Читать книгу Becoming a Reflective Practitioner - Группа авторов - Страница 87

The perspectives of others can be mapped (Figure 4.1). Then any conflict between perspectives can be viewed in the light of ethical principles and issues of authority with the intention of understanding the most ethical response to inform future situations. It shifts from an issue of personal responsibility to act for the best to a collective one.

Following the ethical map trail

1 Pose the question – did I/we act for the best,

2 Consider different perspectives commencing with the practitioner’s own perspective,

3 Consider which ethical principles apply in terms of the best decision,

4 Consider what conflict exists between perspectives/values and how these might be resolved, and

5 Consider authority relationships that determined action.

The last point acknowledges the significance of authority in making decisions, no matter the ethical perspective. In reality, decisions are not necessarily made in terms of what’s best for the patient or family, but in terms of professional interest and dominance that is implicit within normal patterns of relating between professionals⁶. Hence to act for the best, the practitioner may need to challenge the authority of others by championing the most ethical response – what I refer to as the Achilles heel of medical dominance.

Loxley (1997) identifies a number of questions that are useful to inform stages 5 and 6 of ethical mapping:

 Who defines the problem?

 Whose terms are used?

 Who controls the domain or territory?

 Who decides on what resources are needed and how they are allocated?

 Who holds whom accountable?

 Who prescribes the activity of others?

 Who can influence policy makers?

FIGURE 4.1 Ethical mapping (adapted from Johns 1999).