THE TRAIN-OF-THOUGHT WRITING METHOD:Practical, User-Friendly Help for Beginning Writers

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A woman whose first languages are Slavic, German and Russian replied that there are similar words in all of her first languages. She said that in the Slavic language, neither ethics nor morals stands alone as they do in English. A Chinese national said that there are separate Chinese words for both morals and ethics, but they are used interchangeably.

Spanish-, French- and German-speaking people said there are words for both in their respective languages and that the words are used interchangeably. In the textbooks on ethical theory that we reviewed, however, the ethicists made a distinction between ethics and morals which we choose to accept for the sake of clarity.

Melden and Mothershead both suggest that the word ethics is used when referring to a set of principles or standards for conduct, and that the word morals is used when referring to the conduct of a person or group, i. This usage is consistent with the replies of the CDC professionals. Each society, religion, professional group, or distinguishable community has its principles, its standards of conduct.

As persons who are concerned with being responsible in our conduct, we rely ordinarily upon a body of principles for guidance in conduct. In the Judeo-Christian community, there are at minimum the Ten Commandments. In every society, we have laws at the local, national and international levels which describe and dictate both unacceptable and acceptable behaviour.

The list could go on and on. The point here is that we are exposed to a number of standards of conduct, or ethics, as we use the term.

It is quite fitting that we begin the work of setting some standards for ourselves. Why do health professionals need standards for our work? As Professor Melden states, we are persons who are concerned with being responsible. To make good science demands the highest responsibility on our part, which leads to the promotion of safety and health. On the other hand, no matter how good the intentions of the researcher may be, compromised science can lead to death, disease, disability and dismemberment, rather than the protection of workers. The bottom line is that workers suffer when science is compromised.

Why does compromised science happen? From our perspective, there are a number of reasons. Take for example three workplace tragedies: asbestos, benzene and silica. In the early days, the dangers of these substances were unknown. As technology improved, as the science of epidemiology developed and as medicine became more sophisticated, the obvious became evident. In each of these histories, the problems existed, but scientists did not possess or in some cases apply the tools available to uncover them.

Sometimes science is compromised because it is bad science. We are certain that all of you have seen bad science or have read about it in scientific journals. It is opinion expressed in such a way that it appears scientific and therefore factual. This situation is one that can easily be addressed through a rigorous peer review process.

Sometimes science is compromised because the researcher is rushed, due to unrealistic time constraints, lack of funds or influences other than purely scientific analysis. Thoroughness was compromised and conclusions reached with only part of the picture considered. And perhaps worst of all, sometimes science is compromised in pursuit of profit or academic advancement. Likewise, we have all seen evidence of this in the newspapers and professional journals.

In some of these instances, the gain to the researcher was academic standing and not financial at all. In others, financial gain, either immediate or future, influenced the outcome. In the first case referred to above, researchers with financial interests in asbestos did not report their own positive findings until many years later, when many thousands of workers had already suffered and died of diseases associated with uncontrolled asbestos exposure Lemen and Bingham In some instances, we have seen that those who pay for the research may ultimately influence the outcome.

These are but a few of the cases where a code of ethics could come into play, although any code, no matter how wonderful, will not stop the unscrupulous. Occupational health is a complex and difficult discipline in which to prevent unethical conduct. Even when we discover methods for prevention of occupational diseases and injuries, the solution to the problem is often viewed as cutting into profits, or the problem is hidden to avoid the expense of the remedy. The profit motive and the complexity of the issues we address can lead to both abuse and shortcuts in the system.

What are some of the major difficulties? Often, occupationally caused maladies have incredibly long incubation periods, giving rise to confounding variables. By comparison, in many infectious diseases results seem quick and simple. An example is a well-managed vaccine campaign for measles in an outbreak situation. That situation is quite different from asbestosis or carpal tunnel syndrome, where some people are affected, but others are not, and most often months or years elapse before disability occurs.

Occupational health concerns are multidisciplinary. When a chemist works with other chemists, they all speak the same language, each has but one interest and the work can be shared. Occupational health, on the other hand, is multidisciplinary, often involving chemists, physicists, industrial hygienists, epidemiologists, engineers, microbiologists, physicians, behaviourists, statisticians and others.

In the epidemiological-triad host, agent, environment , the host is unpredictable, the agents are numerous and the environment is complex. The cooperation of several disciplines is mandatory. A variety of professionals, with totally different backgrounds and skills, is brought together to address a problem. The only commonality between them is the protection of the worker. This aspect makes peer review even more difficult because each speciality brings its own nomenclature, equipment and methods to apply to the problem.

Because of long incubation periods in many occupational diseases and conditions, coupled with the mobility of the workforce, occupational health professionals are often forced to fill in some blanks since many of those workers exposed or at risk cannot be located. This condition leads to a reliance on modelling, statistical calculations, and sometimes compromise in the conclusions. The opportunity for error is great, because we are not able to fill in all of the cells.

Sometimes it is difficult to relate a malady to the work environment or, even worse, to identify the cause. In infectious diseases, the epidemiological triad is often less complex. In the s, CDC staff investigated an outbreak of illness on a cruise ship. The host was well defined and easily located, the agent was easily identified, the mode of transmission was obvious, and the remedial action was evident. In occupationally related disease and injury, the host is defined, but often difficult to find. There are a number of agents in the work environment, often causing synergism, plus other workplace factors which are not directly involved in the health problem but which play an important role in the solution.

These other workplace factors include such things as the interests and concerns of the labour force, the management and involved government agencies. Similarly, Kenneth W. With the above caveats in mind, we propose to you that the following statements be part of a code of ethics for occupational health. We do not pretend to have all the answers, nor do we alone have all the facts.

Much can be learned from labour and industry about workplace situations and problem resolution. Tripartite review is the only way we know of to minimize the effects of special interest groups. Sometimes good science has no credibility because of perceived compromise. Examples of compromises include the funding source for the study, the interest groups selected to review the study, and known bias of reviewers.

There are judgement calls on the part of the researcher, and even though the judgement and subsequent decision may be sound, there can be a perceived compromise in the study. The best-intentioned researcher can build a bias into a protocol. This will become obvious only upon careful protocol review. For any standard or recommended standard, perception is of utmost importance. If it is viewed that the standard was based on a biased interpretation, then the standard will lack credibility. Standards based solely on the interpretation of the science by individuals associated with the industry under consideration would suffer from such an interpretation or, worse yet, could fall short of adequately protecting the workers at risk.

Building in check factors such as those described above during the development of the new standard will assure that this will not occur. We have attempted to discuss a complex and sensitive issue. There are no easy solutions. What we are attempting is right and just, however, because its goal, to protect the worker in the workplace, is right and just. We cannot do this alone, we cannot do it in a vacuum, because the problems we address are not in a vacuum. We need each other, and others, to ferret out our natural instincts for personal gain and glory and to uncover our built-in biases.

Such an effort will enable us to contribute to the knowledge and enhance the well-being of humanity. Paul W.


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Brandt-Rauf and Sherry I. In the last several decades, considerable effort has been devoted to defining and addressing the ethical issues that arise in the context of biomedical experimentation. Central ethical concerns that have been identified in such research include the relationship of risks to benefits and the ability of research subjects to give informed and voluntary prior consent. Assurance of adequate attention to these issues has normally been achieved by review of research protocols by an independent body, such as an Institutional Review Board IRB. For example, in the United States, institutions engaging in biomedical research and receiving Public Health Service research funds are subject to strict federal governmental guidelines for such research, including review of protocols by an IRB, which considers the risks and benefits involved and the obtaining of informed consent of research subjects.

To a large degree, this is a model which has come to be applied to scientific research on human subjects in democratic societies around the world Brieger et al. The deficiencies of the approach appear, however, in situations where formal protocols are lacking or where studies bear a superficial resemblance to human experimentation but do not clearly fall within the confines of academic research at all. The workplace provides one clear example of such a situation. Certainly, there have been formal research protocols involving workers that satisfy the requirements of risk-benefit review and informed consent.

The purpose of the study was to address the hypothesis that byssinosis is caused by micro-organisms contaminating the cotton rather than by the cotton dust itself. Thus, workers at the Danville plant were to be exposed to varying levels of the micro-organism while being exposed to cotton dust at levels above the standard. Technical review by an OSHA toxicologist cast serious doubt on the scientific merit of the project, which in and of itself should raise ethical questions, since incurring any risk in a flawed study might be unacceptable.

Plainly, there were risks to the worker-subjects without any benefits for them individually; major financial benefits would have gone to the company, while benefits to society in general seemed vague and doubtful. Thus, the concept of balancing risks and benefits was violated. However, even if there was consent, it might not have been entirely voluntary because of the unequal and essentially coercive relationship between the employer and the employees.

Thus, the concept of voluntary informed consent was also violated. Fortunately, in the Dan River case, the proposed study was dropped. However, the questions it raises remain and extend far beyond the bounds of formal research. How can we guarantee informed and voluntary consent in this context? To the extent that the ordinary workplace may represent an informal, uncontrolled human experiment, how do these ethical concerns apply? On an ordinary day in certain workplaces, they may be exposed to potentially toxic substances. Furthermore, to the extent that the risks are known, right-to-know mechanisms provide the worker with the information necessary for an informed consent.

It also requires freedom from coercion or undue influence. The concern would be that powerful incentives minimize the possibility for truly free consent. If so, cannot the worker simply choose a less hazardous occupation? Indeed, it has been suggested that the hallmark of a democratic society is the right of the individual to choose his or her work.

As others have pointed out, however, such free choice may be a convenient fiction since all societies, democratic or otherwise,. Totalitarian societies accomplish this through force; democratic societies through a hegemonic process called freedom of choice Graebner Thus, it seems doubtful that many workplace situations would satisfy the close scrutiny required of an IRB. Since our society has apparently decided that those fostering our biomedical progress as human research subjects deserve a high level of ethical scrutiny and protection, serious consideration should be given before denying this level of protection to those who foster our economic progress: the workers.

It has also been argued that, given the status of the workplace as a potentially uncontrolled human experiment, all involved parties, and workers in particular, should be committed to the systematic study of the problems in the interest of amelioration. Is there a duty to produce new information concerning occupational hazards through formal and informal research? The assertion that workers have an active duty to allow themselves to be exposed is more problematic because of its apparent violation of the ethical tenet that people should not be used as a means in the pursuit of benefits to others.

For example, except in very low risk cases, an IRB may not consider benefits to others when it evaluates risk to subjects. Whether or not one accepts the notion that workers should want to participate, the creation of such an appropriate research environment in the occupational health setting requires careful attention to the other possible concerns of the worker-subjects. One major concern has been the potential misuse of data to the detriment of the workers individually, perhaps through discrimination in employability or insurability. Thus, due respect for the autonomy, equity and privacy considerations of worker-subjects mandates the utmost concern for the confidentiality of research data.

A second concern involves the extent to which the worker-subjects are informed of research results. Under normal experimental situations, results would be available routinely to subjects. However, many occupational studies are epidemiological, e. Yet, if the potential for effective interventions exists, the notification of workers at high risk of disease from past occupational exposures could be important for prevention.

If no such potential exists, should workers still be notified of findings? Should they be notified if there are no known clinical implications? The necessity for and logistics of notification and follow-up remain important, unresolved questions in occupational health research Fayerweather, Higginson and Beauchamp Given the complexity of all of these ethical considerations, the role of the occupational health professional in workplace research assumes great importance.

The occupational physician enters the workplace with all of the obligations of any health care professional, as state by the International Commission on Occupational Health and reprinted in this chapter:. Occupational health professionals must serve the health and social well-being of the workers, individually and collectively.

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The obligations of occupational health professionals include protecting the life and the health of workers, respecting human dignity and promoting the highest ethical principles in occupational health policies and programmes. In addition, the participation of the occupational physician in research has been viewed as a moral obligation. However, the occupational health professional must be particularly sensitive to these potential conflicts because, as discussed above, there is no formal independent review mechanism or IRB to protect the subjects of workplace exposures.

Thus, in large part it will fall to the occupational health professional to ensure that the ethical concerns of risk-benefit balancing and voluntary informed consent, among others, are given appropriate attention. Different tools result in different decisions. How do we decide to meet different and often conflicting needs found both in natural sets of humans such as individual, family, peer group, community and in synthetic sets of humans such as political party, union, corporation, nation which may include many diverse natural sets?

How do we choose a level of risk in setting a permissible exposure limit? On this ladder, those most able to act are rationally obligated to rise to the highest rung of responsibility so that they may act first in pursuit of a moral objective. They are obligated to act before others, because they are best or uniquely able to do so. This does not mean that only they should act.

When those with special obligations fail to act, or need assistance, the obligation falls on the shoulders of those on the next rung. By rational we mean not only an action that logically follows another. We also mean actions taken to avoid pain, disability, death and loss of pleasure Gert The employer has duties based on a unique ability to ensure compliance with rules applicable to an entire workplace. Government has a separate duty based on its unique abilities, for example, to mandate rules if persuasion fails.

There are other assumptions in the framework common to any system of ethical values in any culture. We exist, ecologically, as a global community. In our niche, natural sets of humans such as families or peer groups are more meaningful than synthetic sets such as a corporation or politically defined entity. In this community, we share necessary obligations to protect and to help everyone to act rationally in accordance with their rights, just as we should protect our own rights, regardless of differences in mores and cultural values.

These obligations, when they result in actions that protect workers across an international border, are not the imposition of the synthetic values of one nation upon another synthetic set of people. They are acts of reverent recognition of natural, timeless, universal moral values. Basic human rights, the generic rights to freedom and life or well being derive from needs which, if met, enable us to be human Gewirth They are not given us by any government or enterprise.

We always have had them, logically and phylogenetically. Laws governing the work environment, and rules consistent with rights they implement, are not gifts of charity or benevolence. They are expressions of morality. Acting on the specifications of our rights may result in conflicts between those rights which protect the individual, such as protecting the privacy of personal medical records, and those concerned with the duties of the employer, such as deriving information from medical records to protect other lives through the avoidance of health hazards thus made known.

These conflicts may be resolved, not by depending upon the ability of a lone physician or even a professional society to withstand court or company challenges, but by choosing axioms of moral behaviour that are rational for everyone collectively in the workplace. A critical assumption at the very base of this framework of moral judgement is the belief that there is only one real world and that the generic rights apply to everyone in that world, not as ideals that need not be achieved, but as generic conditions of actual existence. What we should learn is how to use postulates or axioms not only in ethics, but to describe the world and to guide conduct in the absence of perfect knowledge.

They are kept and used if fruitful in the application of basic ethical principles. When they are found to be no longer useful, they can be discarded and replaced with another set of conventions. An example is the common practice of developing professional codes of ethics for corporate physicians and other professionals. They are drafted to protect generic rights and their specifications by bridging gaps in knowledge, to organize experience and to permit us to act in advance of morally or scientifically certain knowledge. These sets of axioms, like all systems of axioms, are neither right nor wrong, true nor false.

We act as if they are right or true in fact they may be and retain them only as long as they continue to be fruitful in permitting us to act rationally. The test of fruitfulness will yield different results in different cultures at different points in time because, unlike generic ethical principles, cultural norms reflect relative values. In cultures of the East, powerful social and legal sanctions enforced professional behaviours consistent with the Buddhist belief in the eightfold path to righteous living, the fifth fold of which was righteous livelihood, or with Confucian traditions of professional responsibility.

In such settings, professional codes of ethics can be powerful tools in the protection of the patient or research subject, as well as the physician or scientist. In cultures of the West, at least at this time despite the strong Hippocratic tradition in medicine, the codes are less effective, albeit retaining a limited value. This is not only because the social and legal sanctions are less powerful, but also because of some assumptions that simply do not fit the realities of current western cultures. The consent is seldom really voluntary or informed. The information conveyed is seldom certain or complete even in the mind of the scientist or physician.

Consent is usually obtained under socially or economically coercive conditions. The promises of the researcher to protect privacy and confidentiality cannot always be kept. The professional may be socially and legally protected by codes that incorporate this doctrine, but the worker easily becomes the victim of a cruel hoax resulting in social stigma and economic duress due to job and insurance discrimination.

The practice should be discarded and replaced with codes made effective by assumptions that fit the real world coupled with socially and legally enforceable protections. It is irrational and therefore immoral to distribute or allocate the burden of risk by caste, that is, to assign different levels of risk for different sets of humans, as marked by genome, age, socioeconomic status, geographic location within the global community, ethnicity or occupation. Risk allocation by caste assumes that there are humans whose generic rights are different from others.

Basic human needs are the same. Therefore, basic human rights are the same. It depends upon the assignment of a risk differential based on calculating the risks of past work practice or prevalent exposure to a toxic substance or hazard in the workplace. Unnecessary risks are never morally acceptable. The generic rights to life and freedom necessitate empowering workers to rationally make and act upon choices made in pursuit of these rights. Empowerment occurs through access to information, educational opportunities to understand and not simply react to information , and unfettered or uncoerced ability to act on this understanding in avoiding or taking risks.

Education that yields understanding may not happen in a typical safety training session, since training is meant to induce a conditioned response to a set of foreseeable signals or events, and not to provide in-depth understanding. Yet not all the causal factors, including events under the control of workers or management, that result in so-called accidents can be foreseen.


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Thus they do not exist in nature. Every event has a cause Planck ; Einstein The concept of chance is an axiom fruitfully used when a cause is not known or understood. It should not be confused with invariable reality. Thus, even if time, financing and training resources were infinitely available, it is impossible to condition a worker to every possible set of signals for every possible event.

Education of the worker and his natural set, such as the family and peer group to which the worker belongs, enhances both understanding and the ability to act in preventing or reducing risk.

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Therefore, it is a specification of generic rights. Choosing an appropriate location where the worker decides or consents to a risk is a critical factor in assuring an ethical outcome. Many decisions such as the acceptance of hazard pay should be made, if they are to even approach being truly voluntary, only in a milieu other than a synthetic setting such as the place of work or a union hall. Family, peer group and other natural sets may provide less coercive alternatives.

Making this choice ethically requires the most neutral or non-coercive setting possible. If these settings are not available, the decision should be made in the most relatively neutral place associated with the most relatively neutral synthetic set or agency that can protect the empowerment of the worker and his or her natural set. The importance to the well-being of a worker of cultural and ethical values found in his or her family, peer group and community underline the importance of protecting their involvement and understanding as ethically based elements in the empowerment process.

Most of us, even physicians, scientists and engineers, have been educated in primary school to understand axiomatic methods. It is not otherwise possible to understand arithmetic and geometry. Yet many consciously confuse assumptions and facts which can be, but are not always, the same in an effort to impose personal social values on a specific course of action or inaction. This is most obvious in how information is presented, selected, organized and interpreted.

Use of words like accidents and safe are good examples. We have discussed accidents as events that do not occur in nature. Safe is a similar concept. If this is done unknowingly, it is a simple mistake called a semi-logical fallacy. If it is done consciously, as is too often the case, it is a simple lie. The confusion with invariable reality of sets of axioms, models of scientific explanation or assessments of data, seems to be concentrated in the setting of standards.

Axiomatic concepts and methods in regulation, the validity of which are assumed and commonly confused with incontrovertible truth, include:. These axioms usually are discussed as if they are the truth. They are no more than discardable assumptions about individuals, risks and their control, based at best on limited information.

Social and economic values implicit in the selection and use of these axioms guide the policy judgements of those who govern, manage and control. These values, not scientific data alone, determine environmental and biological norms and standards in the community and workplace. Thus, these values, judgements based on them, and the axioms selected also must be judged by their reasonableness, i.

Even the most encompassing system of moral axioms should be understood as an experiment in applying moral principles in the work environment, especially the systems of laws and contracts that govern the workplace. Consistent with our framework of moral principles, treated as moral axioms, occupational safety and health laws and rules can be fully integrated with other axiomatic systems that meet other community health needs.

They can be a differentiated but not degraded part of the total community system. Health care, education, wage replacement and rehabilitation, social security, protection of the disabled, and other public health and environmental protection programmes are often coordinated by legislatures with occupational safety and health programmes. In doing this, care must be taken not to impose or inadvertently create or perpetuate a caste system. How is this care to be taken?

Participation by workers and representatives from their freely organized unions in contracted workplace and governmental bodies is a safeguard that should be part of the experiment. Participation is another specification of human rights. It is the first step to the ethical allocation of responsibility and the distribution of the burden of risk in the workplace. The exercise of these rights, however, may conflict with the rights of management and of society as a whole. Resolution of the conflict is found in understanding that these rights are specifications of generic rights, the imperative of which is absolute and which must ultimately prevail through recognition of the participatory rights of workers, management and the public at large in decisions that affect life and freedom in the community they each share.

Since Ramazzini published the seminal text on occupational medicine Ramazzini , we have come to realize that working at certain jobs can cause specific illnesses. At first, only observational tools were available to survey the work environment. As technology developed, we began to be able to measure the environments in which workers plied their trades. Indeed, we have found ways to detect the presence of toxic substances at low levels, before they can create health problems. Now we often can predict the results of exposures without waiting for the effects to appear, and thus prevent disease and permanent injury.

Good health in the workplace is no accident; it requires surveillance of workers and their environments. Early workplace exposure limits were set to prevent acute illness and death. Today, with much better information, we try to meet much lower limits in order to prevent chronic illness and subclinical health effects. The success of this effort is shown by the fact that many countries around the world have adopted the threshold limit values TLVs published by ACGIH, which now number more than , as workplace exposure standards.

Their wide use as enforceable standards has invited critical examination of TLVs and the process by which they were set. Despite their usefulness, TLVs have been criticized from three sectors of the decision-making process: scientific, political and ethical. A brief review of several criticisms follows:.

Scientists criticized the fact that the TLVs set on the basis of substantial data are not distinguished from those based on considerably less data. The TLV Committee recognized that the biological variations among workers, and other factors that could not be calculated, made it impossible to set limits that would guarantee safety for all workers in all environments. Adopting TLVs as enforceable standards creates a political problem, because part of the worker population is not protected. Only zero exposure can provide this guarantee, but zero exposure and zero risk are not practical alternatives.

The data that the TLV Committee worked with were often produced and paid for by industry, and were unavailable to the public. Those protected by this limit-setting process argue that they should have access to the data upon which the limits are based. There is a link between occupational and community exposures. Any adverse health effects seen in workers are a result of their total exposure to environmental contaminants.

Total dose is important in selecting appropriate exposure limits. This need is already recognized for poisons that accumulate in the body, such as lead and radioactive substances. TLVs were set for a five-day work week of eight-hour days, the norm in the United States. TLVs reflect the action of human repair mechanisms. However, many argue that community and occupational exposure limits should not be different.

Without specific information about synergistic or antagonistic effects, exposure limits for both workers and the public reflect only additive interactions between multiple environmental contaminants. When setting limits for a single substance, the complexities of the environments in which we live and work make it impossible to evaluate all potential interactions among environmental contaminants.

Instead, we make the following simplifying assumptions: 1 the basic mix of chemicals in our environment has not changed materially; and 2 the epidemiological information and the environmental criteria used to set standards reflect our exposure to this mix of chemicals. By making these assumptions when setting community exposure limits for individual substances, interactions can be ignored. Although it would be useful to apply the same reasoning to setting workplace exposure limits, the logic is questionable because the mix of substances in the various work environments is not uniform when compared with that in our communities.

A part of the political debate is whether to adopt enforceable international exposure standards. Should an individual country set its own priorities, as reflected in its exposure limits, or should international standards be adopted, based on the best data available? Currently, we rely heavily on toxicity testing of animals to set human exposure limits. We also measure the degree to which that substance can affect somatic systems. However, such an assumption may not be justified today, especially for cancer.

We co-exist with natural carcinogens in our environment. To deal with them, we must calculate the risk associated with exposure to these substances, and then use the best available technology to reduce that risk to an acceptable level. To think we can achieve zero risk is a misleading idea, and possibly the wrong path to take.

Because of the cost and complexity of animal testing, we use mathematical models to predict the risks of exposures to substances at low doses. The best we can do is compute statistically reliable predictions of what are likely to be safe levels of exposure to environmental stresses, assuming a level of risk that the community accepts.

Monitoring of the working environment is the speciality of occupational hygienists. In North America, they are called industrial hygienists. These professionals practice the art and science of identification, evaluation and control of occupational stresses. They are schooled in the techniques of measuring the environment in which people work.

Because of their obligation to protect the health and well-being of employees and the community, occupational hygienists have a deep concern for ethical issues. These canons provide standards of ethical conduct for industrial hygienists as they practice their profession and exercise their primary mission, to protect the health and well-being of working people and the public from chemical, microbiological and physical health hazards present at, or emanating from, the workplace. Practice their profession following recognized scientific principles with the realization that the lives, health and well-being of people may depend upon their professional judgement and that they are obligated to protect the health and well-being of people.

Counsel affected parties factually regarding potential health risks and precautions necessary to avoid adverse health effects. Keep confidential personal and business information obtained during the exercise of industrial hygiene activities, except when required by law or overriding health and safety considerations.

Avoid circumstance where a compromise of professional judgment or conflict of interest may arise. Data developed from monitoring the work environment are critical to improving exposure limits both for workers and for the community. In order to come up with the best limits, which balance risk, cost and technical feasibility, all data from industry, labour and government must be available to those who set the limits.

This consensus approach seems to be growing in popularity in a number of countries, and may become the procedure of choice for setting international standards. Regarding trade secrets and other proprietary information, the new Code of Ethics provides guidelines for industrial hygienists. As professionals, they are obliged to make sure that all parties who need to know information regarding health risks and exposures are given that information.

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However, hygienists must keep key business information confidential, except when overriding health and safety considerations require them to reveal it. This article deals with the ethical issues that arise in the practice of occupational health activities, including occupational health research, with respect to the handling of information on individual employees, not in terms of practicality or efficiency but by referring to what may be regarded as right or wrong.

It does not provide a universal formula for decisions on whether or not practices in handling information or in dealing with issues of confidentiality are ethically justified or defensible. It describes the cornerstone ethical principles of autonomy, beneficence, non-maleficence and equity and their implications for these human rights issues. The basic principles used in ethical analyses can be used in examining the ethical implications in the generation, communication and utilization of other types of information as well as, for example, the conduct of occupational health research.

Since this article is an overview, specific applications will not be discussed in great detail. On the labour market, in an enterprise, or at a workplace, health issues involve, first and foremost, free-living and economically active people. They may be healthy or experience health disturbances which are, in their causation, manifestation and consequences, more or less related to work and workplace conditions. Furthermore, a broad range of professionals and persons with various roles and responsibilities may become involved in the health issues concerning individuals or groups at the workplace, such as:.

Information arising in the practice or science of occupational health and the issues of need-to-know involve all these groups and their interaction. It may also be of high complexity. It is, in reality, an area of core importance in occupational health ethics. The underlying assumption of this article is that people have a need and also a prima facie right to privacy.

Likewise a collective, or a society, needs to know some things about individual citizens. With regard to other things there may be no such need. At the workplace or on the enterprise level, the issues of productivity and health involve the employer and those employed, both as a collective and as individuals. There are also situations where public interests are involved, represented by government agencies or other institutions claiming a legitimate need to know. There are ethical conflicts needing to be resolved in this reconciliation process.

If the needs to know of the enterprise or employer are not compatible with the needs to protect the privacy of the employees, a decision has to be made as to which need, or right to information, is paramount. The ethical conflict arises from the fact that the employer is usually responsible for taking preventive action against occupational health hazards.

To exercise this responsibility the employer needs information on both working conditions and the health of the employees. The employees may wish some types of information about themselves to be kept confidential or secret, even while accepting the need for preventive measures. Consequentialist ethics focuses on what is good or bad, harmful or useful in its consequences.

As an example, the social ambition expressed as the principle of maximizing benefits for the greatest number in a community is a reflection of consequentialist ethics. The deontologist holds moral principles to be absolute, and that they impose an absolute duty on us to obey them. Both these paradigms of basic moral philosophy, separately or in combination, may be used in ethical assessments of activities or behaviours of humans.

When discussing ethics in occupational health, the impact of ethical principles on human relationships and the questions of needs to know at the workplace, it is necessary to clarify the main underlying principles. These can be found in international human rights documents and in recommendations and guidelines stemming from decisions adopted by international organizations. They are also reflected in professional codes of ethics and conduct.

Both individual and social human rights play a role in health care. The right to life, the right to physical integrity, and the right to privacy are of particular relevance. These rights are included in:. Of particular relevance for occupational health service personnel are the codes of conduct formulated and adopted by the World Medical Association. These are:. Individual human rights are in principle unrelated to economic conditions.

Their foundation lies in the right of self determination, which involves human autonomy as well as human liberty. According to this principle all human beings have a moral obligation to respect the human right to self- determination so long as it does not infringe on the rights of others to determine their own actions on matters concerning themselves. One important consequence of this principle for the practice of occupational health is the moral duty to regard some types of information on individuals as confidential.

The first prescribes a moral obligation for all humans not to cause human suffering. The beneficence principle is the duty to do good. It dictates that all humans are under a moral obligation to prevent and to eliminate suffering or harm and also to some extent to promote well-being. One practical consequence of this in the practice of occupational health is the obligation to seek in a systematic way to identify health risks at the workplace, or instances where health or life quality are disturbed as a result of workplace conditions, and to take preventive or remedial action wherever such risks or risk factors are found.

The beneficence principle may also be evoked as a basis for occupational health research. The important practical consequences of this principle lie in the obligation to respect the right to self-determination of everyone concerned, with the implication that priority should be given to groups or individuals at the workplace or in the labour market who are most vulnerable or most exposed to health risks at the workplace. In considering these three principles it is proper to re-emphasize that in the health services the autonomy principle has in the course of time largely superseded beneficence as the first principle of medical ethics.

This in fact constitutes one of the most radical re-orientations in the long history of the Hippocratic tradition. The emergence of autonomy as a sociopolitical, legal and moral concept has profoundly influenced medical ethics. It has shifted the centre of decision-making from the physician to the patient and thereby re-oriented the whole physician-patient relationship in a revolutionary way. This trend has obvious implications for the whole field of occupational health.

Within the health services and biomedical research it is related to a range of factors which have an impact on the labour market and industrial relations. Among these should be mentioned the attention given to participatory approaches involving workers in decision processes in many countries, the expansion and advance of public education, the emergence of civil rights movements of many types and the rapidly accelerating technological changes in production techniques and work organization.

These trends have supported the emergence of the concept of integrity as an important value, intimately related to autonomy. Integrity in its ethical meaning signifies the moral value of wholeness, constituting all human beings as persons and ends in themselves, independent in all functions and demanding respect for their dignity and moral value.

The concepts of autonomy and integrity are related in the sense that the integrity is expressing a fundamental value equivalent to the dignity of the human person. The concept of autonomy rather expresses the principle of freedom of action directed towards safeguarding and promoting this integrity. There is an important difference between these concepts in that the value of integrity admits no degrees. It may be either intact or violated or even lost. Autonomy has degrees and is variable. In that sense autonomy can be more or less restricted, or, conversely, expanded.

Respect for the privacy and confidentiality of persons follows from the principle of autonomy. Privacy may be invaded and confidentiality violated by revealing or releasing information that can be used to identify or expose a person to unwanted or even hostile reactions or responses from others. This means that there is a need to protect such information from being disseminated.

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On the other hand, in the event the information is essential to discover or prevent health risks at the workplace, there is a need to protect the health of individual employees and indeed sometimes the health of a larger collective of employees who are exposed to the same workplace risks. It is important to examine whether the need to protect information on individuals and the need to protect the health of the employee collective and to improve working conditions are compatible.

It is a question of weighing the needs of the individual versus the benefits of the collective. Conflicts may therefore arise between the principles of autonomy and beneficence, respectively. In such situations it is necessary to examine the questions of who should be authorized to know what and for what purposes.

It is important to explore both these aspects. If information derived from the individual employees could be used to improve working conditions for the benefit of the whole collective, there are good ethical reasons to examine the case in depth. Procedures have to be found to deny unauthorized access to information and to use of the information for purposes other than those stated and agreed on in advance. In an ethical analysis it is essential to proceed step by step in identifying, clarifying and solving ethical conflicts. As has been mentioned earlier, vested interests of various kinds, and of various actors at the workplace or in the labour market, can present themselves as ethical interests or stakeholders.

The first elementary step is therefore to identify the main parties involved and to describe their rational interests and to locate potential and manifest conflicts of interests. It is an essential prerequisite that such conflicts of interests between the different stakeholders are made visible and are explained instead of being denied.

It is also important to accept that such conflicts are quite common. Sold Out! Be the first to review. We will let you know when in stock. Thank you for your interest You will be notified when this product will be in stock. I agree to the. Terms and Conditions. How It Works? IMEI Number. Exchange Discount Summary Exchange Discount -Rs.

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