines if such exist, otherwise
international guidelines such as the Declaration of Helsinki.
In research, communities as well as individuals have a right to privacy, and information about them should
be kept confidential, especially when its disclosure may be harmful to the community.
Scientific publication should respect confidentiality to the greatest extent possible. Consent is always
required when an individual research subject can be identified in a publication.

Informed Consent
Informed consent is the process in which a health care provider educates a patient about the risks,
benefits, and alternatives of a given procedure or intervention.

The patient must be competent to make a voluntary decision about whether to undergo the procedure or
intervention.

Informed consent is both an ethical and legal obligation of medical practitioners in the us and originates
from the patient's right to direct what happens to their body.

Implicit in providing informed consent is an assessment of the patient's understanding, rendering an

actual recommendation, and documentation of the process.

The joint commission requires documentation of all the elements of informed consent "In a form,
progress notes or elsewhere in the record." The following are the required elements for documentation
of the informed consent discussion:

1. the nature of the procedure,

2. the risks and benefits and the procedure,
3. reasonable alternatives,
4. risks and benefits of alternatives, and
5. assessment of the patient's understanding of elements 1 through 4.

It is the obligation of the provider to make it clear that the patient is participating in the decision-making
process and avoid making the patient feel forced to agree to with the provider.

IN RESEARCH-

The researcher must obtain voluntary written informed consent from the prospective participant for any
biomedical and health research involving human participants.

7
This requirement is based on the principle that competent individuals are entitled to choose freely
whether or not to participate or continue to participate in the research.
Informed consent is a continuous process involving three main components – providing relevant
information to potential participants, ensuring competence of the individual, ensuring the information is
easily comprehended by the participants and assuring voluntariness of participation.
Informed voluntary consent protects the individual’s freedom of choice and respects the individual’s
autonomy.
Requisites-
1 The participant must have the capacity to understand the proposed research, be able to make an
informed decision on whether or not to be enrolled and convey her/his decision to the researcher in
order to give consent.
2 The consent should be given voluntarily and not be obtained under duress or coercion of any sort or by
offering any undue inducements.
3 In the case of an individual who is not capable of giving voluntary informed consent, the consent of LAR
must be obtained. See section 6 for further details.
4 It is mandatory for a researcher to administer consent before initiating any study related procedures
involving the participant.
5 It is necessary to maintain privacy and confidentiality of participants at all stages.

An informed consent form must include the following:

1. Statement mentioning that it is research
2. Purpose and methods of the research in simple language
3. Expected duration of the participation and frequency of contact with estimated number of participants
to be enrolled, types of data collection and methods
4. Benefits to the participant, community or others that might reasonably be expected as an outcome of
research
5. Any foreseeable risks, discomfort or inconvenience to the participant resulting from participation in the
study
6. Extent to which confidentiality of records could be maintained, such as the limits to which the
researcher would be able to safeguard confidentiality and the anticipated consequences of breach of
confidentiality
7. Payment/reimbursement for participation and incidental expenses depending on the type of study
8. Free treatment and/or compensation of participants for research-related injury and/ or harm
9. Freedom of the individual to participate and/or withdraw from research at any time without penalty or
loss of benefits to which the participant would otherwise be entitled
10. The identity of the research team and contact persons with addresses and phone numbers (for
example, PI/Co PI for queries related to the research and Chairperson/Member Secretary/ or helpline for
appeal against violations of ethical principles and human rights)

Equality, equity and justice

‘Equality’ means sameness in some respect such as human dignity. It is about treating people in the same
way, making sure people get the same opportunities.
‘Equity’ is the application of fairness, which may require unequal treatment. It is about factoring in
people’s different need and assets, understanding that people might need different opportunities and
support.
‘Justice’ has different meanings (there are different types of justice – see below) but generally it signifies
fairness.

The different types of justice:

A. Distributive (ensuring that each person receives a fair share of public resources); this is the
most important type for health care
B. procedural (ensuring a fair process for making decisions and settling disputes)
C. Retributive (ensures punishment of wrongdoers)

8
 D. social(combination of the previous types as applied to asociety in which individuals an group
receive fair treatment and an equitable share of the benefits of society).

The different concepts of distributive justice:

A. Authoritarian (what the highest authority decrees is just)
B. Libertarian (what an individual decides to do with his or her own property is just)
C. Utilitarian (what most contributes to the greatest good of the greatest number is just)
D. Egalitarian (justice is achieved when everybody has equal access to the societal resources that they
need)
E. Restorative or transformative (justice requires favouring previously disadvantaged individuals or
groups)

EQUALITY

EQUITY