Towards a dialogical ethics of interprofessionalism
Irvine Rob1, Kerridge I2, McPhee J2
1 Department of Sociology and Anthropology, Newcastle University, New South Wales, Australia
2 Centre for Values, Ethics and Law in Medicine, University of Sydney, Australia
Contemporary medical practice brings a diverse range of professions and disciplines together in greater and closer contact. This situation of increasing complexity and changing professional roles gives rise to multifaceted ethical dilemmas and theoretical and practical concerns. In this essay we argue that for multidisciplinary relationships to be facilitated and to progress towards interdisciplinary teamwork, moral agents have to go beyond orthodox ethical systems and appeal to normative theory. We will argue that conceptualising ethics as a shared social practice may provide a useful starting point. This dialogic approach places greater emphasis on open deliberation and the articulation, negotiation, exploration and generation of new ethical perspectives in the here and now of clinical practice.
Keywords: Ethics, dialogue, multidisciplinary
J Postgrad Med 2004;50:278-280. Open Access article under the Creative Commons Licence
One of the most significant changes to have occurred in the delivery of health care over the last 40 years is the expansion and diversification of health care labour. Today, hospitals, clinics, and public health programmes are staffed by highly differentiated but mutually dependent professionals who constantly interact with and affect each other.
The desire of all health care providers for treatment to be efficacious and safe provides a necessary reference point for interaction and collaboration. So they may share language, approaches, materials and therapeutic strategies. But it is also possible to find points of contrast within and between professional groups. Professionals differ in the kinds of knowledge and skills that they contribute to the production of favourable patient outcomes; the interests that they pursue; and the kinds of questions and problems that they deem important. They come from different traditions rooted in history with their own distinct moral heritages and accustomed ways of ensuring moral accountability.
Multidisciplinary relationships are also political. The contemporary story of much of health care practice is one of different occupational groups establishing clear professional demarcations and demanding that their expertise to be recognised. To this end they construct their own distinctive, occupationally specific codes of ethics and advance what they deem to be their own ethical theories, for example ‘medical ethics’ against ‘nursing ethics’, which articulate a plurality of ethical visions and moral systems.