Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T04:04:17.315Z Has data issue: false hasContentIssue false
  • English
  • Français

The Hair Stylist, the Corn Merchant, and the Doctor: Ambiguously Altruistic

Published online by Cambridge University Press:  01 January 2021

Lois Shepherd
Get access Rights & Permissions [Opens in a new window]

Extract

The AHP Code of Ethics requires members to serve the best interests of their clients, be clear and honest with them, and keep their secrets confidential. Members pledge to represent their skills and qualifications honestly and to make appropriate referrals to others more qualified when out of their depth.

AHP stands for “Associated Hair Professionals,” or hair stylists, but their Code of Ethics looks a lot like the Hippocratic Oath and the current Principles of Medical Ethics of the American Medical Association. All of these ethics statements emphasize honesty, confidentiality, competence, serving patients’ (or clients’) best interests, and willingness to refer to other qualified professionals. But it’s not just doctors and hair professionals who have Codes of Ethics. The SPCP — Society of Permanent Cosmetic Professionals —requires its members to “maintain high professional standards consistent with sound practices,” “conduct business relationships in a manner that is fair to all,” and avoid false or misleading statements to the effect that the application of permanent makeup is not tattooing, not permanent, and not painful. (Physicians might consider that last point — I’m grateful for the time my doctor once warned me, “This is really going to hurt.”)

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 42 , Issue 4 , Winter 2014 , pp. 509 - 517
Copyright
Copyright © American Society of Law, Medicine and Ethics 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Associated Hair Professionals, Code of Ethics, available at <http://www.insuringstyle.com/hairstylists/membership/ahpcode-of-ethics/>(last visited September 29, 2014).(last+visited+September+29,+2014).>Google Scholar
The Society of Permanent Cosmetic Professionals, Code of Ethics, available at <http://www.spcp.org/information-for-technicians/spcp-code-of-ethics/>(last visited September 29, 2014).(last+visited+September+29,+2014).>Google Scholar
Veatch, R. M., A Theory of Medical Ethics (New York: Basic Books, Inc., 1981): At 6, 92–107 (discussing the inadequacy of reliance on any profession to determine its own moral foundation through agreement among its members).Google Scholar
The 1847 AMA code states that, “There is no profession, from the members of which greater purity of character and a higher standard of moral excellence are required, than the medical.” Id. at 93.Google Scholar
MacKenzie, C. R., “Professionalism and Medicine,” History of the Human Sciences Journal 3, no. 2(2007): 222–227 (citing Osler, W. O. “On the Educational Value of the Medical Society,” in Aequanimitas, with Other Addresses to Medical Students, Nurses and Practitioners of Medicine (Philadelphia: Blakiston, 3rd ed., 1932): 395–423).Google Scholar
Churchill, L. R., “The Hegemony of Money: Commercialism and Professionalism in American Medicine,” Cambridge Quarterly Healthcare Ethics 16, no. 4(2007): 407–414.CrossRefGoogle Scholar
Faden, R. Kass, N. Goodman, S.et al, “An Ethics Framework for a Learning Health Care System: A Departure from Traditional Research Ethics and Clinical Ethics,” Hastings Center Report 43, no. s1(2013): s16–s27.CrossRefGoogle Scholar
Editors, “Looking Back on the Millennium in Medicine,” New England Journal of Medicine 342, no. 1(2000): 42–49.CrossRefGoogle Scholar
American Board of Internal Medicine, Project Professionalism (Philadelphia: American Board of Internal Medicine, 1998): 5.Google Scholar
Project of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine, “Medical Professionalism in the New Millennium: A Physician Charter,” Annals of Internal Medicine 136, no. 3(2002): 243–46.CrossRefGoogle Scholar
Id. (preface by Sox, H.C., editor).Google Scholar
For a discussion of the medical professional literature on definitions and invocations of professionism and altruism, see Hafferty, F. W., “Definitions of Professionalism: A Search for Meaning and Identity,” Clinical Orthopaedics and Related Research 449 (2006): 193–204.Hafferty notes that British definitions of professionalism “do not highlight altruism as a core concept or an organizing principle.” Id. at 199.CrossRefGoogle Scholar
Swick, H. M., “Toward a Normative Definition of Medical Professionalism,” Academic Medicine 75, no. 6(2000): 612–616.Gibson, D. D. Coldwell, L. L. Kiewit, S. F., “Creating a Culture of Professionalism: An Integrated Approach,” Academic Medicine 75, no. 5(2000): 509.Bardes, C. L., “Is Medicine Altruistic? A Query from the Medical School Admissions Office,” Teaching and Learning in Medicine: An International Journal 18, no. 1(2010): 48–49.CrossRefGoogle Scholar
French philosopher Auguste Comte coined the term in the 19th century to describe an ethical obligation “to live for others,” renouncing self-interest. Stanford Encyclopedia of Ethics, s.v. “Auguste Comte,” available at <http://plato.stanford.edu/entries/comte/#EthSoc>(last visited September 29, 2014).Oxford Dictionaries define altruism as “the belief in or practice of disinterested and selfless concern for the well-being of others.” Oxford Dictionaries, available at <http://www.oxforddictionaries.com/us/definition/american_english/altruism>(last visited September 29, 2014).See also MacIntyre, A., “Egoism and Altruism,” in Borchert, D. M., ed., Encyclopedia of Philosophy, 2 (New York: MacMillan, 1967): At 442–466.MacIntyre explains that altruism is often considered the opposite of egoism and describes the resulting preoccupation with determining which of these two motives, or ways of living, govern our actions. He provides a contrary view, writing that, “…if I want to lead a certain kind of life, with relationships of trust, friendship, and cooperation with others, then my wanting their good and my wanting my good are not two independent, discriminable desires.” Id.Google Scholar
Glannon, W. Ross, L. F., “Are Doctors Altruistic?” Journal of Medical Ethics 28 (2002: 68–69.For discussion of physicians' fiduciary obligations, see Mehlman, M. J., “Dishonest Medical Mistakes,” Vanderbilt Law Review 59, no. 4(2006): 1137–1173.Rodwin, M. A., “Strains in the Fiduciary Metaphor: Divided Physician Loyalties and Obligations in a Changing Health Care System,” American Journal of Law & Medicine 21, nos. 2 & 3(1995): 241–257.CrossRefGoogle Scholar
Id. (Glannon and Ross).Google Scholar
Id. Similarly, R. S. Downie writes that “Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work.” R. S. Downie, “Supererogation and Altruism: A Comment,” Journal of Medical Ethics 28, no. 2(2002): 75–76.Google Scholar
Id.Google Scholar
Orentlicher, D., “The Influence of a Professional Organization on Physician Behavior,” Albany Law Review 57, no. 3(1994): 583–605.Google Scholar
Montopoli, B., “Sue Lowden Stands by Chicken Health Care Barter Plan,” CBS News, April 22, 2010, available at <http://www.cbsnews.com/news/sue-lowden-stands-by-chicken-health-care-barter-plan/>(last visited September 29, 2014).For reporting and video footage of the original Lowden comment on bartering with physicians, see E. Kleefeld, “NV-SEN Candidate Sue Lowden (R): ‘Barter With Your Doctor,’” TPN, April 12, 2010, available at <http://talkingpointsmemo.com/dc/nv-sen-candidate-sue-lowden-r-barter-with-your-doctor-video>(last visited September 29, 2014).(last+visited+September+29,+2014).For+reporting+and+video+footage+of+the+original+Lowden+comment+on+bartering+with+physicians,+see+E.+Kleefeld,+“NV-SEN+Candidate+Sue+Lowden+(R):+‘Barter+With+Your+Doctor,’”+TPN,+April+12,+2010,+available+at+(last+visited+September+29,+2014).>Google Scholar
For an early essay presenting a moral argument for understanding the practice of medicine as a business, see Sade, R. M., “Medical Care as a Right: A Refutation,” New England Journal of Medicine 285, no. 23(1971): 1288–92. (Sade compares the physician to a baker.CrossRefGoogle Scholar
American Bar Association, Model Rules of Professional Conduct, Rule 6.01 “Every lawyer has a professional responsibility to provide legal services to those unable to pay. A lawyer should aspire to render at least (50) hours of pro bono publico legal services per year.”) Because the requirement to provide pro bono services is somewhat general, it would be difficult to enforce, even in those states that have adopted Rule 6.01 as part of the regulations governing the conduct of lawyers. New York, however, has recently adopted a rule “requiring applicants for admission to the New York State bar to perform 50 hours of pro bono services.” New York State Uniform Court System, available at <http://www.nycourts.gov/attorneys/probono/baradmissionreqs.shtml>(last visited September 29, 2014). Moreover, courts can appoint lawyers to serve particular clients in a case and when they do so, the lawyers' compensation for such representation will be fixed by the court. See ABA Model Rule 6.2 (“A lawyer shall not seek to avoid appointment by a tribunal to represent a person except for good cause.”).(last+visited+September+29,+2014).+Moreover,+courts+can+appoint+lawyers+to+serve+particular+clients+in+a+case+and+when+they+do+so,+the+lawyers'+compensation+for+such+representation+will+be+fixed+by+the+court.+See+ABA+Model+Rule+6.2+(“A+lawyer+shall+not+seek+to+avoid+appointment+by+a+tribunal+to+represent+a+person+except+for+good+cause.”).>Google Scholar
See Glannon, Ross, , supra note 15.Google Scholar
Blackburn, S., Being Good (New York: Oxford University Press Inc., 2001), at 48–49. Millennial medical student graduates may not be as inclined to support and promote altruism as a core value.Hafferty, F. W., “What Medical Students Know about Professionalism,” Mount Sinai Journal of Medicine 69, no. 6(2002): 385–398. Hafferty writes that classroom discussion with medical students as part of a professionalism curriculum revealed little support for the principle that physicians should subordinate their own interests to the interests of others. The students expressed a need for “balance” in their lives, the importance of taking care of oneself in order to help others, and a lack of commitment to vague and general professional codes and oaths imposed by others. He writes, “Students certainly verbalized a commitment to doing good, but they were unremittingly clear that the who, what, when, where, and why would remain under the control of the ‘do gooder.”’ While some of these attitudes are not particularly problematic under the thesis of this article, we might nevertheless be concerned that once “altruism” is rejected or discredited as the lesson to learn, students may not be taught or may not understand and internalize what their true and more specific ethical and legal obligations are to patients. Most concerning is Hafferty's statement that the students” [m]ost clearly and emphatically… rejected the notion that they were obliged to do anything. Period.” Id. at 391.See also Hafferty, , supra note 12.Google Scholar
Coons, S., “The SUPPORT Trial: Risk and Consent Questions Divide the Clinical Research Community,” Research Practitioner 14, no. 5(2013): 112–117.Annas, G. J. Annas, C. L., “Legally Blind: The Therapeutic Illusion in the Support Study of Extremely Premature Infants,” Journal of Contemporary Health Law & Policy 30, no. 1(2014): 1–36.Macklin, R. Shepherd, L., “Informed Consent and Standard of Care: What Must Be Disclosed,” American Journal of Bioethics 13, no. 12(2013): 9–13.Google Scholar
Wilfond, B. S.et al Compare, “The OHRP and SUPPORT,” New England Journal of Medicine 368, no. 25(2013): E36. DOI:10.1056/NEJMc1307008.Macklin, R.et al, “The OHRP and SUPPORT–Another View,” New England Journal of Medicine 369, no. 2(2013): e3(1–(3). DOI: 10.1056/NEJMc1308015.CrossRefGoogle Scholar
Office for Human Research Protections, Letter to the University of Alabama at Birmingham, March 7, 2013, available at <http://www.hhs.gov/ohrp/detrm$letrs/YR13/mar13a.pdf>(last visited October 1, 2014).(last+visited+October+1,+2014).>Google Scholar
See e.g., Lantos, J. D., “OHRP and Public Citizen Are Wrong about Neonatal Research on Oxygen Therapy,” Bioethics Forum, Hastings Center Report, April 18, 2013, available at <http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=6306&blogid=140>(last visited October 1, 2014).also see comments posted by K. Barrington, on June 10 2013, to Shepherd, L., “The Support Study and the Standard of Care,” Bioethics Forum, The Hastings Center Report, May 17, 2013, available at <http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=6358&blogid=140>(last visited October 1, 2014).(last+visited+October+1,+2014).also+see+comments+posted+by+K.+Barrington,+on+June+10+2013,+to+Shepherd,+L.,+“The+Support+Study+and+the+Standard+of+Care,”+Bioethics+Forum,+The+Hastings+Center+Report,+May+17,+2013,+available+at+(last+visited+October+1,+2014).>Google Scholar
Drazen, J. M. Solomon, C. G. Greene, M. F., “Informed Consent and SUPPORT,” New England Journal of Medicine 368, no. 20(2013): 1929–1931.CrossRefGoogle Scholar
See Wilfond, , supra note 26.Google Scholar
See MacIntyre, , supra note 14 (writing about our misguided preoccupation with understanding actions as taken either in self-interest or benevolence, either with bad motives or good motives).Google Scholar
See Bazerman, M. H. Tenbrunsel, A. E., Blind Spots: Why We Fail to Do What's Right and What to Do about It (Princeton: Princeton University Press, 2011): At 20–21 “[M]ost smart, well-educated doctors are puzzled by the criticism against them, as they are confident in their own ethicality and the ‘fact’ that they always put their patients' interests first …. But the more pernicious aspect of conflicts of interest is clarified by well-replicated research showing that when people have a vested interest in seeing a problem in a certain manner, they are no longer capable of objectivity.”).CrossRefGoogle Scholar
Although a full exploration is beyond the scope of this essay, paternalism is an additional concern that often flows from the best of intentions but, nonetheless, raises concerns about which a well-meaning physician may not even be aware. An overblown sense of altruism may, at least in part, contribute to the pernicious self-rationalization that the doctor always knows best.Google Scholar
Orlowski, J. P. Wateska, L., “The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns: There's No Such Thing as a Free Lunch,” Chest 102, no. 1(1992): 270–273.Wazana, A., “Physicians and the Pharmaceutical Industry, Is a Gift Ever Just a Gift?” JAMA 283 (2000): 373–380.Harris, G. Roberts, J., “Doctors' Ties to Drug Makers Are Put on Close View,” New York Times, March 21, 2007, at A1.CrossRefGoogle Scholar
See Editors, supra note 8.Google Scholar
Fisher, J., Medical Research for Hire: The Political Economy of Pharmaceutical Clinical Trials (New Jersey: Rutgers University Press, 2008);see Harris, Roberts, , supra note 34.CrossRefGoogle Scholar
Perry, J. E., “Physician-Owned Specialty Hospitals and the Patient Protection and Affordable Care Act: Health Care Reform at the Intersection of Law and Ethics,” American Business Law Journal 49, no. 2(2012): 369–416.CrossRefGoogle Scholar
See generally Shepherd, L. Riley, M. F., “In Plain Sight: A Solution to a Fundamental Challenge in Human Research,” Journal of Law, Medicine, and Ethics 40, no. 4(2012): 970–89 (discussing the physician-researcher conflict of interest).CrossRefGoogle Scholar
Johnson, S. H., “Five Easy Pieces: Motifs of Health Law,” Health Matrix 14, no. 1(2004): 131–140, at 131.Google Scholar
Id.Google Scholar
Appelbaum, P. S. Roth, L. H. Lidz, C., “The Therapeutic Misconception: Informed Consent in Psychiatric Research,” International Journal of Law & Psychiatry 5, nos. 3 & 4(1982): 319–329 at 321.Lidz, C. W. Appelbaum, P. S. Grisso, T. Renaud, M., “Therapeutic Misconception and the Appreciation of Risks in Clinical Trials,” Social Science & Medicine 58, no. 9(2004): 1689–1697, 1691.CrossRefGoogle Scholar
Cook, S., Comments at OHRP Public Meeting on Matters Related to Protection of Human Subjects and Research Considering Standard of Care Interventions (Aug. 28, 2013), video recording available at <http://www.youtube.com/playlist?list=PLrl7E8KABz1Gc_ndt9grGg8O_jE5G1RNC>, transcript available at <http://www.hhs.gov/ohrp/newsroom/rfc/Public%20Meeting%20August%2028,%202013/supportmeetingtranscriptfinal.html>(last visited October 1, 2014).,+transcript+available+at+(last+visited+October+1,+2014).>Google Scholar
Id. See also Hochhauser, M., “‘Therapeutic Misconception’ and ‘Recruiting Doublespeak’ in the Informed Consent Process,” IRB: Ethics and Human Research 24, no. 1(2002): 11–12 (explaining how the ubiquitous “brand names” of clinical trials contribute to a research subject's therapeutic misconception).CrossRefGoogle Scholar
“Clinical Trial Subjects: Adequate FDA Protections?” Hearing Before the Committee on Government Reform and Oversight House of Representatives, 105th Congress 152–53 (1998) available at <http://www.gpo.gov/fdsys/pkg/CHRG-105hhrg49827/pdf/CHRG-105hhrg49827.pdf>(last visited October 10, 2014).(last+visited+October+10,+2014).>Google Scholar
“Firefighters Line Funeral of Tyler Doohan, 8, Who Died Trying to Save Family from Fire,” CBS News, January 29, 2014, available at <http://www.cbsnews.com/news/8-year-old-tyler-doohan-who-died-trying-to-save-family-from-fire-gets-a-fire-fighters-funeral/>(last visited October 1, 2014).(last+visited+October+1,+2014).>Google Scholar
Dier, A. Newser, , “Surgeon Walked 6 Miles in Ala. Storm to OR,” USA Today, January 31, 2014, available at <http://www.usatoday.com/story/news/nation/2014/01/31/newser-alabama-snowstorm-surgeon/5078179/>(last visited October 1, 2014).Griffo, M., “Doctor Walks 6 Miles through Snow Storm to Perform Emergency Brain Surgery,” Huffington Post, January 30, 2014, available at <http://www.huffingtonpost.com/2014/01/30/dr-zenko-hrynkiw-6-miles-brain-surgery_n_4697195.html>(last visited October 1, 2014).(last+visited+October+1,+2014).Griffo,+M.,+“Doctor+Walks+6+Miles+through+Snow+Storm+to+Perform+Emergency+Brain+Surgery,”+Huffington+Post,+January+30,+2014,+available+at+(last+visited+October+1,+2014).>Google Scholar