Ethical Concepts and Challenges in Occupational Health Sergio Iavicoli, MD, PhD Italian Workers’ Compensation Authority (INAIL), Research Director International Commission on Occupational Health (ICOH), Secretary General FACULTY DI SCLOSURE I have nothing to disclose Why ethics is important for Occupational health professionals ?
The origins of ethics in occupational medicine Bernardino Ramazzini Compassion : “For we must admit that the workers in certain arts and crafts sometimes derive from them grave injuries, so that where they hoped for a subsistence that would prolong their lives and feed their families, they are too often repaid with the most dangerous diseases and finally, uttering curses on the profession to which they had devoted themselves, they desert their post among the living”. Gratitude : “So, I freely confess that what I now publish is but an imperfect Performance, or rather an Incitement to others to lend their helping hands, till an intire and compleat Treatise is obtain’d, that may deserve a place in the Commonwealth of Physick. Questionless, we owe this piece of Service to the miserable Conditions of Trademen, whose Handy-Works, even those of the meanest and most sordid Production, are so advantageous and necessary to Mankind” . Source: De Morbis Artificium Diatriba, 1700 The dilemma of ethical choice Management of professional dilemmas Professional norms, Laws and codes of ethics, silent regulations knowledge etc Sets of value and culturally Personal set of values conditioned practices in communities /societies Source: Westerholm, 2009
Ethics Morals Some definitions Bioethics Deontology Code of Ethics The historical roots of ethics and occupational health Ethics and health in the classical world Plato (427-347 B.C.) “The slave doctor never talk to their patients individually, or let them talk about their own individual complaints; rather, he prescribes what mere experience suggests, as if he had exact knowledge; and when he has given his orders, like a tyrant, […] but the other doctor, who is a freeman , attends and practices upon freemen; and he carries his enquiries far back, and goes into the nature of the disorder; he enters into discourse with the patient and with his friends, and is at once getting information from the sick man, and also instructing him as far as he is able, and he will not prescribe for him until he has first convinced him”. Source: ( Laws, IV.10.720)
The origins of ethics in occupational medicine Bernardino Ramazzini Source: De Morbis Artificium Diatriba, 1700 I mpact of the philosophic, economic and social thought on the relationship between work and health Portrait of Bernardino Ramazzini , Bianchini Ciarlini Luigi (1758/1830) Civic Museum "Giulio Ferrari, Carpi (MO) Adam Smith The Wealth of Nations, 1776 “Almost every class of artificers is subject to some peculiar infirmity, … if masters would always listen to the dictates of reason and humanity, they have frequently occasion rather to moderate, than to animate the application of many of their workmen”
Karl Marx Das Kapital, 1867 “The division of labour in Manufacture affects the life of individuals at its roots and provides material and impulse for industrial pathology” Pope Leo XI I I Rerum Novarum, 1891 Finally, work which is quite suitable for a strong man cannot rightly be required from a woman or a child. […] Women, again, are not suited for certain occupations; a woman is by nature fitted for home-work, and it is that which is best adapted at once to preserve her modesty and to promote the good bringing up of children and the well-being of the family Principles of Bioethics Autonomy Beneficence ( primum Refers to the right of self- non nocere ) determination, or that people have the right to choose for First do not harm themselves what is best for them Justice No maleficence It implies the fair distribution of benefits Promoting what is good and requires that we through minimisation of risks look at the role of and maximization of benefit entitlement Source: T. Beauchamp e J. Childress: Principles of biomedical ethics, 1979
Ethical and health issues related to occupational medicine Health and work HEALTH “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” DECENT WORK (WHO, 1946) “It involves opportunities for work that is productive and delivers a fair income, security in the workplace, social protection and social integration” (ILO,1999 ) Multiplicity of stakeholders Role in the risk Complexity and management and changes in the protection of world of work workers Occupational physician Social Multidisciplinarity issues Regulatory framework
Society S U Workers’ families B J I nsurance, prevention E Health professionals and social system C T Working environment S Subjects and impact on human settlement involved in the Doctor-patient I decision-making N Other OSH professionals Patient relationship V process of O Employer occupational L WORKER V physician E Occupational health D professionals OSH Service Providers Legislative framework Role of Occupational Physician Health Surveillance Contribution to risk management and assessment Who is examined Individuals Groups What is examined Health condition Harmfulness of working environment Examination Clinic methodology Epidemiological methods methodology Objectives Professional suitability Risk assessment Conclusions of the Diagnosis Assessment of state of process health Test characteristics Specificity Sensitivity Benchmarking Reference values Control groups Variables Dichotomy (yes/no), Continuous ordinals (scales or intervals) Privacy and Micro and family run confidentiality enterprises Vulnerable workers Shared decision (e.g.youth,gender, making migrant) Ethical challenges Overlapping Fragmentation roles Allocation Innovative of scarse technologies resources Source: Handbook for Rural Health Care Ethics: A Practical Guide for Professionals, William A Nelson (Eds), 2009
Why a Code of Ethics? Pros and Cons of codes of ethics CONS PROS I t results from a shared process of a professional and scientific Single case interpretation community I t provides a guide in the Multiplicity of indication on ethic professional choices codes I nterface with current legislation I t gives reference indications on framework and evolving professional conduct knowledge of the world of work I COH Code of Ethics “The occupational health physician is required to act according to the principles of Occupational medicine and Code of Ethics of the International Commission on Occupational Health (ICOH)”
About I COH 2015 2018 2021 2021 1906 2012 Dublin Melbourne Melbourne Milan 1910 Seoul Cancun Brussels 2009 Cape Town 1925 2006 Amsterdam Milan 2003 1928 Iguassu Falls Budapest 2000 1931 The I nternational Commission on Singapore Geneva Occupational Health (I COH) is an 1935 1996 international non-governmental Stockholm Brussels professional society whose aims 1993 1938 are to foster the scientific Nice Frankfurt progress, knowledge and development of occupational 1948 1990 Montreal London health and safety in all its 1987 aspects. 1951 Sydney Lisbon 1984 1954 Dublin Naples 1981 1957 Cairo Helsinki 1978 1960 Dubrovnik 1975 1972 1969 1966 1963 New York Brighton Buenos Aires Tokyo Vienna Madrid The impact of I COH code 1984 1991 2005 2020 1998 2012 Post Graduate Programs and 1994 e 1996 Other Code of Ethics from 1987 2004 INTERNATIONAL ORGANIZATIONS 1992 2002 2008 The ICOH Code of Translations of the ICOH Code of 2014 The ICOH Code of Ethics was adopted in Its preparation discussed by First edition of the ICOH Code of Second edition of The ICOH Code of Ethics was also adopted translated Universities Ethics was approved by Publications Third edition of the Ethics (translated into English and Ethics in another six different the Argentinean legislation as term of the ICOH Code of in the Italian legislation (art. 39 Legislative in Italian the ICOH Board the Board ICOH Code of Ethics French) reference (Resolution 693/2004) languages Ethics Decree n. 81/2008) I COH Code of Ethics Objective The Code of Ethics represents an attempt to translate in terms of professional conduct the values and ethical principles in occupational health. Target The Code applies to occupational health professionals and occupational health services regardless of whether they operate in a free market context subject to competition or within the framework of public sector health services.
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