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Barry Smith
Outside of health research ethics, many health-related professional bodies also create ethical codes and standards to 'guide' the behaviour, not of ethics committees and researchers, but of health practitioners in their day-to-day professional practice. Traditionally, these guidelines focus on a single profession which does reduce the intriguing possibility of developing useful 'trans-professional' codes, for instance, one which might cover the work interface between doctors and nurses.
The article by Ben Gray in this issue of the Journal1 looks at an example of a single professional code in which he examines the case of the New Zealand Medical Association (NZMA). Here, Gray is critical of the insufficient emphasis placed on relational ethics as well as the lack of attention paid to culture. While I support the sentiments behind the article I would like to select four of Gray's assertions for comment.
First, although the NZMA Code is undoubtedly shaped by a few key principles it is not as confined as the picture Gray paints in his abstract and introduction. Indeed there has been critical reflection around 'principalism' over recent years resulting in the inclusion of other principles into ethical statements. Thus, the NZMA document also recognises confidentiality, veracity, fidelity, guardianship of the environment and being professional as key components of its ethical framework. Hence, it is safe to say that we have moved on from the four principle structure which supports the notion that doctors knows best.
Secondly, the concept of autonomy is more complex than Gray suggests in that it only has meaning when individuals are seen to play out the reality of their lives within a culture, community and society. Gray's understanding of autonomy, particularly with regards to 'physician autonomy' which he sees as something that removes a physician from community as well as from collaborative effort, is thus somewhat misleading. As it turns out, the NZMA Code actually refers to patient not physician autonomy, so I am little confused as to the point Gray is attempting to pursue here.
Thirdly, Gray's views on the value of collaboration seem somewhat dated and, more critically, restrictive. The 'patient code' in early 1996 was already implying a link between collaborative work and an ability to serve the best interests of...