Thursday 10 September 2009

Member Care and the Hippocratic Oath, Part 9

Should Member Care Practitioners Be Disciplined?

An impeached and disgraced President Nixon,
leaving the White House and US Presidency
some 35 years ago--August 9, 1974.
Tórnase sin tardar
la mar mansa muy brava;
el mundo hoy despreciar
al que ayer honraba.

Por ende el grande estado
al hombre que ha saber,
face venir cuitado
y tristezas haber.
Sem Tob, 14th century, Spain
Just as placid seas quickly turn fierce in a storm
so honor today can become tomorrow’s scorn.
Therefore remember our exalted state
can suddenly turn to sadness by fate.
If I keep this oath faithfully,
may I enjoy my life and practice my art,
respected by all men and in all times;
but if I swerve from it or violate it,
may the reverse be my lot.
Hippocratic Oath
According to the final part of the Oath, practitioners freely invoke/embrace the consequences of good practice vs poor practice. One’s keeping of this Oath will result in three outcomes:
1. Enjoying life vs not enjoying life
2. Practicing health care vs not being able or allowed to practice health care
3. Being respected by people always vs never being respected by people.
It is not clear however in the Oath who or what is relegating the consequences for the quality of one’s practice. A god? Fate? Some type of Hellenistic karma? Or is it just the acknowledgement that one does not deserve good things from life if one deviates from properly caring for his/her clients/patients, with the word properly being defined by the general parameters of the Oath? Whatever the case, this is serious business and obviously one should never take such a life-impacting oath lightly.
So should there be consequences for member care practitioners who fail to practice ethically and competently? Yes, of course. This is especially true if they consistently practice unethically and incompetently in ways that hurt others.
But what should the consequences be, especially in a field like international member care that is largely unregulated? Should poor practitioners who make serious errors or who are consistently negligent be disciplined or otherwise removed from practice? Probably. But the modus for such action is hazy at best. Perhaps receiving informal or even formal correctives from one’s peers or organizational affiliations are the most we can hope for.
In the Hippocratic Oath, there are no specific external referents to regulatory bodies such as a licensing board, a professional ethics committee, or civil law. For many member care practitioners, the same is true: there is no regulatory body to monitor member care practice and to receive any client complaints. This of course is not the case for professional caregivers in member care who are legally certified in a special field and part of a professional association.
On the More Positive Side:
Good self-care and good social support are the core safeguards to help one continue to practice well and to avoid impairment in judgement, inferior services, and even burnout. In addition having different interests outside of one’s work, an ability to maintain perspective in difficult times, having fun, and being self-aware are also important qualities to promote well being and foster good practice. Know your limits, know your strengths, and know your relevant ethics codes!
Bennett et al in Assessing and Managing Risk in Psychological Practice (2006) remind psychologists [and for our purposes member care practitioners] that good practice is “hard work.” We are encouraged to “Strive for excellence but not perfection” and to know that:
**"You will make mistakes.
**You cannot help everyone.
**You will not know everything.
**You cannot go it alone.
**It is helpful to have a proper mix of confidence and humility.” (p.5)
Reflection and Discussion
We are entrusted to help foster the well-being of individuals, couples, children, families, teams, organizations etc. Again, it's serious business for sure! This serious and final part of the Hippocratic Oath reminds me of an admonition in Deuteronomy 28: 1-2, 15, attributed by many to Moses.
Now it shall be, if you diligently obey the LORD your God, being careful to do all His commandments which I command you today, the LORD your God will set you high above all the nations of the earth. And all these blessings will come upon you and overtake you if you obey the LORD your God…But it shall come about, if you do not obey the LORD your God, to observe to do all His commandments and His statutes with which I charge you today, that all these curses will come upon you and overtake you…”
Comment on this final declaration of the Hippocratic Oath in light of this portion of Jewish-Christian Scripture (which may have preceded Hippocrates by up to 10 centuries!) and in light of these assertions:
1. There are pros and cons for member care practitioners who say that they are accountable to a Higher Being--God.
2. Regardless of one’s profession in life, acting ethically will have certain consequences and acting unethically with have certain consequences.
3. Learning and growth do not occur without making mistakes regardless of one’s level of experience.
4. “Keep this oath faithfully” (Hippocrates) and “Diligently obey the Lord” (Moses). Both can be easily harmonized and can be done simultaneously.
5. Discipline can be misapplied and good practitioners can be seriously hurt by people who are misinformed, overly spiritual, who have political agendas, and in some cases by those who have serious problems themselves. On the other end of the "discipline continuum" are poor practitioners who can essentially do whatever they want with impunity. Both extremes involve serious errors in discipline/accountability with the end result being that people get hurt. The Hippocratic heart (as described in Part 4 of this series) of "doing good and doing no harm" can thus sadly be broken.

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