Trust in Professional Integrity: What is Professional Integrity?

If I had to sit an exam with a two-point short-answer question “what is professional integrity?” I would probably write:

“Professional integrity is professional ethics in action”

Here is my explanation.

“Integrity” is a person’s public front: the decisions, actions and behaviours of an individual that others can see. The chosen behaviour and action allows those around them to make an informed decision about how much they might “trust” that person. What shapes, or drives, the person’s behaviour is the ethical principles to which they subscribe.

Now, a “profession” is a socially recognised label, for example, lawyer, doctor, dentist, teacher, dietitian. This means any “profession”, any one of these socially recognised labels, comes with it an assumed level of “integrity”.

“The socially recognised label for a “profession” comes with an already attached public trust in professional integrity.”

This assumed “professional integrity” is the privilege of choosing to be a professional as a purposely-selected vocation to serve the public and act in the interests of the individual in front of you. A “professional” therefore has a higher expectation of self, and, in a way, the “expectation of self” is to recognise the public’s assumed trust associated with the label. People who choose a “profession”, and maybe this is particularly true of health professionals, are driven by a desire to help others, believe in social equity, and recognise the trust they are afforded by the public.

So, “professional integrity” is still about others’ perception of you, and how much they “trust” what your intentions are, what drives you to give the instruction and information you do. Therefore, an individual practitioner relies on [perception of] “trust” to be effective in their chosen profession. Once that “trust” is lost, it follows the service is no longer effective.

“Professional integrity” is central to the credibility of a profession, and the effectiveness of the service provided by an individual practitioner.”

Any professional association, such as the Academy of Nutrition & Dietetics (AND), or, our Australian equivalent, the Dietitians Association of Australia (DAA), act for and on behalf of the profession. A professional association is the “public voice of the profession”, reflecting the collective professional integrity of the individual practitioners. What the association does and says, and the way in which they conduct their business reflects what [the majority of] the profession wants and stands for.

“The association’s “professional integrity” IS the profession’s integrity, and, at the level of service delivery, IS the individual practitioner’s integrity.”

Here it is: if the individual practitioner has chosen a particular vocation knowing they enter the profession with the expected higher level of self-professional integrity, it seems reasonable the public assumption, and the professional’s assumption, extends to the professional association. What the American group, Dietitians for Professional Integrity (DFPI) is asking of the AND is to protect the dietetic profession’s integrity by recognising the conflict of interest that exists with the AND’s financial ties with the food industry.

Having corporate funding is not against the law, and the AND, like the DAA, rationalise their corporate relations by referencing their “corporate sponsorship policy”. DFPI, as members and non-members of their association, have worked many years trying to support their association to change from the inside. Now they take this request public to encourage their association to remember the principle of “integrity” on which the profession is based. The reason for taking the issue public is twofold 1) to be clear to the public the AND’s reliance on corporate funding is not what dietitians want or support and 2) to use public pressure to hold the AND to account – there is no other avenue available to hold the association to account for a slip in professional ethics.

It is reasonable to suggest it hypocritical the association who can hold an individual to account for a slip in their professional ethics cannot themselves be as easily held to account for their own slip in professional ethics. In playground speak: they get to tell us what to do, but they really can do whatever they want. There is an imbalance of power here too: the association has the power to hold an individual to account but there is no real accountability for the association – accountability of the association relies on the association having a “higher expectation of self” which includes acknowledging this higher position of power.

Even if we put “professional integrity” as a reason to limit corporate involvement in the association to the side for a moment, there is a more obvious reason for a professional association to NOT have corporate sponsorship. This reason is evidence. There is more than enough evidence for a professional association, especially one who is an advocate for health, to recognise the damage these ties have to professional integrity. It is not against the law to have corporate funds, but it is certainly within “professional ethics”. Again, is it hypocritical an association who promotes their profession as “evidence-based” is not in fact operating to the evidence?

What I am saying here is “professional integrity” is more than just “following the law”, it is more than just following policy and procedure. Professional integrity is making an active commitment to the “profession” and the profession’s ethics to put the patient first. If an individual has a high expectation of self, then the association who represents them should have an even higher expectation of its collective self.

There is simply a fundamental philosophical difference between [health] professions, and any company/corporation: a company has financial gain as the driver for behaviour; a profession has the patient and the patient’s interest as the driver for behaviour. Commercial interest and professional interest cannot exist together because of the difference in the dominant driver of behaviour. Even with the best of intentions, once money is the driver, it is difficult to be absolute in defence the acquisition of funds from commercial enterprise does not affect the “patient first” expectation of professions.

Professions have been around long enough to recognise “what is ethical” is, to some extent, subjective. This is why “professions” have “standards of professional practice”, supported by professional registration and accreditation programs. And an individual practitioner can be held to account to these professional standards by “the law”.

Here is the bit I would say to students is “examinable”. For the non-students – this is the “list of professional ethics principles” I would want to see in action to make the decision an individual (and their association) has unquestionable professional integrity…..

Professional integrity is professional ethics in action. Professional ethics is a set of principles outlined by professional practice guidelines, accreditation and credentialing programs, and then the law is the recognised scaffolding to hold practitioners to account [if they move outside these expectations].

Professional ethics means a practitioner:
The links here are specific to Australian dietitians

1. Recognises the public trust in their title and credential and reward this public trust by expecting a higher level of self in professional conduct

2. Follow their profession-specific standards of professional practice including ethical conduct and the requirements for continued learning and development

3. Know the law and by-laws of the association, and recognise this legislative arm is there to protect the public

4. Conduct business within the law, but to subscribe to the higher elements of good governance (transparent, fair and just, accountable, democratic, participatory and responsive)

5. Respect the complexity of conflicts of interest and recognise the role of adequate disclosure of interest

Extending this to professional associations to demonstrate their professional integrity by complying with 1 to 5 plus three more:

The links here are specific to Australia

6. To operate within the law, meaning the associations own laws are in line with the greater law

7. When implementing the association process and procedure, particular attention is given to conflict of interest, as well as procedural fairness and natural justice

8. The terms of good governance are adhered to, and in a collegial and solution-focussed approach to problem-solving

Ok, I made that last one (#8) up – but for those of you who have followed my posts on “dietitian-only discussion groups” would know #8 trumps all others, and means the association is operating to the law and has a [publicly] demonstrated high level of professional ethics that extends to all arms and operations of the association.

PS #7 is a close 2^nd in the “weighting of importance” in the integrity of an association.

@MDPStudy

Want more on professional ethics and professional integrity?

S Tyreman. Integrity: is it still relevant to modern healthcare? Nursing Philosophy 2011; 12:107-118

What is ethics?
Definitions by second-year Monash Medical students.

Medical Ethics Under the Knife

The Global Mail, October 2013

The Royal Australasian College of Physicians produces an internationally respected set of ethics guidelines for health professionals. But the college executive has taken a new edition down from its website and quietly disbanded the committee who authored it. Why? In the meantime, The Global Mail has posted a copy of the draft guidelines here.

Independent Therapeutic Advice: how achievable is it?

Australian Prescriber 2013 36: Supplement 2

This supplement is likely to be of interest to anyone involved in the development of clinical guidelines and clinical research, including:

- Health professionals, trainees and students who use guidelines as a basis for their decision making

- Policy makers and others working to improve the quality of health care

- People involved in university, college and hospital education

Excerpt: Around the world it is commonly assumed that clinical practice guidelines, systematic reviews and the scientific literature are dependable and credible sources of information about the efficacy and effectiveness of therapeutic products. Health practitioners and consumers expect that these are reliable sources of up-to-date information about treatment options, and policy makers rely on them to guide important healthcare decisions.

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