Ethics and the well-being of health professionals

---

The central ethical principles that underlie the practice of health professionals are usually referred to as those of beneficence and non-maleficence. In simpler and plainer language, the former means that health professionals accept an obligation to act for the benefit of their patients while the latter means an obligation to avoid acting so as to cause harm to these patients.

---

While these are familiar terms, what they mean in detail in the context of different health professionals practices is not always articulated. For example, what capacities, skills and attitudes do health professionals need to fulfil the obligation to act for the benefit of their patients?
The capacities are likely to include those of openness, being receptive to what patients say, whether explicitly or implicitly, in describing the situation and their understanding of their needs. The skills are likely to include those of judgement in selecting relevant knowledge and applying it to the patient’s situation while the attitudes are likely to include those of compassion and respect for the patient in his or her situation.
When these are lacking, whether permanently or temporarily, the ability of a health professional to fulfil the central ethical obligations is likely to be impaired such that the outcome of a professional patient engagement may not result in the patient’s benefit nor avoid causing a patient harm.

---

“..there is evidence that health professional well-being contributes not only to the quality of the advice and care they provide but to their personal satisfaction in fulfilling their obligations.”
COLIN THOMSON

---

The demands of health professional practice are known to lead to stress, burnout - a state of physical, emotional, and mental exhaustion that occurs as a result of intense involvement with people over long periods of time in situations that are emotionally demanding - and depression. In many situations, health professionals respond to the onset of these effects of practice by seeking relief in alcohol or other drugs.
All of these factors can affect the fulfilment of the principal ethical obligations that health professionals owe to patients. Such is the recognition of these risks that national registration law mandates the reporting by registered health professionals who have “formed a reasonable belief” that another health professional has practised their profession while intoxicated by alcohol or drugs or placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has impairment. This legal obligation arises only in these defined - and extreme - circumstances. Is there an ethical obligation to address the emergence of such impairments well before they reach the severe level that would prompt mandatory reporting?
Fulfilling the fundamental obligations of beneficence and non-maleficence depends upon maintaining the kind of capacities, skills and attitudes listed above. There is then a basis for an ethical obligation for health professionals to be alert to and to address the effects of the emergence of impairments that would limit those capacities, skills and attitudes.
How might this be done? Individually, dedicated self-assessment of capacities and attitudes at regular intervals can assist, as can the support and honest communication with personal partners or close friends. Professional colleagues can also assist but these relationships are complex because of the mix of personal and professional commitments and may not be a reliable source of timely warning.
One difficulty with approaches such as these is that they are usually delayed until the apparent onset of symptoms of the conditions that need to be addressed. A complicating factor in the recognition of the emergence of the symptoms is that the professional commitment of health professionals can lead to a degree of denial that the symptoms of burnout, stress or depression are affecting the fulfilment of their roles.
Accordingly, an ethical approach that focuses on the development of a lifestyle that is less likely to allow stress, burnout and depression to occur could be preferred: taking a proactive rather than reactive approach. Practices that include dedicated leisure time, ensuring adequate sleep, developing alternative interests and activities, maintaining regular contact with professional colleagues, regular personal reflection and actively pursuing professionalism through continuing professional education are all likely to reduce if not eliminate the likelihood of burnout, stress and depression and unhealthy responses to their emergence.
In addition, there is evidence that health professional well-being contributes not only to the quality of the advice and care they provide but to their personal satisfaction in fulfilling their obligations.
Accordingly, there is an ethical foundation for adopting a deliberate balance between personal and professional practices of self reflection and self-assessment as part of health professional’s fulfilment of the essential obligations of beneficence and non-maleficence.
Colin Thomson
BA, LLB, LLM (Sydney)
www.ehealthinfo.gov.au
Colin Thomson, BA, LLM (Sydney) is Professor of Law at the University of Wollongong and Academic Leader for Health Law and Ethics in the Graduate School of Medicine.  He also works as a consultant.
He was a member of the Medical Research Ethics Committee (1988-91) of the National Health and Medical Research Council and, from 1998-2002 a member, and from 2006-2009, chair of the Australian Health Ethics Committee.  As a consultant, he has advised NHMRC, FaHCSIA, Health Departments of NSW, Qld and Vic and several universities. He is a Senior Consultant with Australasian Human Research Ethics Consultancy Services  (www.ahrecs.com).
Colin has provided training to human research ethics committees, chairs the CSIRO Social Science HREC and is a member of HRECs at Department of Health and Ageing and University of Wollongong/Illawarra Shoalhaven LHD.
He is a joint author of Good Medical Practice: professionalism, ethics and law, 2010, Cambridge University Press.