Orthodox ethical endeavours may be inadequate for the conditions of multidisciplinary health care practice. Health care providers are apt to have well-formed ideas about what makes proper professional practice and professional relationships. Prescriptive ethics, particularly those that are based on the idea of an
a priori universal framework of judgement tend to promote the idea that only one form of professional life is legitimate and acceptable. The effect of this hierarchically ranked order of pre-determined values and principles is to deny the normative relevance of other frames of reference. The voices, situated experiences, ethical discourses and standards of evaluation of other occupational groups are seen as lower, more primitive, or less rational and therefore unacceptable.
Indeed, traditional approaches to morality may pose an ethical threat to the development of interdisciplinary team relationships. This is particularly the case with virtue-based approaches to professional ethics. For example, it is not uncommon to find professional ethical discourse taking the form of an evolutionary account of moral and ethical development. In this discourse, the presumption is that one's own professional standards have reached the highest stage of moral development. These virtues are then used as the standard against which other professions and other forms of professional life are judged, usually to their disadvantage and the benchmark to which all practices must conform.
[6] Professions, like colonial powers, often attempt to impose their will upon different or opposing ethical systems.
[7] Because each profession's standards are imagined to contain the essence of rational thought and professional virtue that is foundational, they are unable to acknowledge the contribution that rival moral frameworks might make. Rather they risk being adjudged dogmatic and in need of assimilation.
If not acted upon, these fault lines may diminish the capacity of health professionals to bridge different value systems and meaning contexts and develop positive relations with one another.
[8],
[9] For example, in 1980 Kundstader observed that one of the key issues confronting physicians and ethics was the failure of practitioners to listen to others whose voices were at odds with their own moral and value frameworks.
[10] Although exhortations to cooperate have been numerous, little seems to have changed over the intervening years. Institutionally and culturally, relationships between health care professionals remain fraught with organizational, status and value differences. For example, an Australian survey of hospital admissions reported that problems with professional interactions were the most common cause of preventable disability or death and were twice as common as those due to inadequate medical skill.
[11] Similar findings have been reported elsewhere in the Australian literature.
[12]The point that we would like to make here is that the problems that arise in multidisciplinary settings are unlikely to admit to a single solution. The differing ways in which health care professionals interact along with the different moral frameworks that they bring to the encounter make it tricky to impose a uniform set of abstract principles. Fashioning the ethical foundations for the deeply complex patterns of multidisciplinary relations and morality would seem to require more imaginative forms of ethical reasoning.
Paul Komesaroff's deployment of what he terms 'microethics' should be seen as a significant attempt to reframe the way that ethics is understood in contemporary medical settings. Drawing from his everyday ongoing clinical practice, Komesaroff identifies clinical encounters not simply as the essence of medical practice but the ground to rethink ethics.
[13]One of the most general insights to be derived from his relational ethics is the notion that ethical thought in the clinical context involves a social element. Ethical deliberation is conceived as a historically situated, two-sided practice characterized by participants doing their utmost to achieve mutual understanding. This approach to ethics seems especially appropriate to multidisciplinary health care environments. In this view ethical consideration is extended from the professional moral agent to the diverse experiences and perspectives of all participants in the clinical encounter. In this way it broadens the idea of the moral community beyond the boundaries of the single profession.
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