Conversations with Alan 3 - Rethinking Medical Oaths and Codes in Modern Practice

Yeah, I think that's incredibly strong.

And it's very different from how I think about ethics.

And, you know, we move through my questions because I'm very interested in accountability and I'm interested in governance.

And you're really challenging me here, which, again, is I'll go to my second question, which is you use that.

remarkable phrase, quote, ethical flexibility, end of quote.

Now, I had to take a breath and have a bit of a walk around the house after I read that phrase, because it had such an impact on me, I think, because how does, you know, is ethical flexibility a tautology? How does ethical flexibility operate with governance and regulation that are often framed by, say, national laws?

Yeah, okay, so I suppose for me ethical flexibility means having a structured way of applying ethical principles when circumstances, they change and they're complex.

But we can't assume that one rigid declaration will provide the right answer in every situation.

Good point, good point.

Now, I'm not saying that flexibility means every clinician, every person gets to decide what's right based on their own personal beliefs because that generates inconsistency and it undermines what we're trying to achieve.

So how do we use ethical flexibility? Well, fundamentally, it comes down to how we design and implement the policy as it heads downstream.

So starting from the top, we have our legislation.

The law establishes the boundaries for everyone.

That's Me in medicine, yourself in education, Tim the tool man, Bill the plumber, we're all under the same set of laws.

But where it starts to come down differently is with our professional code.

So they establish the standards the clinician in healthcare aspect will meet.

So we're registered with APRA and we don't have a criminal history.

We've got the appropriate insurances and we look after our patients.

The institution has their own policy.

So whether that's public healthcare, private healthcare, general practice, it's what we offer, how to offer it, if this, do this.

And then we come down to the person, the individual clinical judgment.

So what can you do? What can't you do? Do you have the knowledge and what are you going to provide? Each They have their different role, but they all need to work together.

Having ethical flexibility, that's a bit of a tongue twister after a bit, helps to navigate the difficult decisions that come up within each boundary.

You said medically assisted dying.

We use that as our example.